Public Health has always been at the forefront of the charge to “meaningfully use” electronic health data. For example, Syndromic Surveillance came about after the terrorist attacks in September 2001, out of a need to detect intentional disease outbreaks as early as possible, even before confirmed lab results were available. Electronic data from emergency room visits were used in an attempt to detect unusual activity automatically and notify public health professionals for follow-up. Also, general disease surveillance systems, used to collect data on diseases that were reportable to public health agencies by law, began using electronic lab results more than 10 years ago as a means to get more accurate and timely data and remove redundant data entry.
However, due in part to the rushed timelines and immature technology and standards, it was slow going. Electronic message contents and formats were, for the most part, nonstandard and regional. The infrastructure for getting the messages to the public health agencies was not yet in place.
The Centers for Medicare & Medicaid Services (CMS) Meaningful Use incentive program has accelerated that progress. CMS’s incentive program pays eligible professionals, eligible hospitals and critical access hospitals to adopt, implement, upgrade or demonstrate meaningful use of certified electronic health record (EHR) technology. EHR vendors must have their products certified in order for their clients to receive their incentive dollars. This means better quality electronic messages that adhere to standards that, in turn, can be more easily received and loaded into appropriate public health data systems. Messages that adhere to standards are also received in a more timely fashion, improving the awareness and reducing response times to public health situations.
The Meaningful Use measures being implemented will improve the collaboration between clinical and public health care. They address communication standards with public health agencies for immunization registries, reportable lab results, syndromic surveillance, cancer registries, and other specialized registries. These activities will improve the readiness of public health agencies, making them better able to respond to public health emergencies.
However, there are still many hurdles to overcome before the goal of true interoperability can be reached. As anyone working in the trenches, trying to exchange electronic health data, can tell you, standards adoption is a slow process. Very often, public health systems must be able to handle multiple versions of “standard messages” as old standards are updated and refreshed. Technology can change so rapidly that it is difficult for public health agencies to keep up. New methods of message transport are developed, coming in and out of favor just as the infrastructure for older methods come online. Funding and resources are often difficult to come by to implement the changes to systems to enable them to accept and properly use this new influx of data.
Public health stands to reap the benefits as more and more health care providers are able to achieve “meaningful use.” This new flow of clean, quality and timely data will help public health agencies understand the population health in their jurisdiction. This can help direct funds where they are needed most and lead to better health outcomes. While progress has been slow to date, the meaningful use incentives are putting us on the path to true public health interoperability.