The Benefits of Health Information Exchange and Electronic Health Records to Environmental Public Health
Lawrence P. Hanrahan PhD MS Chief Epidemiologist Wisconsin Department of Health and Family Services Division of Public Health Bureau of Health Information and Policy Mary Shaffran, MPA Principal Director, Public Health Systems Association of State and Territorial Health Officials Sterling Elliott, MPH Analyst, Public Health Systems Association of State and Territorial Health Officials
Background
on data sharing efforts
Terminology
activities Future Opportunities Environmental Health
Current
Background: What Is A RHIO?
Regional Health Information Organization
Non-ProfitPublic/Private Electronic Health Record Data Exchange Clinical Records Shared Across Provider Systems to Facilitate Care
RHIOs = National Health Information Network (NHIN) Building Blocks
Terminology
HEALTH INFORMATION EXCHANGE refers to local or regional networks of providers, and public health organizations, that facilitate the sharing of client/patient (individual person) information. REGIONAL HEALTH INFORMATION ORGANIZATION (RHIO) is a collaboration of local health care stakeholders providing leadership, oversight, fiduciary responsibility, and governance for the development, implementation, and application of secure health information exchange across care settings. ELECTRONIC HEALTH RECORD (EHR) provides each individual with a secure and private lifetime record of their key health history and care within the health system. The record is available electronically to authorized health care providers and the individual anywhere, anytime in support of high quality care. PERSONAL HEALTH RECORD (PHR) is an individual’s personal collection of information, in an electronic form. It is controlled by the individual, and may contain a patient’s own notes in addition to electronic information from providers.
Source: Glossary of terms related to health information exchange, Public Health Informatics Institute, 2005
Background: Why now?
The Unsustainable Cost of Healthcare – US Healthcare expenditure: $1.8 Trillion/Yr – Unsustainable–Doubles Every 10 Years Patient Safety Concerns – 18% medical errors from inadequate patient information Quality Improvement – 20% of lab & x-ray tests ordered because originals can not be found Lack of Health Information Technology – 49% of notifiable diseases reported Public Health Infrastructure Decline – Bioterrorism $ Infusion For Public Health Information Network (PHIN) – One state projecting 1/3 Allocation Decline for 2006-7
Source: B. Middleton PHIN 2005 Conference
Current Activities: National Initiatives
HHS Office of National Coordinator for Information Technology (ONCHIT) – Inform Clinicians – Interconnect Clinicians – Personalize Care – Improve Population Health Unify public health surveillance architectures Streamline quality and health status monitoring Accelerate research and dissemination of evidence
Develop a Comprehensive Health Information Framework
Current Activities: National Initiatives
ONCHIT Awards
American Health Information Community
– NHIN Pilots (Six RHIO Networks) – Harmonize Health IT Standards – Assess Privacy & Security – Develop Conformance Certification Process for Health IT – help nationwide transition to EHRs – workgroups – InformationLinks
Robert Wood Johnson Foundation
ONCHIT Director, David Brailer
Current Activities: National Initiatives
Legislation (as of Nov. 2005)
– 3 Senate bills; 3 House resolutions – Strong bipartisan support (Newt & Hillary) – Funding to build RHIOs & adopt EHRs
Current Activities: National Initiatives
Some features of bills & resolutions
– Initial funds:
20
– Ongoing sustainability
Loans
3-yr grants for RHIOs; $50 mil FY 06 [HR 2234] Grants for health care providers; $4.5 bil over 5 yrs [S. 1227] Grants for health care providers w/matching funds from providers; $125 mil for FY 06 [S.1418] or grants to establish loan programs [HR 2234, S. 1227, S. 1418]
– Emphasis on interoperability between systems – Government role
HHS
key player in all legislation
Current Activities: Characteristics of RHIOs
RHIOs in 48 states Of 109 RHIOs identified in 2005…
– 21% involved state health departments – 33% involved local health departments – 29% said that a significant driver of effort was ―public health surveillance needs‖
100+
Second Annual Survey of State, Regional and Community-Based Health Information Exchange Initiatives and Organizations, eHealth Initiative Foundation, 2005
Current Activities: Public Health Involvement
National
– American Health Information Community (AHIC)
Dr. Julie Gerberding, CDC Director, AHIC Commissioner E. Mitchell Roob, Secretary, Indiana Family and Social Services Administration, AHIC Commissioner Public health represented in AHIC Workgroups
– Leah Devlin, State Health Director, NC Dept of Health & Human Services, AHIC Biosurveillance Workgroup Member
State
– State Public Health Departments participates in —and sometimes convenes—RHIOs and HIEs
Local
– El Paso County (CO) – Marion County (IN)
Current Activities: State Public Health Involvement
Where
public health is a convener…
– Rhode Island/HealthAlliant Project – Utah Health Information Network (UHIN)
Where
public health participates…
– Wisconsin Health Information Exchange – Indiana Health Information Exchange – North Carolina Health Information Exchange Consortium (NCHIEC)
Current Activities: Wisconsin WI Health Information Exchange (WHIE)
WHIE SE Wisconsin Population 2.06 million (40% of WI) 42 hospitals 5419 physicians 25 health departments 478 pharmacies 1506 laboratories COMMUNICATING BY PAPER
http://whie.imedi.org/
Working with Emerging RHIO eHealth – Connecting Communities for Better Health AHRQ 1 Yr Grant Pilot – HAN / WIR / EMSystem Interconnection Governance / Business Case / Self Sustaining
Current Activities: Wisconsin South Central WI Health Information Data Exchange
•Madison Patient Safety Collaborative (MPSC) •All Participants Use EPIC •EPIC Based In Madison •No Technology Barriers to Exchanging Data •Presentation October 10 2005 •Work Group Commitment for CEO Briefing
Current Activities: What’s ASTHO doing?
