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State and local health departments are facing growing challenges, including infectious disease threats such as Ebola; a rising burden of chronic illness and an increasingly diverse population. At the same time, fiscal constraints accompanying the 2007–2008 recession and its aftermath hammered local, state, and territorial health agencies, which lost nearly 30,000 jobs—6 percent to 12 percent of their total workforces—from 2008 to 2013. Additionally, with Affordable Care Act and Medicaid expansion, the environments in which local health departments (LHDs) are operating is changing rapidly. With wide scale deployment of Electronic Health Records (EHRs) and availability of data, brings new opportunities to improve public health. With these changes, there are a lot of people asking how local health departments should evolve? How would you organize or re-organize a health department in this new environment?

A recent report published by RESOLVE, a nonprofit organization, and funded by the Robert Wood Johnson Foundation (RWJF) provides one perspective. It states that “by 2020, state and local health departments will be more likely to design policies than provide direct services; will be more likely to convene coalitions than work alone; and be more likely to access and have real-time data than await the next annual survey. These new required skills and abilities characterize a new role for health departments as the “chief health strategist” for a community.”

Today, more and more health departments and service providers are implementing EHR making real time data a reality. With meaningful use stage 2 and increasing connectivity, via health information exchange (HIE), data is being uploaded into immunization registries and syndrome surveillance systems. Now state public health officers can monitor real time information and take proactive actions. Furthermore, some advanced cloud based public health EHR systems now display real time community health data onto a county or state map via GIS Health mapping app. This kind of apps technology, provides public health leaders a way to monitor an outbreak e.g. for TB or chronic diseases or Ebola on a county map in real time. With such powerful technology, state and local health departments can be much more proactive in prevention.

Access to such data can be used in a powerful manner to help prevent the spread of diseases and reduce overall costs of health care. According to the Health IT, EHRs can “improve the ability to diagnose diseases and reduce—even prevent—medical errors, improving patient outcomes.”

Health departments will play a vital role in driving the health care system towards prevention and wellness. Many hospitals are already getting underway with these changes. A great example, noted in the RESOLVE report is Maryland’s State Department of Health and Mental Hygiene, who is compiling real-time data to identify common conditions of frequent hospital users (such as diabetes) and preventatively addressing the underlying health issues. Through a partnership with Worcester County health department, and funded by a federal grant, the hospital instituted a home care initiative to reduce admissions, keep more of these patients healthy and at home, and reduce overall costs.

According to the RESOLVE report, EHRs and state HIE systems can identify diseases and the demographic data of these diseases. However, to better prevent the spread of the diseases they must address their communities. They must become the “Chief Health Strategist.” Because awareness of causes at the individual level plays a bigger part of the prevention and early treatment of disease than any other factor. This can go a long way toward prevention.

There is still a lot of work to do to create a true interoperable environment but with meaningful use stage2, the building blocks are already in place. Using new EHR technology that is focused on public health, forging a new “strategist” role for public health provides an opportunity to improve the health of millions of Americans.

What do you think? What are opportunities, hurdles and risks of health departments evolving to a strategist role and not providing direct services?

For further reading: http://www.rwjf.org/en/blogs/culture-of-health/2014/12/seizing_opportunitie.html?cid=xtw_rwjflive_ff_201412