As public health departments around the country scramble to respond to the Zika outbreak, they are faced with a stark reality: their health IT systems face challenges that prevent the effective use and sharing of data to combat epidemics.

Seamless information sharing between public health officials and physicians on the front lines is critical to enable actionable insights necessary for success, says Kenyon Crowley, deputy director of the Center for Health Information and Decision Systems (CHIDS) at the University of Maryland’s Robert H. Smith School of Business.

However, public health departments nationwide typically are challenged by HIT barriers that include the complexity and usability of the software, the inability of software to support certain unique public health reporting needs, as well as the lack of standards for effective data exchange.

“One of the big problems right now in being able to combat Zika is getting data from the community and being able to share that data rapidly with partners in order to determine where to invest resources and support,” Crowley says. “Public health departments that haven’t done a good job of implementing electronic health records and surveillance systems in ways to exchange data across the different stakeholders are going to have a much harder time combatting Zika than those that can quickly identify hotspots of trouble through data from the field and provide triage.”

Bloomberg file photo

To help these departments overcome these obstacles, Crowley and a team of researchers at the University of Maryland, have developed a new tool—called the Public Health Information Technology (PHIT) Maturity Index—to better assess their IT capabilities and to counter shortcomings.

By leveraging the PHIT Maturity Index, public health officials can measure their departments’ progress in using IT to support their respective missions. PHIT systems include electronic health records, public health reporting data systems such as surveillance systems, and ancillary systems such as health information exchanges.

“A public health department has a range of responsibilities in the communities they serve,” says Crowley. “There are 10 essential services of public health. Each of these activities has a number of data and information needs associated with it and IT to be used to support the more effective and efficient accomplishment of those services.”

The PHIT Maturity Index includes four measurement categories—scale and scope of use, PHIT quality, PHIT human capital, policy and resources, and PHIT community infrastructure—along with 14 sub-dimensions associated with 55 questions, used to develop a score based on which public health departments can benchmark themselves. The index is designed to help departments “gauge their position in relation to a set of stages that progressively and incrementally detail better use of IT” to effectively and efficiently achieve their public health missions.

“These departments can use the PHIT Maturity Index to identify where their gaps are and plan appropriately,” adds Crowley.

With funding from the Robert Wood Johnson Foundation, UMD researchers conducted a two-year study of the adoption and implementation of a NextGen electronic health record system by the Montgomery County Department of Health and Human Services in Maryland and a local primary care coalition, which works with hospitals and clinics to provide safety net services using a separate eClinicalWorks EHR. Based on their research, recently published in Frontiers in Public Health Services and Systems Research, they developed the PHIT Maturity Index.

“We evaluated the systems being used within Montgomery County to accomplish their different aims, and worked closely with the department to understand how they were or were not facilitating the information needs of those services,” says Crowley. “There hasn’t been a lot of research done on the use of EHRs in public health departments.”

One of the challenges faced by public health departments is that they use commercial-off-the-shelf EHR systems designed for large, multi-specialty practices for typical clinical care.

“The nuances and unique needs and customizations that these departments require are not always easily available to them,” according to Crowley, who nonetheless notes that syndromic surveillance is a core requirement of the Meaningful Use program.

“We hope that public health departments nationwide will use the index,” he says. “The value of the index increases with the size of the networks using it. As more departments use it, they have a better ability to benchmark their progress.”

Additional information on the PHIT Maturity Index can be found here.

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