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Public Health Data Standards Consortium http://phdatastandards.info. PHDSC / eHealth Initiative Annual Conference May 2005, Washington, D.C. Public Health Participation in Health Information Exchanges:
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Public Health Data Standards Consortium http://phdatastandards.info
PHDSC / eHealth Initiative Annual ConferenceMay 2005, Washington, D.C. Public Health Participation in Health Information Exchanges: Barriers and Challenges to the Widespread Adoption and Use of Health Information Technologies Walter G. Suarez, M.D., M.P.H. President, Public Health Data Standards Consortium walter.suarez@sga.us.com 952-854-3401
Barriers and Challenges • Most barriers experienced by Public Health in the adoption of HIT are similar to those experienced by clinical and administrative sectors in health care • Barriers can be organized into the following dimensions: • Regulatory • Organizational • Cultural • Financial • Technical
Barriers and Challenges - Regulatory • Lack of a clear mandate for public health to adopt national standards and interoperability across systems • Fragmentation in the requirements and relationships between Federal, State and Local public health agencies with respect to HIT
Barriers and Challenges - Regulatory • Public Health functions respond to State/ Local requirements, enabling authorities, statutorily established responsibilities, and they vary from state to state • Variation in the adoption of a privacy framework for public health information, affecting the ability of agencies and organizations to adopt HIT
Barriers and Challenges - Organizational • Fragmentation of categorical programs in public health, their interaction with clinical care and their data flows/data collection efforts • Lack of uniformity in the definition of public health business processes
Barriers and Challenges - Organizational • Varying levels of HIT readiness across states and local agencies • Limited identification of ‘business cases’ in Public Health where the adoption and use of standards and health information technology demonstrate cost-benefits • Most benefits are long term • Most costs imply large upfront investment • “Urgent need” not yet identified
Barriers and Challenges - Cultural • Traditional separation between clinical practice, personal care and public health practice • Varying levels of interaction and interdependencies between public health programs and clinical/personal care • Personnel readiness to adopt new technologies and standards
Barriers and Challenges - Cultural • Difficulty in transitioning from a ‘batch’ mentality to a real-time approach to public health practice • Few public health programs have taken advantage of HIT to transform their business processes into real-time or near-real-time data flows • Staff and organizational resistance to change
Barriers and Challenges - Financial • Ongoing budget constraints and competing funding priorities in public health • Public health information infrastructures across states are under-funded and vulnerable to deeper funding cuts • HIT funding for public health continues to be programmatic and fragmented, creating “HIT-rich/HIT-poor” programs
Barriers and Challenges - Financial • Limited funding commitment from public health for standards development efforts • Lack of model incentives to demonstrate value of investing in public health infrastructure and HIT • Shifting HIT priorities in response to new/changing national demands and federal requirements
Barriers and Challenges - Technical • Infrastructure/Connectivity Issues • Disparities in the availability and access to high-speed connectivity (rural vs urban PH programs) • Dependency on low-speed connectivity between some public health programs and trading partners • Standards Issues • Lack of standards for many electronic health information exchanges (e-HIE) in public health • Existing standards for selected e-HIE in PH not widely adopted due to complexities, cost, modification of existing processes/systems, resistance to change
Barriers and Challenges - Technical • Applications and Interoperability Issues • Most public health applications are custom-developed and built to respond to unique program features • Some can interoperate with internal systems within the agency • Very few are capable of interoperating with external systems such as electronic health records • Human-ware issues • Resistance to process changes • Resistance to adopt and adapt to new technologies • Resistance to larger reliance on HIT