Interoperability of Information Systems Managed and Used by the Local Health Departments

Background: In the post-Affordable Care Act era marked by interorganizational collaborations and availability of large amounts of electronic data from other community partners, it is imperative to assess the interoperability of information systems used by the local health departments (LHDs). Objectives: To describe the level of interoperability of LHD information systems and identify factors associated with lack of interoperability. Data and Methods: This mixed-methods research uses data from the 2015 Informatics Capacity and Needs Assessment Survey, with a target population of all LHDs in the United States. A representative sample of 650 LHDs was drawn using a stratified random sampling design. A total of 324 completed responses were received (50% response rate). Qualitative data were used from a key informant interview study of LHD informatics staff from across the United States. Qualitative data were independently coded by 2 researchers and analyzed thematically. Survey data were cleaned, bivariate comparisons were conducted, and a multivariable logistic regression was run to characterize factors associated with interoperability. Results: For 30% of LHDs, no systems were interoperable, and 38% of LHD respondents indicated some of the systems were interoperable. Significant determinants of interoperability included LHDs having leadership support (adjusted odds ratio [AOR] = 3.54), control of information technology budget allocation (AOR = 2.48), control of data systems (AOR = 2.31), having a strategic plan for information systems (AOR = 1.92), and existence of business process analysis and redesign (AOR = 1.49). Conclusion: Interoperability of all systems may be an informatics goal, but only a small proportion of LHDs reported having interoperable systems, pointing to a substantial need among LHDs nationwide

How Much Do We Spend? Creating Historical Estimates of Public Health Expenditures in the United States at the Federal, State, and Local Levels

The United States has a complex governmental public health system. Agencies at the federal, state, and local levels all contribute to the protection and promotion of the population\u27s health. Whether the modern public health system is well situated to deliver essential public health services, however, is an open question. In some part, its readiness relates to how agencies are funded and to what ends. A mix of Federalism, home rule, and happenstance has contributed to a siloed funding system in the United States, whereby health agencies are given particular dollars for particular tasks. Little discretionary funding remains. Furthermore, tracking how much is spent, by whom, and on what is notoriously challenging. This review both outlines the challenges associated with estimating public health spending and explains the known sources of funding that are used to estimate and demonstrate the value of public health spending

Characteristics of Local Health Departments Associated with Their Implementation of Electronic Health Records and Other Informatics System

Background: Information technology and information systems (IT/IS) play a critical role in the daily operation of local health departments (LHDs). Assessing LHDs’ informatics capacities is important, especially within the context of broader, system-level health reform efforts. Research Objective: This study assesses a nationally representative sample of LHDs’ level of adoption of information systems, technology, and the factors associated with adoption/implementation. Specifically, five areas of public health informatics were examined: electronic health records (EHRs), health information exchange (HIE), immunization registry (IR), electronic disease reporting system (EDRS), and electronic lab reporting (ELR). Data Sets and Sources: Data from NACCHO’s 2013 National Profile of LHDs was used. Descriptive statistics and multinomial logistic regression were performed for the five implementation-oriented outcome variables of interest, with three levels of implementation. Independent variables included infrastructural capacity, financial capacity, and other characteristics theoretically associated with informatics capacity. Study Design: This study uses a cross-sectional survey research design. Principal Findings: Thirteen percent of LHDs had implemented HIEs. About 22 % had implemented EHRs, 47% ELR, 72.2% EDRS, and 82% had implemented Immunization Registry. Significant determinants of health informatics adoption included provision of greater number of clinical services, greater per capita public health expenditures, having health information system specialists on staff, having larger population size, having decentralized governance system, having one and more local boards of health, and having top executive with greater number of years in the job. Conclusions: The capacity of LHDs to use real-time, local data and information is critical. Many LHDs do not have this capacity. This may be due to lack of specialized staff, availability of data systems, or a host of other political or organizational constraints. This is especially the case for smaller jurisdictions. Cross-jurisdictional sharing or regionalization of some informatics and surveillance functions may be a reasonable approach to address these shortfalls. Implications for Public Health Practice and Policy: A combination of investment in public health informatics infrastructure, additional training of new informatics staff and existing epidemiologists, and better integration with healthcare systems is needed to augment LHD informatics capacity and ensure governmental public health can meet the information needs of the 21st century

Not Only How Much but How: The Importance of Diversifying Funding Streams in a Reimagined Public Health System

Revenue diversification may be a synergistic strategy for transforming public health, yet few national or trend data are available. This study quantified and identified patterns in revenue diversification in public health before and during the COVID-19 pandemic. We used National Association of County and City Health Officials’ National Profile of Local Health Departments study data for 2013, 2016, 2019, and 2022 to calculate a yearly diversification index for local health departments. Respondents’ revenue portfolios changed fairly little between 2016 and 2022. Compared with less-diversified local health departments, well-diversified departments reported a balanced portfolio with local, state, federal, and clinical sources of revenue and higher per capita revenues. Less-diversified local health departments relied heavily on local sources and saw lower revenues. The COVID-19 period exacerbated these differences, with less-diversified departments seeing little revenue growth from 2019 to 2022. Revenue portfolios are an underexamined aspect of the public health system, and this study suggests that some organizations may be under financial strain by not having diverse revenue portfolios. Practitioners have ways of enhancing diversification, and policy attention is needed to incentivize and support revenue diversification to enhance the financial resilience and sustainability of local health departments

Characteristics of Local Health Departments Associated with Implementation of Electronic Health Records and Other Informatics Systems

Objective: Assessing local health departments’ (LHDs’) informatics capacities is important, especially within the context of broader, systems-level health reform. We assessed a nationally representative sample of LHDs’ adoption of information systems and the factors associated with adoption and implementation by examining electronic health records, health information exchange, immunization registry, electronic disease reporting system, and electronic laboratory reporting. Methods: We used data from the National Association of County and City Health Officials’ 2013 National Profile of LHDs. We performed descriptive statistics and multinomial logistic regression for the five implementation-oriented outcome variables of interest, with three levels of implementation (implemented, plan to implement, and no activity). Independent variables included infrastructural and financial capacity and other characteristics associated with informatics capacity. Results: Of 505 LHDs that responded to the survey, 69 (13.5%) had implemented health information exchanges, 122 (22.2%) had implemented electronic health records, 245 (47.5%) had implemented electronic laboratory reporting, 368 (73.0%) had implemented an electronic disease reporting system, and 416 (83.8%) had implemented an immunization registry. LHD characteristics associated with health informatics adoption included provision of greater number of clinical services, greater per capita public health expenditures, health information systems specialists on staff, larger population size, decentralized governance system, one or more local boards of health, metropolitan jurisdiction, and top executive with more years in the job. Conclusion: Many LHDs lack health informatics capacity, particularly in smaller, rural jurisdictions. Cross-jurisdictional sharing, investment in public health informatics infrastructure, and additional training may help address these shortfalls

The Great Recession and Fiscal Allocation for Public Health: How Has Our Slice of The Pie Changed?

This presentation was given at the American Public Health Association Annual Meeting\u27s Annual Public Heath Finance Roundtable