0-e-health scenarios · web viewsection 0 overview—e-health scenarios - 1 section 0.3 overview...

Section 0.3 Overview

e-Health ScenariosE-health has proven time and time again to be vital to many public health departments’ success. This section provides examples of how e-health was put to good use in four care scenarios to enhance your understanding of how electronic health records (EHR), health information exchange (HIE), and other forms of health information technology (HIT) may help you reach your goals of improving health and health care for those served.

The purpose of these four scenarios is to illustrate possibilities and potential of e-health as you begin to adopt and optimize use of HIT, EHR, and HIE within your own local public health service, and to encourage you to seek support from your state for enhancements to help you achieve the most you can from your chosen technology.

Time needed: 2 hoursSuggested other tools: NA

Real Life e-Health Use in Public HealthLocal public health departments strive to uphold national standards when executing their mission to promote healthy communities (see: http://www.cdc.gov/nphpsp/essentialServices.html). These standards reflect significant opportunities for strategic use of HIT, EHR, and HIE to:

1. Monitor health statuses to identify community health problems.

2. Diagnose and investigate health problems and health hazards in the community.

3. Inform, educate, and empower people about health issues.

4. Mobilize community partnerships to identify and solve health problems.

5. Develop policies and plans that support individual and community health efforts.

6. Enforce laws and regulations that protect health and ensure safety.

7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.

8. Assure a competent public health and personal health care workforce.

9. Evaluate the effectiveness, accessibility, and quality of personal and population-based health services.

10. Research for new insights and innovative solutions to health problems.

Local public health departments often work with many different types of partners on strategies to improve the health of individuals, families and their communities. Thus, they can realize tremendous benefits from new technologies such as mobile applications, enhancements to clinical decision support in EHRs, and significantly expanded use of HIE. Real life examples can help illustrate how HIT, EHR, and HIE can intersect within this framework. The scenarios examine the following direct services and care coordination provided by local public health departments:

1. Antepartum care for those needing Women, Infants, and Children (WIC) assistance and other preventive health services to promote healthy pregnancies and births.

Section 0 Overview—e-Health Scenarios - 1

2. Postpartum care for those needing WIC assistance and other services, including intersection with social services, to promote maternal health, parenting and child growth and development.

3. Child screening for those children needing assessment of physical, emotional, and developmental milestones, early identification of problems and referrals for early intervention and treatment services, such as medical or dental services, WIC, early childhood intervention services offered through schools, public assistance programs and other types of community support services.

4. Infectious disease management, such as tuberculosis, to promote containment of contagious diseases within families and communities.

Each scenario includes:

A story illustrating in narrative form how local public health currently uses EHR, and how additional EHR functionality, HIE, and other forms of HIT could be used.

A template summarizing the narrative story into a structure that illustrates how HIT, EHR, and/or HIE (highlighted in red) are used at each step within the scenario.

A matrix that identifies the key users and the information used by each of them.

Important Note: These scenarios illustrate how HIT, EHR, and HIE functionality can be used. You may find that your local public health department and/or state do not yet have some of the capabilities illustrated; or your state may have other capabilities that these use cases do not include. Your state may also have requirements for obtaining consent for release of information via HIE that are more stringent than those required under the HIPAA Privacy Rule.

Scenario 1: ANTEPARTUMKari is 15 years old and presents at a family planning clinic (FPC) to request a pregnancy test. She has missed two periods. The pregnancy test is positive. The nurse at the FPC learns Kari is attending high school, but is fearful of being teased when the other kids find out she is pregnant. She thinks she may drop out. Her parents do not have much money, and do not have health insurance as her father was recently laid off from work. Kari authorizes the FPC nurse to make referrals to the local public health (LPH) department for Women, Infants, and Children’s (WIC) assistance, and the Family Home Visiting (FHV) program, to Kari’s primary care provider (PCP), and to Human Services to apply for Medicaid. Each of these referrals is conducted via the state-certified health information exchange (HIE) organization (HIO).

