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National Public Health Improvement Initiative

2011 National Public Health Improvement Initiative (NPHII)
Grantee Meeting

Atlanta, Georgia
March 30 – April 1, 2011

Health Information Technology

Speakers: Jeff Armitage, Epidemiology Surveillance Coordinator, Division of Public Health, Nebraska Department of Health and Human Services; Seth Foldy, MD, MPH, Director of the Public Health Informatics and Technology Program Office (PHITPO), CDC; Steve Frederick, Manager, Health Data and Evaluation, Lincoln-Lancaster County Health Department

Description: With the introduction of Meaningful Use criteria, the distribution of state Health Information Exchange HIE) grants via the Office of the National Coordinator of Health Information Technology (ONCHIT), and recent developments in BioSense, public health agencies are in a unique position to receive, and in some cases exchange, EHRgenerated data with providers for laboratory reporting, immunizations and syndromic surveillance. Not only will these changes support core functions of public health departments, they will help document quality improvement and further achievement of national public health goals.


Expanding Meaningful Use to include Syndromic Surveillance of Chronic Disease in Nebraska: A Promising Practice [PDF - 991KB] - J. Armitage
Local Health Department Perspective: Health Information Technology [ PDF - 383KB] - S. Frederick

Key Themes & Highlights

  • The HITECH Act, implemented through ARRA, provides meaningful use incentives to eligible providers and hospitals that implement electronic health records (EHR). Three public health objectives focus on reporting to public health: reporting electronic laboratory results (ELR), syndromic surveillance (SS), and immunization data. Another population health objective requires that EHR have the capability to generate disease lists. Meaningful use incentives will be staged in three phases and while public health objectives are options now, they may be mandatory in the near future.
  • Incentives for meaningful use will start this calendar year between April and December. It is vital for public health agencies to address potential barriers such as helping old partners send data in new formats, bringing new partners on board, bring old systems up to ONC standards and to effectively deal with the data influx.
  • To help, grants are available through CDC with cross cutting language for help with EHR planning and implementation. Additional 90/10 match funding from Medicaid can be used to support public health information systems that facilitate or accelerate meaningful use. It is important to build connections with State agency leaders for public health meaningful use objectives (ELR, IIS, SS) as well as the department leader for interoperability, the State HIT Coordinator, and the State Medicaid office.
  • Syndromic surveillance offers distinct benefits to State public health agencies in being able to identify significant changes in incidence in real time rather than retrospectively. Facilitating hospital participation is a vital aspect of effect syndromic surveillance. Methods currently being utilized in Nebraska include offering stipends for participation and legislative changes in State policy.
  • HIE systems in Nebraska are providing a large amount of close to real time morbidity data. This has enabled them to create applications with this influx of data such as Dashboard.

Links Mentioned:

CDC - Meaningful Use:


ONC Certifications & Standards:

CMS Meaningful Use Incentives Program:

Beacon Community Project:

Questions and Answers:

Q: What software do you use for IIS at the State level and is it easy to connect various EHRs?

A: Nebraska obtained its software from Wisconsin. It’s not an off the shelf, not bidirectional, but over time the HIE should help support interoperability.

Q: How do you hope to use information gathered from HIE to affect changes with primary care providers (PCPs) and collect outpatient data?

A: PCPs use reporting software to reduce medical errors; it provides interactive data sets for eligible providers and hospitals for healthcare system improvement.

Q: Would you speak to your proposed approach regarding using HIE data for outpatient care and chronic disease management?

A: We’re thinking about the role of health and about improving clinical care. Our focus is on hypertension, a primary care provider sensitive condition, and how to integrate outpatient data from providers or insurers or both. Also we’re thinking about how to feed that data back to providers and would like to integrate it into long term data sets such as hospital discharge data and public health. (Seth Foldy suggested looking into the Beacon projects within respective states to get a better understanding of how to utilize public health interoperability to drive public health projects.)

Q: How do you broker discussions with providers? Who do you partner with? How do you reach out to statewide coalitions?

A: There is a State Cardiovascular Disease program which is chaired by state coalitions that provides a good way to integrate and talk to organizations and stakeholders.  ASTHO and NAACHO also provide connection points on maps on who to talk to make the exchange work.

Q: Which dashboard software do you use? How much & how long to implement?

A: LogiXML. We paid $22,000 for software and training. Started the process in June, the first panels were up in July. We will share any of the applications with anyone who is interested.

Q: Can you create trend data for dashboard?

A: Yes, we have been able to visualize trends and analyze them.

Q: When you say you are a direct care provider, are you working as a provider that receives incentives from CMS?

A: We define ourselves as a direct care provider based on clients served, i.e. general assistance clients.


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