Leveraging Health Information Exchange to Support Public Health Situational Awareness: The Indiana Experience

Public health situational awareness is contingent upon timely, comprehensive and accurate information from clinical systems. Ad-hoc models for sending non-standard clinical information directly to public health are inefficient and increasingly unsustainable. Information sharing models that leverage Health Information Exchanges (HIEs) are emerging. HIEs standardize, aggregate and streamline information sharing among data partners, including public health stakeholders, and HIE has supported public health practice in Indiana for more than 10 years. To accelerate nationwide adoption of HIE-supported situational awareness processes, the CDC awarded three HIEs across the nation, including Indiana, New York and Washington/Idaho. The Indiana partners included Indiana University School of Medicine, Regenstrief Institute, Indiana Health Information Exchange, Indiana State Department of Health, Health & Hospital Corporation of Marion County, and Children’s Hospital Boston. Activities included augmenting biosurveillance processes, enabling bi-directional communication, enhancing automated detection of notifiable conditions, and demonstrating technological advances at national forums. HIE transactions destined for public health were enhanced with standardized clinical vocabulary and more complete physician contact information. During the 2009 H1N1 flu outbreak, the HIE delivered targeted public health broadcast messages to providers in Marion County, Indiana. We will review the partnership characteristics, activities, accomplishments and future directions for our health information exchange.     

Organizational and Market Dynamics Associated with Usable,Accessible Health Information Exchange for Skilled Nursing Facilities

Information discontinuity between hospitals and skilled nursing facilities (SNFs) is a critical barrier to safe and effective transitions. To engage effectively in information sharing, SNFs need structural health information exchange (HIE) capabilities but also HIE design and workflows that result in electronic information actually being accessible and usable at the point of care. We use nationally representative SNF data to identify key facility characteristics, and characteristics of the facility’s top hospital referral partner, that are associated with likelihood of SNFs having access to electronic information sharing tools. Controlling for those capabilities, we then assess the extent to which those same characteristics influence the extent to which the SNF reports usable information received electronically that is actually available at the point of care. We conducted pooled, cross-sectional survey data analyses. We identified our sample of SNFs through the Office of the National Coordinator SNF Health IT Survey (2016-2017). From this survey, we generated our SNF HIE capability metric (ability to electronically query for or receive patient information from outside sources) as well as our key study outcome—whether SNFs report usable electronic information from outside sources available at the point of care. Organizational SNF characteristics were pulled from the SK&A Nursing Home datafile as well as the CMS Nursing Home Public Use file. We matched each SNF to the hospital responsible for sending the highest percent of their referrals using Medicare referral pattern data and used these same data to calculate a measure of SNF referral relationship concentration. We then, for each partner hospital, used the American Hospital Association (AHA) IT Supplement to identify general and SNF-specific HIE capabilities. We use linear probability models to estimate the association between relevant organizational characteristics (of the SNF and partner hospital) and both HIE outcomes: (1) SNF HIE capabilities and (2) SNF self-reported availability of usable and accessible outside information at the point of care (controlling for HIE capabilities). Nationally representative sample of skilled nursing facilities (N = 1,189). Controlling for the presence of an EHR, SNFs are more likely to electronically query for or receive information from outside sources if they are large (+10.3%, top tertile compared to bottom; P = .004), if they are part of a large chain (+11.7%, member of 70+ nursing home chain, compared to standalone; P = .001), and if their partnering hospital reports having a health information portal (+7.5%; P = .049). Adjusting for SNF HIE capabilities, SNFs have a higher probability of usable electronic information available at the point of care if their top partner hospital reports participation in a community HIO (+7.6%; P = .018). Hospital information portals increase SNF access to HIE infrastructure, but community-level HIOs increase the likelihood that SNFs actually have accessible, usable electronic information from hospitals at the point of care. Community HIOs appear to play a critical role in SNFs having usable, timely access to outside sources of health information. HIOs have significant opportunity to bolster their value proposition through greater engagement with SNFs and other postacute providers on supporting their informational needs and transitional care processes with hospitals. Office of the National Coordinator for Health IT.     

