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ISDS Annual Conference Proceedings 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
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ISDS 2012 Conference Abstracts

State and Local Health Agency Engagement in HIE: A
Cross-Sectional Survey
Brian E. Dixon*1, 2, 3, Roland E. Gamache1, 2 and Shaun J. Grannis4, 2

1School of Informatics, Indiana University, Indianapolis, IN, USA; 2Regenstrief Institute, Indianapolis, IN, USA; 3Center of Excellence
on Implementing Evidence-Based Practice, Department of Veterans Affairs, Veterans Health Administration, Health Services
Research and Development Service, Indianapolis, IN, USA; 4Indiana University School of Medicine, Indianapolis, IN, USA

Objective
To characterize state and local health agency relationships with

health information exchange organizations.

Introduction
There is growing interest in leveraging available health informa-

tion exchange (HIE) infrastructures to improve public health sur-
veillance (1). The Health Information Technology for Clinical and
Economic Health Act and Meaningful Use criteria for electronic
health record (EHR) systems are among the factors driving the de-
velopment, adoption and use of HIEs. HIEs deliver or make accessi-
ble clinical and administrative data as patients are admitted,
discharged, and transferred across hospitals, clinics, medical centers,
counties, states and regions (2). While several HIE infrastructures
exist (3), there is little evidence on the engagement in HIE initiatives
by state and local health agencies.

Methods
An online survey of state and local health officials was conducted

in six states where HIEs were known to be present. Half of the states
were funded by the Centers for Disease Control and Prevention
(CDC) to engage public health agencies in HIE activities; the other
half received no such funding. A total of 143 officials were invited to
participate; 73 (51%) responded. The survey asked respondents about
their agencies awareness, engagement, and data exchange with HIEs.
The survey further asked agencies about their perceptions of barriers
and challenges to public health engagement with HIE organizations.

Results
Just 25% of agencies had a formal relationship, typically created

through a memorandum of understanding or data usage agreement,
with at least one nearby HIE. The majority (54%) of agencies either
had no relationship (20%) or only an informal relationship (34%)
with an HIE. The remaining agencies (18%) reported that no HIE ex-
isted in their jurisdiction. Agencies in states that had received CDC
funding for HIE engagement were more likely (14 versus 2) to be
formally partnered with an HIE.

Conclusions
Few public health agencies are formally engaged in HIE. Financial

costs, human resources, and concerns regarding privacy/security were
the top cited barriers to broader engagement in HIE. For public health
to be an active participant in and reap the benefits of HIE, greater in-
vestment in state and local public health informatics capacity, in-
cluding human resources, and education regarding HIE privacy and
security practices are needed.

Keywords
Health Information Exchange; Electronic Laboratory Reporting; Pub-
lic Health Surveillance; Public Health Informatics

Acknowledgments

This work was supported, in part, by the Indiana Center of Excellence in
Public Health Informatics through a grant from the CDC (501HK000077).

References

1. Savel TG, Foldy S. The role of public health informatics in enhanc-
ing public health surveillance. MMWR Surveill Summ. 2012;61:20-
4.

2. Dixon BE, Zafar A, Overhage JM. A Framework for evaluating the
costs, effort, and value of nationwide health information exchange. J
Am Med Inform Assoc. 2010;17(3):295-301.

3. eHealth Initiative. The State of Health Information Exchange in 2010:
Connecting the Nation to Achieve Meaningful Use. Washington,
DC2010 [cited 2010 September 29]; Available from: http://ehealth-
initiative.org/uploads/file/Final%20Report.pdf.

*Brian E. Dixon
E-mail: bdixon@regenstrief.org

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e105, 2013