Bridge-building: collaborating on a shared vision for digital health
The modern public health agency relies on information to ensure the health and wellbeing of its constituents. That information is often the result of public health surveillance activities, and electronic health records (EHRs) are an important potential data source. Especially when one considers the considerable inconsistencies of infectious disease reporting in the U.S. (Emerg Infect Dis. 2011 Jan;17(1):23-9. doi: 10.3201/eid1701.100660.)
I recently participated in a visioning session titled “Building the Bridge: The Digital Intersection of Health Care and Public Health.” Co-sponsored by the Robert Wood Johnson Foundation, Deloitte Consulting and the Public Health Informatics Institute, this meeting was an important convening of representatives from health care, health information technology and public health communities. Our aspiration behind this meeting was to begin creating a bridge among these three different groups and improve bi-directional exchange of health information between public health and health care. Meeting objectives included:
- To establish a common vision for exchange of actionable information between public health and health care. Health care organizations, public health agencies and EHR companies must identify and attain a unified vision and approach for cost-effective and sustainable public health surveillance.
- To agree that electronic case reporting (eCR) is an initial opportunity to test this vision. There is intense interest within the public health community on eCR right now and as we collectively prepare for Meaningful Use Stage 3 we wanted to see if the provider and EHR developer communities would be interested in engaging on that opportunity.
- To outline a plan for eCR proofs-of-concept, that is, pilot demonstrations in various jurisdictions.
- To identify aspects of governance, initially for the eCR proofs-of-concept. Once refined through experience, the governance principles can gradually address other aspects of information exchange between health care and public health.
A common vision
While we identified challenges, overall, everyone was optimistic that a digital bridge between health care and public health can be accomplished. All parties agreed that eCR was the appropriate first step for this initiative and recognized the value of improved data flows: 1) more complete, accurate, and timely reportable disease case data, 2) earlier detection of and response to outbreaks and emerging pathogens, and 3) better compliance with public health reporting requirements. There was also agreement that this effort could evolve to address chronic diseases and health disparities. Undergirding this vision is a recognition that public health must get more strategic and unified as it approaches the provider and EHR communities with interoperability concepts. More and more public health practitioners seem to be coalescing around a “one public health” ethos that should limit narrow, disease or jurisdiction-centric approaches that scatter limited resources.
Importance of governance
The collective group agreed that accomplishing the vision of eCR is not a technical challenge, but a matter of governance, will and resources. A governing entity—comprised of representatives from each stakeholder group—will need to be established to set parameters and measures of effectiveness for the proof-of-concept phase. The governing principles set during the proof-of-concept phase could later expand to other surveillance domains in public health. The governance process will be transparent and include workgroups addressing requirements, legal and policy issues, sustainability, and technical architecture. This will help ensure collaboration with existing eCR efforts led by ASTHO, CSTE, APHL, CDC, HL7 and others. As the governance effort gears up in the coming weeks check this website for updates and opportunities to contribute.
Meeting participants agreed that multiple demonstration sites are necessary before rolling out this initiative broadly. The group had many ideas on the critical success factors for the eCR proof of concept. In particular, we agreed that acknowledging and building on important work already accomplished will be important. That work includes HL7 standards for patient data, a common minimal set of data elements for a case report, and a streamlined approach for implementing case detection logic in EHR systems. Planning and recruitment for the proof-of-concept demonstrations should begin this fall.
The future of electronic surveillance
“Through more efficient data sharing, the digital bridge will empower both public health and health care.”
While this effort will build on electronic case reporting work under development, it is also intended to identify a consistent, nationwide, long-term, and sustainable approach to using health care’s EHR data to improve public health surveillance. Through more efficient data sharing, the digital bridge will empower both public health and health care with the information needed to improve their constituents’ and patients’ health. I hope you are interested in participating and encourage you to contact me or return to phii.org soon for more information.