What is working in terms of connecting public health systems and HIEs

Report identifies the real-world experiences and best practices

PARCA eNews – Sept. 13, 2017 – The ONC last week issued its report on connecting public health information systems and Health Information Exchange (HIE) organizations. The purpose of the study was to learn lessons from the field in terms of what works and what challenges remain in terms of how HIEs benefit public health jurisdictions.

The study was conducted by Clinovations Government + Health (CGH) to examine how public health jurisdictions use existing health information exchanges to distribute information to healthcare providers. The report highlights best practices and lessons learned in the use of HIE organizations to mediate connections to public health information systems.

CGH worked with ONC to identify jurisdictions at various levels of HIE maturity and integration with public health information systems. They included 10 awardees of ONC grants and 8 that had no ONC funding.

The report synthesizes interview respondents’ experiences for other jurisdictions to consider using in their interoperability environments. The ONC emphasizes that this report is a snapshot of where things stand and should not be construed as comprehensive research work.

To be clear the report defined HIE organizations as those that operate across the country in state and local regions to facilitate health information sharing for trading partners that may include, but are not limited to patients, inpatient and ambulatory health care providers, other care providers, care coordinators, laboratories, health insurance carriers, and local and state governments.

In response to questions about why an organization joined an HIE, respondents consistently cited two primary goals:

• Streamline the number of connections (and reduce associated costs) for health care providers, HIE organizations and public health agencies to exchange public health information; and 
• Support health care providers to achieve public health requirements for the Medicare and Medicaid EHR incentive programs.3

What they found in part, is that integration of public health information systems and HIE organizations is increasing, but is not yet widespread across the country. Data from a 2012 Association of State and Territorial Health Officials (ASTHO) survey found that only 13 state public health agencies receive lab results and nine agencies receive reportable diseases through an HIE organization.

That said, the health agencies reported getting better data from HIEs. The researchers discovered instances of higher quality in public health data transmitted from HIE organizations, as compared to clinical information systems. 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.

In terms of successfully establishing an HIE, the interviews with state and regional public health jurisdictions revealed the following keys for success:

• Leadership with top- and second-tier champions who meet frequently and possess a range of technical and informatics skill sets; 
• Flexible technical solutions with aligned terminology and transport standards that meet public health data requirements; 
• A mix of state and federal funding streams; 
• Privacy and security principles embedded in governance and architecture at early stages of development and ongoing operation; 
• A legal and policy environment that encourages standardized public health reporting through an HIE organization and permits secondary data use; and 
• Health IT developers that deliver affordable and efficient connectivity solutions. 

The full report is available online.