Emphasizing Public Health Within a Health Information Exchange: An Evaluation of the District of Columbia’s Health Information Exchange Program

INTRODUCTION: Clinovations Government Solutions (CGS) was contracted in 2013 to conduct a mixed-methods evaluation of the District of Columbia (D.C.) Health Information Exchange (HIE) program as part of their Cooperative Agreement Grant funded by the Office of the National Coordinator in 2010. The evaluation was to focus on the progress of the HIE, how many providers and hospitals were participating in the program, and what benefits were being realized through the use of the HIE. During the course of the evaluation, the CGS team found that the use of the HIE to support public health reporting was one of its core elements. BACKGROUND: The D.C. HIE is one of 56 HIE that were funded out of the Cooperative Agreement program. The HIE program was managed by the District of Columbia Department of Health Care Finance (DHCF), which also manages the District of Columbia Medicaid Program. The program was initially designed to accomplish the following: developing state-level directories and enabling technical services for HIE within and across states; ensuring an effective model for governance and accountability; coordinating an integrated approach with Medicaid and public health; and developing or updating privacy and security requirements for HIE within and across state borders. As the evaluation progressed, the CGS team discovered that the relationship between the DHCF and the District of Columbia Department of Health (DOH) had become a cornerstone of the D.C. HIE program. METHODS: The CGS team used a mixed-methods approach for the evaluation, including a review of documents developed by the DHCF in its HIE program, including its original application. We also conducted 10 key informant interviews and moderated two small-group discussions using a semistructured protocol; and we developed a survey that measured the use, satisfaction, and future sustainability of the HIE for over 200 providers within the District of Columbia. FINDINGS: While the evaluation focused on the D.C. HIE program in its entirety, the results indicated the value of utilizing the HIE for public health reporting to enhance the surveillance activities of the DOH. Specifically, the DHCF and DOH collaboration resulted in using the HIE to electronically capture and report immunization data; and in requiring electronic lab reporting and results as part of the Meaningful Use Requirement—which can assist in detecting HIV/AIDS and providing better care for the district’s high population of individuals with HIV/AIDS. Electronic lab reporting and electronic prescribing within the HIE can assist the DOH and providers in identifying specific diseases, such as tuberculosis and viral hepatitis, before they affect a significant part of the population. DISCUSSION: Given the severe health disparities in the district, the ability of the D.C. HIE program to collect public health information on affected populations will be instrumental in better understanding and identifying methods of supporting these populations through improved surveillance and identification of the appropriate treatments. The D.C. HIE program is uniquely positioned to support these populations due to the partnership of DHCF with the D.C. DOH. CONCLUSION AND NEXT STEPS: The District of Columbia has made significant strides in expanding its public health infrastructure and activities. Three key areas of growth were identified that have the potential to transform the District of Columbia’s public health approach: establishing sufficient feedback loops, collection of environmental data, integration, and interoperability.