At 14 weeks gestation, the public health nurse (PHN) makes a home visit to see Kari. She learns that Kari’s parents are very upset about the pregnancy, but are willing to help out as much as they can. An application for medical assistance has been completed and an appointment is scheduled for WIC. Kari has seen her PCP, and has been told she was 12 weeks pregnant. Upon the recommendation of both the FPC nurse and a referral from the PCP, the FHV program is offered to Kari. Kari agrees to enroll in the FHV program and signs consent forms to allow the PHN to share information with the school, human services, WIC, the PCP, other agencies that might be of help, and with Kari’s parents and father of the baby. This consent information is maintained by the HIO to facilitate future exchanges of health information.

During the visit, the PHN completes a health history intake and exam, and enters the data into the LPH’s EHR. Kari is experiencing nausea and vomiting each morning and has missed several days of school. Her boyfriend is 16 years old and wants her to have an abortion. He is not ready to be “saddled” with a baby. Kari shared that she had been at a party and she had been drinking. She was pretty drunk and is not sure who she might have had sex with that night. Her mom is disappointed, as she didn’t want Kari to


end up like her—having to drop out of school, unable to get an education, and stuck in low wage jobs. Kari states she has been smoking for the past year, but does not do any other kinds of drugs. Both of her parents smoke and Kari’s attitude is “What’s the big deal about smoking?”

As she develops the plan of care with Kari, the PHN documents in the EHR that Kari will meet with the PHN and participate in the FHV program, which will incorporate teaching, counseling and guidance related to a healthy pregnancy, preparation for childbirth, and parenting. It will also provide mentoring on how Kari should handle emerging crises, including her friends at school, her parents, and the father of the baby. Kari will try to go to school, but if this doesn’t work out she might consider alternative school. Because Kari has given consent for the PHN to share and coordinate the plan of care with the community-based teen parent case management team, the school, her PCP, and other specified community providers, the PHN is able to send these providers an electronic health summary and plan of care. The PHN also encourages Kari to sign up to use the personal health record (PHR) offered by her PCP so she can track progress on meeting her plan of care. Kari is anxious to learn more about what it means to be pregnant. She does not think she can cut down on her smoking now because she is too stressed out.

At her 32 weeks gestation visit, the PHN continues to support Kari’s involvement with the teen parent case management team involving the school nurse, LPH agency, and human services. Kari continues to participate in the FHV program and has stayed in school. Her PHR diary shows she has decreased her smoking by a half pack daily. Her goal is to have stopped completely by the time the baby is born. She has even convinced her parents to decrease their smoking. During this home visit, Kari informs the PHN that she has been having some premature contractions and that her PCP has put her on bed rest. Fortunately, it is summer so she won’t need to miss school. The father of the baby has not been involved. Kari reports that he wants nothing to do with her anymore. She states “He is denying that he is the father of the baby as he claims other guys have had sex with me, so how do I know he is the father?”

At 40 weeks gestation, the local hospital social worker sends a secure email message to the PHN to inform that Kari delivered a 7-pound, 5-ounce baby girl. Discharge planning is underway.

Scenario Template

Name: LPH Antepartum

Description: Local Public Health antepartum services for pregnant teen

Primary actor: Public Health Nurse (PHN)

Secondary actors: Family Planning clinic, Family Home Visiting (FHV) Team, WIC, Primary Care Provider (PCP), Social Services, parents, father of baby, school nurse

Preconditions: PHN has permission to home visit and share health data with other providers and/or social service agencies.

Post-condition: Birth of Child

Scenario: Step Action

1 Family Planning clinic refers to FHV Program – secure email

Other referrals made by FP clinic WIC appointment, provide dates – paper, phone,

patient portal PCP appointment – provider portal Social services: Medicaid application – paper

2 Referral from PCP – secure email, HIE

PHN home visit scheduled – phone


3 Home visit is made Designate consent for release of information via LPH

EHR, and sent to PCP (HIE), school (fax), human services (HIE), and others

Document history and assessment – EHR Establish care plan and ongoing visit schedule in –

EHR Encourage involvement of family and father of baby

– EHR Smoking cessation support – EHR, mobile app, Web

resources (QuitPlan, etc.)

