Rationale, model and practice experience for local public health leadership in developing community-level electronic health information systems

Major resources are being dedicated to electronic health records (ehr) and information (ehi) exchange. While larger health care systems have adopted ehr and ehi, local community-based private physician offices and hospitals lag behind the earlier adopters. Gaps in adoption of these systems at the community level, the national consensus on the need for these systems, and unprecedented resources being dedicated to developing these systems present major challenges and opportunities for both public health and health care.

Challenges to developing ehi networks for either heath care or public health are increasingly recognized as social and political, rather than technological. Fragmentation and competition at virtually all levels present major challenges to coordination and collaboration necessary for the development of effective ehi exchange. Competition for market share among major hospitals, physician groups, software vendors, and insurance companies reflect many of these challenges. Competing efforts to establish RHIOs exacerbate the challenges. Greater Jacksonville provides an example of unique leadership and critical support provided by a local health department to overcome an extensive array of these barriers and challenges. Successes in obtaining grants shared by multiple partners, designation as a CMS demonstration site, and progress in advancing and maintaining ehi within the community are examples of LHD leadership in the diffusion of ehr and development of ehi within the Jacksonville community.

The benefits of LHD leadership in the public-private sector initiative, compelling reasons for LHD involvement in the development of ehi, examples of applying the theories and practices of community engagement and coalition and consortium development, and the successes in promoting ehr and developing ehi will be discussed. This model and lessons learned have important implications for: development of the national public health information network (PHIN), building local public health system capacity, and enhancing the connections between clinical/hospital systems and public health systems.