Institutional factors affecting the electronic health information exchange by ambulatory providers

ObjectiveElectronic exchange of health information by health entities along the care continuum can vastly improve patient health outcomes as well as reduce costs. To realize the national goal of a health information highway, it is important for a large pool of ambulatory providers to engage in health information exchange (HIE) to share clinical information with affiliated and unaffiliated providers. Applying institutional theory, this research seeks to examine the key institutional factors that influence the HIE use by ambulatory practices.Material and MethodsData was gathered through a web-based survey of 320 ambulatory providers in the US state of Illinois. Partial least squares approach to structural equation modeling was used to examine the influence of five institutional factors viz. government, patients, peers, affiliates and technology vendors on the use of HIE by ambulatory providers to share clinical information with (i) affiliated providers, and (ii) external, unaffiliated providers.FindingsWe found positive and significant influence of government initiatives, patients, peers and affiliates on ambulatory providers’ HIE with affiliated providers (R² = 0.347) and unaffiliated providers (R² = 0.328). Peer influence was positive and significant for HIE with unaffiliated providers only. No significant influence of technology vendors on HIE use by ambulatory practices was found.ConclusionAddressing a critical gap in our knowledge of how ambulatory providers engage in HIE, we provide compelling evidence for the influence of institutional factors on ambulatory providers’ electronic HIE with both affiliated and unaffiliated providers. Policy makers and healthcare leaders need to pay attention to the institutional factors and frame appropriate programs to augment and promote the use of HIE by ambulatory providers.     

Low-income, ethnically diverse consumers' perspective on health information exchange and personal health records

We surveyed low-income, ethnically diverse consumers regarding their attitudes towards providers' use of electronic health information exchange (HIE) and consumer use of HIE through personal health records (PHRs). Amongst respondents (n=214), 48% had an annual household income below $15,000 and 62% spoke a language other than English at home. A majority indicated that they supported providers' use of HIE (61%). Support for providers' use of HIE was independently associated with consumer willingness to permit health care providers other than their primary care doctor to view their electronic medical record information (odds ratio (OR)=2.92, 95% confidence interval (CI)=1.31-6.50) and beliefs that electronic health record use would improve quality of care (OR=2.70, 95% CI=1.18-6.18). Seventy-eight percent would potentially use PHRs. Potential PHR use was independently associated with Internet usage rates, (OR=4.46, 95% CI=1.77-11.22), belief that PHR use would improve their understanding of their own healthcare (OR=3.12, 95% CI=1.27-7.67) and comfort with sharing PHR data with their primary care doctor (OR=2.79, 95% CI=1.09-7.11). Low-income, ethnically diverse consumers affected by interoperable health information technology (IT) initiatives largely support using PHRs and HIE, provided these systems demonstrate benefits and address the privacy and security of their electronic health information. Although we found interest in PHRs comparable or higher than nationally representative populations, support for HIE was lower, and thus efforts will need to be made to engage low-income and ethnically diverse consumers to participate in interoperable health IT initiatives.     

Electronic Health Information Quality Challenges and Interventions to Improve Public Health Surveillance Data and Practice

Objective

We examined completeness, an attribute of data quality, in the context of electronic laboratory reporting (ELR) of notifiable disease information to public health agencies.

Methods

We extracted more than seven million ELR messages from multiple clinical information systems in two states. We calculated and compared the completeness of various data fields within the messages that were identified to be important to public health reporting processes. We compared unaltered, original messages from source systems with similar messages from another state as well as messages enriched by a health information exchange (HIE). Our analysis focused on calculating completeness (i.e., the number of nonmissing values) for fields deemed important for inclusion in notifiable disease case reports.

Results

The completeness of data fields for laboratory transactions varied across clinical information systems and jurisdictions. Fields identifying the patient and test results were usually complete (97%–100%). Fields containing patient demographics, patient contact information, and provider contact information were suboptimal (6%–89%). Transactions enhanced by the HIE were found to be more complete (increases ranged from 2% to 25%) than the original messages.

