Public Health Data Standards Consortium http:phdatastandards'info

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Public Health Data Standards Consortium
http//phdatastandards.info
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PHDSC / eHealth Initiative Annual ConferenceMay
2005, Washington, D.C.
Public Health Participation in Health Information
Exchanges Barriers and Challenges to the
Widespread Adoption and Use of Health Information
Technologies Walter G. Suarez, M.D.,
M.P.H. President, Public Health Data Standards
Consortium walter.suarez_at_sga.us.com 952-854-3401
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Barriers and Challenges

• Most barriers experienced by Public Health in the
  adoption of HIT are similar to those experienced
  by clinical and administrative sectors in health
  care
• Barriers can be organized into the following
  dimensions
• Regulatory
• Organizational
• Cultural
• Financial
• Technical

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Barriers and Challenges - Regulatory

• Lack of a clear mandate for public health to
  adopt national standards and interoperability
  across systems
• Fragmentation in the requirements and
  relationships between Federal, State and Local
  public health agencies with respect to HIT

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Barriers and Challenges - Regulatory

• Public Health functions respond to State/ Local
  requirements, enabling authorities, statutorily
  established responsibilities, and they vary from
  state to state
• Variation in the adoption of a privacy framework
  for public health information, affecting the
  ability of agencies and organizations to adopt HIT

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Barriers and Challenges - Organizational

• Fragmentation of categorical programs in public
  health, their interaction with clinical care and
  their data flows/data collection efforts
• Lack of uniformity in the definition of public
  health business processes

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Barriers and Challenges - Organizational

• Varying levels of HIT readiness across states and
  local agencies
• Limited identification of business cases in
  Public Health where the adoption and use of
  standards and health information technology
  demonstrate cost-benefits
• Most benefits are long term
• Most costs imply large upfront investment
• Urgent need not yet identified

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Barriers and Challenges - Cultural

• Traditional separation between clinical practice,
  personal care and public health practice
• Varying levels of interaction and
  interdependencies between public health programs
  and clinical/personal care
• Personnel readiness to adopt new technologies and
  standards

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Barriers and Challenges - Cultural

• Difficulty in transitioning from a batch
  mentality to a real-time approach to public
  health practice
• Few public health programs have taken advantage
  of HIT to transform their business processes into
  real-time or near-real-time data flows
• Staff and organizational resistance to change

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Barriers and Challenges - Financial

• Ongoing budget constraints and competing funding
  priorities in public health
• Public health information infrastructures across
  states are under-funded and vulnerable to deeper
  funding cuts
• HIT funding for public health continues to be
  programmatic and fragmented, creating
  HIT-rich/HIT-poor programs

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Barriers and Challenges - Financial

• Limited funding commitment from public health for
  standards development efforts
• Lack of model incentives to demonstrate value of
  investing in public health infrastructure and HIT
• Shifting HIT priorities in response to
  new/changing national demands and federal
  requirements

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Barriers and Challenges - Technical

• Infrastructure/Connectivity Issues
• Disparities in the availability and access to
  high-speed connectivity (rural vs urban PH
  programs)
• Dependency on low-speed connectivity between some
  public health programs and trading partners
• Standards Issues
• Lack of standards for many electronic health
  information exchanges (e-HIE) in public health
• Existing standards for selected e-HIE in PH not
  widely adopted due to complexities, cost,
  modification of existing processes/systems,
  resistance to change

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Barriers and Challenges - Technical

• Applications and Interoperability Issues
• Most public health applications are
  custom-developed and built to respond to unique
  program features
• Some can interoperate with internal systems
  within the agency
• Very few are capable of interoperating with
  external systems such as electronic health
  records
• Human-ware issues
• Resistance to process changes
• Resistance to adopt and adapt to new technologies
• Resistance to larger reliance on HIT