BACKGROUND: Health systems are starting to focus on population health, and public health is being tasked with collecting and improving clinical quality metrics. In addition, public health is trying to determine the utility of collecting electronic health record (EHR) data to improve surveillance. The Utah Department of Health (UDOH) partnered with an Accountable Care Organization (ACO) to understand public health’s role within health systems, and form a foundation for integrating public health and clinical data.
METHODS: UDOH created a clinical data team of a chronic disease epidemiologist, health program specialist, data analyst, informatacist, and physician. To pilot integration, the team formed a partnership with an independent ACO of outpatient clinics with high health information technology capacity. UDOH received the ACO’s de-identified electronic health record (EHR) data to calculate NQF measure 0018 (hypertension in control) and assess patient demographics. UDOH analyzed the Utah Behavioral Risk Factor Surveillance System (UT-BRFSS) data by small area to supplement the EHR analysis. Stakeholder meetings determined the ACO’s needs that could be met with UDOH resources to improve population health.
RESULTS: Analysis of 2013-2015 EHR data showed patients residing in Southwest Utah had the highest disease burden with a hypertension control rate of 31.4%, as defined by NQF 0018. According to UT-BRFSS 2013-2015, Southwest Utah had higher poverty and uninsured rates (59.0% and 18.2% respectively) than Utah as a whole (53.9% and 13.9% respectively). Stakeholder meetings revealed the ACO’s desire to have timely data feeds from vital records, controlled substance database, and hospital discharge database. The ACO also requested public health expertise in improving their worksite wellness program with evidence-based activities. The ACO requested further analysis of the EHR and public health data to determine factors associated with hypertensive and diabetic patients who have not been seen regularly in their clinics, as well as with those who have been seen but have out of control hypertension or diabetes.
CONCLUSIONS: Public health – health system integration, starting with data sharing, has potential to benefit both entities to create a comprehensive picture of chronic disease burden. This will allow public health and health systems to better allocate resources, target interventions, and evaluate intervention effectiveness. Further exploration of how to create sustainable and scalable public health – health system integration is warranted given its ability to fill knowledge gaps to achieve mutual population health goals.