Health Information Exchange for Community Health Improvement

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Health Information Exchange forCommunity Health
Improvement

• HPCA-HPHA Conference
• June 14, 2006
• Sharon H. Vitousek, M.D.

www.nhop.org
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Health Information Exchangeat Three Levels

• Community (Population)
• Health services systems
• Individual health

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Health Information Exchange forCommunity Health
Improvement

• Why?
• (What?)
• What are the barriers?
• What would help most?

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Why? What? Barriers? Help?

• Common Goal
• Improve the health and quality of life for the
  people in North Hawaii

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The mission of NHCH is to improve the health
status of the people in its service area
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Why? What? Barriers? Help?
Improve Health Status

• Disparities
• Death rates
• Hospitalization Rates
• Risk Factors
• Behavioral
• Physical and Social Environment
• Access to Primary Care and Health Insurance
• Preventive Services
• Protective Factors
• Individual
• Physical and social environment
• Life expectancy

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Role of Health Information Exchange in CHI?

• Identify priorities
• (Disparities and root causes)
• Engage stakeholders in improvement
• Mobilize resources
• Improve policies, programs and practices
• Document what works
• Track progress

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Why? What? Barriers? Help?
It Works!

• Vermont Social Well-being of Vermonters and
  Financing Prevention
• www.ahs.state.vt.us/01SWB/01SWBCoverTOC.pdf
• Sustainable Seattle
• Maine Development Foundation
• Curitiba, Brazil

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Why? What? Barriers? Help?

• Local Community Health Profile (CHP) Report
• www.nhop.org
• IOM Model
• Definition of North Hawaii Community
• Data Sources
• Formatted by Developmental Stage
• Community Selected Priorities
• Outcomes
• Community collaboration around the data
  priorities
• Use of CHP to mobilize resources - grants

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North Hawaii Outcomes Projects Role

• Facilitate improvement of health and quality
  of life in North Hawaii by
• Preparing and analyzing a Community Health
  Profile
• Identifying critical health issues
• Partnering to catalyze collaboration for
  improvement
• Identifying evidence-based strategies for
  improvement
• Monitoring outcomes and progress

www.nhop.org
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An annual community health assessment is like an
annual physical exam
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Institute of Medicine Community Health
Improvement Process
Source Community Health Improvement A Role for
Performance Monitoring
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Community Health ProfileData Sources

• Focus Groups
• North Kohala
• Waimea
• Waikoloa
• Honokaa
• Pharmacists
• Behavioral health
• Clergy
• Employers
• Community task forces
• Community forum Breakout groups

• Secondary Data
• US Census
• DOE
• DOH
• -Vital statistics
• -Primary Care Needs Data Book
• www.hawaiioutcomes.org
• HHIC-hospital discharge rates
• Police records
• County Data Book
• Healthy People 2010
• US Dept. Health Human Services
• Primary Data
• Surveys HHS, BRFSS, YRBS
• www.howsyourhealth.com,

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Community Health Data Ideally Includes Population
Health Measures

• Protective Factors
• Social Cohesion
• Ratio of Primary Care Physicians

• Risk Factors
• Income Distribution
• Housing Segregation

Source Ichiro Kawachi, Ph.D. Income Inequality,
Primary Care, and Health Indicators
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How Healthy Are We?Life Course Framework
Improving indicators
Declining Indicators
Evidence-based strategies and Resources
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Measuring Community Health

• Health
• it takes a community

Recommendations to the Mayor
How many deaths will it take till he knows that
too many people have died Blowing in the Wind,
Bob Dylan
www.nhop.org
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Community Selected Priorities2000

• Increase
• ?Educational Attainment
• ?Youth Activities
• ?Qualified Workforce

• Decrease
• ? Substance Abuse
• ?Child Abuse and
• Family Violence
• ?Teen Pregnancy

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Lessons Learned and Challenges

• Good data is necessary, but not sufficient
• Data gets people to the table and can inspire
  collaboration
• Local, credible, committed, partners are
  essential
• Community facilitation and organizing - Five
  Mountains Hawaii
• Health education and support - Tutus House
• More than Behavior- mod
• Importance of addressing root causes and barriers
• Barriers are often related to environment, time,
  and money

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Why? What? Barriers? Help?

• Data Barriers
• Common sub-county geographic definitions
• Access to sub-county population denominators to
  calculate age-adjusted rates
• Surveys- BRFSS, HHS, ATOD, YRBS
• Funding
• Small sample size at sub-county levels
• Some surveys not done regularly- ATOD
• Some questions not done annually

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• Not all that counts
• can be counted and
• not all that is counted counts.

Albert Einstein
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• Raw data is an unworthy substrate for final
  decision making. Like crude oil it has the
  necessary ingredients, but when used directly
  will only clog the gears of an operating process
• data points the direction in which we must
  turn- to find the answers to why. The why is
  judgmental and good judgment will require through
  study and evaluation of the facts.

Source Daniel F. Hanley, M.D., 1975 Maine
Medical Journal
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Why? What? Barriers? Help?

• Access to relevant data and comparisons
• Structure to analyze, prioritize, assess
  alternative strategies, identify existing
  resources, assets and gaps oversee
  implementation, and track progress
• Processes to be inclusive and outcome driven
• Facilitative leadership
• Funding

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Why? What? Barriers? Help?

• Address Data Barriers
• Structure State, county and local levels
• Processes
• Facilitative Leadership
• Long Term Funding

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North Hawaii Community Health Improvement
Health Care Providers
Health Insurers
Non Profits (NGOs)
Community
Gov Agencies
Employers
Health Data Organizations
Schools
DOH- OHSM BRFSS, HHS, Research SMS, PHRI
etc Hawaii Outcomes Institute/ Hawaii Heath Data
Warehouse
Media
Hawaii Health Information Corp Health Insurers
Faith Based Organizations
Grass Roots Community Groups
SHPDA UH Center on the Family
Funding Organizations
Hawaii Health Information Exchange Initiative
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Problem Identification Prioritization Cycle
Form Community Health Coalition
Prepare Analyze Community Health Profiles
Identify Critical Health Issues
Source Community Health Improvement A Role for
Performance Monitoring
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Analysis and Implementation Cycle
Analyze Health Issue
Monitor Process and Outcomes
Inventory Resources
Implement Strategy
Develop Health Improvement Strategy
Identify Accountability
Develop Indicator Set
Source Community Health Improvement A Role for
Performance Monitoring
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Increase Links to Existing Resources

• Local access to health insurance
• Chronic disease support and self-management
• Local behavior change programs
• Local SES support
• Local case management

• DOH-
• HHI
• Chronic disease
• SORH, Office of Inequality
• Business
• Schools
• Media
• Nonprofits
• United Way
• Hawaii Community Foundation
• Research
• UH, PHRI,
• Community-Based
• Advocacy
• Healthcare providers
• Policy makers-County and State

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Use a Multilevel Approach to CHI
Source Promoting Health Intervention
Strategies from Social Behavioral Research, p.
43
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Focus on High Leverage Policies

• School
• Physical education required
• Healthy food choices
• Harm reduction policies
• Work
• Worksite wellness
• Model drug policies
• Support balance family and work
• Screening for High BP
• Community/County/State
• Planning designed to address the increasing
  income gap via housing transportation support
  for early child hood development, increase
  access to primary care

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Health It takes a community