Conclusion

ELR data from clinical information systems can be of suboptimal quality. Public health monitoring of data sources and augmentation of ELR message content using HIE services can improve data quality.Electronic laboratory reporting (ELR), the electronic submission of laboratory data following the confirmation of an infectious disease, was demonstrated more than a decade ago to be an effective method to increase the timeliness of notifiable (communicable) disease reporting as well as the number of notifiable disease case reports submitted to public health agencies.¹ With pervasive, increasingly sophisticated information technology and the rise of interconnected systems, the medical community recognizes the need for proven methods and best practices for managing electronic health information. This recognition has led to investments from the U.S. government, states, and a number of private foundations totaling billions of dollars for the development, implementation, and adoption of electronic health record (EHR) systems, which support laboratory, surveillance, and other information systems.^2–6 Such initiatives seek to improve the timeliness, accuracy, and completeness of data needed to support a variety of services, including surveillance activities.The number of state health agencies receiving ELR data has increased during the past decade. Currently, more than 40 states in the U.S. have the capacity to receive electronic reports from laboratories,⁷ and the number of electronic reports submitted to state agencies is expected to increase given Stage 2 “meaningful use” program incentives (i.e., increased reimbursement for the adoption and use of EHR systems) from the U.S. Centers for Medicare & Medicaid Services that require eligible hospitals and encourage eligible providers to submit notifiable disease laboratory results to public health agencies using ELR.⁸Simply reporting laboratory data electronically instead of using paper, however, does not solve the fundamental challenge of receiving high-quality, reliable data in support of public health functions. Several studies suggest that ELR may not improve data completeness.^9–11 These studies indicate that important challenges persist beyond adoption of ELR for the public health surveillance and informatics communities to collaboratively address. One of those challenges is improving poor data quality.Poor data quality is a pervasive issue affecting all industries and organizations using information systems.¹² Typical data quality issues encountered include inaccurate data, inconsistencies across data sources, and incomplete (or unavailable) data necessary for operations or decisions.¹³ In health care, the completeness of data in EHR systems has been found to vary from 30.7% to 100.0%.¹⁴Despite the pervasive nature of this problem, there is little evidence characterizing the impact of poor data quality on health-care delivery processes or population outcomes. General estimates of impacts include increased costs, with up to 40%–60% of a service organization''s expenses consumed as a result of poor data; poorer decisions that take longer to make; lower consumer satisfaction with information systems; and increased difficulty in reengineering work and information flows to improve service delivery.¹³ Impacts on health care include less informed decisions when humans or machines use poor quality data inputs from EHR systems.^15,16 For example, a study comparing electronic pharmacy data with the medications actually taken by patients found that only 5% of patients had perfect agreement between their computerized medication profile and the medications actually consumed.¹⁷ Clinical queries of such pharmacy databases could lead to errors of omission and comission when making prescribing decisions.The importance of data quality is increasing as the nation develops an infrastructure to collect, store, manage, and exchange large amounts of health-care information. Policies that are encouraging ELR, including the Health Information Technology for Economic and Clinical Health (HITECH) Act provisions of the American Recovery and Reinvestment Act of 2009, also incentivize hospitals and physician practices to use technology to better coordinate patient care as well as the information about care delivery processes.^18,19 Better management and coordination of information across the nation''s fragmented health delivery system require health information exchange (HIE), which is defined as the electronic transfer of clinical and administrative information across diverse and often competing health-care organizations.^20,21Federal policies and programs to encourage HIE have given rise to a number of HIE organizations in nearly every state and territory.²² These organizations primarily focus on improving individual patient care processes and outcomes by leveraging large volumes of clinical and administrative data from payers, hospitals, outpatient clinics, and pharmacies. In addition to patient care, several HIEs are supporting population health functions, including ELR to public health agencies.^23–26 Because HIEs are patient-centric, they have the capacity to provide public health programs with comprehensive medical records. In the case of ELR, an HIE may be able to deliver liver enzymes in parallel with the results of a positive laboratory test for hepatitis C. Yet, little evidence remains demonstrating how and to what effect such enhanced ELR would have on public health surveillance programs.Given a paucity of evidence that ELR does or does not impact the quality of data received by public health, we examined the completeness of ELR data from clinical information systems in two states. In addition to characterizing the completeness of ELR data, we further compared raw data directly sent from clinical information systems with data enhanced by an HIE. If an HIE can improve the completeness of ELR data submitted to public health, enhancement methods would represent a valuable, effective method for improving notifiable disease data quality. Improving data quality will likely translate into improvements in disease surveillance processes, impacting both clinicians and public health professionals.     

