Assessing and Improving Local Health Departments’ e-Health Capability and Capacity

1. Assessing and Improving Local Health Departments’ e-Health Capability and Capacity Karen Soderberg, MS Office of Health Information Technology, Minnesota Department of Health Bethany Bradshaw, MPH Applied Public Health Informatics Fellow, Wisconsin Department of Health Services

2. 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 2011-2013from 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)

3. 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 Source: Healthiest Wisconsin 2020, http://www.dhs.wisconsin.gov/hw2020/

4. Methods Minnesota 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) • Required part of annual web-based assessmentsince 2010 • 52 Community Health Boards • 11 questions • Minnesota e-Health Profile

5. 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

6. EHR Adoption by LPH Minnesota Wisconsin 60% response rate 40% EHR adoption Most common : CHAMP Of those with no EHR, 60% have no plans to adopt 75%: paper is primary system • 100% response rate • 100% EHR adoption across CHBs • 2 Local Health Departments (LHDs) do not have EHRs • PH-Doc, CHAMP, CareFacts

7. Health Information Exchange Activities in LPH, Minnesota vs. Wisconsin

8. HIE Partners for LPH Minnesota (n= 52) Wisconsin (n= 58) Wisconsin Department of Health Services (74%) No HIE (26%) Hospitals (22%) Laboratories (22%) 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.” • Health or county-based purchasing plans (44%) • Minnesota Department of Health (42%) • Minnesota Department of Human Services (29%) • County/city department outside jurisdiction (21%)

9. Needed HIE Connectivity for LPH

10. Top 3 HIE Challenges for LPH Minnesota (n= 52) Wisconsin (n= 58) Insufficient information (48%) Unclear return on investment (38%) Lack of technical support (34%) • Competing priorities (42%) • Do not know exchange partners’ HIE ability (40%) • Exchange partners do not have HIE ability (40%)

11. Most Needed EHR-Related Skills in LPH, Minnesota vs. Wisconsin

12. 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.

13. 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.

14. 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-researchers-implementers/beacon-community-program/learning-guides) • Minnesota e-Health Profile (http://www.health.state.mn.us/e-health/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)

15. 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

16. 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