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Indiana Public Health Use of HIE in Communicable Disease Surveillance and Emergency Preparedness

Rationale / Objectives

A major challenge for public health is facilitating timely communication of information between public health agencies and health care providers. Timely communication of information to health care providers during a public health event can improve overall response to such events. However, traditionally used labor-intensive, mail-based processes to send public health information to the provider community were inefficient and costly. [3]

The Indiana Network for Patient Care (INPC) wanted to connect all hospitals and physicians in a single community and delivers public health alerts to providers by leveraging an electronic clinical messaging system within the context of a health information exchange. [3,4]

Improving the speed of delivery of public health alerts and ensuring their integration into clinical workflow increases the likelihood that public health agencies can influence clinical decision-making. If providers are able to access timely, actionable information through existing work practices, there is a better chance they will modify standard care in response to the new information. [3]

Project/Program Description & Major Achievements

A major challenge for public health is facilitating timely communication of information between public health agencies and health care providers. Addressing this challenge can improve overall response during, for example, a public health event. Traditional use of labor-intensive, mail-based processes to send public health information to the provider community was inefficient and costly. [3]

The Indiana Network for Patient Care (INPC) aspired to connect all hospitals and physicians in a single community, and deliver public health alerts to providers, by leveraging Indiana Health Information Exchange (IHIE), an electronic clinical messaging system within the context of a health information exchange. [3,4]

Improving prompt delivery of public health alerts and ensuring their integration into clinical workflow would improve the likelihood that public health agencies influence clinical decision-making. If providers are able to access timely, actionable information through existing work practices, there is a better chance they will modify standard care in response to the new information. The public health alert interface within DOCS4DOCS® was completed in early 2009. Since then, nine public health alerts have been disseminated to physicians in Marion County . There were 3,085 physicians eligible to receive an alert through DOCS4DOCS® as of April 29, 2009. Of those, DOCS4DOCS® successfully processed messages for 3,021 (97.9%) providers.The cost savings to public health over the traditional system of a mail-based public health alert was $117.92 per 100 letters.[3]

 

Lessons Learned

Many of the partnership projects between Marion County and IHIE have had funding support from the Centers for Disease Control and Prevention (CDC), the leading national public health institute of the United States, as well other public health organizations. Public health support has helped expand and deepen the development and maintenance of IHIE technologies. The close relationship between IHIE and a university informatics department also helps to fuel innovation. [1]

Further Description

IHIE focused first on receiving and storing information about patient care from multiple organizations, enabling statistical analysis and queries about care received by individual patients across multiple providers when appropriate.. Building a partnership in 2004, the system partnered with the Indiana State Department of Health to implement such surveillance, which now includes more than 110 hospitals. Marion County has used this data for a wide range of applications, including:  tracking seasonal and pandemic influenza, assessing the possible impact of other outbreaks, detecting carbon monoxide threats, and assessing the severity of heat wave health effects. IHIE also began providing “push” delivery of laboratory results and other messages and documents in the early 2000s in a program called “Docs4Docs.” Once these data streams were established, IHIE could detect and route reportable disease laboratory results to the Marion County health department. This increased the speed and the quantity of reportable lab results received, while reducing the reporting workload on laboratories.[1,2]

Major Achievements

The public health alert interface within DOCS4DOCS® was completed in early 2009. Since then, nine public health alerts have been disseminated to physicians in Marion County. [3]

  • There were 3,085 physicians eligible to receive an alert through DOCS4DOCS® as of April 29, 2009. Of those, DOCS4DOCS® successfully processed messages for 3,021 (97.9%) providers. Messages to 64 providers were “lost” during the message generation process. This bug was fixed prior to the sending of the second broadcast message. Of the 3,021 providers, 158 (5%) of them were returned as undeliverable. [3]
  • The process of providing public health alerts through the community health information exchange provides a cost savings to public health over the traditional system of a mail-based public health alert of $117.92 per 100 letters. [3]
  •   The INPC handles over a million secure health transactions daily and contains:
    • 3 billion pieces of clinical data to support care for an area with a population of about 6 million people
    • 80 million radiology images
    • 50 million text reports
    • 750,000 EKG readings[4]

    Metric Result Detail
     Number of physicians eligible to receive an alert through DOCS4DOCS 3,085 Of April29,2009
    Number of  successfully processed DOCS4DOCS messages for providers 3,021(97.9%) 5% of them returned undelivered  
    Number of lost messages 64  
    Number of INPC Health transactions per day Over million  
    Cost saving to public health $117.92/100 letters