Ethical justification for conducting public health surveillance without patient consent

Public health surveillance by necessity occurs without explicit patient consent. There is strong legal and scientific support for maintaining name-based reporting of infectious diseases and other types of public health surveillance. We present conditions under which surveillance without explicit patient consent is ethically justifiable using principles of contemporary clinical and public health ethics. Overriding individual autonomy must be justified in terms of the obligation of public health to improve population health, reduce inequities, attend to the health of vulnerable and systematically disadvantaged persons, and prevent harm. In addition, data elements collected without consent must represent the minimal necessary interference, lead to effective public health action, and be maintained securely.     

Public reporting of quality information on Medicaid health plans

Transparency through public reporting of quality data is key to achieving the Institute of Medicine's (IOM) vision for 21st century health care. This article reviews the status of States' voluntary public reporting of Medicaid managed care (MMC) quality data, and analyzes these data. Twenty-one States, including 17 of the 20 largest managed care States, have made plan-level data publicly available online, although the data are sometimes thin, with few measures reported, hard-to-access, and old. We conclude that CMS could better leverage the power of public reporting for quality improvement (QI) by increasing the visibility of health plan employer data and information set (HEDISV) data that States already collect.     

Does participation in health information exchange improve hospital efficiency?

The federal government allocated nearly $30 billion to spur the development of information technology infrastructure capable of supporting the exchange of interoperable clinical data, leading to growth in hospital participation in health information exchange (HIE) networks. HIEs have the potential to improve care coordination across healthcare providers, leading ultimately to increased productivity of health services for hospitals. However, the impact of HIE participation on hospital efficiency remains unclear. This dynamic prompts the question asked by this study: does HIE participation improve hospital efficiency. This study estimates the effect of HIE participation on efficiency using a national sample of 1017 hospitals from 2009 to 2012. Using a two-stage analytic design, efficiency indices were determined using the Malmquist algorithm and then regressed on a set of hospital characteristics. Results suggest that any participation in HIE can improve both technical efficiency change and total factor productivity (TFP). A second model examining total years of HIE participation shows a benefit of one and three years of participation on TFP. These results suggest that hospital investment in HIE participation may be a useful strategy to improve hospital operational performance, and that policy should continue to support increased participation and use of HIE. More research is needed to identify the exact mechanisms through which HIE participation can improve hospital efficiency.     

State and Local Health Agency Engagement in HIE: A Cross-Sectional Survey

Objective

To characterize state and local health agency relationships with health information exchange organizations.

Introduction

There is growing interest in leveraging available health information exchange (HIE) infrastructures to improve public health surveillance (1). The Health Information Technology for Clinical and Economic Health Act and Meaningful Use criteria for electronic health record (EHR) systems are among the factors driving the development, adoption and use of HIEs. HIEs deliver or make accessible clinical and administrative data as patients are admitted, discharged, and transferred across hospitals, clinics, medical centers, counties, states and regions (2). While several HIE infrastructures exist (3), there is little evidence on the engagement in HIE initiatives by state and local health agencies.

Methods

An online survey of state and local health officials was conducted in six states where HIEs were known to be present. Half of the states were funded by the Centers for Disease Control and Prevention (CDC) to engage public health agencies in HIE activities; the other half received no such funding. A total of 143 officials were invited to participate; 73 (51%) responded. The survey asked respondents about their agencies awareness, engagement, and data exchange with HIEs. The survey further asked agencies about their perceptions of barriers and challenges to public health engagement with HIE organizations.

