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City, county health officials struggling with health data exchange

Funding and expertise are scarce as local public health officials prepare to be inundated with immunization, syndromic surveillance and lab patient data, thanks to meaningful use.

HARTFORD, Conn. -- In the midst of a record-setting heatwave outside, the hottest topic of discussion inside the National Association of City and County Health Officials national convention wasn't the weather, or even meaningful use -- even though those topics ranked up there.

The hottest topic was funding, especially as local officials prepare to receive three categories of granular new population data -- immunizations, syndromic surveillance and lab tests. Mass quantities of data will become available in stage 1 of meaningful use; under the HITECH Act, providers must send that data to health departments.

That quantity will only increase as statewide health information exchanges (HIEs) harness more information in the coming years. Health data exchange will let officials more effectively understand local health issues and keep their constituents healthier, said Health & Human Services CTO Todd Park in a keynote address.

But many public health departments barely have IT resources to handle their current needs. Most also face budgetary pressures, like the rest of local and national governmental entities in this sputtering economy -- and, unlike hospitals and health care providers, they don't qualify for meaningful use funding from Washington. How to develop and upgrade systems to support that influx of data, and where the funds will come from to pay for it, are key considerations for local health departments, according to officials attending the convention.

In a breakout session on HIEs, speakers from several health departments as well as James Daniel, ONC public health coordinator, said city and county health officials do have a few partners who can help build the necessary IT infrastructure to handle incoming data from physician and hospital electronic health record (EHR) systems.

The clearest path to building that health data exchange infrastructure is for a health department to partner with a Federally Qualified Health Center (FQHC) that is eligible for meaningful use funding.

That's what the Ingham County (Mich.) Health Department did. That partnership, said assistant deputy health officer Marcus Cheatham, got the department set up with an EHR system, plugged into the regional and statewide HIE, and, perhaps most importantly, eligible for tech help from the regional extension center (REC) -- which health departments otherwise aren't.

Health information exchanges potential source of help

Tapping HIEs for assistance might be an option, too, said Art Davidson, director of public health informatics at Denver Public Health. He noted that many public health agencies struggle with disparities between the new Health Level 7 International (HL7) 2.5.1 and old HL7 2.3.1 health data exchange standards as they perform meaningful use-mandated tests when local physicians attest for incentive checks.

Some health information exchanges, Davidson said, are offering services in which they take data from senders in any form they have it and translate it into a form usable by the recipient. This can help take the IT load off a health department struggling to parse data from new EHR systems.

HIEs might be able to help local health departments receive EHR data. They can also act as a conduit between providers and other HIEs to collect and store local health data, Davidson said, thus relieving local public health officials from what could be a large IT burden. Some health departments -- such as the city of Boston's -- are taking reports directly from physicians. This, however, is unlikely a sustainable model for many other agencies, he said.

Meanwhile, some health departments have partnered with schools of public health, Davidson noted. In such cases, the research institutions' data centers become the meaningful use repository that the health department cannot afford to build.

Keep in mind that stage 1 of meaningful use is geared more toward testing and confirmation that

Health data exchange will let officials more effectively understand local health issues and keep their constituents healthier.

health data exchange works. A health department tackling only one of the three required data sets (syndromic surveillance, labs or immunization data) and learning how to take in data and analyze it is better off than one attempting all three data sets at once, Davidson suggested. This way, lessons learned from the first iteration can be applied to the other two. Better yet, a partner such as a state HIE or public health school can handle the data sets before they become a stickier IT problem at the end of stage 3.

Although it's a long shot and sort of an indirect way to secure funding, Daniel said it's possible that there could be funds for local public health departments in their state's Medicaid coffers. Get to know the Medicaid commissioner, he encouraged session attendees, because the federal State Medicaid Health IT Plan -- the same one that funds registries for physicians applying for Medicaid meaningful use funding -- can be used to recoup federal dollars for IT infrastructure costs that enable meaningful use transactions.

"[For] anything helping Medicaid clients when you're building new technology, you can get 90% reimbursement on the state dollars that you spend," Daniel said. The caveat, he added, is that the reimbursement is pro-rated to the percentage of Medicaid clients who are part of the patient universe the project will benefit.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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