Integrating child health information systems in public health agencies.

Public health agencies at state and local levels are integrating information systems to improve health outcomes for children. An assessment was conducted to describe the extent to which public health agencies are currently integrating child health information systems (CHIS). Using online technology information was collected, to assess completed and planned activities related to integration of CHIS, maturity of these systems, and factors that influence decisions by public health agencies to pursue integration activities. Of the 39 public health agencies that participated, 18 (46%) reported already integrating some or all of their CHIS, and 13 (33%) reported to be planning to integrate during the next 3 years. Information systems most commonly integrated include Early Hearing Detection and Intervention (EHDI), immunization, vital records, and Newborn Dried Bloodspot Screening (NDBS). Given the high priority that has been placed on using technology to improve health status in the United States, the emphasis on expanding the capability for the electronic exchange of health information, and federal support for electronic health records by 2014, public health agencies should be encouraged and supported in their efforts to develop, implement, and maintain integrated CHIS to facilitate the electronic exchange of health information with the clinical healthcare sector.

All Kids Count 1991-2004: developing information systems to improve child health and the delivery of immunizations and preventive services.

The All Kids Count program began in late 1991 with funding from The Robert Wood Johnson Foundation. The purpose was to improve child health and the delivery of immunizations and preventive services through the development of health information systems. All Kids Count concluded in mid-2004 having worked directly with 38 state and local health agencies through its grant and Connections program. The lessons learned from the 13-year program are applicable to other public health and medical care initiatives. Health information systems projects should: (1) involve stakeholders from the beginning, (2) recognize the complexity of establishing a population-based information system, (3) develop the policy/business/value case for information systems, (4) define the requirements of the system to support users' needs, (5) develop information systems according to current standards, (6) address common problems collaboratively, (7) plan for change, (8) plan boldly but build incrementally, (9) develop a good communications strategy, and (10) use the information (even if not perfect). Opportunities exist for public health agencies to share their experiences from developing immunization registries and integrated child health information systems and to develop collaborative approaches to improving the nation's health information infrastructure.

Key elements for successful integrated health information systems: lessons from the States.

The Genetic Services Branch, Maternal and Child Health Bureau of the Health Services and Resources Administration has provided funding to state health departments to integrate their newborn dried blood-spot screening programs with other early child health information systems since 1999. In 2001, All Kids Count conducted site visits to these grantees to identify and describe best practices in planning, developing, and implementing their integration projects. The site visits were organized around 9 key elements considered critical to the success of an information systems integration project: leadership, project governance, project management, stakeholder involvement, organizational and technical strategy, technical support and coordination, financial support and management, policy support and evaluation. Best practices for each of the key elements and 5 lessons learned were documented in Integration of Newborn Screening and Genetic Service Systems with Other Maternal & Child Health Systems: A Sourcebook for Planning and Development. The lessons learned are overarching conclusions that agencies should consider when planning and implementing integrated information systems. This article briefly describes the key elements, their best practices as implemented by states, and the lessons learned.

Assessing organizational readiness and capacity for developing an integrated child health information system.

The Tool for Assessment and Planning (the Tool) assists public health teams in designing child health information integration projects from planning through early implementation. The tool is a companion to Integration of Newborn Screening and Genetic Services Systems with Other Maternal and Child Health Systems: A Sourcebook for Planning and Development (the Sourcebook). The Tool and the Sourcebook focus on 9 key elements considered critical to supporting information systems integration. The 9 key elements are: leadership, project governance, project management, stakeholder involvement, organizational and technical strategies, technical support and coordination, financial support and management, policy support, and evaluation. Project teams can use the Tool to assess their organizational readiness and capacity by examining the critical components and strategies required to support success based on the 9 key elements. The questions are intended to promote discussion among project team members and to identify specific action steps. The Tool includes a planning matrix to track those action steps and to identify accountable personnel. Strategically examining the critical elements and documenting next steps increases the likelihood of a successful integration project.

All Kids Count Connections: a community of practice on integrating child health information systems.

Integrated child health information systems consolidate data about multiple health care services a child receives into information useful to families, private health care providers, public health officials, and others. The challenges to successful integration faced by public health agencies are similar, yet system integration projects have historically struggled in isolation to overcome these barriers. All Kids Count created a community of practice called Connections to bring together 11 state and local public health agencies engaged in child health information system integration projects to learn from each other, capture best practices, and collaboratively address challenges. As demonstrated by All Kids Count Connections, communities of practice can be employed by geographically distributed public health agencies to address complex issues.