Evaluating public health uses of Health Information Exchange - a review

Evaluating public health uses of health information exchange

Pages S46-S49 Jason S. Shapiro

The paper focuses on providing general evaluation methods for 6 different use cases representing the use of health information exchange (HIE) in public health aspects

Let’s give a look at the different use cases and proposed evaluation method

1. Mandating reporting of laboratory diagnosis. Where reporting is done electronically based on the results of ordered laboratory tests The author recommended the calculation of Recall as a measure for evaluating the impact of the use of HIE in reporting such laboratory diagnosis before and after implementing the HIE public health reporting functionality

2. Mandating reporting of physician based diagnosis. Reporting by physicians independently to Health Department about diagnosis or risk factors utilizing ICD9-CM and CPT codes The author pointed out the difficulty in adopting the Recall as a measure and suggested the use of Precision

3. Public health investigation. Where the use of computerized queries replaces the traditional investigational activities The author pointed out the difficulty of specifying certain measure(s) for this Because it depends on the nature of Clinical Information System and data scope, amount exposed and granulated data. As a solution to this the author recommended to have qualitative or semi qualitative studies and surveys.

4. Disease-based non-reportable laboratory data. Reporting certain diseases of interest for biosurveillance It is difficult to specify certain evaluation plan for such data because the discovery of such data is dependent on development of new, cheap and fast assays to help clinicians. Therefore an evaluation plan should be constructed in parallel to HIE construction based on community specific parameters.

5. Antibiotic-resistant organism surveillance. The detection takes place through electronic reporting of microbiology culture resistance results. Evaluation may be done by estimating the rate of resistance before and after system implementation

6. Population level quality monitoring. It emphasizes the public health involvement in secondary prevention of chronic diseases by consistent reporting rate of preventive measures (ex. rate of colonoscopy) Pre and post-implementation studies will be best in this case by the use of standard sets of quality measures

Comments: Reading the title and introduction is quite enough to realize how proactive the author was in choosing such topic where all people are focusing on bringing HIE initiatives to life, such vision allows us not to focus on implementation and loose our main goal which is improving healthcare quality for the whole population.

The author selected six different use cases, and I think that those are the most important use cases for the use of HIE in public health activities and the he started to describe them in quite well organized matter by describing the use case and providing the suggested evaluation approach, although the description was quite clear I felt the using diagrams here would be useful and saves time and get reader’s attention as the Chinese proverb says” A picture is better than thousands of words”

For those use cases where specifying a certain evaluation approach is difficult the author was really brilliant in providing reasons for this difficulty and simple roadmap for the adoption of other approaches suitable to different situation.

The author hit an important area of the use case of interest for biosurveillance as this one of the hottest topics that gained a lot of debates, but I was eager to have detailed information about this use case and it is impact on the rapid and early detection of bioterrorisim attacks so as to emphasize the concept of considering such use case for future design of HIE and Clinical Information Systems.

Reviewed By

Mohamed Aly Abd-Elmoneam

Clinical Information Systems BMI-512 winter 2008