Getting it Together

North Carolina's local public health organizations are finally catching up with the 21st century. With the state's Department of Health and Human Services (DHHS), they have laid the foundation to roll out a new enterprisewide solution called the Health Information System (HIS).

The HIS will let local public health departments statewide generate reports, reconcile bills and access a host of additional applications that weren't available on the old Health Services Information System (HSIS).

Although technology in the health-care business improved significantly since the 1980s, the information system that North Carolina's 85 local health departments use to send data to the state health department is obsolete.

"It's not a robust system," said Daniel Staley, health director of the Appalachian District Health Department (ADHD) in Boone, N.C., and chairman of the state's local health directors' technology committee. "You can't very well build an electronic medical record out of it."

The mainframe-based software isn't much help in complying with the federal Health Information Portability and Accountability Act, because the old system forced operators to enter the same data repeatedly for different purposes, not only wasting time, but also increasing opportunities for error.

Sometimes, Staley said, it seems just plain ornery.

"You have to really think about how to outsmart it to get what you need."

The DHHS designed the HSIS in the early '80s to help its Division of Public Health (DPH) collect data from local health departments to show how they were fulfilling their state contracts. In turn, the DHHS needed this data to deliver reports to the federal government and other grant-giving organizations, said Joy Reed, head of the local technical assistance and training branch at the DPH.

Over the years, at the request of local health departments, the state added a module for local departments to schedule patients and another for Medicaid billing.

"It's a state-run system, and they can only collect the data that the state wants and has fields for," Reed said, adding that pulling more than a few basic management reports is also a tremendous problem, requiring the local agency to wait for state IT professionals to design a query in the mainframe, generate a report and ship back the results.

Some local health departments have made do with the state system. Others, Staley explained, have implemented third-party software for their daily operations, but still rely on batch communication to share the required data with the state.

DIY Too Costly

The ADHD never invested in its own, more modern IT system because it couldn't spare the money.

"Then there's the issue that every time you had a change at the state level, your vendor would have to make a change [at the local level]," Staley said. The resulting delays could set the department back in its data collection and billing.

In preparing its RFPs for the new system, the DHHS drafted four sets of requirements. They included:

• the core functions the DPH needs immediately, plus functions that are common to the DPH and the state's divisions of mental health and rural health;

• functions unique to the division of mental health;

• functions unique to the division of rural health; and

• functions the DPH would like, but that aren't essential.

The current implementation covers just the first set, and includes only public health facilities. If funds permit, the DHHS could eventually exercise any of the other three options, possibly bringing the mental health and rural health programs onto the system as well.