Improving Access to EHRs



Evolving National Efforts and Resources to Improve Information Exchange

The resources available on this page are designed to share what is happening at the national level and encourage participation within and across state public health agencies to improve public health informatics for HAI surveillance and outbreak response.

The availability of new tools and processes are constantly evolving in public health informatics. The resources in this toolkit demonstrate how public health investigators can access the information they need during an outbreak today. However, as systems become more integrated and interoperable, that approach could change. The U.S. Department of Health and Human Services (HHS) has affirmed that sharing health information more broadly with providers, consumers, and others to support better decisions while maintaining privacy will help achieve the Department of Health and Human Services Triple Aim:

  • Better Care
  • Smarter spending
  • A healthier nation

The interoperability between public health, healthcare, patients, and research is essential to realizing a Learning Health System. A Learning Health System that can take advantage of interoperable systems and domains will allow the nation to achieve the Triple Aim goal. To guide the nation toward these goals, the Office of the National Coordinator (ONC) released A Shared Nationwide Interoperability Roadmap – Draft Version 1.0 (Roadmap) which defines the implementation of how the U.S. government, in collaboration with the private sector, should approach sharing electronic health information and addresses the collaborative impact of all stakeholders in advancing interoperability.

This also speaks directly to the second goal of the Federal Health IT Strategic Plan 2015-2020, which sets a blueprint for federal agencies to support the nation's continued development of a responsive and secure health IT and information use infrastructure to help transform healthcare delivery and improve individual and community health. The plan recognizes the important role of public health agencies in keeping individuals and communities safe and healthy and supports strategies to enhance health IT interoperability and information use for public health entities, ultimately driving toward a Learning Health System.

Become Engaged at the Local Level

There are several resources that may already exist within the health department to facilitate implementing the tools described in this kit.

  • Contact your state public health Meaningful Use (MU) Coordinator

The Meaningful Use (MU) coordinator may already have working relationships with several hospital informatics and IT contacts.

  • Contact your state Health Information Exchange (HIE) coordinator [directory]

Depending on the jurisdiction, there may be one or more robust health information exchanges (HIEs) operating that can facilitate access to important clinical data. The HIE can act as a point of aggregation for secure exchange of certain clinical or public health information.

Many associations have peer groups focused on informatics including ASTHO and National Association of County and City Health Officials (NACCHO). There are also groups focused on informatics that can help identify and build capacity across the health department.

Joint Public Health Informatics Taskforce (JPHIT): Provides a common voice in public health informatics for a more robust enterprise capable of better protecting the population and seeks to unify the public health message in the context of growing and moving towards accrediting public health departments with specific capabilities and to provide measured performance improvement in the area of health information exchange.

Public Health Informatics Institute (PHII): Aims to improve the performance of the public health system by advancing public health practitioners’ ability to strategically manage and apply health information systems. Additionally, PHII has resources dedicated to building an informatics ­savvy health department.

The public health community is also working towards enterprise-wide solutions that aim to provide solutions to common public health informatics challenges.

Public Health Community Platform: With the goal of providing a forum for common information exchange and development of innovative and interoperable systems, ASTHO is leading the joint development of a CDC­-funded initiative: the Public Health Community Platform (PHCP). A platform is a common architecture that is a base upon which other synergistic applications, processes, or technologies are developed.

Health Information Technology Policy Committee Meeting: Jan. 13, 2015 Testimony on Public Health Outbreak Management and Response Health IT Needs. The HIT Policy Committee.

The Standards and Interoperability (S&I) Framework Public Health Tiger Team, a cross­ disciplinary group, is supporting the integration of public health and the clinical care sector by gathering requirements and providing input into a number of S&I Initiatives including Structured Data Capture, Data Access Framework, and Clinical Quality Framework.

Additional Resources

Virginia Department of Health report summarizing results from ASTHO HAI Capacity Building Project on public health direct access to hospital electronic medical records (May 2014). To obtain the report, contact the HAI Program Coordinator.

The Illinois Department of Public Health developed an infection control tool called the XDRO registry. The purpose of the XDRO registry is to improve surveillance for carbapenem resistant Enterobacteriaceae (CRE) and to improve inter - facility communications.

CDC Public Health Information Network (CDC PHIN): Aims to improve the capacity of public health to use and exchange information electronically by promoting the use of standards, defining functional and technical requirements.

CDC Meaningful Use website: Serves as a central reference point for information related to the CMS Electronic Health Record Incentive Program (Meaningful Use) for public health practitioners.

CDC EHR toolkit: CDC and the Public Health Informatics Institute developed an organized set of field-tested tools designed to support planning for a public health surveillance program that will rely on data from EHR systems.

The Sequoia Project currently supports two initiatives: the eHealth Exchange, a rapidly growing community of exchange partners who share information under a common trust framework and a common set of rules; and Carequality, a public-private collaborative effort to build consensus among existing health IT data exchange programs regarding technical specifications and best practices.

CDC Public Health Law Program developed an Issue brief on Federal Public Health Laws Supporting Data Use and Sharing.


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Information for this toolkit was collected through interviews with state health agencies and feedback from national-level stakeholders. See the methodology for more details.