Indiana Pioneers Public Health-HIE Partnerships

As public health departments and hospital CIOs work toward electronic submission of immunization and disease reporting data as part of the meaningful use requirements, a few early pioneers are already reaping the rewards of health information exchange. Speaking at a November National eHealth Collaborative briefing, Joseph Gibson, M.P.H., Ph.D., director of epidemiology for the Marion County Health & Hospital Corp. in Indianapolis, described some specific gains his county has made through participation in the Indiana Health Information Exchange (IHIE).

The first example Gibson cited involves tuberculosis screening. Every year outreach workers do screenings for TB in Indianapolis homeless shelters. When they get a positive result, it is often difficult to track the person down again. But because the HIE gets real-time emergency department registration information, if someone registers to get emergency services, the HIE can be set to automatically alert that location that this person has had a positive TB screen and prompt them to get a chest x-ray.

Another HIE feature that saves Marion County’s health department a lot of work is the ability to use the HIE to send alerts, Gibson added. IHIE was established and initially funded through providing laboratory results to clinicians, so in Central Indiana, almost all of the lab results go through IHIE, through an interface called Docs4Docs. “We were able to work with IHIE to use that same interface to deliver alerts from public health departments,” he said. The first message sent through the HIE was on April 29, 2009—the H1N1 virus. “We can deliver messages to 95 percent of active physicians in the community in a manor that fits their current work flows. They already go out to Docs4Docs each day and collect all their lab results for their patients,” Gibson explained. “So in that same place they look every day, we now had a place to put an alert on how to test for H1N1 and a few weeks later we put out a second one with more information about H1N1 testing and treatment.”

Approximately six alerts per year go out within an hour of when the county provides IHIE with the message. “It is in a physician’s in-box the next time they look at their labs,” he said, “so we have been very happy with that.”

A main focus of public health involves reportable diseases, case reporting and investigation. Rather than relying solely on physician reports, now Marion County gets assistance from the HIE. Because IHIE receives all lab results, it can automatically screen those to look for positive results on specific reportable diseases and pass those on to public health departments. “Because of that, we get at least four times as many case reports as we would have with spontaneous reporting, and we get them earlier,” Gibson said. “As soon as the physician is getting that positive lab result, the public health agency is getting it as well.” The HIE has also enhanced the information the county gets with those labs. A next step is to provide doctors with case report forms that are already partially filled out based on lab information.

Currently, a lot of public health department effort is spent on the phone trying to contact a clinician to get more information so officials can evaluate a case and decide what follow-up is necessary. “In 2010 our health department got over 9,000 case reports and somewhere between 85 and 90 percent of those case reports required us to contact hospital staff to get more information,” Gibson said. A lot of the needed information is in the HIE. The IHIE board recently granted public health agencies 90 days of access into the HIE for patients that have positive lab result for a reportable disease. “We already have this arrangement for one hospital, and our nurses estimate that probably 80 percent of the time it allows us not to have to contact clinical staff to get information,” he noted. “We are looking at going from 9,000 contacts of clinical staff a year to something over 1,000 contacts. That is a big savings for us in terms of efforts. And a big selling point for the HIE is that their customers in the clinical care world would have to spend a lot less time giving us that information.”

These are just a few examples of big efficiency gains. But Gibson is convinced that his department is “just scratching the surface of what is possible when we have HIE working with public health to harness that information.”