The public health nurse enters her work station, checks her e-mail, goes out to the Web for information about the most recent vaccine that has been licensed, enters her home visit for the new mother into the public health management system, and then checks the immunizations of the other children in the home on an immunization registry. The modern public health department has computers, Internet access, networks, and multiple computer programs. How do the managers of this public health department assure that their computer systems support all of the needs of the public health programs served while also being as efficient as possible? What should managers be doing to assure that systems are integrated and interoperable?  How should public health managers plan for client information to move between their electronic health record system and those of other providers? What information will the public health department get from e-health records?

The growing demands in public health are forcing local health departments to look at existing information systems and seek new solutions to move forward. Despite having spent significant amounts in technology, systems and planning, most public health departments lack the ability to gather, analyze and use information needed to respond to public health problems. Traditionally public health departments have used silo systems that don’t talk to each other, have made decisions based on specific program needs, and all systems have been independent. Public health departments can no longer afford to have systems that are not interoperable and work independently. Health departments need processes to collaborate on system application decisions. There needs to be a strategy of achieving the vision of interoperable systems.

Recently the National Association of County and City Health Officials (NACCHO) and the Public Health Informatics Institute (PHII) undertook a process to define the business processes of public health.  A business process is the sets of related tasks defined to produce a specific programmatic (business) result.   Much of the work at a health department cuts across departmental lines.  Thus, understanding how the work actually gets done is key to designing better information systems.  ‘Business process’ is not a phrase often heard in the halls of a public health department but thanks to the NACCHO-PHII project is becoming a phrase of importance to more and more health department leaders.  Once defined, the business processes can serve as the foundation for developing a base set of detailed information system requirements.  By sharing information system requirements, we encourage development of a new generation of systems that integrate data, support more effective population health assessment, and streamline workflow.  Through shared definition of our work processes and information needs every  local health departments benefits.

What distinguished this information system project from others was its collaborative nature; eight health department leaders from medium to large cities and counties joined forces with PHII to convince themselves that they have more in common. Collaboratively defining the business processes of local health departments created common understanding of how we do our work, helped  health department better understand how their work contributes to accomplishing our health protection and health improvement goals, and how our work processes are intimately linked to a host of external partners. In addition, the business process project helped encouraged best practices and has stimulated more concrete thinking about practice improvement and performance measurement. 

It is essential that informatics principles and the collaborative approach to requirements development be widely understood if public health departments are to develop the capacity to support the functions of public health. The full report is available “Taking Care of Business: A Collaboration to Define the Local Health Department Business Processes” is available at http://www.phii.org.  It is suggested reading for all public health administrators.

To comment or share your thoughts on this article to be included in the next HA edition, please e-mail tricia.todd0002@umn.edu.