Connecting Community Data for Population Health: Supporting Use of EHR Data for Community Health Assessments

By Bree Allen, MPH, SHINE Fellow, Office of Health IT, Minnesota Department of Health; Karen Soderberg, MS, Research Scientist, Office of Health IT, Minnesota Department of Health; and Marty Laventure, PhD, Director, Office of Health IT, Minnesota Department of Health

This article is a supplement to the Spring 2017 issue of NACCHO Exchange, which focuses on how local health departments are implementing the concepts of Public Health 3.0 to improve population health. NACCHO thanks the authors for their important contributions. To download the issue, visit http://eweb.naccho.org/prd/?na753pdf and create or log into your MyNACCHO account.

Introduction

Public Health 3.0 (PH3.0) calls for local public health to lead the way in leveraging cross-sector data to address community health needs, especially around social determinants of health.1 In Minnesota, many communities have been meeting this call to action by collaborating across clinical care and local public health to mobilize data into knowledge and ultimately improve the health of all people in their communities (see Figure 1). These activities have been spurred not just by PH3.0, but also by health reform efforts that encourage community-wide engagement in health and Minnesota’s Accountable Health Model.

Figure 1. Using Informatics to Improve Public Health Practice

Historically, community health needs have often been surveilled using population-based surveys. Minnesota’s local health departments have struggled to receive timely population health data provided by these surveys and similar estimation sources. Additionally, traditional surveillance resources face challenges including low response rates, inadequate representation from all population groups, limited local area estimation and chronic disease information, and a lag from data collection to availability of data. These local health departments range broadly in size, geography, and data/informatics resources. They are decentralized and independent of the state health agency, and very few provide direct clinical care services.

Some local health departments have explored, in partnership with their local healthcare providers, the use of data housed within electronic health record (EHR) systems. This partnership is largely fueled by the common need to develop actionable, outcomes-oriented, and collaborative population health assessments, and enabled by near-universal adoption of EHR systems among Minnesota’s hospitals and clinics. Most Minnesota hospitals complete a community health needs assessment (CHNA) every three years, and local public health is required to generate a community health assessment (CHA) at least every five years.

Opportunities and Challenges

EHR data have the opportunity to play a large role in supporting population health activities beyond the boundaries of a health organization’s patient population. EHR data have the potential to provide timely and complete data for subpopulations, geographic areas, and health conditions that are typically underrepresented in traditional assessment methods. Additionally, EHR system adoption is high in Minnesota clinics (98%) and hospitals (100%), and therefore can serve as a robust local information source.

Despite these opportunities, many communities in Minnesota face challenges to using EHR data. First and foremost is a resource issue, ranging from limited staff availability to limited capacity for data analysis. In small communities, the healthcare providers have similar resource issues. EHR data also tend to have inconsistent data quality and incomplete population coverage (i.e., only those seeking care). Finally, sharing data across organizations poses legal challenges associated with data-sharing agreements and ensuring data privacy protections.

There is still great potential for information derived from EHRs to benefit the health of populations. By working together to understand how these data can describe population health, communities can develop strategies that can “move the needle” toward real health outcomes to carry PH3.0 forward.

Collaborations

A number of collaborations among partners including local public health departments, providers, and health plans have developed in Minnesota for the purpose of using EHR data to develop actionable, outcomes-oriented, and collaborative population health assessments. Two are described in this paper.

The Center for Community Health (CCH) is a seven-county metro area collaboration among public health agencies, health plans, and providers. Their mission is to align the population health assessment process across the participating Minnesota metro region, address priority issues via collaborative action plans, and increase overall organizational effectiveness. Under the guidance of this collaborative, a local provider and three local public health departments collaborated to pilot the use of EHR data to enhance general health surveillance. The partnership established data definitions and rules around an initial set of variables that align with population health measures, including percentage of patients who were overweight or obese and percentage of patients who used tobacco. The pilot allowed the collaborative to identify and map individuals with high health needs, including patients that have had repeated inpatient and emergency department visits. Pilot barriers included identifying staff and resources to assign to this new work, addressing data quality issues, and interpreting the data.

