Section 0.2 Overview

Overview of e-HealthThis document provides an overview of e-health both broadly and in the context of public health. Read the sections below to understand more about these topics.

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Defining e-HealthThis section provides definitions for the terms used throughout the toolkit.

E-health is the adoption and effective use of electronic health record (EHR) systems and other health information technology (HIT), including health information exchange (HIE), to improve health care quality, increase patient safety, reduce health care costs, and enable individuals and communities to make the best possible health decisions. Across the nation, e-health has emerged as a powerful strategy to transform access, care delivery, patient experiences, and health outcomes. Furthermore, e-health is essential to support the exchange of information necessary for health reform initiatives such as accountable care.

The subsections below define important elements of e-health.

Electronic Health Record (EHR) and Local Public HealthMany public health providers have encountered EHRs, either in their practice, or in the office of their own physician. HealthIT.gov provides the following description of EHR1 .

An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care. EHRs can:

Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results

Allow access to evidence-based tools that providers can use to make decisions about a patient’s care

Automate and streamline provider workflow

One of the key features of an EHR is that health information can be created and managed by authorized providers in a digital format capable of being shared with other providers across more than one health care organization. EHRs are built to share information with other health care providers and organizations – such as, specialists, hospitals, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care.

Use of an EHR varies greatly within local public health agencies. For instance, mental health or chemical health divisions would have a need for a client record as described above, but other divisions of a public

1 http://www.healthit.gov/providers-professionals/faqs/what-electronic-health-record-ehr

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health agency may not provide services on an individual client basis. For those areas where client care is provided, toolkits are available for those specialties: behavioral health, clinics, home health, etc. Please refer to the appropriate toolkit as a guide for HIT implementation based on the type of care provided.

Local health departments are using electronic health record systems in Minnesota, according to the Minnesota e-health report, Local Public Health: e-Health Capacity, Capability, and Challenges, 2012. The report is detailed below.

Health Information Technology (HIT)HIT is the overall category we use to describe the hardware, software, devices, etc. that are used to manage and improve health. Specifically, we are using the following definition:

HIT is the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision-making.

Reference: http://www.healthit.gov/policy-researchers-implementers/glossary

Health Information Exchange (HIE)Health information exchange or HIE means the electronic transmission of health related information between organizations according to nationally recognized standards [Minn. Stat. §62J.498 sub. 1(f)]. Reference: https://www.revisor.mn.gov/statutes/?id=62J.498

Interoperability DefinedThe Office of the National Coordinator for Health Information Technology (ONC) describes interoperability as the ability of two or more systems or components to exchange information and use the information that has been exchanged. The eHealth Initiative enhances that description by adding that the information exchanged should be accurate, secure, and verifiable.

Public Health and HIEAgain, specific divisions within a local public health agency may have HIE goals and capabilities based on a client's EHR. These are noted in the HIT Toolkit specific to their discipline. On a broader level, looking at local public health as a whole, HIE is key to many public health initiatives, especially efforts related to Meaningful Use. Individual patient EHRs can be compiled and analyzed stasticstically to provide data on trends within or across populations broken down into categories such as age, gender, or race. This data can be invaluable in determining public health needs for a given population, as well as guiding public health-related intiatives and incentives for legislators and health care program administrators, as well as clinicians and other providers of general and specialty health care services.

As part of the meaningful use incentive program, providers are required to have the capability to submit electronic data to public health agencies for:

• Immunization registries

• Reportable lab results

• Syndromic surveillance

Public health agencies need to be able to receive this information in a secure way even without having an EHR themselves.

Examples of HIE in the public health world:

• Statewide Health Information Network for New York (SHIN-NY) Health Information Exchange (HIE) for Public Health Use Case (Patient Visit, Hospitalization, Lab Result and Hospital Resources Data)

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Link: http://www.health.ny.gov/technology/projects/docs/health_information_exchange_for_public_health_-_use_case.pdf

• Evaluating Public Health Uses of Health Information Exchange

J Biomed Inform. 2007 December; 40(6 Suppl): S46–S49.

