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HIT and Interoperability Initiatives: HIT and Interoperability Initiatives:

Assuring a Role for the LHD SafetyNetAssuring a Role for the LHD SafetyNet

presented at the

National eHealth Collaborative

August Board of Directors MeetingThursday, August 13, 2009

by:

Yvonne Claudio, DM, MS

The Local Health Department SafetyNetThe Local Health Department SafetyNetThe National Association of County

and City Health Officials

NACCHO supports efforts that protect and improve the health of all people and all communities…

–promotes national policy–develops resources and programs, seeking health equity–supports effective local public health practice and systems

represents approximately 3,000 LHDs across the US

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Background Information

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LHD—A Key Safety Net Provider

Facilities in medically underserved communities….• Local health departments (via health centers/clinics)• Community health centers (FQHCs and FQHC Look Alikes)• Independent clinics and health centers• Free clinics• Clinics in schools, homeless shelters, housing projects• Public hospitals

Source: Institute of Medicine, 2000 America’s Healthcare Safetynet: Intact but Endangered.

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Patient Population/Communities Served

LHDs deliver health care to patients who are...• poor• medically uninsured/underinsured• Medicaid covered• vulnerable• chronically sick• with inadequate access to health care resources• facing barriers to care (language, cultural issues)• mobile • experience disparities in health status and quality of care

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SafetyNet Role Aligns with Public Health Core Functions/Essential Services

• Assessment--– Monitor health status– Diagnose and investigate health problems and health hazards– Inform, educate, and empower people about health issues– Mobilize community partnerships to identify and solve health problems

• Policy development--– Develop policies and plans that support individual and community health efforts– Enforce laws and regulations that protect health and ensure safety

• Assurance--– Link people to needed personal health services and assure the provision of health

care when otherwise unavailable– Assure a competent public health and personal health care workforce– Evaluate effectiveness, accessibility, and quality of personal and population-based

health services– Research for new insights and innovative solutions to health problems

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Comprehensive Primary Care Services

# LHDs % Providing Primary CareLHD Population 11%<25,000 930 7%25,000-49,000 490 9%50,000-99,999 346 16%100,000-499,999 400 16%500,000+ 127 25%

Guesstimate: 260 LHDs provide primary care@ 2 clinics each--520 health centers@ 5 clinics each--1,350 health centersSource: NACCHO, 2008 National Profile of Local Health Departments, July 2009

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Philadelphia Department of Public Health (sample SafetyNet LHD)

8 FQHC Look-Alike Centers• located in poorest, medically underserved areas

–City Stats • Population--1.5 million• Persons below poverty level--24% or 360,000 residents

–PDPH Patient Stats• 80,000 patients (180,000 visits per year)

Sites serve approximately 1/4 of the City’s poorest residents57% are uninsured; 24% have Medicaid coverage

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LHDs—Add’l Health Services Population in Jurisdiction

50,000-99,000 100,000-499,999500,000+

Family Planning 59% 62% 66%

Prenatal Care 37% 42% 40%

Oral Health Care 33% 43% 57%

Mental Health 12% 13% 27%

Substance Abuse 8% 9% 24%

Home Health 26% 18% 11%

Source: NACCHO, 2008 National Profile of Local Health Departments, July 2009

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Maintaining Community’s Health (Sample Listing of Services)

Prevention and Treatment…

• Immunizations

• Lead Screenings

• Communicable Disease

• Nutrition Services

• Substance Abuse

• Mental Illness

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HIT of Relevance to LHDs

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HIT Supporting Clinical Services• EMR• E-Prescribing• Pharmacy Information System• Automated Lab System• Digital Radiology System (x-rays, mammography)• Case Management System--to track/manage pts • Social Services/Benefits Counseling system• Practice Management System• Web-based Resources • Smart Card/Mobile Solution

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HIT Supporting Public Health Services

• Surveillance systems

• Case management systems/registries

• Laboratory information systems

• Electronic vital records

• Animal control IT

• Medical examiner IT systems

• Web-based and mobile systems

—for informing, alerting, response, reporting

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Challenges to HIT Adoption/Interoperability• Scarce resources/funding cuts

– tight budgets– limited staff resources– new County and City budget cuts

• Insufficient knowledge/skills, access to training– lack knowledge of industry HIT initiatives/opportunities– computer skills; IT management; project management

• Information systems issues– paper records reliance– inadequate/dated IT (hardware, software)– stand alone/siloed IS

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HIT--The Challenges to Adoption• Additional Costs Issues

–Automating core processes—that tie into EMR/ interoperability functionality

–Facilities enhancements--including inadequate space, electrical and communications wiring; air conditioning)

–PC training

Funding for EMR and Interoperability Initiatives may be insufficient…to establish functional effective IT infrastructure and/or interoperability…precludes LHD involvement

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Suggestions for Policy Development/Refinement

Meaningful Use !plus Meaningful…

» Requirements » Funding» Partnerships» Planning» Monitoring/Progress

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Meaningful Requirements

Require applicants to….• Outline requirements for engaging safetynet/

publicly-funded providers• Detail the extent to which partners’ IT systems are

incorporated to maximize interoperability—and meet each other’s need for data

• Demonstrate how will improve public health IT infrastructure supporting emergency preparedness functions

Utilize the power of the RFP/RFA…

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• Set-asides might be necessary to…–assure support and strengthening of the

traditional “have-not” providers, i.e, public sector/safetynet providers

–fund organizations relative to need; proportional to providers’ resource access, etc

–establish other IT critical to effective implementation of EMRs/interoperability

–engage currently excluded providers (FQHC Look-Alikes; Behavioral providers, etc)

Meaningful Funding

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• Loans–Will safetynet organizations apply?–Will resources be available to facilitate their

application• Incentives Stipulations

–Scaling incentives—so orgs which started, but lag behind IT adoption also receive some payments

Some “have-not” providers will not get…» seed monies» incentive payments

Meaningful Funding

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Engaging publicly funded facilities/safetynet providers

• Documented/measurable participation/engagement

• Evidence of impact on/contribution of partner

Is there a need to consider exemptions to RHIO fees/

support for fees payment?

“Meaningful” Partnerships

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Planning and prioritizing components of HIT Projects

• EMR Functionality—Turn on key functionalities– Clinical reminders

– Reporting/querying capacity

• Supporting other IT needs– Case Management systems

– Lab systems

• Establishing critical interoperability– Interoperability within the organization (replace paper systems)

– 24/7 real time automated reporting

“Meaningful” Planning

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• Closely tracking progress of HIT/Interoperability Initiatives–Among “Haves” and “Have Nots”

• Who has started/not started?• What are the hurdles/barriers?

– Track to assure the no one lags– Taking corrective action to address major hurdles

• By 2011—Who is lagging? Who is gaining? • By 2014—Who has gained? Who has lagged?

“Meaningful” Monitoring/Progress

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• Improved safetynet infrastructure• Enhanced PH IT Infrastructure• Increased interoperability/data sharing

Efficient/effective health care!Improved patient and community health!

Health care cost savings!

Meaningful Outcomes…

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Contact:

NACCHO

Contact: Valerie Rogers, MPH

Thank You!