RHIOs and PublicHealth

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Public Health and Personal Healthcare -- A Continuum

For years, Public Health and Personal Healthcare have existed in two clear-cut silos. With the exceptions of public health reporting or public health alerts, Public Health has generally been seen as an entirely different business practice from healthcare. Everyone is grateful when Public Health focuses on prevention and education to reduce the disease burden in the population, but try to get public health reports or other necessary information out of a healthcare system already overburdened with redundant reporting and documentation for reimbursement purposes. Public Health data needs are quickly added to the list for the interface engineers of the providers, but the priority tends to be right down there with all of the other non-mission-critical priorities.

In the Long Beach Network for Health discussions, however, it has become increasingly clear that, in its correct placement, Personal Healthcare is sandwiched by Public Health. In a really effective healthcare system, Public Health's preventive and educational activities would start while a child is in the womb with Maternal and Child Health activities (maternal nutrition, healthy behaviors, etc.), continue into Personal Healthcare as direct care for a condition or health issue is necessary, and then flow through into Public Health research to inform the next round of prevention and education measures.

If you view the healthcare world in the above terms, it becomes immediately apparent that Public Health may be the greatest beneficiary of any health information exchange effort. Public Health should be knocking down the doors of providers in local health jurisdictions to talk about win-win strategies for solving everyone's needs.

Public Health may also provide positive value input into the titanic "RHIO business case" efforts. The state of public health information systems is possibly even more fragmented than those of healthcare providers. Millions of dollars are spent annually on systems for Public Health reporting and disaster response.

I have a working theory that the information available to Public Health would be much more relevant, timely, and accurate if: 1) Specialized homeland security grant funding for public health were applied to the implementation of working NHIN models in each state and 2) a portion (25% to 50% is my guess) of the aggregated maintenance costs for the individual silo public health reporting/tracking systems were re-allocated to support the maintenance costs of the jurisdiction's HIE infrastructure. And, incidentally, if Public Health providers HIE to healthcare providers, the priority of Public Health's technology and/or infrastructure requests will become top priorities for their community partners.

From: Laura, Long Beach Network for Health

Public Health as First Responders

On December 17, 2003, Homeland Security Presidential Directive (Hspd-8) added public health and clinical care personnel to the list of individuals considered to be "first responders." In some communities, Public Health has never before been seen as a partner in initial response for disasters.

As Public Health integrates into Emergency Management, there are basic challenges of coordination that are magnified by a lack of an integrated response environment. The ability to integrate emergency response planning for fragile, injured, linguistically isolated, or just plain scared-out-of-their-minds populations with distributed resources is mind-boggling. Public Health is understaffed, underfunded, and every grant we add to the plate brings its own difficulties -- new reporting systems, intensive audits (usually not coordinated amongst agencies), and often they do not pay for the human resources needed to manage the newly funded functions.

Here in Long Beach, CA, we're struggling with helping our community manage distributed pharmaceutical and equipment caches across multiple health jurisdictions. We're struggling with standardizing processes for everything, while still allowing jurisdictional autonomy. I am happy to see that the Robert Woods Johnson Foundation and the Public Health Informatics Institute have developed the Common Ground: Transforming Public Health Information Systems program.

Long Beach Health Department is investing heavily in the Long Beach Network for Health as a platform to create cross-organizational disaster preparedness and management tools. Things are moving slowly, but steadily, forward as we define the community need for personal and public health information exchange, as well as community-wide disaster preparedness and response tools.

From: Laura, Long Beach Network for Health