Results

Just 25% of agencies had a formal relationship, typically created through a memorandum of understanding or data usage agreement, with at least one nearby HIE. The majority (54%) of agencies either had no relationship (20%) or only an informal relationship (34%) with an HIE. The remaining agencies (18%) reported that no HIE existed in their jurisdiction. Agencies in states that had received CDC funding for HIE engagement were more likely (14 versus 2) to be formally partnered with an HIE.

Conclusions

Few public health agencies are formally engaged in HIE. Financial costs, human resources, and concerns regarding privacy/security were the top cited barriers to broader engagement in HIE. For public health to be an active participant in and reap the benefits of HIE, greater investment in state and local public health informatics capacity, including human resources, and education regarding HIE privacy and security practices are needed.     

Health care consumers' preferences around health information exchange

PURPOSE Consumer buy-in is important for the success of widespread federal initiatives to promote the use of health information exchange (HIE). Little is known, however, of consumers' preferences around the storing and sharing of electronic health information. We conducted a study to better understand consumer preferences regarding the privacy and security of HIE. METHODS In 2008 we conducted a cross-sectional, random digit dial telephone survey of residents in the Hudson Valley of New York State, a state where patients must affirmatively consent to having their data accessed through HIE. RESULTS There was an 85% response rate (N = 170) for the survey. Most consumers would prefer that permission be obtained before various parties, including their clinician, could view their health information through HIE. Most consumers wanted any method of sharing their health information to have safeguards in place to protect against unauthorized viewing (86%). They also wanted to be able to see who has viewed their information (86%), to stop electronic storage of their data (84%), to stop all viewing (83%), and to select which parts of their health information are shared (78%). Among the approximately one-third (n = 54) of consumers who were uncomfortable with automatic inclusion of their health information in an electronic database for HIE, 78% wished to approve all information explicitly, and most preferred restricting information by clinician (83%), visit (81%), or information type (88%). CONCLUSION Consumers in a state with an opt-in consent policy are interested in having greater control over the privacy and security of their electronic health information. These preferences should be considered when developing and implementing systems, standards and policies.     

Leveraging Cloud Computing to Address Public Health Disparities: An Analysis of the SPHPS

As the use of certified electronic health record technology (CEHRT) has continued to gain prominence in hospitals and physician practices, public health agencies and health professionals have the ability to access health data through health information exchanges (HIE). With such knowledge health providers are well positioned to positively affect population health, and enhance health status or quality-of-life outcomes in at-risk populations. Through big data analytics, predictive analytics and cloud computing, public health agencies have the opportunity to observe emerging public health threats in real-time and provide more effective interventions addressing health disparities in our communities. The Smarter Public Health Prevention System (SPHPS) provides real-time reporting of potential public health threats to public health leaders through the use of a simple and efficient dashboard and links people with needed personal health services through mobile platforms for smartphones and tablets to promote and encourage healthy behaviors in our communities. The purpose of this working paper is to evaluate how a secure virtual private cloud (VPC) solution could facilitate the implementation of the SPHPS in order to address public health disparities.     

Identifying Opportunities to Strengthen the Public Health Informatics Infrastructure: Exploring Hospitals’ Challenges with Data Exchange

Policy Points

• Even though most hospitals have the technological ability to exchange data with public health agencies, the majority continue to experience challenges.
• Most challenges are attributable to the general resources of public health agencies, although workforce limitations, technology issues such as a lack of data standards, and policy uncertainty around reporting requirements also remain prominent issues.
• Ongoing funding to support the adoption of technology and strengthen the development of the health informatics workforce, combined with revising the promotion of the interoperability scoring approach, will likely help improve the exchange of electronic data between hospitals and public health agencies.

