The Local Health Department SafetyNet The Local Health Department SafetyNet HIT and Interoperability Initiatives: HIT and Interoperability Initiatives: Assuring a Role for the LHD SafetyNet Assuring a Role for the LHD SafetyNet presented at the National eHealth Collaborative August Board of Directors Meeting Thursday, August 13, 2009 by: Yvonne Claudio, DM, MS
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The Local Health Department SafetyNet HIT and Interoperability Initiatives: Assuring a Role for the LHD SafetyNet presented at the National eHealth Collaborative.
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The Local Health Department SafetyNetThe Local Health Department SafetyNet
HIT and Interoperability Initiatives: HIT and Interoperability Initiatives:
Assuring a Role for the LHD SafetyNetAssuring a Role for the LHD SafetyNet
presented at the
National eHealth Collaborative
August Board of Directors MeetingThursday, August 13, 2009
by:
Yvonne Claudio, DM, MS
The Local Health Department SafetyNetThe Local Health Department SafetyNetThe National Association of County
and City Health Officials
NACCHO supports efforts that protect and improve the health of all people and all communities…
–promotes national policy–develops resources and programs, seeking health equity–supports effective local public health practice and systems
represents approximately 3,000 LHDs across the US
The Local Health Department SafetyNetThe Local Health Department SafetyNet
Background Information
The Local Health Department SafetyNetThe Local Health Department SafetyNet
LHD—A Key Safety Net Provider
Facilities in medically underserved communities….• Local health departments (via health centers/clinics)• Community health centers (FQHCs and FQHC Look Alikes)• Independent clinics and health centers• Free clinics• Clinics in schools, homeless shelters, housing projects• Public hospitals
Source: Institute of Medicine, 2000 America’s Healthcare Safetynet: Intact but Endangered.
The Local Health Department SafetyNetThe Local Health Department SafetyNet
Patient Population/Communities Served
LHDs deliver health care to patients who are...• poor• medically uninsured/underinsured• Medicaid covered• vulnerable• chronically sick• with inadequate access to health care resources• facing barriers to care (language, cultural issues)• mobile • experience disparities in health status and quality of care
The Local Health Department SafetyNetThe Local Health Department SafetyNet
SafetyNet Role Aligns with Public Health Core Functions/Essential Services
• Assessment--– Monitor health status– Diagnose and investigate health problems and health hazards– Inform, educate, and empower people about health issues– Mobilize community partnerships to identify and solve health problems
• Policy development--– Develop policies and plans that support individual and community health efforts– Enforce laws and regulations that protect health and ensure safety
• Assurance--– Link people to needed personal health services and assure the provision of health
care when otherwise unavailable– Assure a competent public health and personal health care workforce– Evaluate effectiveness, accessibility, and quality of personal and population-based
health services– Research for new insights and innovative solutions to health problems
The Local Health Department SafetyNetThe Local Health Department SafetyNet
Guesstimate: 260 LHDs provide primary care@ 2 clinics each--520 health centers@ 5 clinics each--1,350 health centersSource: NACCHO, 2008 National Profile of Local Health Departments, July 2009
The Local Health Department SafetyNetThe Local Health Department SafetyNet
Philadelphia Department of Public Health (sample SafetyNet LHD)
8 FQHC Look-Alike Centers• located in poorest, medically underserved areas
–PDPH Patient Stats• 80,000 patients (180,000 visits per year)
Sites serve approximately 1/4 of the City’s poorest residents57% are uninsured; 24% have Medicaid coverage
The Local Health Department SafetyNetThe Local Health Department SafetyNet
LHDs—Add’l Health Services Population in Jurisdiction
50,000-99,000 100,000-499,999500,000+
Family Planning 59% 62% 66%
Prenatal Care 37% 42% 40%
Oral Health Care 33% 43% 57%
Mental Health 12% 13% 27%
Substance Abuse 8% 9% 24%
Home Health 26% 18% 11%
Source: NACCHO, 2008 National Profile of Local Health Departments, July 2009
The Local Health Department SafetyNetThe Local Health Department SafetyNet
Maintaining Community’s Health (Sample Listing of Services)
Prevention and Treatment…
• Immunizations
• Lead Screenings
• Communicable Disease
• Nutrition Services
• Substance Abuse
• Mental Illness
The Local Health Department SafetyNetThe Local Health Department SafetyNet
HIT of Relevance to LHDs
The Local Health Department SafetyNetThe Local Health Department SafetyNet
HIT Supporting Clinical Services• EMR• E-Prescribing• Pharmacy Information System• Automated Lab System• Digital Radiology System (x-rays, mammography)• Case Management System--to track/manage pts • Social Services/Benefits Counseling system• Practice Management System• Web-based Resources • Smart Card/Mobile Solution
The Local Health Department SafetyNetThe Local Health Department SafetyNet
HIT Supporting Public Health Services
• Surveillance systems
• Case management systems/registries
• Laboratory information systems
• Electronic vital records
• Animal control IT
• Medical examiner IT systems
• Web-based and mobile systems
—for informing, alerting, response, reporting
The Local Health Department SafetyNetThe Local Health Department SafetyNet
Challenges to HIT Adoption/Interoperability• Scarce resources/funding cuts
– tight budgets– limited staff resources– new County and City budget cuts
• Insufficient knowledge/skills, access to training– lack knowledge of industry HIT initiatives/opportunities– computer skills; IT management; project management
• Information systems issues– paper records reliance– inadequate/dated IT (hardware, software)– stand alone/siloed IS
The Local Health Department SafetyNetThe Local Health Department SafetyNet
HIT--The Challenges to Adoption• Additional Costs Issues
–Automating core processes—that tie into EMR/ interoperability functionality
–Facilities enhancements--including inadequate space, electrical and communications wiring; air conditioning)
–PC training
Funding for EMR and Interoperability Initiatives may be insufficient…to establish functional effective IT infrastructure and/or interoperability…precludes LHD involvement
The Local Health Department SafetyNetThe Local Health Department SafetyNet