Topology of local health officials' advice networks: mind the gaps.

OBJECTIVE: To determine how a health officials' advice network might contribute to a high-performing public health systems by facilitating diffusion of innovation and best practices. DESIGN: A secondary analysis of cross-sectional data obtained from the National Association of County and City Health Officials 2010 Profile of local health departments (LHDs) using network analysis. SETTING: The Profile survey is distributed biannually to all 2565 LHDs in the United States. In 2010, it included a network question: "In thinking about your peers who lead other local health departments in the U.S., list the five LHDs whose leaders you communicate with most frequently about administrative, professional, and leadership issues in public health." PARTICIPANTS: The network question was answered only by the top executive. The subjects are 1522 health officials who answered the network question plus 477 named as contacts (n = 1999). MAIN OUTCOME MEASURES: Measurements to assess network topology were density, centralization, transitivity, and reciprocity. At the node level, average centrality, clustering, effective network size, and clique count were measured. The convergence of iterated correlations algorithm was used to detect subgroups. RESULTS: : A sparsely connected core periphery network exhibited minimal evidence of unified communication. Mutually connected small groups tend to clump within state boundaries suggesting gaps in information flow. The pattern persisted at the regional level with an average health official having an effective network of only 2 others. CONCLUSIONS: Communication between peers may not be the primary way professional information diffuses among local health officials. National groups involved in performance improvement may wish to consider strategies to increase the diffusion of best practices and innovations through this network.

Implementing health information exchange for public health reporting: a comparison of decision and risk management of three regional health information organizations in New York state.

Health information exchange (HIE) is a significant component of healthcare transformation strategies at both the state and national levels. HIE is expected to improve care coordination, and advance public health, but implementation is massively complex and involves significant risk. In New York, three regional health information organizations (RHIOs) implemented an HIE use case for public health reporting by demonstrating capability to deliver accurate responses to electronic queries via a set of services called the Universal Public Health Node. We investigated process and outcomes of the implementation with a comparative case study. Qualitative analysis was structured around a decision and risk matrix. Although each RHIO had a unique operational model, two common factors influenced risk management and implementation success: leadership capable of agile decision-making and commitment to a strong organizational vision. While all three RHIOs achieved certification for the public health reporting, only one has elected to deploy a production version.

A system dynamics evaluation model: implementation of health information exchange for public health reporting.

OBJECTIVE: To evaluate the complex dynamics involved in implementing electronic health information exchange (HIE) for public health reporting at a state health department, and to identify policy implications to inform similar implementations. MATERIALS AND METHODS: Qualitative data were collected over 8 months from seven experts at New York State Department of Health who implemented web services and protocols for querying, receipt, and validation of electronic data supplied by regional health information organizations. Extensive project documentation was also collected. During group meetings experts described the implementation process and created reference modes and causal diagrams that the evaluation team used to build a preliminary model. System dynamics modeling techniques were applied iteratively to build causal loop diagrams representing the implementation. The diagrams were validated iteratively by individual experts followed by group review online, and through confirmatory review of documents and artifacts. RESULTS: Three casual loop diagrams captured well-recognized system dynamics: Sliding Goals, Project Rework, and Maturity of Resources. The findings were associated with specific policies that address funding, leadership, ensuring expertise, planning for rework, communication, and timeline management. DISCUSSION: This evaluation illustrates the value of a qualitative approach to system dynamics modeling. As a tool for strategic thinking on complicated and intense processes, qualitative models can be produced with fewer resources than a full simulation, yet still provide insights that are timely and relevant. CONCLUSIONS: System dynamics techniques clarified endogenous and exogenous factors at play in a highly complex technology implementation, which may inform other states engaged in implementing HIE supported by federal Health Information Technology for Economic and Clinical Health (HITECH) legislation.

Growth of a scientific community of practice public health services and systems research.

BACKGROUND: Public health services and systems research (PHSSR) is an emerging discipline that examines the organization, financing, and delivery of public health services. PURPOSE: The objective of this descriptive study is to provide insight into the discipline's growth by examining the researchers, practitioners, and policymakers who are engaged in PHSSR and their expertise, sources of funding, collaboration patterns, productivity, and challenges. METHODS: A 27-item online survey was conducted and analyzed in 2010. It targeted 2067 individuals who had participated in PHSSR groups, meetings, and events since 2004. The response rate was 41%. Descriptive statistics characterized demographics, expertise and mentoring, funding, publication, and collaboration. RESULTS: Half of the community members became involved in 2004 or after. More than 40% of the community collaborates in some form. Challenges include knowledge distribution, an agenda to secure ongoing funding, and translating research evidence to public health practice. CONCLUSIONS: A clear resource for the community is a nucleus of productive and engaged members who foster its growth.