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College of Public Health

East Tennessee finds Local Health Department Engagement in Quality Improvement related to Health Information Technology Use

A collaborative new study conducted by graduate students and faculty at the East Tennessee College of Public Health examined the relationship between quality improvement (QI) and health information technology (HIT) use in local health departments (LHDs) and found significant relationships between engagement in QI and use of certain HIT. LHDs who engaged in current QI activities were 1.7 times more likely to use electronic health records (95% CI: 1.02, 2.798), twice as likely to use practice management systems (95% CI: 1.19, 3.34), and 2.2 times more likely to use electronic syndromic surveillance systems (95% CI: 1.39, 3.52). Those associations held after controlling for confounding variables (total population size, total expenditures, and total FTEs). The research team included Kendra Johnson and Tina Nguyen, Master of Public Health candidates, Dr. Robin Pendley, Assistant Professor in the Department of Health Services Management and Policy, and Dr. Shimin Zheng of the Department of Biostatistics and Epidemiology. The findings were published in Frontiers in Public Health Services and Systems Research in October 2013.

Investigators used data from 625 LHDs that participated in the National Association of County and City Health Officials (NACCHO) 2010 National Profile of Local Health Departments Survey Core Questions and Module 1. "Because very little research had been conducted to examine if HIT was used as a tool for improving quality in public health agencies (although the relationship had been theorized at a conceptual level), we were motivated to explore the relationship between QI and HIT use in LHDs through the analysis of actual data captured by NACCHO," says Ms. Johnson, lead author. Interestingly, the results show that the most common HIT that LHDs used were immunization registries (88.7%) followed by electronic health records (65.6%), whereas the least common HIT used were national health information networks (18.4%) and practice management systems

"LHDs and their system partners that utilize HIT as part of their QI decision making will be better positioned to support evidence-based decision making and to implement the provisions of the Affordable Care Act," says Dr. Pendley. Further, use of HIT may support LHDs in fulfilling the aims of the US Department of Health and Human Services Public Health Quality Forum (PHQF), which identified information technology as a priority area for quality improvement in public health. The findings also have implications for LHDs that are exploring public health accreditation, since, as Pendley added, "accreditation is essentially a QI process."
The authors recommend that the public health community utilize this study's baseline information as a foundation to pursue future research examining how HIT is used in QI decision-making in local public health agencies.

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