Assessing and Improving
Local Health Departments’ eHealth Capability and Capacity
Bethany Bradshaw, MPH
Applied Public Health Informatics Fellow,
Wisconsin Department of Health Services
Karen Soderberg, MS
Office of Health Information Technology,
Minnesota Department of Health
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Background: Minnesota
Local public health (LPH) is engaged in e-health
• Active participation and leadership in the Minnesota e-Health
Initiative
• Significant part of the Minnesota Southeast Beacon Project
• Received over $750,000 in e-health loans and grants between 20112013 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)
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Background: Wisconsin
• Minimal LPH engagement with e-health
• LPH 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
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Source: Healthiest Wisconsin 2020, http://www.dhs.wisconsin.gov/hw2020/
Methods
Minnesota
• Required part of annual
web-based assessment
since 2010
• 52 Community Health
Boards
• 11 questions
• Minnesota e-Health Profile
Wisconsin
• Voluntary, 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 Questions
• Electronic 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 LPH
Minnesota
Wisconsin
• 100% response rate
• 60% response rate
• 100% EHR adoption
across CHBs
• 40% EHR adoption
• 2 Local Health
Departments (LHDs) do not
have EHRs
• PH-Doc, CHAMP, CareFacts
• Most common : CHAMP
• Of those with no EHR, 60%
have no plans to adopt
• 75%: paper is primary
system
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Health Information Exchange Activities in
LPH, Minnesota vs. Wisconsin
Health Information Exchange Activities,
Minnesota vs. Wisconsin
80%
70%
Percentage of Respondents
60%
50%
40%
Minnesota (n=52)
67%
Wisconsin (n= 58)
30%
50%
52%
20%
31%
21%
10%
25%
26%
12%
0%
Receive secure messages
Send secure messages
Securely query
HIE Activity
No HIE
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HIE Partners for LPH
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.”
Minnesota (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%)
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Needed HIE Connectivity for LPH
Minnesota: Needed HIE Partners (n= 52)
100%
90%
80%
70%
60%
50%
94%
92%
40%
30%
56%
56%
52%
20%
10%
9
0%
Primary Care Clinics
Hospitals
Health or county-based Minnesota Department of LHDs and CHBs outside
purchasing plans
Health
jurisdiction
Top 3 HIE Challenges for LPH
Minnesota (n= 52)
Wisconsin (n= 58)
• Competing priorities
(42%)
• Insufficient information
(48%)
• Do not know exchange
partners’ HIE ability
(40%)
• Unclear return on
investment (38%)
• Exchange partners do
not have HIE ability
(40%)
• Lack of technical support
(34%)
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Most Needed EHR-Related Skills
in LPH, Minnesota vs. Wisconsin
80%
70%
Percentage of Respondents
60%
50%
40%
Minnesota (n=52)
69%
Wisconsin (n=58)
30%
50%
20%
44%
40%
45%
40% 38%
36%
27% 26%
10%
17%
14%
0%
Person to design, Person to lead
maintain, and implementation
customize EHR
Person to train Person to manage Person to develop Person to get EHR
staff on EHR
and process the and write EHR
ready for use
data
reports
EHR-Related Skill
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Findings
• Importance 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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Recommendations
• States 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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Resources
• Public Health & Electronic Health Information Exchange: A
Guide to Local Agency Leaderships (www.phii.org)
• ONC Beacon Program Learning Guides
(http://www.healthit.gov/policy-researchersimplementers/beacon-community-program/learning-guides)
• Minnesota e-Health Profile (http://www.health.state.mn.us/ehealth/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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Acknowledgements
• Minnesota Office of Health Information Technology
• Minnesota Office of Performance Improvement
• Minnesota Local Public Health Association
• Wisconsin Department of Health Services, Division of Public
Health
• Wisconsin Local Health Departments
• Wisconsin Tribal Health Agencies
• Applied Public Health Informatics Fellowship Program
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Contact Information
Karen Soderberg, MS
Office of Health Information Technology
Minnesota Department of Health
Karen.Soderberg@state.mn.us
(651) 201-3576
Bethany Bradshaw, MPH
Office of Health Informatics
Wisconsin Department of Health Services
Bethany.Bradshaw@gmail.com
(608) 267-6782
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