4 Refers patient to teen parent case management team (school nurse, LPH, and human services) – HIE

5 Share plan of care with teen, parent, case management team HIE Send periodic update summaries and risk factors to

PCP (HIE) Patient updates diary in PHR from PCP, uses mobile

app to track cigarette use

6 Health status Patient reports PCP put her on bed rest at 32 weeks

due to premature contractions. Document in EHR. Document in EHR support for emotional and

paternity issues Send or receive updates to PCP or others as

needed (HIE)

6 Secure email from hospital social work to PHN re: birth of child

Other: Case followed through hospital discharge in postpartum care

Scenario 2: POSTPARTUM


At 40 weeks gestation, Kari delivered a 7-pound, 5-ounce baby girl. She is planning to breastfeed. She will be living with her parents. She is 16, so her parents expect that she will also get a part-time job to help with the expenses of the baby. A first dose of Hepatitis B vaccine was administered at the hospital. The hospital sent a referral for continued home visiting services to the local public health department via secure email. Immunization records were sent to the state’s immunization registry via the state-certified HIE organization (HIO).

At her two-week postpartum home visit by the public health nurse (PHN), Kari complains of being very tired. The baby is eating every two hours. Kari’s mom thinks the baby is not getting enough milk and wants her to supplement. The WIC staff has told her she needs to breastfeed more often. At the baby’s two-week checkup she had regained her birth weight and the doctor said everything is just fine. Kari says, “I don’t know who I should listen to. School will be starting in a couple of weeks. I don’t know how I will be able to stay awake, take care of the baby, do my homework, and work. Having a baby really sucks. At first my friends all came over, but now they aren’t coming around because I am stuck here and can’t go out with them.” A referral is made to the Lactation Consultant via secure email. Kari is enrolled via a secure email in the Follow Along Program (FAP), located in same office as the local public health agency. A care plan is established and the plan and assessment are documented in the EHR. Any abnormal findings or concerns can be sent to Kari’s PCP by her PHN via secure email.

At her six weeks postpartum visit, Kari tells the PHN that she has seen her doctor for her six-week checkup. She says: “I am so tired all the time. I don’t feel like doing anything. The doctor thinks I might be having some postpartum depression and thinks I should see a mental health person. I have lost a lot of weight and don’t feel like eating anything. I quit breastfeeding. The baby reacted to the formula. WIC had to contact my doctor to get special formula. You told me I need to get the baby back to the doctor when she is 2 months old. I made an appointment online. Will she have to get shots?” The PHN checked Kari’s clinic via the provider’s portal to verify that the referral was made and obtained the name of the mental health provider.

When the baby is 4 months of age, Kari completes the 4-month Ages & Stages Questionnaire (ASQ) via the LPH agency’s portal. The ASQ goes directly to the LPH EHR. The PHN adds a summary note in the EHR and the ASQ and note are sent to the Follow Along Program via the HIO and to Kari’s personal health record (PHR). A review of the immunization registry via the HIO indicates all recommended immunizations have been given. Kari states that her next appointment is scheduled in two weeks. She says she still feels depressed, is now on medication for depression, and is seeing a psychiatrist monthly. She has returned to school and her grades are good. Her mom is helping with babysitting. Kari is working on weekends. “I make just enough money to buy diapers. I don’t have any time for me. I go to school, I take care of the baby, and I work. My friends are all busy doing fun things. Sometimes I wish I had never had this baby, but then I start playing with her and she smiles and talks back to me and I know that things will get better as she gets older.“

When the baby is 9 months old and the PHN makes a home visit, Kari says, “Can you believe it? Someone turned me in to child protection. My old boyfriend came over to see the baby. He offered to stay with the baby while I ran to the store to get some sodas. When I returned home, the baby was crying and he was so upset. The next day she had some bruises on her arm. Do you think he could have hurt her?” The PHN assessed the baby’s physical condition and Kari’s physical and emotional responses to her baby’s needs. Results are documented in the EHR. Because Kari’s consent for release of information allows the PHN to contact the Child Protection Social Worker about the status of the child protection report, the PHN is able to review this via the HIO. Based upon the social worker’s assessment and actions taken by Social Services, the PHN will plan a follow-up home visit and communicate with the PCP and mental health provider via secure email.