The Public/Private Health Informatics Collaborative (PPHIC) is a partnership among multiple local public health departments within Hennepin County, Minnesota’s largest county serving 1.2 million people, and providers serving the county’s geography. The project’s aim is to share EHR data from these providers, specifically around non-reportable diseases and conditions (e.g., diabetes), to produce timely estimates of health status indicators to support program and policy evaluation. The project vision was a result of partnerships established in the Hennepin County Community Health Improvement Plan (CHIP) started in 2011. Additionally, sharply declining response rates in traditional public health surveillance methods spurred action.

Because multiple health systems are involved in this collaborative, a common data dictionary needed to be established. PPHIC made sure selected variables aligned with the Centers for Disease Control and Prevention’s reporting requirements and standard public health reporting, when applicable. Despite widely used interoperability data standards, there is variation in EHR data between systems and EHR vendors. To ensure comparability between variables, the collaborative created a crosswalk elaborating how data are stored and collected by provider. This crosswalk was used to establish a common definition of variables; for example, race/ethnicity and tobacco user (see Figure 2). PPHIC’s approach involves sharing data and consolidating it into a single repository managed by Hennepin County Public Health Department, with patient identity and health system de-identified. The collaborative is currently working to get all data-sharing agreements signed before acquiring a limited data set from each provider and assessing the EHR data quality.

Figure 2. Example variable crosswalk by provider

Discussion

This paper describes two active collaborations that are focused on using EHR data to improve population health and develop actionable population health assessments. Additional promising cross-sector collaboration exists around the state among public health, hospitals and health systems, and health plans. Some of these collaborations involve data sharing, and some are based on aggregated reports from health providers. Regardless of how the information is shared, both CCH and PPHIC have demonstrated the importance of leveraging cross-sector data to address community health needs. Specifically, both collaboratives have established consensus on defining health indicators to align with required reporting to develop streamlined and actionable population health assessments. Furthermore, the lessons learned by these collaboratives can support all of Minnesota’s communities as they explore opportunities to develop their local collaborations.

Best practices and lessons learned will be shared publicly in the form of a toolkit assembled by a project team at the Minnesota Department of Health, including definitions for EHR-extracted data, data-sharing agreement templates, EHR data evaluation techniques, and strategies for understanding data limitations. Readers can request this resources by e-mailing Bree Allen at bree.allen@state.mn.us.

 

References

  1. DeSalvo, K. B., O’Carroll, P. W., Koo, D., Auerbach, J. M., & Monroe, J. A. (2016). Public Health 3.0: Time for an upgrade. American Journal of Public Health, 106(4), 621-622.

 

 

Growing Informatics Capabilities at Local Health Departments Can Effectively Address Poor Health Outcomes and Improve Efficiency

This entry is the first in a series of “NACCHO Annual preview” blog posts, which feature interviews with presenters ahead of NACCHO Annual 2017. Joseph Gibson, MPH, PhD, Director of Epidemiology at Marion County Public Health Department in Indiana, highlights the importance of acquiring informatics capabilities in his upcoming presentation, “From Top to Bottom: Building Informatics Skills throughout Your Agency,” and offers advice to other local health departments working to obtain these skills. Continue reading

Member Spotlight: Director and Health Officer Dawn C. Allicock Discusses Innovative Management Models and Addresses the Public Health Effects of Zika and Hurricane Matthew

Interview by Taylarr Lopez, Communications Specialist, NACCHO

NACCHO’s Member Spotlight series features interviews with local health department leaders and staff about their careers in public health. This interview features Dawn C. Allicock, MD, MPH, CPH, Director and Health Officer with the Florida Department of Health in St. Johns County. She is a member of NACCHO’s Board of Directors.  Below she shares her background in public health and highlights a few of her greatest accomplishments in the field.

Tell us about your career path in public health.

I have been the Director and Health Officer with the Florida Department of Health in St. Johns County (DOH – St. Johns) since 2004. I have a varied and diverse medical education and public health background that forms my focused vision for public health.

