Meaningful Change Coming to Public Health

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.

Also, the large number of hospitals that have been submitting on paper and are going to start sending electronically in the next few years is a huge capacity issue for public health agencies, he says. “There is a lot of hand holding and several steps that require epidemiologists and infection control people to make sure you are filtering data for the appropriate results. That takes a lot of time. It is important not to turn off the paper-based reporting until you are sure the electronic submission is working properly. In Massachusetts, we required that they send both for six weeks.”

In order to meet meaningful use requirements, the lab result must be sent to the public health organization from a certified electronic health record (EHR). But most hospitals use separate LIS (laboratory information system) software that sends data directly to public health. “If the LIS is not a certified module, then it would appear not to meet meaningful use,” says Noam Arzt, president of the San Diego-based HLN Consulting LLC, which advises public health agencies on IT issues. “I don't think people have worked through that issue yet.”

Arzt notes that some states have achieved interoperability on immunization, while others are still working on it. “Of the three meaningful use goals, this is probably the easiest to understand and least controversial because the states have been working on it for some time,” he says. “Many agencies just haven't had the funding to embellish their immunization information systems. And on the provider side, some aren't electronic yet or can't extract that data in a usable format yet.”

WILL PUBLIC HEALTH BE READY?

There is some concern about the level of preparedness of state agencies to receive data. The first Medicare providers that adopt EHRs were hoping to test data transmission with public health agencies by April 2011 to receive their incentive payments. Last November the Association of State and Territorial Health Officials (ASTHO) asked its members if they would be ready to receive data by April. Seventy-nine percent said they planned to have their electronic lab reporting system ready; 85 percent planned to have their immunization information system ready; but only 52 percent plan to have their syndromic surveillance system ready.

Respondents to ASTHO's survey cited lack of funding, lack of flexibility with current funding, and a lack of technical expertise as the top three barriers to readiness. A few respondents mentioned that they may have the technical capability to receive messages, but are concerned about the capacity to deal with an influx of providers who plan to send data, according to ASTHO.

TRADITIONALLY THE STATE SYSTEMS ARE SOMEWHAT SILOED AND PROGRAM-SPECIFIC AND THE CROSSOVER IS NOT AS IDEAL AS IT SHOULD BE. WE WANT TO LOOK AT OUR INFRASTRUCTURE FROM AN ENTERPRISE PERSPECTIVE RATHER THAN AS A SET OF INDIVIDUAL SYSTEMS. -AMY ZIMMERMAN

The Rhode Island Department of Health has undertaken an effort to assess its readiness to exchange electronic data with the hospitals and eligible providers in the Ocean State. Leading that project is Amy Zimmerman, MPH, chief of health information technology for the department.

The department is trying to discern how it can maximize electronic health information without creating point-to-point interfaces for each program with every provider, Zimmerman says. “Traditionally the state systems are somewhat siloed and program-specific and the crossover is not as ideal as it should be,” she adds. “We want to look at our infrastructure from an enterprise perspective rather than as a set of individual systems.”