Scenario Template

Name: LPH Postpartum


Description: Postpartum/newborn home visiting


Secondary actor:

Hospital, Lactation consultant, Follow Along Program (FAP), primary care provider (PCP), pharmacy, family, WIC, mental health provider, state Immunization Registry, Child Protection Social Worker

Preconditions: Public Health Nurse has permission to home visit and share health data with other health care providers and/or social service agencies/WIC.

Post-condition: Ongoing parenting and child welfare monitoring


1 Intake/referral from Hospital via secure email Consent for release of information signed by patient loaded from hospital

EHR to HIE Continuity of Care Document (CCD), discharge summary (D/S), and

history and physical exam (H&P) for mother and baby retrieved from HIE; CCD to mother’s PHR at PCP

Hepatitis B at hospital, immunization to Immunization Registry via HIE Patient contacted by PHN and home visit scheduled by phone, patient

portal

2 Home visit for mother/baby Review/update as applicable consent for release of information via HIE Document mother/baby assessment in EHR

Care plan established w/patient and documented in EHR Referral to lactation consultant – secure email, portal Referral to Follow Along Program (FAP) – secure email, portal

3 Follow-up visit PCP recommends mental health evaluation for postpartum depression PHN verifies referral to mental health by PCP – secure email Baby: WIC contacted PCP for change in formula due to intolerance Mother scheduled 2 month well child checkup with baby’s PCP – LPH

portal

4 Follow-up visit ASQ completed by parent via LPH portal and results are sent to LPH

EHR. PHN adds summary note in EHR and sends to FAP database via HIE

o Results that do not fall within the normal standards are sent to PCP via secure email

o PCP sends copy to mother’s PHR Verify immunizations through Immunization Registry via HIE Mother reports she is on antidepressant, seeing psychiatrist monthly

5 Follow-up visit Mother reports child protection involved. Reports incident w/old boyfriend

babysitting and bruises on child’s arms. PHN assesses and documents mother and baby interaction Contact Child Protection social worker and PCP for case file via HIE Plan follow up home visit based on feedback from social worker sent to

EHR via secure email Notify PCP and social worker of status via HIE

Infant May need referrals for apnea monitor or other special equipment

Other: Ongoing child development and parenting support; monitor child and mother


Scenario 3: Early Childhood ScreeningCarson is a 3-year-old WIC client who is being seen by a WIC Outreach worker for recertification for WIC assistance along with his mother and younger brother. His mom states that both children are overdue for immunizations and their most recent checkups, but their Medicaid has lapsed. The WIC Outreach worker gives her a Medicaid application so she can reapply. They have a PCP, but without Medicaid they cannot afford appointments. The mom also states that they moved here last year and the boys had some immunizations at a local federally qualified health center (FQHC). The WIC Outreach worker notes these providers in the LPH EHR. The WIC Outreach worker schedules an appointment for Carson and his brother for checkups and immunizations via the LPH EHR. Carson is at the appropriate age for an Early Childhood Screening (ECS), so the checkup will also be his ECS. The WIC Outreach worker affirms that the mom has access to the Internet and is shown how to log onto the LPH portal to complete a health history form and Ages and Stages Questionnaire – Social Emotional (ASQ-SE) prior to the appointment. The worker also has the mom sign up with the state-certified HIE organization (HIO) and supply consent information so health information can be shared with the PCP and others as designated.

The day before Carson’s appointment, the WIC Outreach worker checks the next days’ appointments. The worker obtains Carson’s state medical information number from the WIC Web site and initiates an eligibility inquiry for Medicaid. A denial is received and a note is placed in the EHR to hold billing until the Medicaid approval goes through. (If necessary, the state’s sliding fee scale or safety net services may be used if Carson is found to be ineligible for Medicaid.)

