Assessing and Improving Local Health Departments e-Health Capability and Capacity

Bethany Bradshaw, MPHApplied Public Health Informatics Fellow,Wisconsin Department of Health Services*

Karen Soderberg, MSOffice of Health Information Technology,Minnesota Department of Health

Background: MinnesotaLocal public health (LPH) is engaged in e-healthActive participation and leadership in the Minnesota e-Health InitiativeSignificant part of the Minnesota Southeast Beacon ProjectReceived over $750,000 in e-health loans and grants between 2011-2013 from Office of Health Information Technology (OHIT)Developed and responded to annual informatics survey Preparing for the Minnesota 2015 Interoperable EHR Mandate http://www.health.state.mn.us/e-health/hitimp/index.html

Note: In Minnesota, local public health services are provided through Community Health Boards (CHBs), which have statutory responsibilities for public health (Minnesota Stat. Chapter 145A)*

Background: WisconsinMinimal LPH engagement with e-healthLPH has not received any e-health related grant funding

Survey is first e-health assessment of Wisconsin LPH

Healthiest Wisconsin 2020: access to high-quality health services that are coordinated across health, public health, and other care systems Focus area: Systems to manage and share health information and knowledge including with LPH

Source: Healthiest Wisconsin 2020, http://www.dhs.wisconsin.gov/hw2020/ *

MethodsMinnesotaRequired part of annual web-based assessment since 2010

52 Community Health Boards

11 questions

Minnesota e-Health Profile

WisconsinVoluntary, stand-alone survey (Select Survey)

Distributed by email: 88 City/County/City-county Health Departments, 11 Tribal Health Centers

5 questions from Minnesota survey; several definitions

20 questions (skip pattern)

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Common QuestionsElectronic health record (EHR) adoption

Health information exchange (HIE) activities used

HIE partners

Largest challenges to HIE

Most needed EHR-related skills and/or roles for new and/or existing staff

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EHR Adoption by LPHMinnesota100% response rate

100% EHR adoption across CHBs 2 Local Health Departments (LHDs) do not have EHRsPH-Doc, CHAMP, CareFacts

Wisconsin60% response rate

40% EHR adoption Most common : CHAMP

Of those with no EHR, 60% have no plans to adopt

75%: paper is primary system*

Health Information Exchange Activities in LPH, Minnesota vs. Wisconsin*

HIE Partners for LPHMinnesota (n= 52)Health or county-based purchasing plans (44%)Minnesota Department of Health (42%)Minnesota Department of Human Services (29%)County/city department outside jurisdiction (21%)Wisconsin (n= 58)Wisconsin Department of Health Services (74%)No HIE (26%)Hospitals (22%)Laboratories (22%)*HIE was defined as the electronic transmission of health related information between organizations according to nationally recognized standards. Health information exchange does not include paper, mail, phone, fax, or standard/regular email exchange of information.

Needed HIE Connectivity for LPH*

Top 3 HIE Challenges for LPHMinnesota (n= 52)Competing priorities (42%)

Do not know exchange partners HIE ability (40%)

Exchange partners do not have HIE ability (40%)Wisconsin (n= 58)Insufficient information (48%)

Unclear return on investment (38%)

Lack of technical support (34%)*

Most Needed EHR-Related Skills in LPH, Minnesota vs. Wisconsin*

FindingsImportance of education and buy-in to advance LPH e-health capacity and capability.No clear picture of EHR capability in LPH because no certification or standards.LPH agencies are not meeting their HIE needs.Comparison across states identifies differences and opportunities for collaboration and sharing.Assessment of LPH e-health is necessary to:Identify gaps. Identify barriers to effective strategies and efficient use of resources (local and state).Evaluate e-health programs.

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RecommendationsStates should implement a statewide e-health / informatics assessment for LPH.Work with NACCHO to access state-specific data.LPH associations in collaboration with states should develop a LPH e-health workgroup.Provide policy and guidance; develop an e-health roadmap and shared vision; and offer trainings and education.LPH should engage in e-health collaborations and opportunities for funding.e-health can support LPH participation in Accountable Care Organizations.LPH staff should continue their learning.Online courses (e.g., MOOCs), Public Health Informatics Institute, Minnesota e-Health Initiative.Leverage current resources and tools.

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ResourcesPublic Health & Electronic Health Information Exchange: A Guide to Local Agency Leaderships (www.phii.org) ONC Beacon Program Learning Guides (http://www.healthit.gov/policy-researchers-implementers/beacon-community-program/learning-guides) Minnesota e-Health Profile (http://www.health.state.mn.us/e-health/assessment.html) E-Health toolkits (http://www.stratishealth.org/expertise/healthit/index.html)Minnesota e-Health Guides (http://www.health.state.mn.us/e-health/reports.html) Wisconsin survey report (http://www.dhs.wisconsin.gov/localdata/index.htm)

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AcknowledgementsMinnesota Office of Health Information TechnologyMinnesota Office of Performance ImprovementMinnesota Local Public Health Association

Wisconsin Department of Health Services, Division of Public Health Wisconsin Local Health DepartmentsWisconsin Tribal Health AgenciesApplied Public Health Informatics Fellowship Program

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Contact Information

Karen Soderberg, MSOffice of Health Information TechnologyMinnesota Department of HealthKaren.Soderberg@state.mn.us (651) 201-3576

Bethany Bradshaw, MPHOffice of Health InformaticsWisconsin Department of Health ServicesBethany.Bradshaw@gmail.com(608) 267-6782

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****Alternatively we can present the full questions:Which of the following health information exchange activities are currently used by your local health department to electronically exchange health information (send or receive) with other organizations, assuming appropriate consents have been obtained. (multi-select)Does your local health department electronically receive health information via health information exchange from any of the organizations listed below? (multi-select)Does your local health department electronically send health information via health information exchange to any of the organizations listed below? (multi-select)Which EHR-related skills and/or roles are in greatest need within your organization? This includes adding new staff or developing the current staff. (select up to 3)Indicate the largest challenges related to electronic exchange of health information via health information exchange with outside organizations (select up to 3)

*It is important to note that although MN CHBs have EHRs, 10% were planning to assess and plan for a new year and 17% to select and implement a new EHR*Shows WI is still in initial phases of HIE activities and EHR adoption. MN is in more advanced phase where LHDs are limited by resources and partners, not their own technical abilities.*Person to manage and process that data: shows that MN is further along with EHR utilization with WI is still mostly focused on implementation*