The Status of LHD Information Systems:
Results from the 2010 NACCHO Informatics Needs
Assessment
Wednesday, May 26, 2010
Alastair Matheson
Senior Analyst, Informatics
Overview of Webinar
0
6
10
• Goals of the webinar
2
2
3
3
• Purpose of the project
• Topics covered
• Key findings
• Implications
• Questions
Implications
20
Key findings
Minutes of webinar
• Overview of the project
Questions
Topics covered
30
25
Overview of the
project
Purpose of the project
40
Goals of the webinar
9
Introduction
50
10
60
Wednesday, May 26, 2010
Five Things First…
• This webinar will be recorded and available on
NACCHO’s website
• The slides will also be available for download
• Please complete the evaluation when you receive
the link
• Type your questions in the box as we go
• Quick poll…
Wednesday, May 26, 2010
Poll—Knowledge and Experience with PHI
Please rate your knowledge and experience of public health informatics (PHI):
•
1 (I have barely heard of PHI)
•
2 (I have some knowledge of PHI but little experience)
•
3 (I am familiar with some PHI terms and uses)
•
4 (I have fairly extensive knowledge and experience with PHI)
•
5 (I am very knowledgeable about PHI)
Wednesday, May 26, 2010
Goals of Webinar
• To show why NACCHO undertook this initiative
• To present some of the key findings of the study
• To discuss implications of the findings
• To make you want to read the reports
Wednesday, May 26, 2010
Purpose of the Project
• Focus on health informatics due to HITECH Act
• To fill the gap in knowledge about LHDs’ use of
informatics
• To guide NACCHO’s programs  better serve
LHDs
• To inform and influence national and state policy
and decision-makers
Wednesday, May 26, 2010
Overview of the Project
• Web survey Nov 2009 to Jan 2010 (42% response rate)
• Focus groups in Feb and Mar 2010 (41 participants)
• Data analysis from Jan to April 2010
• Two reports:
 Full version contains all the findings (http://eweb.naccho.org/prd/?na334pdf)
 Summary version with key findings (http://eweb.naccho.org/prd/?na335pdf)
• Many potential future analyses
Wednesday, May 26, 2010
Topics
• Nomenclature
• Physical infrastructure
• Skills and capacity within LHDs
• Informatics workforce needs
• System development and implementation
• Electronic health records
• Surveillance
Wednesday, May 26, 2010
Topics (cont.)
• Other information systems
• Barriers to implementation
• ARRA/HITECH funding
• Health information exchange
• Knowledge management
• Web 2.0
• Ways NACCHO can help
Wednesday, May 26, 2010
Key Findings
• Some LHDs well advanced in their informatics use
• Most LHDs have areas for significant improvement
Nomenclature
• Many people have not heard the term informatics
• Some think it pertains to data and information flow
• It can be difficult to communicate informatics
concepts to general workforce
Wednesday, May 26, 2010
Control of Physical Infrastructure
IT System Security
6%
15%
Data Management
31%
23%
Software Support
13%
Software Selection
15%
18%
23%
Hardware Allocation and Support
8%
12%
11%
25%
19%
20%
0%
15%
14%
12%
19%
20%
13%
12%
19%
40%
7%
9%
7%
13%
10%
60%
9%
11%
5%
10%
7%
11%
8%
9%
8%
80%
100%
Percentage of LHDs
Individual LHD Department/Program
LHD through a Central Department
City/County IT Department
LHD and City/County
LHD and State Health Department
Shared among Three or More
NB. Not all categories are included so the total is less than 100%
State Health Department
n=306–309
Skills and Capacity in LHDs
• Most LHDs have staff who can extract, use and
interpret data
• About a third of LHDs rely on SHDs for some to
provide some or all of their informatics activities
• 31% LHDs do not use GIS
• 14% rely on contractors to maintain their web site
Wednesday, May 26, 2010
Workforce Needs
Using Clinical Data to Improve Quality of Care
13%
Using Word Processing, Spreadsheet and Presentation Software (e.g.,
Microsoft Office)
13%
18%
Designing and Running Reports from Information Systems
12%
8%
Basic Computing Skills
11%
17%
Using and Interpreting Quantitative Data
7%
Using and Interpreting Qualitative Data
6%
0%
5%
13%
10%
4%
6%
9%
10%
11%
8%
10%
15%
7%
20%
25%
30%
35%
40%
Percent of LHDs
#1 Priority
#2 Priority
#3 Priority
n=270
45%
Poll—What Aspect of MS Office?
