Bringing Electronic Reporting to the State Health Department in Maryland

    • November 21, 2010

The Problem. Patricia Swartz, MS, MPH, worked in the infectious surveillance department of the Maryland Department of Health and Mental Hygiene. Because the department lacked automated reporting, Swartz and her colleagues had to sort through paper reports from laboratories and health care providers that notify the public health department about infectious diseases. Reviewing the paper reports was time-consuming and slowed down the investigation of potentially dangerous diseases.

Swartz also was frustrated because she had ideas for making information more accessible to public health practitioners but did not know the language with which communicate those ideas to the department's information technology specialists.

Grantee Perspective. When Swartz became a Robert Wood Johnson Foundation (RWJF) Public Health Informatics Fellow at the Johns Hopkins University School of Medicine in 2005, she was able to gain a better understanding of the role that public health informatics could play in automating information systems at the Maryland Department of Health and Mental Hygiene. Public health informatics is the systematic application of information, computer science and technology to public health practice, research and learning.

Swartz, who had worked for the Maryland Department of Health and Mental Hygiene for three years, took courses in her fellowship that gave her new skills in computer operating systems and networks as well as information technology project management. Through her courses, she developed an interest in user requirements—put simply—what physicians, laboratory staff, public health practitioners and others need to make it easier to use technology.

For example, one of the critical functions of public health is gathering data about potential outbreaks of deadly diseases. To obtain this information, public health departments rely on reports from physicians, hospitals and laboratories. However, because many public health departments are not set up to receive reports electronically, physicians, hospitals and laboratories must often report these incidents on paper—a time-consuming task. They often do not hear back from the public health departments about how their reports were used, which may diminish their motivation to report other incidents.

Research project as a fellow. For her research project during her fellowship, Swartz (under the mentorship of Anna Orlova, PhD, and Harold Lehmann, MD, MPH) conducted a survey of more than 200 physicians, nurses and others who work in outpatient clinics across the country to learn more about how they report information to public health departments, and what type of information they would like to get back from the departments and in what form.

"I learned that a lot of providers are very interested in public health information," she said. "They are interested in getting it in electronic formats, which I thought was important. If they got this information, they would have more of an awareness that the public health department is there and is trying to establish regular communication with them."

Specifically, her survey found that 60 percent of the respondents do not receive feedback from public health departments regarding reported infectious disease information, though more than 60 percent of respondents would like feedback on reported cases and more than 60 percent would like information on health indicators in their community, e.g., alerts on outbreaks or a map of cases in their area.

As one respondent put it: "We get very little information from our health department, making it easy for us to forget to notify them regarding notifiable conditions. We never get feedback on that information."

Swartz also found that a large percentage of respondents (79%) expressed a preference for some type of electronic reporting (41% online, 22% through electronic health records and 18% via e-mail).

Using the information she gained. At the end of her fellowship, Swartz returned to the Maryland Department of Health and Mental Hygiene as a public health informatician. There, she is taking steps to solve the problems that first interested her in public health informatics. For example, the department is part of the Centers for Disease Control and Prevention's Public Health Information Network, a national initiative to improve the capacity of public health to use and exchange information electronically by promoting the use of standards and defining functional and technical requirements.

To fulfill the requirements of participation in this network, Swartz is working to establish electronic reporting by laboratories to the public health department. She is coordinating with laboratories to ensure that they comply with the health information standards (the protocol that allows different computer systems to communicate with one another and exchange information).

Swartz said she learned about these national standards in her coursework during the Public Health Informatics Fellows Training Program. She also learned the language of information technology so she can communicate with the information technology staff about the implementation of these standards.

Swartz has assisted with Maryland Department of Health and Mental Hygiene's efforts to sign up one commercial laboratory to begin sending its reports electronically. She is working with four other laboratories, which are at various stages of converting to electronic reporting. Since the U.S. Health and Human Services department's publication of the final rules to support Meaningful Use of Electronic Health Records, Swartz is helping the Maryland Department of Health and Mental Hygiene build up its capacity for interoperability to support one of the Meaningful Use criteria for electronic laboratory reporting. She has also begun collaboration with the Maryland Health Information Exchange's initiative to bring on more laboratories for electronic reporting.

"I am really applying what I learned in the fellowship to my job every day," she said. "The fellowship prepared me with the informatics, communication and leadership skills that I need in order to apply informatics tools to meet the needs of public health professionals and others in the health department. It is also my hope that health departments will be able to return valuable public health information to reporting health care providers to improve regular communication and patient care."

RWJF Perspective: From 2005 to 2010, RWJF supported the Public Health Informatics Fellows Training Program, which funded four universities with informatics programs supported by the National Library of Medicine to increase their ability to train informaticians who specialize in public health and to develop future leaders in public health informatics. Predoctoral, doctoral and postdoctoral students were eligible to participate in the two-year fellowship program.

"RWJF was looking to improve how public health departments used information systems to fulfill their missions. A key challenge for those departments was the lack of a robust public health informatics academic community that could conduct research, develop trained informaticians and spread best practices. This program enabled us to establish public health informatics as a legitimate and recognized branch of informatics," said Stephen J. Downs, an assistant vice president at RWJF and deputy director of its Health Group.