Are Local Health Departments Ready for Meaningful Use?
The National Association of County and City Health Officials (NACCHO), with support from the Centers for Disease Control and Prevention, conducted needs assessments to find out how informatics has fared at the local level, and to identify any needs and gaps in current informatics capacity at local health departments.
Gulzar H. Shah, Ph.D., M.Stat, M.S.S., Lead Research Scientist at NACCHO, presented the results of two needs assessment surveys and accompanying focus groups from the last two years at this week's Public Health Informatics Conference. The 2010 survey looked at overall informatics capacity, while the 2011 survey honed in on use of meaningful use-certified electronic health record (EHR) systems. Shah noted that the response rate was down in 2011, likely due to budget cuts and staff resources, however preliminary results were promising.
Among the 134 local health departments that responded, 62% were able or planning to receive data from meaningful use-certified EHR systems, with more large health departments responding positively (89%) than small ones (45%). Fewer than half of respondents were already receiving and processing data for immunization registries, electronic lab reporting and syndromic surveillance – the three public health requirements under meaningful use of EHRs.
Not surprisingly, among those not yet receiving meaningful use data from EHRs, top reasons included a lack of funding and not having an EHR system in place locally from which to receive data. However, a significant number also said they needed more technical assistance to be able to receive the data. More than three-quarters of these respondents were not aware that they could be receiving technical assistance from the state level.
When it came to general informatics, in focus groups some discussed the merits of the terminology used by the field. "Colleagues think it's just a nonsensical buzz word," said one participant. Some even suggested changing the term "public health informatics" to something simpler, like "e-public health" (though one session attendee noted that public health informatics is an ingrained term, and is really just one slice of the broader topic of e-public health).
Whatever we call it, most of the 309 survey respondents said that their staff have an adequate level of physical infrastructure needed to do their jobs. That said, very basic barriers emerged in informatics capabilities, with budget and staff time and training again topping the list. One of the biggest challenges is that in order to work on public health informatics efforts, resources would have to be diverted from on-the-ground programs.
“It was a choice: use the people to give vaccines, or use the people to put the information in computers,” said one focus group attendee.