Article after article has been written about the challenges of Community Health.
Very few of these articles disagree that true community health improvement starts upstream of hospitals and clinics and then continues downstream, yet we continually see hospitals and clinics charged with assessing the community’s health.
Even the Affordable Care Act requires nonprofit hospitals to regularly assess their communities’ health needs and how they plan to handle them.
Virtually all hospitals are promoting community care and making efforts to help with health of their total community.
However, the question needs to be asked:
- Are hospitals and associated clinics really best suited to be challenged with improving the health of the community?
Articles such as this one from Fierce Healthcare list many different problems faced by hospitals who are trying to make their communities healthier.
Some of the problems include:
- Low to no return on investment
- Lack of community coordination and capability to integrate data
- Financial dis-incentives (for instance, spending money on initiatives that reduce incoming revenue)
- Lack of funding sources to help reach beyond the hospital system
All of these issues are difficult to overcome and probably will not be solved easily without outside help.
- What role do public health agencies play?
- What group of healthcare providers is more likely to have the most knowledge of the social determinants of the population they serve?
- What group of providers are most likely to actually visit people in their homes and best understand the actual health determinants of the population?
Equally important, the funding sources for the various programs administered by public health agencies require data from the efforts by the public health agencies to justify continued funding.
Public Health agencies have considerable experience reporting against metrics of various programs to help with the continued funding of many different programs.
This different perspective on reporting metrics is just one of the methods in which public health departments could help the health care provider community beyond their own agencies.
Many of the public health agencies nationwide have updated to an EMR that serves as the data repository for all the information relevant to their clients.
Most of the time that data within the systems of public health agencies does not duplicate the data hospitals would have on the same patient.
Rather, public health data would complement the hospital clinical information with a wide variety of social and community information, such as:
- Family relations
- Housing
- Financial
- Education
- Addictions
- Safety
- Long term health
- Contagious disease control information
Many public health departments now have the capability to securely exchange clinical data to reduce duplication and provide a more accurate history for other facilities.
In the last few years public health has contributed to the various private and state HIEs to help with the big picture of community health.
Granted, the exchange of data might not provide completely perfect information every time, but what system does?
The amount of data available for shared use can help both providers significantly, both clinically and economically.
The biggest questions that comes to mind after reading an article on the challenges of improving community health are:
- Where are the public health departments?
- Why do we rarely see articles about public health participating cooperatively with other health care providers to improve community health?
- What can be done to help draw the silos of both outside health care and inside health care together?
The tools to accomplish much better cooperation are now available.
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