ONC Pushes Public Health Agencies to Improve HIE Integration


HIE Integration

The few public health agencies with HIE integration have reported more complete, higher quality data than those without a connection.

An ONC resource on how public health agencies utilize health information exchange (HIE) integration contains best practices and insights using interviews from public health agencies in 16 jurisdictions.

The findings detailed in the report focus on strategies for public health and HIE integration across six categories: leadership, technical, financial, privacy and security, policy, and health IT developers.

ONC partnered with Clinovations Government + Health (CGH) to examine HIE use among public health agencies. These state and community agencies can assist in improving the health of populations through disease prevention activities using data from public health screening and treatment services, laboratories, pharmacies, environmental health monitors, emergency medical services, local public health agencies, and clinical care providers.

Public health agencies function within states and communities and collect data from providers to use for data registries and disease surveillance systems. With an HIE connection, public health agencies can benefit from improved interoperability and reduce redundant connections.

While public health information systems with HIE integration have increased in recent years according to ONC, the practice is not yet widespread. In 2012, a survey from the Association of State and Territorial Health Officials (ASTHO) found 13 state public health agencies received lab results and nine received reportable diseases through HIE organizations.

“This trend occurs as researchers discover instances of higher quality in public health data transmitted from HIE organizations, as compared to clinical information systems,” stated the report. “For example, a 2013 investigation of electronic lab report messages finds data enriched by an HIE organization is more complete, compared to data from clinical systems.”

Public health systems with integrated HIE organizations have also been shown to yield improvements in care coordination and clinical efficiency, according to qualitative research in upstate New York, central Texas, Indiana, and New Mexico.

Still, HIE integration within public health systems is a relatively recent undertaking.

ONC highlighted three factors as contributing to this lack of integration:

  • An existing reporting infrastructure already facilitates public health reporting for health care providers.
  • The HIE organization’s technical solution does not often supply public health agencies with the level of data required for public health functions
  • Limited resources are available to dedicate to HIE infrastructure.

In its report, ONC determined that a combination of flexible, standardized technical solutions, policy enabling standardized public health reporting through HIE organizations and secondary data use, and affordable connectivity solutions offered by health IT developers could address these issues.

Interviewees highlighted a number of objectives driving the need to encourage more HIE integration in this care setting.

Most stated HIE integration could streamline the number of connections and thereby reduce costs for healthcare providers, HIE organizations, and public health agencies sharing information. Additionally, integration could support providers in achieving public health requirements for the EHR incentive programs.

Other interviewees expressed interest in developing a sustainable platform for clinical and public health data exchange for improved analytics and quality measurement.

To achieve these aims, ONC outlined ways public health agencies can overcome barriers to HIE integration — specifically, lack of standardization, gaps in standard use and adoption, lack of aligned messaging standards, and inconsistent data quality pose issues in integration.

Improving standards for public health data exchange is especially necessary.

“EHRs that meet ONC’s Health IT Certification Program requirements support transport protocols such as Direct for transport of Continuity of Care Documents (CCDs),” wrote ONC. “Public health content is standardized at the provider (EHR) and public health level, but the method of transport is not. The HL7 implementation guides and certification standards for public health information exchange do not require any specific transport mechanism, which can vary by state or region.”

Using transport methods such as the Direct standard could assist in improving standardization in public health data exchange.

To help public health agencies more efficiently exchange health data, ONC provided a summary of best practices for HIE use.

“One jurisdiction’s HIE organization respondents describe an increasingly electronic environment as being overall good for the community with the ability to share information across trading partners,” stated ONC.

“However, public health agency respondents caution against the growing electronic gap between public health and health care providers, where health care providers increasingly use health IT with exchange capabilities, but public health agencies do not have comparable technology to participate in exchanges,” the agency advised.

Finally, ONC emphasized the need for collaboration between public health agencies, HIEs, healthcare providers, and health IT developers to work toward bidirectional, standards-based health data exchange.

“Standards alignment must integrate public health information systems and HIE organizations, with transport mechanisms and terminologies meeting all of the public health data requirements,” maintained ONC.

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