What aspect of using MS Office do you think people need training on?
•
How to use word processing
•
How to add and manipulate data in spreadsheet software
•
How to build databases
•
How to output data in a meaningful way
•
How to make flashy presentations
•
Something else
Wednesday, May 26, 2010
Barriers to Informatics Training
100%
90%
84%
80%
72%
Percent of LHDs
70%
60%
54%
50%
40%
40%
38%
30%
26%
20%
10%
0%
Time Away from
Other Duties
Cost of Training
Distance to the
Training
Lack of Knowledge
about Courses
Barrier
Restrictions on
Spending Grant
Funding
Other Trainings Took
Precedence
n=271
System Development and Implementation
• Development of systems is driven by funding opportunities
• Funding opportunities relate to external agencies priorities
(may not match LHD’s)
• “Development is driven by what gets attention”
• Focus group participants positive about SHDs consulting
with LHDs
• LHDs use informatics to positively impact health
Wednesday, May 26, 2010
LHDs’ Use of EHRs
100%
3%
4%
90%
80%
42%
70%
57%
Percent of LHDs
60%
Don't Know
All Paper
50%
Part electronic, Part paper
All Electronic
40%
42%
30%
30%
20%
10%
13%
9%
0%
Primary care
Dentistry
n=86 (Primary care)
n=69 (Dentistry)
Challenges when Implementing EHRs
90%
82%
80%
70%
70%
Percent of LHDs
60%
48%
50%
46%
40%
30%
24%
24%
20%
10%
0%
Workforce Training
Interoperability
Managing Staff
Expectations
Ongoing
Privacy and Security
Maintenance Costs
of Health Data
Challenge
Reporting on the
Data
n=40
Electronic Surveillance Systems
100%
11%
90%
22%
18%
8%
8%
10%
18%
18%
14%
8%
10%
80%
23%
70%
38%
30%
Percent of LHDs
33%
60%
35%
Do Not Use
Surveillance System
50%
83%
40%
78%
30%
80%
Use Surveillance
System
59%
49%
20%
Don't Know
52%
52%
43%
10%
0%
Population Category
n=265
Other Information Systems
• Many LHDs (usually 30–50%) collect data on paper
• Office computers are the other main mechanism for collection
• Between 50 and 75% LHDs store data on paper
• Web-based databases are also common storage sites
• Data are often mailed or faxed
• In other instances other people have access to the database
• LHDs will use different methods for the same data
Wednesday, May 26, 2010
System Compatibility
14%
19%
All Can Share Data
Some Can Share Data
None Can Share Data
16%
Don't Know
52%
n=257
Poll—Ways to Achieve Internal Interoperability
Which of the following is the most important activity for achieving internal interoperability?
