HIT and Interoperability Initiatives: Assuring a Role for the LHD SafetyNet

1. 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

2. 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

3. Background Information

4. 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.

5. 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

6. 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

7. Comprehensive Primary Care Services # LHDs % Providing Primary Care LHD Population 11% <25,000 930 7% 25,000-49,000 490 9% 50,000-99,999 346 16% 100,000-499,999 400 16% 500,000+ 127 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

8. 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

9. LHDs—Add’l Health Services Population in Jurisdiction 50,000-99,000100,000-499,999500,000+ 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

10. Maintaining Community’s Health (Sample Listing of Services) Prevention and Treatment… Immunizations Lead Screenings Communicable Disease Nutrition Services Substance Abuse Mental Illness

11. HIT of Relevance to LHDs

12. 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

13. 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

14. 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

15. 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

16. Suggestions for Policy Development/Refinement Meaningful Use ! plus Meaningful… • Requirements • Funding • Partnerships • Planning • Monitoring/Progress

17. 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…

18. 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) Meaningful Funding

19. 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 Meaningful Funding

20. 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? “Meaningful” Partnerships

21. 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 “Meaningful” Planning

22. 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? “Meaningful” Monitoring/Progress

23. Improved safetynet infrastructure Enhanced PH IT Infrastructure Increased interoperability/data sharing Efficient/effective health care! Improved patient and community health! Health care cost savings! Meaningful Outcomes…

24. Contact: NACCHO Contact: Valerie Rogers, MPH Thank You!