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Electronic Health Record Incentive Program Supporting Public Health Outbreak Response

Posted By Janet Hamilton, Friday, April 24, 2015
Updated: Friday, April 24, 2015

Providers are sharing data more quickly with local health departments, and when disease is spreading quickly, time is important.

Electronic information sharing has been crucial to support our response to our current measles outbreak where we have identified four measles cases in two neighboring Florida counties so far. Historically, data shared from providers was mostly paper and usually took days to get into the hands of public health officials. Now the data is electronic and it is shared in almost real time. We are using our syndromic surveillance system to look for new measles cases that may not have already been reported; review our immunization registry to rapidly identify high priority contacts of the cases to target exclusions and offer disease preventing prophylactic treatment; and when suspected infections been identified, we are getting crucial confirmatory laboratory results back electronically right into our disease surveillance system within hours of results. The system is saving public health workers time and allowing us to do a better job protecting the community as we work to halt the spread of measles.

This shift (from paper to electronic information sharing) is due in large part to the American Reinvestment & Recovery Act (ARRA), which includes many measures to modernize our nation's infrastructure, one of which is the "Health Information Technology for Economic and Clinical Health (HITECH) Act.” The HITECH Act supports the concept of electronic health records - meaningful use [EHR-MU], an effort led by Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC). HITECH proposes the meaningful use of interoperable electronic health records throughout the United States healthcare delivery system as a critical national goal.

While bringing about national adoption for any federal program is a difficult endeavor, implementation of new EHR reporting is gaining widespread adoption. The EHR Incentive Program incentivizes eligible hospitals and other entities for meaningfully using health IT as well as reporting electronic data on three public health measures: (1) immunizations, (2) syndromic surveillance, and (3) reportable laboratory results. The program differentiates between eligible hospitals and eligible professionals, and the listing of stage 2 public health objectives for each are below.

Table1: List of the Stage 2 Meaningful Use Public Health Objectives

Eligible hospitals reporting these three measures have gained momentum over the course of 2014. New EHR Incentive Program data show that 72 percent of stage-2 hospitals reported on all three public health measures.

The ONC recently put out a data brief called Hospital Reporting on Meaningful Use Public Health Measures in 2014. The data are encouraging:
  • Almost nine in 10 stage 2 hospitals were able to electronically report to their immunization registry
  • Three quarters of stage 2 hospitals reported syndromic surveillance data electronically to their local public health agency
  • More than eight in 10 stage 2 hospitals submitted laboratory results electronically to their local public health agency

The brief goes on to project that as more hospitals shift to stage 2 in coming years, it can be expected that electronic exchange between hospitals and public health agencies will likely increase. The ONC data brief also found that when reporting was optional instead of mandatory, fewer hospitals shared public health data with local health department officials: “While almost three-quarters of stage 2 hospitals reported, without exclusion, on all applicable public health measures, only 5% of stage 1 hospitals did the same.” As hospitals and public health departments progress to interoperability, everyone will get better data in a more timely way. Sharing of data in standardized electronic formats will improve population health, help contain dangerous outbreaks more quickly and result in better patient care coordination.

Proposed MU stage 3 objectives, the third and final phase of the MU incentive program, is currently out for public comment. CSTE will be preparing comments through the Surveillance and Informatics Steering Committee. Please join us to help craft our response as well as consider submitting responses directly from your health department.

Janet Hamilton, MPH serves as the Surveillance/Informatics Steering Committee Member-at-Large on the CSTE Executive Board and Surveillance and Surveillance Systems Manager at the Florida Department of Health. To learn more about surveillance and informatics, please join a subcommittee.
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