Roaches, Roach Motels, and Electronic Silos: The Role of Informatics in the Integration of Health Care and Public Health

by Gulzar H. Shah, PhD, MStat, MS; Kristie Waterfield, MBA;  Mark Renfro; Zahid Butt, MD


Health Informatics Innovations and Applications highlights ways that health informatics innovations and applications are supporting stakeholders in public health practice and policy to advance their mission of improved population health. The series will also highlight innovations in health care informatics.

electronic silos

The thrust of this blog is on informatics silos and the potential role of informatics to incentivize partnership between health care and public health. This focus grew out of a brainstorming session between two health care informatics experts, Dr. Zahid Butt, CEO of Medisolv Inc., and Mr. Mark Renfro, Executive Director of HealtHIE Georgia Corporation, and myself, a researcher of public health informatics who got involved in informatics during my work at a public health practice agency a couple decades ago (elaborated on in my previous blog). Last month, I was able to convince these two health care informatics experts to come to Statesboro, Georgia, for a series of day-long mutually beneficial activities and to discuss why health care and public health remain “strange bedfellows,” given that the two industries have a significant impact on the health status of communities, and how informatics may be a catalyst in facilitating better partnerships between them.

Read the full transcript of this interview here

Interoperability of Patient Data

According to Dr. Butt, interoperability of patient data, or lack thereof, can be a catalyst as well as a hindrance in promoting the integration of health care and public health. Informatics can be the glue to such integration as it can fulfill communication, data transfers, and information-sharing needs for both industries. Dr. Butt and Mr. Renfro agree, asserting that from a health care point of view, a major barrier has been the inability to interface with public health agencies due to lack of public health agencies’ readiness to receive data from care delivery sites whether it’s physicians’ offices or hospitals. “The fax machine is the cockroach of the health care and public health industry,” says Dr. Butt, providing a vivid metaphor to underscore the fact that paper records continue to exist, regardless of the popularity of electronic health and medical records. Mr. Renfro adds that the lack of interoperability for public health agencies is thought to be “money-driven.” Many organizations of common interest to public health and health care, including community service boards (CSBs), are just getting into electronic health records. So they are going from “paper silos to electronic silos,” Mr. Renfro adds. Interoperability is critical now to go beyond data exchange between hospitals and physicians to all the other stakeholders within the community, such as nursing homes, CSBs, and public health departments. 

The lack of integration among health care and public health, from the health care industry’s point of view again, is the lack of reciprocation in data exchanges.

Information Exchange Can Reinforce the Integration

The impression I got from listening to my guests is that care providers do not perceive value in exchanging their data. Dr. Butt characterizes the health care data-exchange this way: “It’s like a roach motel, as the data and information go in but rarely come out.” Data reporting and sharing requirements do exist for health care providers, but care providers often get published reports from public health agencies that are not real-time in any sense of the word. Care providers can make better use of public health data if the information is generated rapidly and shared back with other partners, particularly health care providers, very much like health care information systems that share real-time data going from the physician’s office to the hospital or from the hospital to a physician’s office. So the value addition for care coordination will occur if public health agency data can become a part of the medical care-giving process. Public health agencies can contribute to the care process only if they find a way to communicate data that are meaningful to caregivers, rather than only publishing such data as annual or quarterly reports.

Population Health and Informatics as a Bridge to this Common Destination

Data and informatics can be a bridge between health care and public health, provided they make population health a common goal. But the question is – does the health care industry see population health as a priority? I challenged my colleagues to see whether this stereotypical view of health care as an industrial complex driven by profit motives is true in this day and age, asking whether it appears paradoxical for profit-driven care providers to engage in the prevention of population health, given that a constant stream of sick people may be to their advantage. Given the emphasis on and growth of population-based payment models, my colleagues argue that the stereotype is no longer true, explaining that defensive care giving, lack of integration of information systems, and oversight supports a system geared towards over-prescribing and over-utilization of services.

The good news concerning health care’s role in population health is that accountable health care is now incentivized to practice preventive health management through initiatives such as patient-centered medical homes (PCMH), the model that needs to rely on modern information science and tools with the goal of population management. An example of a national initiative that utilizes a population health approach is the Centers for Medicare & Medicaid Services (CMS), which recognizes chronic care management (CCM) as a critical component of primary care that contributes to better health and care for individuals. CMS’ initiative for integrating behavioral health care with primary care is another example. Integrating behavioral health care with primary care, “behavioral health integration” or “BHI,” is now widely considered an effective strategy for improving population health outcomes for mental or behavioral health conditions.

The Takeaway

Public health agencies need to play a proactive role in making the case for value of data exchange and better integration of health care and public health, and to work proactively with the health care industry to educate caregivers on how and why they should join hands in assuring population health.

Related Articles in the Journal of Public Health Management and Practice:
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JPHMP Consulting Editor of Biostatistics Dr. Gulzar Shah and guests discuss informatics silos and the potential role of informatics to incentivize partnership between health care and public health. https://wp.me/p7l72S-3Kp


Dr. Gulzar Shah

Gulzar H. Shah, PhD, MStat, MS, currently serves as a Professor of Health Policy and Management and the Department Chair, Health Policy and Community Health, at the Jiann-Ping Hsu College of Public Health (JPHCOPH), Georgia Southern University. He served the JPHCOPH as an Associate Dean for Research before accepting the Department Chair position in 2017. Prior to moving into academia, Dr. Shah spent over 17 years serving in public health practice, first at the Utah State Department of Health, and subsequently at the National Association of Health Data Organizations (NAHDO) and National Association of County and City Health Officials (NACCHO). [Full bio.]

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