HIT opportunities in public health

The Health IT Policy Committee (HITPC) met with public health officials to begin a conversation on how to use policy levers to improve health IT's integration into public health initiatives.

Chesley Richards, director of the Office of Public Health Scientific Services at the Centers for Disease Control and Prevention, named numerous opportunities where the HITPC could assist in fostering this relationship. These include the following:

• Helping identify synergies between public health IT and developing population health management IT in clinical care
• Fostering sharing of IT infrastructure among state and local partners to facilitate better connection with clinical care
• Further engaging public health in relevant standards development activities
• Advancing the development of public health guidance in electronic formats that can be used to support clinical decision making

Health IT already has played a role in outbreak investigations of the CDC, which is involved in disease surveillance, the deployment of outbreak response teams, laboratory testing; and informing and protecting the public. For example, Richards cited how public health access to EHRs helped contain a fungal meningitis outbreak; how clinical guidelines were used to support screening and possible case identification of Ebola as well as isolation and infection control; and use of limited lab testing for the Chikungunya virus.

"Ebola has brought to the fore important considerations for health IT," said John Loonsk, MD, CMIO of CGI Federal and Johns Hopkins Center for Population Health IT. "It shows us how important health IT readiness is for events. Here in the U.S. we need to recognize that those needs are a subset of broader public health needs."

Health IT policy leaders should begin to think about and talk about EHR functions associated with provisions of care, such as those related to supporting outbreak management and response. This entails discussions on interoperability challenges, and the need to share data with different healthcare organizations as well as local government agencies, he said.

Public and population health functions share many health IT needs whether they are outbreak management, hospital infection control disease management, specialty registries, clinical research or other population-related acivities. "Importantly, population health IT and aggregate data systems are not synonymous," he said, adding that aggregate data play an important role for reporting and situational awareness.

Loonsk shared some of the components of outbreak management health IT, which includes index case identification; screening for additional cases; reporting for monitoring and case management; case management; case reporting and visualization; countermeasure delivery (i.e., medication, vaccines and quarantines) and tracking; and research and long-term follow-up.

Loonsk said EHRs play a role for index case identification, delivery of lab data and delivery of guidance, which frequency changes during an event. They complement larger systems in CDC's work, like surveillance and outbreak management systems utilized at state and local health departments; public health lab information management systems; and countermeasure tracking and delivery systems utilized in health agencies.

While considering integration challenges between health IT and public health, some thought also must be given to the challenge of program silos within the government, he said. "Each program has its own approach to how something is pursued."