Better Public Health with Improved Health Information Exchange

Public health relies on data reported by health care partners, and information technology makes such reporting easier than ever. However, data are often structured according to a variety of different terminologies and formats, making data interfaces complex and costly.

As one strategy to address these challenges, health information organizations (HIOs) have been established to allow secure, integrated sharing of clinical information among numerous stakeholders, including clinical partners and public health, through health information exchange (HIE). We give detailed descriptions of 11 typical cases in which HIOs can be used for public health purposes.

We believe that HIOs, and HIE in general, can improve the efficiency and quality of public health reporting, facilitate public health investigation, improve emergency response, and enable public health to communicate information to the clinical community. (Am J Public Health. 2011;101: 616-623.)

Public Health relies on data reported by health care partners to conduct nearly every aspect of its core functions. Information technology offers the opportunity to replace manual reporting processes with automated ones, and innovators are increasingly developing such approaches. The electronic transfer of data for public health reporting requires each health care partner to translate data from its proprietary structures — its vocabulary or format for storing data, and its protocols for sending the data as messages — into standards defined specifically by and for various public health authorities so the data are represented consistently and can be analyzed in a uniform fashion.[ 1][ 2] However, the cost of developing these interfaces and associated translation services is high, partly because each specific use of clinical data to support public health (e.g., notifiable disease surveillance, birth and death registration, hospital adverse event reporting, occupational health, injury prevention, and chronic disease improvement) currently requires a separate, dedicated technical solution and the requisite management and organizational activities on each side to support the initiative. Consequently, electronic data gathering has not been widely adopted for public health purposes, even where the benefits of electronic public health reporting have been well described.[ 3-5]

Recently, health information organizations (HIOs) across the country have been developing networks to enable health information exchange (HIE) among diverse stakeholders within a given region. These stakeholders may include clinicians, provider organizations, pharmacies, laboratories, radiology facilities, payers, emergency management and first responder groups, and health departments.[ 6] Although there is some public health agency involvement in many HIOs, the primary use case of most HIOs — that is, the way that a system would be used by end users — is centered around direct patient care with the primary goals of improving providers’ access to information, thereby improving the safety and quality of care, and reducing costs.[ 7-12] As part of this work, HIOs provide the organizational infrastructure, legal underpinnings, and technical expertise to enable HIE. This includes building physical data interfaces between the stakeholders and the HIO, and mapping proprietary database codes from each stakeholder to widely accepted standard vocabularies.

Although HIOs usually do this work for clinical use cases, public health agencies can also leverage it to help promote a variety of public health use cases. As demonstrated in several jurisdictions, public health involvement in the identification and development of use cases, data standards, and protocols in the early stages of HIOs can help drive this synergy.[ 13] There are, however, certain preconditions: the requisite data must exist in electronic form, analytics that are appropriate for public health purposes must be created, and the HIOs involved must understand the value of the public health use cases.

The federal government, state governments, and foundations have supported the development of important infrastructure for HIOs. In 2004, the Office of the National Coordinator of Health Information Technology (IT) laid out a number of health IT goals, 2 of which were to “interconnect clinicians” and “improve population health”; these can be loosely translated into supporting the development of HIE for clinical and public health use cases.[ 14] Since then, the Office of the Coordinator has launched 2 rounds of programs to fund testing of nationwide health information network prototypes.[ 15-17] In 2005, the Robert Wood Johnson Foundation provided a series of small grants to help link public health officials to emerging HIOs through the InformationLinks program.[ 18]

More recently, the Centers for Disease Control and Prevention (CDC) implemented a large program to examine the extent to which HIOs can be used to support biosurveillance activities.[ 19] In an example of local government support, the New York City Department of Health and Mental Hygiene led a CDC-funded Center of Excellence in Public Health Informatics. The department was also one of 3 participants (along with New York State) in the previously mentioned CDC biosurveillance program. New York State has also funded contracts totaling more than $840 million to support the development of HIOs for both clinical and public health use cases.[ 20]

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