The Local Health Department SafetyNet
HIT and Interoperability Initiatives:
Assuring a Role for the LHD SafetyNet
presented at the
National eHealth Collaborative
August Board of Directors Meeting
Thursday, August 13, 2009
by:
Yvonne Claudio, DM, MS
The Local Health Department SafetyNet
The 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
The Local Health Department SafetyNet
Background Information
The Local Health Department SafetyNet
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.
The Local Health Department SafetyNet
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
The Local Health Department SafetyNet
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
The Local Health Department SafetyNet
Comprehensive Primary Care Services
# LHDs
LHD Population
<25,000
25,000-49,000
50,000-99,999
100,000-499,999
500,000+
930
490
346
400
127
% Providing Primary Care
11%
7%
9%
16%
16%
25%
Guesstimate: 260 LHDs provide primary care
@ 2 clinics each--520 health centers
@ 5 clinics each--1,350 health centers
Source: NACCHO, 2008 National Profile of Local Health Departments, July 2009
The Local Health Department SafetyNet
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 residents
57% are uninsured; 24% have Medicaid coverage
The Local Health Department SafetyNet
LHDs—Add’l Health Services
Population in Jurisdiction
50,000-99,000 100,000-499,999
500,000+
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
The Local Health Department SafetyNet
Maintaining Community’s Health
(Sample Listing of Services)
Prevention and Treatment…
• Immunizations
• Lead Screenings
• Communicable Disease
• Nutrition Services
• Substance Abuse
• Mental Illness
The Local Health Department SafetyNet
HIT of Relevance to LHDs
The Local Health Department SafetyNet
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
The Local Health Department SafetyNet
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
The Local Health Department SafetyNet
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
The Local Health Department SafetyNet
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
The Local Health Department SafetyNet
Suggestions for Policy
Development/Refinement
Meaningful Use !
plus Meaningful…
» Requirements
» Funding
» Partnerships
» Planning
» Monitoring/Progress
The Local Health Department SafetyNet
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…
The Local Health Department SafetyNet
Meaningful Funding
• 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)
The Local Health Department SafetyNet
Meaningful Funding
• 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
The Local Health Department SafetyNet
“Meaningful” Partnerships
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?
The Local Health Department SafetyNet
“Meaningful” Planning
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
The Local Health Department SafetyNet
“Meaningful” Monitoring/Progress
• 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?
The Local Health Department SafetyNet
Meaningful Outcomes…
• Improved safetynet infrastructure
• Enhanced PH IT Infrastructure
• Increased interoperability/data sharing
Efficient/effective health care!
Improved patient and community health!
Health care cost savings!
The Local Health Department SafetyNet
Thank You!
Contact:
NACCHO
Contact: Valerie Rogers, MPH