Healthy hearts: Information technology for population health improvement

Background: With increasing chronic disease and ever-limited resources, Institute of Medicine, Affordable Care Act and others advocate for improvements in population health through integration of public health and primary care. Federal incentive programs such as Meaningful Use (MU) and Patient Centered Medical Home encourage use of electronic health records (EHR) to achieve health and efficiency goals. Leveraging incentive programs and informatics tools, the Illinois Department of Public Health launched Healthy Hearts, a statewide cardiovascular quality improvement project as a model for integrating primary care and public health.

Objective: We aim to use EHR data to inform quality improvement at primary care clinics and to build partnerships between clinics and local health departments (LHDs) to address community-level cardiovascular risks.

Methods: Clinics upload data to the Illinois Public Health Node, a MU-certified state framework for data aggregation and transmission. Using popHealth, an ONC-sponsored, open-source software system, we will produce dashboard reports on cardiovascular MU clinical quality measures. Through leadership groups, LHDs will coordinate with clinics to address community-level risk factors. Performance will be measured through adoption of quality improvement strategies, adherence to guidelines, impact on cardiovascular health among clinic patients, and linkages between LHDs and clinics.

Results: Three clinics have been recruited for the pilot phase. Clinics have successfully transmitted test batches of data to the Node. Clinics and LHDs have met to identify opportunities for collaboration and have convened leadership groups for each community. Data transmissions begin in the spring of 2013.

Discussion: Health informatics is key to integration of public health and primary care. Federal incentive programs motivate clinics to improve data processes and improve efficiency. Collaboration with LHDs addresses community-level risk factors. Healthy Hearts has the potential to inform data-driven quality improvements and to utilize health information technology to drive the integration of primary care and public health.