ContextThe novel coronavirus 2019 (COVID‐19) pandemic has highlighted significant barriers in the exchange of essential information between hospitals and local public health agencies. Thus it remains important to clarify the specific issues that hospitals may face in reporting to public health agencies to inform focused approaches to improve the information exchange for the current pandemic as well as ongoing public health activities and population health management.MethodsThis study uses cross‐sectional data of acute‐care, nonfederal hospitals from the 2017 American Hospital Association Annual Survey and Information Technology supplement. Guided by the technology‐organization‐environment framework, we coded the responses to a question regarding the challenges that hospitals face in submitting data to public health agencies by using content analysis according to the type of challenge (i.e., technology, organization, or environment), responsible entity (i.e., hospital, public health agency, vendor, multiple), and the specific issue described. We used multivariable logistic and multinomial regression to identify characteristics of hospitals associated with experiencing the types of challenges.FindingsOur findings show that of the 2,794 hospitals in our analysis, 1,696 (61%) reported experiencing at least one challenge in reporting health data to a public health agency. Organizational issues were the most frequently reported type of challenge, noted by 1,455 hospitals. The most common specific issue, reported by 1,117 hospitals, was the general resources of public health agencies. An advanced EHR system and participation in a health information exchange both decreased the likelihood of not reporting experiencing a challenge and increased the likelihood of reporting an organizational challenge.ConclusionsOur findings inform policy recommendations such as improving data standards, increasing funding for public health agencies to improve their technological capabilities, offering workforce training programs, and increasing clarity of policy specifications and reporting. These approaches can improve the exchange of information between hospitals and public health agencies.     

The Northwest Public Health Information Exchange’s Accomplishments in Connecting a Health Information Exchange with Public Health

In 2007 the Centers for Disease Control and Prevention (CDC) issued a Request for Proposal for the “Situational Awareness through Health Information Exchange” project. The Situational Awareness project’s goals are to connect public health with health information exchanges (HIEs) to improve public health’s real-time understanding of communities’ population health and healthcare facility status. During this same time period the Health and Human Services’ Office of the National Coordinator for Health Information Technology released several reports identifying the growing number of communities involved in health information exchange and outlining the requirements for a Nationwide Health Information Network (NHIN). CDC saw the possibilities of using HIEs and the NHIN to accelerate the real-time sharing of clinical and facility-based resource utilization information to enhance local, state, regional, and federal public health in responding to and managing potentially catastrophic infectious disease outbreaks and other public health emergencies. HIEs would provide a unified view of a patient across health care providers and would serve as data collection points for clinical and resource utilization data while NHIN services and standards would be used to capture HIE data of importance and send those data to public health. This article discusses how automated syndromic surveillance data feeds have proven more stable and representative than existing surveillance data feeds and summarizes other accomplishments of the Northwest Public Health Information Exchange in its contribution to the advancement of the National agenda for sharing interoperable health information with public health.     

Implementing a network for electronic surveillance reporting from public health reference laboratories: an international perspective.

Electronic data reporting from public health laboratories to a central site provides a mechanism for public health officials to rapidly identify problems and take action to prevent further spread of disease. However, implementation of reference laboratory systems is much more complex than simply adopting new technology, especially in international settings. We describe three major areas to be considered by international organizations for successful implementation of electronic reporting systems from public health reference laboratories: benefits of electronic reporting, planning for system implementation (e.g., support, resources, data analysis, country sovereignty), and components of system initiation (e.g., authority, disease definition, feedback, site selection, assessing readiness, problem resolution). Our experience with implementation of electronic public health laboratory data management and reporting systems in the United States and working with international organizations to initiate similar efforts demonstrates that successful reference laboratory reporting can be implemented if surveillance issues and components are planned.     

中国突发公共卫生事件网络直报系统及时性的研究

目的分析我国突发公共卫生事件网络直报系统的及时性,探讨提高突发公共卫生事件监测报告及时性的有效途径与策略。方法应用描述性流行病学方法,利用统一的调查表收集并分析2005~2006上半年通过国家突发公共卫生事件网络直报系统报告并已结案的突发公共卫生事件,分析在事件发现及网络直报等环节有关时间变量和病例报告情况的信息。结果从事件发现到网络直报的时间间隔中位数为1d(P25~P75:0~4d);从事件确认到网络直报的时间间隔中位数为1h(P25~P75:0~13h);事件确认后2h内网络直报率为57.37%。结论突发事件网络直报系统的建立对我国及时发现和报告突发公共卫生事件发挥了重要作用,但网络直报系统的及时性仍有待进一步提高。加强对医疗机构的培训和指导,更有利于提高网络直报系统的及时性。     