Public Health Informatics Policy Committee Issue report on the connections between EHRs and Public Health Information Network Conference call series on EHRs and public health Privacy & public health practice series
ASTHO
Future Opportunities
RHIOs Public health participation in AHIC & other national bodies Legislation Increased use of personal health record
Emerging
Future Opportunities: Adoption Trends in the Next 5 Years
EHR
adoption in…
– 41% of large hospitals (300
beds) – 25% of small physician practices (1-4 physicians) – 38% in larger practices (20< – physicians) – 21% of home health agencies – 14% of skilled nursing facilities
―Functional Gaps in Attaining a National Health Information Network‖, Health Affairs, Sept./Oct. 2005
Future Opportunities for You
Find
out in your area…
– What entities (health depts, hospitals) are linked to RHIOs? – Have any groups in your area received grants for health data sharing efforts (RWJF, ARHQ)? – Are there opportunities to participate in strategic planning around health information technology?
But what about environmental health?
health information systems connect individual illness & exposure & community health Sharing information via RHIOs would provide
– More clinical data for environmental health research and practice – More information on community hazards for the clinical sector
Environmental
Environmental Public Health Tracking
Example
Programs:
– Lead – Asthma
Example:
Wisconsin Environmental Public Health Tracking
– Part of larger WI-PHIN – Hypothesis generation about exposure and health outcomes
Example:
Childhood leukemia & benzene concentrations Programs
Age Adjusted Childhood Leukemia Incidence Rates per 100,000 by County 1990-2000
Estimated County Median Benzene Exposure Concentration by County, 1996
Wisconsin Public Health Information Network
Conceptual Representation – Information Flows and Services
PHIN Portal Shared User Base NEDSS Base System WE-TRAC Traditional Public Health Partners Non-Traditional Public Health Partners
Secure access via WAMS for authentication* Role based access to Program Area Modules (i.e. NEDSS, HAN, etc.)
Integrated Data Repository Common Demographic Data State/Local Public Health Agencies Labs, Clinics Hospitals ERs Cancer Registries CDC
Secure Data Transfer
SPHERE
EPHTN Childhood Cancer Birth Defects
Common Observational Data Program Area
GIS/Data Visualization Statistical Analysis
Module Specific Data
Data Driven & User Initiated Alerts
Health Alert Network
• Directories • Forums • Training • Calendar • Survey • Emergency Alerting • Topic Areas • Digests • Search • Redundant Email
Data Driven Alerts
* State of Wisconsin Web Access Management System
In an ideal world…
Data flows securely, quickly, and seamlessly between clinical, general public health, and environmental public health for increased efficiency and efficacy in public health and healthcare and the ultimate goal of improved population health & safety
Questions for Discussion
How can information systems from the clinical sector, general public health, and environmental public health be linked for greater efficiency and effectiveness of all public health and clinical care? How does public health ensure that it is included the development of EHR systems as both a recipient and a provider of information? What are the benefits of participation? What are the costs?
For more information
HHS ONCHIT: http://www.os.dhhs.gov/healthit/ eHealth Initiative: http://www.ehealthinitiative.org/ CCBH Resource Center http://ccbh.ehealthinitiative.org/ Robert Wood Johnson RHIO – Public Health Initiative http://www.informationlinks.org/ Suggested Readings on Health Information Exchanges http://www.phii.org/pages/RWJFgrant_reading.html http://www.phii.org/RWJFgrant.html Wisconsin PHIN: http://ehp.niehs.nih.gov/docs/2004/7150/abstract.html
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