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Spring, 2005 How public health agencies can secure their place at the information-sharing table Dr. Virginia Caine is Director of Marion County Health Department, which encompasses Indianapolis and covers a metro area of 1.4 million people. Dr. Caine also serves as Associate Professor of Medicine for the Infectious Disease division of the Indiana University School of Medicine. She is the past president of the American Public Health Association (APHA), the nation’s oldest and largest public health organization. Transforming Indianapolis into the wired city “I’m a very persistent person,” the practicing physician observed. She then added some advice for other public health officers who are planning to participate in local health information exchange projects: “You’ve got to get out there and get aggressive.” What Dr. Caine means, in essence, is that public health agencies should actively reach out to their counterparts in the private sector – or risk finding themselves on the periphery of the local health care arena. To get invited to the table, sometimes public health has to help create the environment in which the players get together. In Indianapolis, health care leaders started laying the groundwork for this local collaboration a decade ago. As the home of the Regenstrief Institute for Health Care, the city of Indianapolis, surrounding Marion County, and the state of Indiana are among the first to benefit from Regenstrief’s internationally recognized research and practice of medical informatics. In February 2004, 13 institutions – including public health organizations as well as hospitals, providers, researchers, and economic development groups – established a local health electronic information infrastructure called the Indiana Health Information Exchange (IHIE). Its goal: to use information technology and shared clinical information to improve the quality, safety, and efficiency of health care in the state of Indiana. Recognizing the tremendous potential of the health information exchange activities in her regional “backyard,” Dr. Caine saw early on that her role as public health officer was to ensure that the Marion County Health Department would have an opportunity to make substantial contributions to the local health information partnership. When she observed that duplication of patient data was a major problem for physicians, Dr. Caine, as co-chair of the public health data initiative for the collaboration, was in a position to help address that problem. Her organization, the Health and Hospital Corporation of Marion County, which operates the health department as well as hospitals and clinics, also provided funding. “Showing that kind of commitment for the collaboration definitely got people’s attention.” Getting people to the table “We were looking at how to reduce health care costs substantially, and at the same time, from a population-based standpoint, we were asking questions like: How does this benefit the population as a whole? How do we decrease the health costs, but improve the quality of the health care for the people we are serving? Is everybody aware of what the issues are? What are some standardized things we can look at? All of us were interested in chronic disease management, and we were very interested in our immunization records. “We held a mirror up to health care in the county and showed them where the problems were,” she said of the role of the health department as public health advisor. As a result of this approach, the hospital administrators began to see how understanding health trends among various populations helped them in their business planning. “For example, in ’95 we realized that pediatric asthma was the number one hospital admission in Marion County,” she said. “And the smoking rate, especially among teens, was off the chart. So the health department helped to form an asthma coalition." Before the local health care leaders joined forces, paths of public health and health care leaders seldom crossed. “The majority of hospital administrators won’t invite you [public health] to the table because you’re not on their radar,” she said. One way to get on the radar is demonstrate the ability to link people. But she cautioned, “If you focus only on public health, it doesn’t make a dent. Health care delivery organizations are your major partners.” Early in the outreach process, Dr. Caine asked the executive director of the Indiana Hospital Association to host a breakfast with local hospital CEOs to talk about the community health assessment. The meeting opened a lot of minds and a lot of doors for future collaboration. “CEOs can be tough to meet,” Dr. Caine admitted. “At first, you might try for a second-in-command with a direct line to the CEO. Do the groundwork. Show them data they don’t have and how data can be useful in their business planning.” Success factors and challenges
She also noted how to increase the effectiveness of public health officials as local collaborations take hold:
Dr. Caine found someone she calls “a creative go-to-guy,” the deputy director of Marion County Health Department, who understood clinical data repositories and could communicate to hospitals in their language what was needed to integrate both public health and medical care systems. Paint a picture “If everybody is on the same system, and the hospitals are using the same messaging standards,” Dr. Caine said, “we can look at data from the doctor’s office as well as hospital discharge data and emergency room data. You can look at all the data, compare them, and identify where pockets of infection are taking place. “For example, we had a huge outbreak of shigellosis, nearly 1,000 cases,” she continued. “And we immediately recognized the demand and efficiency for a well-developed information and communication system. What we were lamenting is: We get a lot of hospital data, a lot of emergency room data. But I can’t get what’s happening in the private doctor’s office in a timely fashion. We can have a huge problem going on, and the people aren’t sick enough yet to go to the emergency room. So it’s not registering right away.” Once your health department is tracking an unfolding story, she said, you’ve got to get the information to health care providers in the form of an alert. “We’ve done it the old-fashioned way,” said Dr. Caine. “Use your fax machine. Do a media blitz with radio and television. Now we’re into e-mail, where you try to blanket e-mail all the providers. If everybody were on the system, though, they would have an alert appear as soon as they got on the computer. “We’re working to get to that point,” she added. “Physicians have to report communicable diseases to us. And some of these diseases should be reported within 24 hours. Same day. Report it immediately. We’re working on a computer form they can fill in quickly and send to us immediately, so they don’t have to fax or call.” Technology is only one part of the equation
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