EXECUTIVE SUMMARY: Hospital CIOs and CMIOs across the country, as well as their counterparts in public health departments, are preparing to submit and accept health records electronically. While experts say that the transition from paper will provide an unprecedented opportunity to engage the health community on population health in a more meaningful and coordinated way, some observers, including public health officials, say public health agencies are not prepared to make the switch.
Hennepin County Medical Center, a 469-bed hospital in Minneapolis, has been working with the Minnesota Department of Health (MDOH) on using computer systems to submit immunization data for almost 15 years. But only recently has that process been truly automated.
“Historically we would send an Excel file that would be processed through the immunization registry software, but there was a lot of manual work on both ends to get that data cleaned up and validated,” recalls Kevin Larsen, M.D., Hennepin's chief medical information officer.
But now Hennepin is involved in one of the first pilots of the Direct Project sponsored by the Office of the National Coordinator for Health IT (ONC). It has begun sending HL7 immunization data directly from its clinical systems to MDOH using secure, encrypted messaging. “We also now have a button in our [Verona, Wis.-based] Epic EMR that lets users look up data in the state immunization registry,” Larsen says. “We want the state database to be the one source of truth and build it into our decision support logic. They are going to be more adept at following any changes in immunization guidelines.”
WE WANT THE STATE DATABASE TO BE THE ONE SOURCE OF TRUTH AND BUILD IT INTO OUR DECISION SUPPORT LOGIC. THEY ARE GOING TO BE MORE ADEPT AT FOLLOWING ANY CHANGES IN IMMUNIZATION GUIDELINES.-KEVIN LARSEN, M.D.
Across the country, hospital CIOs and CMIOs, as well as IT officials at public health departments, are doing assessments of their capabilities to exchange data. Stage 1 of the meaningful use guidelines requires eligible hospitals to choose one of three menu options related to public health:
Submitting electronic data to immunization registries;
Electronic lab reporting for a predefined set of monitored conditions; or
The capability to submit electronic syndromic surveillance data. (Syndromic surveillance is defined as the systematic collection and analysis of data for the purposes of detecting and characterizing outbreaks of disease.)
Executives who work in public health informatics are excited that these capabilities are part of the meaningful use guidelines. “Public health has been seeking to engage the larger health community on population health for decades,” says Bill Brand, director of programs for the Public Health Informatics Institute in Decatur, Ga. “This is a tremendous opportunity to engage in a more coordinated way.”
Of the three use cases, public health agencies have made the most progress on creating immunization registries and the least progress on syndromic surveillance, but lab reporting is what hospital CIOs should be focusing on most, stresses Jim Daniel, CIO at the Massachusetts Department of Public Health who has taken a one-year leave to work as public health coordinator for the ONC. “If we can get that data flowing, public health departments can do so much more than they currently are just by avoiding a lot of the manual data entry they are doing now. They can focus on disease surveillance. They could catch a hepatitis A outbreak and zero in on the cases before more people are exposed.”
Electronic lab reporting is a challenge for both hospitals and public health agencies, explains Daniel. “A lot of labs are sending data with HL7 2.3.1 and they have to upgrade their message format to 2.5.1 and start sending LOINC [Logical Observation Identifiers Names and Codes] and SNOMED [Systematized Nomenclature of Medicine] codes,” he adds.