Local public health department adoption and use of electronic health records

First Review

This is a review for the article by J. Mac McCullough et al. Local public health department adoption and use of electronic health records.

Background and Purpose

Local Health Departments (LHDs) foster the health of individuals and populations through various activities including delivery of clinical services; disease surveillance and reporting; and immunization data reporting. Electronic Health Records (EHRs) may be used to support and improve these activities and thus the ability of LHDs to improve population health. This study explores the adoption, use and retention trends of EHRs by LHDs between 2010 and 2013 in an effort to understand the factors necessary to promote EHR adoption.

Research Design and Methods

Historical profile survey data collected by NACCHO (National Association of County & City Health Officials) between 2010 and 2013 were analyzed using a lagged logistic regression model and computing univariate and bivariate statistics regarding adoption and discontinuation rates during that period.

Results

By 2013, only 22% of LHDs participating in the surveys reported using EHRs (only a 2.7% increase from 2011). Between 2010 and 2013, 8.5% of the LHRs discontinued EHR use. By comparison, between 2008 and 2012, there was more than a 35% increase in EHR adoption by acute care hospitals. Factors significantly affecting EHR adoption include size of population served, general population density of catchment area, range of primary care services offered, per capita expenditures and governance changes (e.g., change in board membership or state/local shared governance status).

Conclusion

Information system use enhances the ability of LHDs to support reporting, surveillance and other public health services. Promotion of EHR adoption and retention must take into account factors strongly associated with historical success. It may be necessary to strengthen leadership and establish policies that will ensure acceleration of EHR adoption among LHDs to keep pace with adoption and use rates in other health system areas thus promoting interoperability and improved delivery of care.

Limitations

The data collected is self-reported and from a secondary source thus ability to establish causality is not possible. There is likely differences in the understanding of terms and formal definition of what constitutes an EHR among the survey respondents. A limited subset of LDHs participated in the survey relative to total LDHs in the United States. Additional research is needed to understand how EHRs are used by LHDs to protect and promote population health. Data usage within departments and data sharing with external partners should be examined for greater understanding of the benefits of EHR use in the public health arena.

Comments

Because I work in public health, I am concerned with the issues addressed in this article. Regional and Local Health Services (RLHS) is the unit within the Texas Department of State Health Services that is responsible for supporting local health departments throughout Texas. RLHS is currently exploring the possibility of providing a statewide, cloud-based EHR for all LDHs in Texas.

Second Review

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