Published online 2007 August 31. doi: 10.1016/j.jbi.2007.08.003

In addition, all Community Health Boards (CHB) report that their local public health departments used electronic health record systems in 2012. CHBs submitted data to the Minnesota Department of Health via the Local Public Health Planning and Performance Management Reporting System (LPH PPMRS) that showcases the use, exchange, gaps, and barriers found in the LPH setting in Minnesota.

This Minnesota e-health report, Local Public Health: e-Health Capacity, Capability, and Challenges, 2012, can be found in its entirety at: http://www.health.state.mn.us/e-health/reportlph2012.pdf

Highlights from this report include:

• Most CHBs are planning changes to their EHR systems in 2013

• Most CHBs conducted some type of activities relating to health informatics in the previous year

• 67% of CHBs received secure health information from other organization; 27% sent secure health information to other organizations

• Exchange partners varied greatly

The report concludes,"Local public health in Minnesota has made progress on adopting electronic health record systems, but use of these systems in minimal and not meeting their needs for secure exchange of health information with key partner organizations. CHBs have the greatest need to exchange with hospitals and primary care clinics, but few of them were able to do so in 2012. Barriers to exchange were largely systemic, with unknown or no ability to exchange with partner organizations. CHBs also face staffing barriers, with need for people to help manage the process and data, design and mange the EHR, and help with implementation."

Benefits of e-Health The use of electronic systems to manage client information and deliver care has been increasing and will continue to increase. Tremendous benefits can be realized if we can electronically and securely exchange client health information with appropriate caregivers.

We can help ensure this transformation is positive for clients, their families and loved ones, and for caregivers if we focus on benefits.

In general, electronic health records (EHR) and health information exchange (HIE) can:

• Improve the quality and safety of care delivered to patients

• Enable creation of electronic patient registries that track care patterns and health care use

• Achieve greater efficiency and improve use of resources

• Communicate in transitions of care and across the health care continuum

• Promote sound decision making and evidence-based practices

• Strengthen privacy and data protection

• Guide population and public health initiatives

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When public health services intersect with health care providers and other agencies to coordinate provision of services—and potentially to be an active participant in a health reform initiative such as an accountable care organization (ACO)—the following benefits can be derived:

• Improved communications between public health administrators, health care providers, and other community service agencies can enhance awareness of available services and yield more timely and potentially less costly services.

• More timely and secure access to data—upon which more immediate and targeted action can be taken—can result from utilizing formal HIE structures.

• Adequate public health services and programming that focuses on the needs of the community as supported by data – and the ability to customize services to meet those needs.

• More complete and accurate aggregation of data across the continuum of care for individuals’ health and social needs can help achieve the nation’s triple aim goals of providing a better experience of care, improving the quality of care, and providing the most cost effective care.

Impact of EHRs on Clinical PracticeIn 2013, the Minnesota Health Information Technology Ambulatory Clinic survey included some opinion questions regarding the impact EHRs have had on the clinic’s practice. There is strong agreement on the positive impact of EHRs, particularly on two important measures: nine in ten clinics agree that the EHRs have alerted their providers to potential medication errors, and that they have enhanced patient care. Furthermore, agreement is strong on all of items shown in Figure1.

Figure 1: Impact of EHRs on Minnesota Clinic Practice, 2013

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Source: Minnesota Department of Health, Office of Health Information Technology, www.health.state.mn.us/e-health/assessment.html

GlossaryAs you work through the tools, there may be terms or abbreviations that are unfamiliar or for which you want to be sure of the meaning. To help clarify terms or abbreviations, we have provided the link below:

The Minnesota e-Health Glossary, (http://www.health.state.mn.us/e-health/glossary.html)

ConclusionThe era of paper records is ending. Implementation of e-health is a journey, and like other journeys there will be challenges. That said, the evidence is clear that benefits outweigh the concerns.

Copyright © 2014 Stratis Health. Updated 03-10-14

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