The WIC Outreach worker notes that the age-appropriate Child &Teen Checkup (C&TC) template in the EHR has been pre-populated with information supplied by the mom through the portal. (If this had not been done, the worker would have initiated an automated call to remind the mom to do so prior to the appointment or arrive early to use the kiosk in the LPH department’s waiting room.) The staff member then accesses additional information on Carson available through the state’s WIC website, such as his


height, weight, food intake history, and previous public health services. This website is not interfaced with the LPH EHR so the worker prints it, abstracts pertinent data into the EHR, and scans it into the EHR. Finally, in preparation for Carson’s visit the next day, the worker accesses both Carson’s and his brother’s immunization records through the state’s immunization registry—accessible via the state HIO—to pull this data into the LPH EHR. Some immunization data appear to be missing, so the worker sends a secure email message to Carson’s PCP and the FQHC to see if they have additional information that may not yet be posted to the immunization registry.

When Carson arrives for his appointment, the PHN updates demographic information in the LPH EHR and verifies the accuracy of the data entered by the mom into the C&TC. The PHN also completes the Early Screening Inventory-Revised (ESI-R) developmental screening test, and the EHR generates a Screening Summary. The Screening Summary must be sent to the WIC program via electronic fax, as it is not yet able to receive this electronically.

The EHR’s immunization alerting system identifies which vaccines are due (or overdue). The PHN prints out copies of the appropriate Vaccine Information Statements (VIS) and has the mom use a kiosk in the LPH department to electronically complete and sign the Screening Checklist for Contraindications to Vaccines. The immunization administration information is pushed to the immunization registry via the state-certified HIO.

The PHN asks Carson’s mother if she uses a personal health record (PHR) to maintain her children’s health information. She does not, but is interested and knows that the PCP offers a PHR. The PHN prints out copies of the checkup and immunizations for the mom and reminds her that she has access to some of this information via the HIO or via the PCP, providing it directly to a PHR.

Carson has failed the developmental test and has an elevated score on the ASQ-SE. The PHN therefore initiates a referral request to the Early Childhood Intervention program and the school district because the mom requested a referral to Head Start. Because she has set up appropriate consents for release of information in the state HIO, the Screening Summary is pushed directly to these programs and the PCP as the referrals are made.

Upon completion of the visit, the EHR generates a claim that is automatically held until Carson’s Medicaid is reinstated. The Outreach worker monitors when Carson’s eligibility is confirmed in order to release the billing hold.

A few weeks later, a notice is received from Head Start by secure email stating that Carson was accepted into Head Start for the fall and will need another checkup. The Outreach worker calls Carson’s mother, who states she is not sure that Carson can go to Head Start due to transportation problems. The Outreach worker returns a secure email message to Head Start reporting the transportation problem. Head Start is able to arrange for transportation and a confirmation is sent to the Outreach worker. Mom speaks to the Outreach worker and arranges for the checkup and any additional testing that is needed.

Scenario Template

Name: LPH Early Childhood Screening

Description: Child & Teen Checkup, Early Childhood Screening (ECS)


Secondary actor:

WIC Outreach worker, Primary Care Provider (PCP), Early Childhood Intervention (school district), Head Start program

Preconditions: Child missed checkups and behind on immunizations; failed developmental screening tests

Post-condition: Ongoing care coordination with LPH, PCP, specialty care, school and early childhood programs



1 WIC Outreach worker schedules Child Teen Checkups and immunizations appointments for children via LPH portal Mother asked to use LPH portal to complete health history and ASQ-SE Mother given Medicaid application - paper Checks via state-certified HIE organization (HIO) that mother has signed

consents for release of information to PCP and others

2 Prior to Child & Teen Checkup LPH sends eligibility inquiry and receives response concerning eligibility for

Medicaid and places hold on billing EHR Checks HIO for immunization records for the children; uses secure email to

gain additional immunization data from PCP and FQHC Access state’s WIC website and enter data into EHR

o Height, weight, food intake historyo Previous LPH services

3 Child & Teen Checkup appointment at LPH department PHN reviews health history and other data entered by mom through LPH portal

to LPH EHR PHN conducts and documents checkup and developmental screening in EHR. PHN alerted to immunizations due as posted in the EHR from the immunization

registry pushed to the EHR via the HIO Mother signs Vaccine Information Sheet Screening Checklist for

contraindications to Vaccines via the LPH kiosk PHN: Administers immunizations and documents in the EHR, which

automatically updates the immunization registry via the HIO Copies printed and provided mom to place in PHR when available