•
Coordinating grants at CDC (and other federal partners)
•
Ensuring that statewide HIEs deal with all LHDs’ needs (e.g. infectious diseases, case management,
environmental health, planning and assessment)
•
Building on Common Ground to standardize LHDs’ business processes/workflow
•
Developing better connectivity among state information systems
•
Develop an information system that meets LHDs’ needs (e.g. infectious diseases, case
management, environmental health, planning and assessment)
•
Something else
Wednesday, May 26, 2010
Barriers to System Development
Insufficient Funding
47%
No Time/Resources to Divert from Program Activities
11%
Lack of Project Management Staff
26%
8%
11%
4%
9%
10%
No Knowledge about the Systems Available
4%
9%
8%
10%
10%
18%
16%
No One with the Technical Skills to Support the System
0%
15%
20%
30%
40%
50%
60%
70%
80%
Percent of LHDs
#1 Barrier
#2 Barrier
#3 Barrier
n=259
Plan to Seek Stimulus Resources
100%
90%
22%
38%
80%
45%
47%
33%
44%
46%
53%
11%
Percent of LHDs
70%
Don’t Know
60%
29%
50%
29%
40%
No Plans to Seek Resources
36%
40%
40%
30%
67%
37%
Plan to Seek Resources
34%
20%
38%
32%
10%
20%
13%
13%
14%
17%
0%
Population Category
n=258
Planning to Work with SHD on HIE
100%
90%
22%
29%
30%
25%
35%
37%
80%
47%
Don't Know
47%
Percent of LHDs
70%
60%
No Plans to Work with the
SHD
25%
36%
25%
34%
50%
32%
Plan to Work with the SHD
23%
40%
44%
26%
30%
29%
20%
28%
38%
12%
Already Working with the
SHD
50%
25%
28%
17%
10%
13%
9%
0%
2%
15%
8%
8%
2%
Population Category
n=256
Electronic Exchange of Health Data
100%
94%
90%
80%
Percent of LHDs
70%
60%
50%
47%
40%
37%
35%
30%
27%
20%
10%
0%
State Health Departments
Other LHDs in the Area
Laboratories
Entity Data Are Exchanged with
Hospitals
Other Healthcare Providers
n=236
Health Information Exchange
30%
35%
HIE in the Area
No HIE in the Area
Don't Know if There Is an HIE in the Area
36%
n=254
•
Is this accurate or does it reflect LHDs’ lack of engagement?
Wednesday, May 26, 2010
Health Information Exchanges
“What you enter today you can see tomorrow,
so all that information will be accessible to
the local health department in real time.
And that is one of the biggest bonuses for
public health”
—LHD focus group participant
Wednesday, May 26, 2010
Knowledge Management
90%
80%
78%
70%
Percent of LHDs
60%
50%
39%
40%
30%
20%
17%
15%
13%
10%
3%
0%
Spreadsheets and
Charts
Regular Data
Reports
Web-Based
None of These
Dashboards
Knowledge Management Display Used
Local Dashboard
Other
n=246
Web 2.0
50%
47%
45%
40%
37%
35%
Percent of LHDs
30%
26%
25%
20%
16%
15%
11%
11%
10%
7%
5%
1%
0%
Facebook
Twitter
Don't Know
YouTube
Myspace
Web 2.0 Technology
Blogs
Other
SlideShare
n=115
Poll—Length of Time Using Web 2.0
How long has your organization been using Web 2.0 technologies
•
Never used Web 2.0 at all
•
Used to use Web 2.0 but no longer do
•
Less than 6 months
•
Between 6 and 12 months
•
Between 1 and 2 years
•
More than 2 years
Wednesday, May 26, 2010
Implications
• Health outcomes are affected by LHD use of informatics
• Better communication with LHDs required
 Informatics concepts
 National opportunities such as EHR and HIE funding
 Tools and resources that can help
 Understanding which systems should be linked
• LHDs need dedicated informatics funding and staff to
overcome barriers
Wednesday, May 26, 2010
Implications
• LHDs need dedicated informatics funding and staff to
overcome barriers
• LHDs need support with informatics skills, possibly
through RECs
• LHDs could benefit from improved tools for handling data
• Challenges cannot just be solved at a local level
• Let’s start with interoperability of LHD information systems
Wednesday, May 26, 2010
Before You Hang Up
• Please complete the (very) short evaluation of this webinar
• Both reports available in NACCHO’s bookstore very soon
• Hard copies of summary report available
• Tell all your colleagues about public health informatics
Wednesday, May 26, 2010
Questions?
Comments?
Wednesday, May 26, 2010