Public Health Practice within a Health Information Exchange: Information Needs and Barriers to Disease Surveillance

Abstract

Introduction:Public health professionals engage in frequent exchange of health information while pursuing the objectives of protecting and improving population health. Yet, there has been little study of the information work of public health workers with regard to information exchange. Our objective was to gain a better understanding of information work at a local health jurisdiction before and during the early stages of participation in a regional Health Information Exchange.Methods:We investigated the information work of public health workers engaged in disease surveillance activities at a medium-sized local health jurisdiction by conducting semi-structured interviews and thematically analyzing interview transcripts.Results:Analysis of the information work of public health workers revealed barriers in the following areas: information system usability; data timeliness, accuracy and completeness; and social interaction with clients. We illustrate these barriers by focusing on the work of epidemiologists.Conclusion:Characterizing information work and barriers to information exchange for public health workers should be part of early system design efforts. A comprehensive understanding of the information practice of public health workers will inform the design of systems that better support public health work.

Defining Health Information Exchange: Scoping Review of Published Definitions

“…‘Exchange’,55 – 57 , 141 ‘access’,69 , 82 , 138 , 207 , 218 – 220 ‘movement’,154 , 163 , 172 , 173 , 175 – 177 , 221 ‘sharing’,2 , 59 , 99 , 200 , 222 ‘multi-directional transfer’,223 ‘moving’,127 , 224 , 225 ‘bi-directional’,47 , 191 , 194 ‘mobilizes’,226 ‘connectivity’,54 ‘data flow’,122 ‘transferring’,55 , 61 ‘transfer’,58 , 70 , 109 , 112 , 115 , 133 , 160 , 216 ‘feed data repositories’,109 ‘transmission’,76 , 80 , 186 , 188 , 189 , 217 , 227 , 228 ‘transport’,49 , 100 , 184 ‘moves’,162 ‘access to and retrieval’87 , 110 , 111 , 115 , 121 , 130 , 160 and ‘link’/‘linking.’191 , 229 – 231 …”

“…‘Stakeholders’,52 , 68 , 74 , 84 , 106 , 117 , 126 , 127 , 181 , 254 “multi-stakeholders”,69 , 92 , 195 , 241 ‘public–private stakeholders’,91‘public health stakeholders’,254 “other or third parties”17 , 143 and “other healthcare providers.”25 , 154…”

“…Information security,25 , 30 , 43 , 60 , 70 , 89 , 95 , 98 , 100 , 127 , 153 , 157 , 164 , 173 , 182 , 191 , 198 , 227 , 234 , 238 , 255 ‘coded’,41 , 195 improved capacity for informed ‘decisions’,17 , 27 , 38 , 47 , 65 , 69 , 83 , 109 , 116 , 152 , 229 , 245 , 247 , 253 ‘effective’,21 , 71 , 103 , 115 , 121 , 129 , 160 , 234 , 252 ‘efficient’,33 , 84 , 95 , 121 , 148 , 160 , 233 – 235 ‘safer’,37 , 71 , 87 , 110 , 111 , 121 , 233 ‘coordinated’,81 , 234 ‘equitable’,37 , 71 , 110 , 111 , 115 , 121 , 129 , 130 ‘timelier’,103 , 121 patient-centred healthcare,37 , 71 , 84 , 110 , 111 , 115 , 121 , 129 , 130 ‘real-time’ information transfer,27 , 99 , 139 , 164 , 198 , 256 enhance ‘quality’ of healthcare,53 , …”

“…The uses of HIE in population health were stressed in a number of definitions 97 , 127 , 165 , 255 , 288. Relevant concepts covered the uses of HIE for supporting public and community health practices, population health monitoring and research (see Box 14).…”

Identifying health facilities outside the enterprise: challenges and strategies for supporting health reform and meaningful use

“…Billing, quality improvement, adverse event detection, and research require identifying facilities where services were performed. The provenance or origin where data was captured is also important for routine monitoring of population health, such as disease surveillance (30,31). To deliver contextually relevant clinical decision support (CDS) alerts based on emerging public health threats, CDS systems also must accurately identify facilities including specialties and providers within those facilities (32,33).…”