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Chronic disease management and population health Stage 2 meaningful-use requirements for public health reporting and an increased focus on public health throughout the country have made it necessary for private HIEs to include reporting capabilities within the tools they offer to physicians, but HCOs don’t always understand how complex the public health reporting system is. For years, federal and state public health groups have collected data from a variety of stakeholders, and they know the nuances of public health reporting. They realize how complex it is to normalize, extract and format data for reporting. They are well versed in establishing interfaces that can handle large amounts of


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complex data and utilize the same messaging standards used by HIEs. Furthermore, the shift to pay-for-performance reimburse- ment models and a focus on keeping large patient populations healthy is based in part on providing better care for patients with one or more chronic diseases. Chronic diseases are the burdens for public health departments, which measure prevalence in the population. They have experience designing large-scale, chronic disease-management (CDM) programs, but have lacked the regional infrastructure to deploy and man- age them. State public health departments know what kind of CDM support is needed within their areas of operation, based on the data they capture, and they will increasingly lean on private hospitals and health systems to relieve the strain of CDM on their budgets.


Public health programs succeed because of investments in systems to facilitate timely electronic reporting and disease surveillance. Better use of integration tools and encourage- ment of provider participation through meaningful use will lead to more success, and public health departments will always be part of any regional health community. Their vari- ability will never be an issue, and their burden for disease reporting and CDM will only grow in importance. Public health must be integrated into any HIE for it to remain rel- evant, and it’s essential that providers, HIEs, public health entities and payers all work together to facilitate CDM and improved population health. No party can build truly suc- cessful regional programs on its own.


Business operations


An enterprise HIE needs to deliver a return on investment to the HCO that runs it, and that organization needs to un- derstand the opportunities that exist for leveraging the HIE as a tool to increase efficiency, reduce costs and open new revenue streams. Many statewide HIEs arose with funding provided by ONC, and as a result, they have had to develop forward-looking business models that set up new sources of revenue once government funds run dry.


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Medicare and Medicaid are set to withhold reimbursement for things such as preventable readmissions and hospital- acquired infections, with an emphasis on better reporting of these events by HCOs. Public health groups have experience with streamlining reporting operations and digging into the data around these types of occurrences. These groups are not immune from the aforementioned shifts in reimbursement and care models, and public and private payers alike are look- ing for ways to better manage the health of whole patient populations. HIEs that can assist with better managing these patient populations can tap payers as new sources of revenue. Public health entities are vast consumers of health informa- tion, and they are greatly improving their ability to support standards-based messaging, making them ideal partners for private HIEs.


As more hospitals and health systems and independent, regional entities develop HIEs across the country, they can look to public health organizations for guidance on building a robust technical infrastructure, understanding the com- plexities of data exchange and reporting, and creating new revenue streams in a challenging economic environment. Most important, by applying lessons learned from public health to the creation of enterprise HIEs, private organizations can provide higher-quality care to patients.


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