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Realizing the Public Health Benefits of HIE

October 6, 2009
by David Raths
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Health information exchange holds out the promise of innovation for public health organizations. I remember that in 2008 then-National Coordinator for Health IT Robert Kolodner, MD, 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.

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 of them in just a few hours. Previously they would be sent them out by mail or fax.

A second project under way 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. 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, one thing that has to happen is that 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 added 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 to hospital and other officials to reach out to them and get them involved early."

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

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