Abstract
Background: With dramatic gains in the proportion of physician offices using Electronic Health Records (EHRs), public health departments are looking at a profound and vast source of information on the health status and health behaviors of the people they serve. While EHRs are arguably the largest “new” source of data, many other types of administrative and other data exchange occur across the nation’s 2,800 health departments. The ability to access and make use of these myriad data sources is not at all uniform.
Research Objective: Characterize informatics capacities and needs of local health departments Data Sets and Sources: This project draws on interview data from 50 leaders of local health departments across the United States.
Study Design: This project employed a key-informant based study design, where 50 leaders from local health departments across the country were interviewed about current practices, capacities, and needs in the realm of public health informatics in fall 2014. Participants were purposively selected by their LHD’s size and informatics uptake based on response to the 2013 Profile from the National Association of County and City Health Officials.
Analysis: Data were coded thematically and independently in batches by two researchers. After each batch of interviews was coded, coding was compared, differences were resolved iteratively, and all interviews were re-coded using the consensus definitions. Qualitative data analysis focused on major drivers of informatics uptake, or lack of uptake. Analysis paid special attention to the notion of modifiable versus non-modifiable characteristics that affected uptake of more sophisticated systems or practices.
Principal Findings: Preliminary results show wide variability in the types of systems LHDs utilize, as well as the availability of formal data collection and management technologies. This appears somewhat to be a function of size, but at least as important from participant perspectives are statutory responsibilities, local county context, and interaction with the state. Interoperability is the exception, not the rule. Many LHD leaders said that even with new systems in development, interoperability is not a prospective value, although the lack thereof is a significant constraint. The majority of interview participants who have EHRs have had them for fewer than five years, and many fewer than one year. The majority of leaders from small LHDs said they didn’t think they would be able to analyze most new electronic health information that might be accessible in the future due to challenges with human capital.
Conclusions: Even with significant financial and other operational constraints, leaders interviewed as part of this project talked about a reasonably bright, if uncertain, future for public health informatics. Uptake of more advanced systems and analytic strategies appears contingent on funding, training, and good relationships with the state health agencies to ensure appropriate data that collected by public and private organizations are available to protect and improve population health.
Implications: Uptake of informatics systems is limited by many non-modifiable constraints. However, leaders can cross-train existing staff and advocate for greater support from SHAs.
Original language | American English |
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State | Published - Apr 2015 |
Event | Keeneland Conference for Public Health Systems and Services Research - Duration: Apr 21 2015 → … |
Conference
Conference | Keeneland Conference for Public Health Systems and Services Research |
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Period | 04/21/15 → … |
Disciplines
- Public Health
- Health Services Administration
- Health Policy
Keywords
- Characterizing
- Informatics capacities
- Landscape
- Local health departments
- Needs
- Post-Affordable Care Act