4 Child failed developmental screening and has abnormal ASQ-SE score Referral request and information sent to School’s early childhood intervention

program and Head start programs via HIO, or State Certified HIE Service Provider

Copy of screenings and summary of results sent to PCP via secure email

5 Follow up Referral from Head Start received via secure email for repeat C&TC Transportation issue resolved with Head Start via secure email messaging PCP prepared to conduct check up with electronic data from LPH EHR/HIO

Specialty care 3 Referrals to ST, PT, OT, child psychologist, other specialty care

Possible sliding Fee scale or safety net services if ineligible for Medicaid.

Other Information:

Care coordination with PCP, specialty care, early childhood services, school and public health. Results out of normal range and quarterly Screening Summary sent to PCP via secure email.


Scenario 4: Infectious Disease ManagementThe LPH department received notification that the state’s public health department (PHD) learned of a suspected tuberculosis (TB) case when a local hospital filed a report with the online infectious disease reporting system. In addition, the state health department has learned that there are several more recent cases of TB around the state. This information is being pushed via the state’s HIO to all LPH departments and providers in the state, and to the traveler app for mobile phones. The state is requesting LPH assistance to identify a common exposure point, explore potential sources of exposure, and supply information to the state via the HIO.

The local public health nurse (PHN) calls the hospital’s infection control practitioner and learns that the individual was started on TB medications after testing positive for TB and presenting an abnormal chest x-ray. The hospital would like to send him home as soon as possible and the practitioner sends the PHN the continuity of care document and other information via secure email. The PHN calls the individual and explains that if he is tolerating medications he will be allowed to return home. However, he cannot leave home or have visitors until he is no longer infectious. He agrees to these terms and says he recently flew abroad, but refuses to provide flight information. The PHN calls the patient’s spouse to determine whether there are children under age 5 in the home and whether anyone is immunocompromised, learning that one child has diabetes. The PHN determines the home has Internet access and requests that the family log on to the state HIO and set up appropriate consents for release of information to the designated resources.

The PHN checks to make sure that consents for release of information are provided in the HIO. The PHN also identifies, via the HIO, that the patient has mycobacterium tuberculosis by DNA probe. The PHN prints a copy of the lab report for the patient, who has been skeptical that he has TB. The lab report is provided to the patient during the home visit, and baseline vital signs, weight, and an eye exam are done and documented in the LPH EHR. During the home visit, the patient also is taught about TB,


medications, contact investigation, and the need for isolation. The three children at home are given Mantoux tests. The spouse will go to the hospital clinic for a TB blood test because she has received the Bacillus Calmette-Guerin (BCG) vaccine against TB. The lab loads the test results to the HIO and the PHN can see that the results are positive. Two of the children at home are found to have negative Mantoux tests. The diabetic child’s Mantoux test was positive. The PHN calls a fourth child, who is away at college, and asks the college infirmary to administer a Mantoux text. Results are returned to the PHN and are positive. The PHN calls the child at college and recommends a chest x-ray. The PHN assists the spouse in logging onto the PCP’s portal to schedule follow-up appointments. Instructions regarding what is needed for follow-up on positive TB screening are e-faxed to the PCP.

During the home visit, the PHN learns that the previously hospitalized patient was seen at a local clinic. The PHN notifies the clinic via secure email of the need for post-exposure testing of contacts. The PHN again asks the patient for flight information so the quarantine officer at the airport can notify the airline and other passengers can be notified. He declines to supply the information and denies any other close contacts. His blood pressure is elevated and he is not taking his medications. The PHN offers to get a mediminder box, but this is also declined. Latent TB Infection (LTBI) treatment is recommended and extensive teaching is performed with the client regarding why this is recommended, especially since one child has diabetes, but this is declined. The PHN notifies the PCP that the family is refusing LTBI treatment. The PHN conducts follow-up with the child at college and finds that neither a chest x-ray nor a visit to PCP has been done.

