1. Assessing and Improving Local Health Departments’ e- Health Capability and Capacity Bethany Bradshaw, MPH Applied Public Health Informatics Fellow, Wisconsin Department of Health Services 1 Karen Soderberg, MS Office of Health Information Technology, Minnesota Department of Health

2. Background: Minnesota Local public health (LPH) is engaged in e-health Active participation and leadership in the Minnesota e-Health Initiative Significant part of the Minnesota Southeast Beacon Project Received over $750,000 in e-health loans and grants between 2011- 2013 from Office of Health Information Technology (OHIT) Developed and responded to annual informatics survey Preparing for the Minnesota 2015 Interoperable EHR Mandate http://www.health.state.mn.us/e-health/hitimp/index.html http://www.health.state.mn.us/e-health/hitimp/index.html Note: In Minnesota, local public health services are provided through Community Health Boards (CHBs), which have statutory responsibilities for public health (Minnesota Stat. Chapter 145A) 2

3. Background: Wisconsin Minimal LPH engagement with e-health LPH has not received any e-health related grant funding Survey is first e-health assessment of Wisconsin LPH Healthiest Wisconsin 2020: “access to high-quality health services” that are “coordinated across health, public health, and other care systems” Focus area: “Systems to manage and share health information and knowledge” including with LPH Source: Healthiest Wisconsin 2020, http://www.dhs.wisconsin.gov/hw2020/http://www.dhs.wisconsin.gov/hw2020/ 3

4. Methods Minnesota Required part of annual web-based assessment since 2010 52 Community Health Boards 11 questions Minnesota e-Health Profile Wisconsin Voluntary, stand-alone survey (Select Survey) Distributed by email: 88 City/County/City-county Health Departments, 11 Tribal Health Centers 5 questions from Minnesota survey; several definitions 20 questions (skip pattern) 4

5. Common Questions Electronic health record (EHR) adoption Health information exchange (HIE) activities used HIE partners Largest challenges to HIE Most needed EHR-related skills and/or roles for new and/or existing staff 5

6. EHR Adoption by LPH Minnesota 100% response rate 100% EHR adoption across CHBs 2 Local Health Departments (LHDs) do not have EHRs PH-Doc, CHAMP, CareFacts Wisconsin 60% response rate 40% EHR adoption Most common : CHAMP Of those with no EHR, 60% have no plans to adopt 75%: paper is primary system 6

7. Health Information Exchange Activities in LPH, Minnesota vs. Wisconsin 7

8. HIE Partners for LPH Minnesota (n= 52) Health or county-based purchasing plans (44%) Minnesota Department of Health (42%) Minnesota Department of Human Services (29%) County/city department outside jurisdiction (21%) Wisconsin (n= 58) Wisconsin Department of Health Services (74%) No HIE (26%) Hospitals (22%) Laboratories (22%) 8 HIE was defined as “the electronic transmission of health related information between organizations according to nationally recognized standards. Health information exchange does not include paper, mail, phone, fax, or standard/regular email exchange of information.”

9. Needed HIE Connectivity for LPH 9

10. Top 3 HIE Challenges for LPH Minnesota (n= 52) Competing priorities (42%) Do not know exchange partners’ HIE ability (40%) Exchange partners do not have HIE ability (40%) Wisconsin (n= 58) Insufficient information (48%) Unclear return on investment (38%) Lack of technical support (34%) 10

11. Most Needed EHR-Related Skills in LPH, Minnesota vs. Wisconsin 11

12. Findings Importance of education and buy-in to advance LPH e-health capacity and capability. No clear picture of EHR capability in LPH because no certification or standards. LPH agencies are not meeting their HIE needs. Comparison across states identifies differences and opportunities for collaboration and sharing. Assessment of LPH e-health is necessary to: Identify gaps. Identify barriers to effective strategies and efficient use of resources (local and state). Evaluate e-health programs. 12

13. Recommendations States should implement a statewide e-health / informatics assessment for LPH. Work with NACCHO to access state-specific data. LPH associations in collaboration with states should develop a LPH e-health workgroup. Provide policy and guidance; develop an e-health roadmap and shared vision; and offer trainings and education. LPH should engage in e-health collaborations and opportunities for funding. e-health can support LPH participation in Accountable Care Organizations. LPH staff should continue their learning. Online courses (e.g., MOOCs), Public Health Informatics Institute, Minnesota e-Health Initiative. Leverage current resources and tools. 13

14. Resources Public Health & Electronic Health Information Exchange: A Guide to Local Agency Leaderships (www.phii.org)www.phii.org ONC Beacon Program Learning Guides (http://www.healthit.gov/policy-researchers- implementers/beacon-community-program/learning-guides)http://www.healthit.gov/policy-researchers- implementers/beacon-community-program/learning-guides Minnesota e-Health Profile (http://www.health.state.mn.us/e- health/assessment.html)http://www.health.state.mn.us/e- health/assessment.html E-Health toolkits (http://www.stratishealth.org/expertise/healthit/index.html)http://www.stratishealth.org/expertise/healthit/index.html Minnesota e-Health Guides (http://www.health.state.mn.us/e-health/reports.html)http://www.health.state.mn.us/e-health/reports.html Wisconsin survey report (http://www.dhs.wisconsin.gov/localdata/index.htm)http://www.dhs.wisconsin.gov/localdata/index.htm 14

15. Acknowledgements Minnesota Office of Health Information Technology Minnesota Office of Performance Improvement Minnesota Local Public Health Association Wisconsin Department of Health Services, Division of Public Health Wisconsin Local Health Departments Wisconsin Tribal Health Agencies Applied Public Health Informatics Fellowship Program 15

16. Contact Information Karen Soderberg, MS Office of Health Information Technology Minnesota Department of Health Karen.Soderberg@state.mn.us (651) 201-3576 Bethany Bradshaw, MPH Office of Health Informatics Wisconsin Department of Health Services Bethany.Bradshaw@gmail.com (608) 267-6782 16