I received a BA from Dartmouth College, an MD from the Eugenio Maria de Hostos University School of Medicine in the Dominican Republic, and an MPH from the University of South Florida, College of Public Health Practice Executive Program. In 2008, as a member of the Charter Class for Voluntary National Certification in Public Health, I became one of the first in the nation to become certified in public health. I completed my pediatric residency training at the University of Missouri, Columbia and I am licensed to practice medicine in Florida, Texas, and Nebraska. I am board certified in urgent care medicine and board eligible in pediatrics.

After working as a private practitioner in Texas, I answered a calling to work in public health. Prior to my current role, my public health positions have included medical director of a not-for-profit pediatric clinic funded by the Texas Healthcare Network; pediatrician for the DOH in both St. Lucie and Okeechobee Counties; and Medical Director/Senior Physician and Laboratory Director of DOH – St. Lucie County.

What are some of the highlights of your career in public health? What makes the work that you do worthwhile?

I proactively implemented the Baldrige/Sterling Management Model at DOH – St. Johns, resulting in evidenced-based results, increased accountability, efficiency, and improved public health outcomes. I led my agency to achieve recognition in the Florida Governor’s Sterling Award for Performance Excellence in 2009 and 2015 and the Florida Governor’s Sterling Sustained Performance Excellence Award in 2011 and 2017.

In the past few years, DOH – St. Johns has been recognized on the national stage for its role-model status as an outstanding public health agency. I have been privileged to share our performance excellence journey as a keynote speaker at both the Centers for Disease Control and Prevention and at the Texas Department of State Health Services in Austin, TX. In 2012, I participated on a panel and presented an abstract at the annual American Public Health Association Conference. Additionally, DOH –St. Johns has been recognized by NACCHO as a Project Public Health Ready-certified health department in 2010 and again in 2015. Our St. Johns County Health Leadership Council has been recognized in a University of Kentucky study as one of 12 high-performing public health partnerships in the United States. I am excited to be part of the integrated Florida Department of Health, the first centralized state health department to achieve Voluntary National Public Health Accreditation. And, finally, it would be remiss of me not to share how proud I am to lead the local health department as the healthiest county in Florida for the sixth consecutive year, according to the Robert Wood Johnson Foundation and the University of Wisconsin.

What challenges are you or your health department currently facing?

St. Johns County is ranked by the U.S. Census Bureau as the 16th fastest growing county in the nation. The population has nearly doubled since the year 2000. There has also been a continuous flow of emerging public health issues like Ebola and Zika virus and problems created by natural disasters including Hurricane Matthew, which affected our county more than any other in Florida. Each day, I have to prioritize our resources and human capital to best meet each imminent and emerging public health need for my community. At the same time, I must never lose sight of what the greatest health threats are now and in the future and who is and will be most at risk. Additionally, I must keep in mind what it will take to mitigate these threats and reach the greatest number of high-risk populations with whatever resources are available. These are the ultimate challenges of public health.

What is the biggest change you’ve seen in public health since you’ve started in this field?

The biggest change I have seen in public health is the recognition of public health as a profession. Not only do we see the increase in Master of Public Health degrees, we have seen universities begin to offer undergraduate degrees in public health as well. As a member of the first cohort of recipients to be certified in public health (CPH) in 2008, it was with joy that we hired an individual for an Environmental Specialist position who had not just an MPH but also a CPH. Additionally, we now have voluntary national public health accreditation for state and local health departments. Accreditation raises the level of our profession and ensures that we have a set of standards that all public health departments must meet and to which health departments are held accountable.

How are you positioning yourself and/or your health department for the future?

In keeping with the national and state direction of public health, DOH – St. Johns continues to align its health department services to the 12 Public Health Domains of Public Health. Additionally, DOH – St. Johns recognizes that as a high-performing government health department, we must also codify our role as the Chief Health Strategist for our community and align our core functions to support this role of the Local Chief Health Strategist. We have developed a three-year strategic plan using a balanced scorecard approach with four strategic priorities: health protection and promotion; financial and business excellence; service to customers and community; and workforce development. To ensure optimal success, we will continue on the journey of performance excellence by using our embedded Sterling/Baldrige Management Model.