Shortly after the home visit, the PHN learns that at least one other individual with a positive TB test reported to the state has identified the flight. The airport and airline are notified. The traveler app is updated to alert travelers with more specific information.

The PHN continues to work with the family to encourage their cooperation, to perform regular testing, and to gain acceptance of LTBI treatment. The client is no longer infectious after three negative sputum tests and isolation is discontinued, but the PHN continues daily direct observed therapy monitoring to ensure he is taking the TB medications. The LPH EHR continues to receive lab results through the HIO and has alerts to advise the PHN when follow-up activity is needed. The PHN also works with the diabetic child’s PCP, and with a kidney specialist to whom the child was referred.

Scenario Template

Name: LPH: Infectious Disease Contact Investigation and Follow up

Description: Tuberculosis outbreak: Disease carrier and contact investigation and follow up

Primary actor: Local PH Nurse (PHN)

Secondary actor:

Patient and close patient contacts (family) Potential community exposures (school, work, friends, travel) Providers: Infectious disease specialist, primary care provider (PCP), hospital State Public Health Department (PH) Laboratories: hospital, PCP, PH, commercial lab Pharmacies: hospital and retail

Preconditions: Request by state PH for TB contact investigation due to suspected local case of TB and several more across state

Multiple community exposures, including overseas travel

Post-condition: TB case follow up


1 Spouse asked to log onto HIO to establish consent for release of information to hospital, PCP, and others as designated

Hospital supplies LPH Continuity of Care Document (CCD), discharge summary (D/S), and history and physical exam (H&P) via


secure email

2 Initial LPH visit to patient and family (wife and 3 children, 1 with diabetes) Vital signs (V/S), meds, allergies, and known problems for all

members of family identified and documented in EHR Close contact investigation: Wife and 4 children (oldest in college.)

Administer Mantoux test to 3 children. Document in EHR Wife to have TB test at hospital (BCG vaccinated).

o Hospital lab confirms positive TB test and sends results to LPH, state PH, and patient via HIO

o Declines Latent TB Infection (LTBI) treatment – teaching and recommendations documented in EHR

Fourth child in college: Notify college infirmary via e-fax from LPH EHR to administer Mantoux to oldest child

o Results returned via fax were positive. Called to recommend seeing the PCP and get CXR.

Request flight/travel details from client refused State PH department sends alert via push from HIO to all LPHs,

providers, and mobile app for travelers State learns from another patient that exposure point is an overseas

flight. State notifies airport and airline and updates LPHs, providers, and public via traveler app

3 Infectious disease follow-up and health concerns PHN collects and delivers sputum samples to PH lab for processing Previously hospitalized patient continues to have high BP Informed PCP of risk of delayed sputum conversion in uncontrolled

diabetics via secure email Child is contagious, with elevated blood sugar Phone to PCP who adjusts medications via e-prescription to

pharmacy, available to LPH via HIO Determined not infectious after 3 negative sputum results. Results

sent to state PH via secure email FU appointment w/PCP who sends LPH update via secure email

4 Contact follow-up screening Oldest son F/U via phone call: PCP appointment and CXR not

done; encourages checkup and LTBI treatment Coordinate care for child with diabetes with PCP via secure email Continues direct observed therapy for duration Retest contacts 8 weeks after last exposure

Other Information:

Continued follow-up by PHN to assure completion of treatment, direct observed therapy, screening contacts


Your public health agency may or may not provide all the services that are part of the scenarios above. These do show, however, the possibilities that exist with e-Health in the public health arena. It reminds us that e-Health initiatives affect more than a primary care provider.

The HIT Toolkit for Local Public Health includes tools to aid HIT advancements for agencies with a variety of goals. While some tools are beneficial for any EHR journey, specific tools may be more relevant based on your organization's array of services.

Copyright © 2014 Stratis Health. Updated 03-06-14


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