The Public Health Information Technology (PHIT) Maturity Index: Evaluating and Improving the Adoption and Use of PHIT
Enterprise Systems Planning, Health and Human Services Integration Track (3)
2017 8th Annual State Health IT Connect Summit, March 28-29 in Baltimore
Presenter: Teresa Rivera, President and CEO, UHIN Day 01 | 2:30:3:30 Tuesday, March 28th 2017
Project Description/associated implementation: This presentation will include a detailed study of a natural experiment enabled by the public health IT transformation efforts of Montgomery County, Maryland, a large suburban county. Montgomery County has been engaged in on-going efforts to improve public health services leveraging new IT systems. Notably, the Montgomery County Department of Health and Human Services (DHHS) and a public-private network of safety net clinics supported by the Primary Care Coalition of Montgomery County (PCC) embarked on the process of implementing an EHR that supports coordination across Social, Somatic, Dental and Behavioral Health Services. The EHR aimed to provide greater visibility of patient information across service areas and more efficient communication and management of information both internally and externally. Qualitative and quantitative data collection techniques were used. We conducted an intensive analysis of this EHR implementation across PCC and DHHS facilities (12), using interviews (61), observations (16), patient focus groups (3) and surveys (55.5% overall response rate) of EHR users before and after the EHR implementation, and client chart reviews (67), which provided a rich qualitative record. Staff participating in the study included DHHS and PCC clinical providers, administrative and client services staff, and managers at multiple levels across worksites including Access to Social and Health Services, Behavioral Health Programs, Public Health Clinics, and Public Health Dental Services. Patients included in this study typically received a mix of somatic, behavioral and social services through the health department. A detailed chart review was conducted to enable our understanding of the use, breadth, capability, interaction and usability of both legacy and existing systems. The experiences of implementing PHIT and the factors important to successful value realization were distilled and assessed for Index inclusion. Survey data was analyzed using factor analytic strategies to assess the reliability and validity of subscales and their conceptual structure, and t-tests and multivariate regression provided inferential insights. The factor analysis included components relating to pre and post-implementation staff perceptions of: Information Gaps; EHR Impacts; Perceived Usefulness; Perceived Ease of Use; Future Use Intentions; Knowledge about System; and Training. The factors in combination with controls for demographics, employment history, and computer literacy were used in the regression models.
Further, a Delphi exercise was conducted with six experts representing public health systems at the state and local level and multi-stakeholder national groups. The Index design, narrative and corresponding questionnaire received written feedback, followed by a virtual focus group to obtain further feedback. Experts were asked to provide feedback on how instructive and measureable Index elements were, which elements needed to be added, changed or removed, and how to best design the Index to reflect macro and micro-level areas of importance. After the virtual focus group, a refined model was distributed for a concluding round of written comments, which were incorporated into the final PHIT Maturity Index.
Background: Public health information technology (PHIT) has the potential to improve the effective and efficient use of information in achieving public health objectives. Information technology maturity models have been extensively used in other domains to guide information technology assessment and planning, but an information technology maturity model tailored for public health departments has heretofore been unavailable.
Purpose: The purpose of this study was to develop a Public Health Information Technology Maturity Index.
Methods: An extensive literature review and content analysis was conducted of information system adoption, use, and maturity in general and in the public health systems and services research context in particular. Primary data were collected through staff interviews (61), staff observations (16), patient focus groups (3), and staff surveys (3) over the course of a multi-year technology implementation, including pre- and post-implementation of an electronic health record system at a large suburban public health department. Data were analyzed using qualitative and quantitative methods to extract potential categories for inclusion in the index. A Delphi exercise whose panelists included experts from state and local public health departments and national multi-stakeholder groups was conducted.
Results: A Public Health Information Technology Maturity Index, questionnaire, and scoring guide were created. The Maturity Index consisted of four primary categories: Scale and Scope of PHIT Use; PHIT Quality; PHIT Human Capital, Policy and Resources; and, PHIT Community Infrastructure, along with fourteen subdimensions. Implications: The PHIT Maturity Index represents a practical approach to aid public health system stakeholders, notably health departments, in the evaluation of their information technology deployment decisions. As benchmark data become available, it will enable comparative assessment and possible linking of information technology maturity and multi-agency interoperability to population health outcomes.
Research article details at: http://uknowledge.uky.edu/frontiersinphssr/vol5/iss2/5/ Video brief about the research: http://go.umd.edu/PHITMIVideo
Target Audience for Discussion Group: Information Technology leadership responsible for public health, e.g. State and Public Health Department Information Technology Management.
Why the topic/project is at the leading edge of health IT, health and human services transformation Medical records should follow a patient no matter where the patient is in the care continuum. This includes geographic boundaries. Recognizing the cross border care sought by those living near state lines and travelers, UHIN, the state-designated HIE in Utah, has partnered with the HIEs in Arizona and western Colorado to share ADTs when patients living in one HIE have a medical encounter at a facility participating in an HIE in another state. In the few months since ADTs began being sent across state lines, more than 4,000 have been sent. SUCCESS STORY: A Colorado pathologist was notified his patient had been admitted to a Utah hospital, and through his own HIE was able to access the Utah-generated CCD. From the CCD he was able to review the patient’s lab work, and use it as a baseline for the follow up care, ensuring far better coordinated care.
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