How long have you been a member of NACCHO and what value do you find in belonging?

I have been a member of NACCHO since being appointed as Health Officer in 2004. NACCHO has been valuable in offering support and resources to me in my role as Director and Health Officer, leader and convener of the local public health system, and now as the head of an agency tasked with being the local Chief Health Strategist for my community. My agency uses NACCHO’s various tools and trainings like Mobilizing for Action through Planning and Partnerships, accreditation, quality improvement training and tools, and information on health equity on a daily basis. Additionally, the benefits of NACCHO experienced through attendance at various events, established relationships with other health officers, and the availability of information on best, good, and promising practices being implemented nationwide by various NACCHO members cannot be overstated.

What do you enjoy doing in your time away from work?

I really enjoy spending quality time with my family. While an accomplished pianist in my teens, I now enjoy listening to my brother, the maestro, making the piano talk! I also enjoy mentoring and partnering with my niece who is following in my footsteps. Currently, she is completing a doctorate in public health. Lastly, I love travelling with my husband and reading.

For more interviews in the series, visit NACCHO Voice Member Spotlight.

Mental Health Among People with Disabilities: Local Health Departments Can Promote Awareness on Dual Diagnosis

By Evelyn Arana, NACCHO Health and Disability Fellow

This story originally ran in NACCHO’s Health People, Health Places blog.

In recognition of May’s Mental Health Month, organizations and people across the US are raising awareness for mental health. NACCHO joins the National Alliance on Mental Illness, Mental Health America, and other organizations nationwide in recognizing the importance of addressing mental health illness. It is also important to recognize the increased risk of mental health illness among people with disabilities. Local health departments (LHDs) can embrace Mental Health Month and play a fundamental role in efforts to increase awareness of mental health illness among people with disabilities. NACCHO’s Health and Disability team offers LHDs support and guidance in increasing awareness of mental health illness among this population. Continue reading

Member Spotlight: Health Department Director Muriel DeLaVergne-Brown Discusses Her Experiences in Public Health and the Benefits of Being a NACCHO Member

Interview by Taylarr Lopez, Communications Specialist, NACCHO

NACCHO’s Member Spotlight series features interviews with local health department leaders and staff about their careers in public health. This interview features Muriel DeLaVergne-Brown, RN, MPH, Health and Human Services Director of the Crook County Health Department in Prineville, OR. She is a member of NACCHO’s Global Climate Change Workgroup, the 2017 Winter Leadership Meeting Committee, and the Leadership Development Institute Community of Practice. Below she shares her path in public health and highlights a few of the challenges her health department is addressing. Continue reading

Tobacco Cessation for Cancer Survivors: A Resource Guide for Local Health Departments

Local health departments (LHDs) play a vital role in minimizing the impact of cancer in their communities. NACCHO supports LHDs in planning, implementing, and evaluating evidence-based cancer prevention and control strategies to improve population health. With that said, NACCHO has released of Tobacco Cessation for Cancer Survivors: A Resource Guide for Local Health Departments. This guide details the importance of tobacco cessation for cancer survivors and features recommendations on how local health departments can use existing resources to link cessation services to cancer survivors. This resource guide was created through collaboration with American Cancer Society under the Centers for Disease Control and Prevention cooperative agreement DP1315 National Support to Enhance Implementation of Comprehensive Cancer Control Activities.

Download Tobacco Cessation for Cancer Survivors: A Resource Guide for Local Health Departments from the NACCHO website today.

Improving the Health of Communities by Investing in Tomorrow’s Workforce Today

By Claude-Alix Jacob, MPH, NACCHO President and Chief Public Health Officer for the Cambridge Public Health Department (MA)

The local health department (LHD) workforce is the backbone of the nation’s public health infrastructure. While healthcare issues have historically overshadowed the public health tenets of prevention and population health, LHD leaders and staff are truly on the front lines of keeping U.S. residents healthy and safe. Despite its critical importance, the LHD workforce is facing numerous challenges that the nation must confront to ensure the health and well-being of our communities. Continue reading