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Going Public with HIEs

December 1, 2009
by David Raths
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WIth a solid infrastructure and the right people, public health organizations stand to benefit from HIEs.

This posting has been edited due to spacing concerns. To read all of David Raths' blogs in their entirety, please visit /contributors/david-raths.

Health information exchange (HIE) holds out the promise of innovation for public health organizations. In 2008, then-National Coordinator for Health IT Robert Kolodner, M.D., and Deputy National Coordinator Charles Friedman stressed to me in an interview that CIOs should be thinking about their role in population health, beyond just supporting individual care and personal health records.

“It is a golden opportunity, but we need that standardization in labs across the country in order to mine the data.”

But there is still infrastructure to build and standards to be developed before the potential is realized. And public health officials need to be at the drawing board when HIEs are planned.

One community that is starting to see some real results is Cincinnati, home to the HealthBridge network.

Since its founding in 1997, HealthBridge has become one of the most advanced HIEs in the country. Each month, about 3 million clinical lab tests, radiology reports, and other results are transmitted electronically to physicians in the greater Cincinnati-Northern Kentucky area through HealthBridge's network and clinical messaging system.

Five years ago, with a grant from the Robert Wood Johnson Foundation, Tim Ingram, a health commissioner in Hamilton County, Ohio, got involved in creating a regional public health alert system.

“We are using HealthBridge to dispense public health communicable disease alerts to several different categories of physicians,” he told me in a recent interview. “It has been very successful with outbreaks of shigella, cryptosporidium, and recently, with H1N1 virus advisories. We use it sparingly, and only when relevant.”

Ingram says the system has created a more efficient means of communication for public health agencies.

Almost 2,000 physicians get the information in their clinical inbox; it lights up in the corner as a public health alert. These alerts are created and sent out to all physicians in just a few hours, whereas previously, they would be sent out by mail or fax.

A second project underway involves automating clinical lab reporting systems. There are 100 communicable diseases that must be reported to public health departments, such as sexually transmitted diseases or E. coli infections. Previously, providers would fax or mail that information. “But in a trauma situation, time is everything,” Ingram says. “With contagious diseases, the more quickly we act, the fewer people get sick. So as that lab result moves to the provider's mailbox, we want that type of result routed to the public health department where the individual resides, at the same time.”

Ingram says that for the system to expand, clinical labs and HIEs have to standardize on LOINC codes. “It is a golden opportunity, but we need that standardization in labs across the country in order to mine the data,” he says.

He adds that because public health departments already have reporting systems to the state and to the Centers for Disease Control, interfaces have to be created between those reporting systems and HIEs like HealthBridge. “We are currently double-entering that data into those systems because there are no interfaces,” he says.

Ingram stresses to people working on establishing HIEs that they should make sure public health is at the table. “You have to have a population focus, and if the public health commissioner isn't involved in HIE or isn't on the advisory board, I suggest hospital and other officials reach out to them and get them involved early.”

What else needs to happen before more public health agencies see some tangible results?

Healthcare Informatics 2009 December;26(12):34