2004年福建省突发公共卫生事件监测结果分析

目的:了解福建省突发公共卫生事件基本情况,进一步规范各类突发公卫事件的报告、处置,提高应对各类突发公卫事件的敏感性。方法:分析2004年国家突发公共卫生事件报告管理信息系统与省FTP监测系统的各类突发公卫事件。结果:FTP系统是目前的主要报告途径,占各类报告途径的68.4%(91/133);各地对突发公共卫生事件报告工作不够平衡,福州、漳州等市工作较好;传染性疾病类依然是我省各类突发公卫事件的主要构成类型,占83.5%(111/133);春秋两季是各类突发公卫事件的好发季节;各类学校是各类突发公卫事件好发场所。结论:加强各级各类医疗机构与疾控机构报告及时性,加强重点单位学校的监测,加强重点月份(2、3、9月)监测。     

Transforming the public health information infrastructure

The public health information infrastructure is undergoing a transformation that is enabled by changes in health care informatics. The implementation of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the patient medical record information standards, and National Health Information Infrastructure (NHII) recommendations by the National Committee on Vital and Health Statistics provide the basis for improved data reporting to public health agencies. The U.S. Department of Health and Human Services should provide leadership and resources for this transformation. Newly available federal resources will have the greatest effect on improving the information infrastructure if there is a strong commitment to developing and implementing public health data standards that build upon the National Electronic Disease Surveillance System.     

Methods for Leveraging a Health Information Exchange for Public Health: Lessons Learned from the NW-PHIE Experience

The intent of this article is to provide public health and health information exchanges (HIEs) insight into activities and processes for connecting public health with clinical care through HIEs. In 2007 the CDC issued a Request for Proposal (RFP) for the “Situational Awareness through Health Information Exchange” project. The project’s goals are to connect public health with health information exchanges (HIEs) to improve public health’s real-time understanding of communities’ population health and healthcare facility status. This article describes the approach and methodology used by the Northwest Public Health Information Exchange to achieve the project’s goals. The experience of the NWPHIE Collaboration provides an organizational and operational roadmap for implementing a successful regional HIE that ensures secure exchange and use of electronic health information between local and state public health and health care entities.     

Improving the reporting of public health intervention research: advancing TREND and CONSORT

BACKGROUND: Evidence-based public health decision-making depends on high quality and transparent accounts of what interventions are effective, for whom, how and at what cost. Improving the quality of reporting of randomized and non-randomized study designs through the CONSORT and TREND statements has had a marked impact on the quality of study designs. However, public health users of systematic reviews have been concerned with the paucity of synthesized information on context, development and rationale, implementation processes and sustainability factors. METHODS: This paper examines the existing reporting frameworks for research against information sought by users of systematic reviews of public health interventions and suggests additional items that should be considered in future recommendations on the reporting of public health interventions. RESULTS: Intervention model, theoretical and ethical considerations, study design choice, integrity of intervention/process evaluation, context, differential effects and inequalities and sustainability are often overlooked in reports of public health interventions. CONCLUSION: Population health policy makers need synthesized, detailed and high quality a priori accounts of effective interventions in order to make better progress in tackling population morbidities and inequalities. Adding simple criteria to reporting standards will significantly improve the quality and usefulness of published evidence and increase its impact on public health program planning.     

Assessing the level of public health partner spending using the funding formula analysis tool

Public health services are delivered through a variety of organizations. Traditional accounting of public health expenditures typically captures only spending by government agencies. New Hampshire collected information from public health partners, such as community centers that host smoking cessation classes or health education done by Girls, Inc. This study compares the new data to spending by government agencies, focusing on breakdowns by fund source and service categories. Expanded funds secured by these partners account for a 42% of all local public health spending, and they spent 4 times more than government agencies on promoting healthy behavior. The funding formula analysis tool revealed that these partners spent in ways that would be politically difficult to achieve. In an era of declining budgets, an understanding of public health's partners is increasingly vital.