Public Health Meaningful Use - Position Statement

I. ASTHO Supports the Meaningful Use of Electronic Health Record Data to Support Public Health Objectives

The Association of State and Territorial Health Officials (ASTHO) supports state and territorial health agencies’ efforts to improve population health through the meaningful use of data from electronic health records (EHRs). ASTHO supports meaningful use of EHRs to increase healthcare quality, safety, efficiency, coordination of care, and population health.

II. Within This Context , ASTHO Recommends:

• State public health agencies work closely with state and territorial Medicaid agencies to define how public health will be involved in the meaningful use incentive process and the definition of meaningful use in each state. State health officials should establish a collaborative relationship with state Medicaid directors to address meaningful use readiness.
• State health officials should establish a strong relationship with the state health IT coordinator to ensure that public health is involved in state health information exchange (HIE) planning and understand how the HIE will be involved in meaningful use planning. This should include how current and future public health IT systems should be appropriately connected with the HIE.
• State public health agencies should consider changes to public health IT systems and programs to support healthcare providers and hospitals in achieving meaningful use.
• State public health agencies should use population health-related clinical quality measures reported by healthcare providers and hospitals to support public health objectives and help reduce health disparities.
• Federal cooperative agreements that support state public health IT systems should allow for flexibility in funding for states to prepare their systems to support the public health information system infrastructure.
• Federal cooperative agreements that affect public health information systems should be coordinated to support meaningful use objectives.
• States should pursue 90/10 Medicaid administrative match to support public health information systems that will accelerate meaningful use.
• Future public health oriented meaningful use objectives should include criteria that support public health goals and improve efficiency of data exchange between state and territorial health agencies and healthcare providers.

III. Background: Improving Population Health through State Health Agency Involvement in the Meaningful Use of Electronic Health Records

The HITECH Act¹, promotes the use of electronic health records (EHR) and health information exchanges to promote high quality care, reduce costs, facilitate coordination of care among providers and improve the health of the population.  Implementing meaningful use of EHRs by providers will require a public health infrastructure that can support the receipt and exchange of data with the provider community.

The HITECH Act promotes the meaningful use of electronic health records by offering Medicaid and Medicare providers incentives for using EHRs that support meaningful use objectives set forth in regulation by the Centers for Medicare and Medicaid Services (CMS) and standards established by the Office of the National Coordinator for Health Information Technology. Providers will receive incentives after they purchase and meaningfully use certified EHRs that support these objectives.

Public health objectives include reporting of immunizations, laboratory results, and syndromic surveillance data to public health authorities and the capability of EHRs to generate lists of patients with chronic conditions.  All providers must choose at least one public health objective to support meaningful use criteria. In addition, states have the opportunity to redefine meaningful use to require some or all public health objectives in the set of required objectives.

Healthcare providers and hospitals that receive meaningful use incentives will be required to report on clinical quality measures related to population health. These measures, including smoking cessation, influenza vaccine coverage, and healthy weight screening, could help ensure healthcare providers provide focused prevention services among their patient population.  In combination with demographic information that will be required for electronic health records, providers will have the opportunity to promote public health objectives among populations with the greatest health disparities.

At the same time healthcare providers will increasingly adopt health information technology and will send data to state public health agencies, those agencies are decreasing the number of staff due to budget cuts.  ASTHO’s state budget cut survey of state and territorial public health agencies found that 42% of states have eliminated entire programs while 40% of states have resorted to layoffs to trim budgets².  Separately, ASTHO has also found that states, on average, need at a bare minimum $2 million per year to prepare their public health information systems for data that will be sent to states’ public health information systems³. The HITECH Act appropriated $30 billion to support the adoption of health information technology and promote data exchange. However, only $30 million of this has been specifically targeted at public health agencies to support meaningful use.

For state and territorial public health agencies to engage with the healthcare community and accept data from meaningful use certified EHRs, they will need more flexible funding that allows them to support information technology infrastructure that is shared across multiple distinctively funded programs.  Currently, many federal cooperative agreements require funding to be spent only on systems that support specific programs. By coordinating cooperative agreements across multiple programs, state and territorial public health agencies could better plan and integrate their public health information systems and leverage funding to support multiple programs.

In a letter to state Medicaid directors, CMS stated that it will provide a 90/10 Administrative Match to states to enhance information technology infrastructure that supports and accelerates meaningful use⁴. Through state Medicaid agencies, state public health agencies can apply to CMS to use this funding for public health information systems to support meaningful use. New objectives for meaningful use stages 2 and 3 should include public health objectives that support population health objectives and provide valuable information to providers.

Approval History:

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and approved by the ASTHO Board of Directors. Position Statements are not voted on by the full ASTHO membership.

eHealth Policy Committee Review and Approval: October 19, 2010

Board of Directors Review and Approval: December, 2010 Policy Expires: December, 2012

For further information about this Position Statement, please contact ASTHO eHealth Policy staff.

Related ASTHO Publications:

• ASTHO General Policy Statement
• eHealth Policy Statement

Notes

1. The HITECH Act was implemented by the American Recovery and Reinvestment Act (Public Law 111-5) in February 17, 2009.
2. ASTHO Budget Cut Survey, Winter 2010.
3. ASTHO Survey on Meaningful Use Readiness, June 2010.
4. August 17th Letter to State Medicaid Directors, Re: Federal Funding for Medicaid HIT Activities.