Public Health Informatics in the Age of EHRs and the ACA: Getting to Priorities

1. Public Health Informatics in the Age of EHRs and the ACA: Getting to Priorities John W. Loonsk MD FACMI, Brian Castrucci, James B. Sprague MD PHI Conference April, 2014

2. Our Mission and Funding Areas • We believe in a strong governmental public health system • We fund • Training the public health workforce • Building the public health infrastructure • Improving information and data management

3. Our Principles • Translating the theoretical to the practical • Focusing on the “boots on the ground” • Supporting projects that are • Replicable • Sustainable • System-wide national impact • Domestic focus

4. Related Activities • With Duke and CDC, fostering public health / primary care integration though “Practical Playbook” project (practicalplaybook.org) • Focused on public health workforce including work with the Public Health Informatics Institute (PHII) to help form Public Health Informatics Academy and the PHII Requirements Lab (www.phii.org/what-we-do) • Committed to advancing informatics for a strong public health system

5. Context • Public health informatics at critical juncture • Over 70% of hospitals and 45% of community providers now have Electronic Health Records (EHRs) subsequent to over 30 billion in public incentive dollars • Health departments not commensurately supported to participate in electronic interaction with clinical care • Electronic Health Records (EHRs) do not address many population health functional needs

6. Context • New clinical payment methodologies and the Affordable Care Act (ACA) are pushing clinical care organizations to address more population health functions • Health is rapidly entering an era of “big data” and clinical care is the largest health data producer • Jurisdictional, infrastructural, privacy, data and workforce challenges continue to face public health informatics

7. Relevant Terms • Population health • Public health • Population health management Population Health Clinical Care Health Department Population Health Management Public Health

8. Question How should public health informatics proceed in this age of Electronic Health Records and the Affordable Care Act?

9. Methods • Initiated interviews with senior thought leaders • Convened 32 public health, clinical care, and health informatics leaders including senior representation from the CDC, ONC, ASTHO, NACCHO, CSTE and others Discussed industry trends, challenges and strategies for moving forward • Complete findings and plans will be forthcoming

10. Findings • EHRs are only one of many important health IT applications • Population health management and public health share a number of common functions • Clinical care population health will principally focus on the 5% of patients who use 50 to 80% of health resources • Health Information Exchange organizations are either "the answer“ for public health or are "dead"

11. Findings – “Information” • Public health access to EHRs, multi-payer claims databases, and reported data is frequently non-existent or problematic • Factors involved in connecting to clinical care and low public health "Meaningful Use" reporting numbers are complex • Basic case reporting still eludes automated clinical care – public health exchange

12. Findings – “Public Health” • Data sciences for big data clinical care analytics are not yet reconciled with epidemiology • Needs for a "value exchange" / partnership between Accountable Care Organizations and public health • Public health funding silos impede progress • Health departments will continue to offer the “jurisdictional denominator” and complete population perspective

13. Initial Conclusions • Needs for action • Government HITECH and ACA efforts do not significantly advance informatics solutions for a strong, population-inclusive public health system • Clinical care organizations and EHR vendors are early in consideration of population health functions

14. Strategies • Establish public health / clinical care value equation • e.g. a public health – ACO business contract • Advance second generation approaches to accessing information • e.g. role-based access "accounts" in EHRs for public health workers Population Health Clinical Care Health Department Population Health Management Public Health Data, Value, and Synergies

15. Strategies • Help rationalize health department and population health IT • e.g. sharing population health and public health reporting infrastructure • Align population health incentives, funding and workforce • e.g. help reduce barriers from silo'ed program funding Population Health Clinical Care Health Department Population Health Management Public Health Data, Value, and Synergies