Statewide EHR Decisions are a Big Opportunity – When Local Public Health is Fully Supported
Across the country, many states are taking meaningful steps toward statewide EHR modernization, aiming to create more connected and integrated health record systems across agencies and care environments.
This is an exciting development. A well-designed statewide solution can improve data sharing, reduce administrative burden, and strengthen care coordination.
But there’s one critical factor that determines whether local communities truly benefit:
Was the system designed for local public health work – or for hospitals?
Local Public Health and Hospital Care Are Fundamentally Different
Hospital and physician-practice EHRs are typically designed around:
episodic encounters
specialty referrals
inpatient/outpatient clinical billing
lab and imaging orders
acute care documentation
Local health departments, by contrast, operate in a completely different model.
Local public health focuses on:
prevention and wellness
community-based services
longitudinal home visiting
immunization and communicable disease clinics
grant-funded program reporting
population-level outcomes
The CDC describes local health departments as the backbone of community prevention and population health services — roles that extend far beyond traditional medical treatment.
In addition, the National Association of County and City Health Officials (NACCHO) highlights that local health agencies deliver essential services like outreach, care coordination, screenings, and public health programming.
This diagram from NACCHO illustrates the variety of ways local health departments serve their communities.
Local Public Health Teams Deserve the Same Consideration as Hospital Staff
Naturally, when a hospital selects an EHR, enormous effort goes into ensuring the physicians, nurses, and clinical staff have workflows that fit their environment. Their time is valued and their needs are prioritized. Their systems are tailored to support them.
Local public health professionals deserve the same careful consideration.
These teams are the ones running vaccination clinics, visiting families in their homes, responding to outbreaks, supporting vulnerable populations, and keeping communities healthy — often behind the scenes and with far fewer resources.
Yet too often, public health teams must adapt their work to tools designed for hospital billing cycles or inpatient care.
Public health is not an afterthought. The people doing this work should have tools and software that work for them.
Why the Best Approach Isn’t Always One System — It’s Two Systems That Share Data
Too often, statewide EHR conversations assume the goal should be a single platform for everyone.
The better approach is often two systems, each designed for its purpose — and both willing to share data.
That is the entire reason health information networks and interoperability frameworks exist: so hospitals, physician practices, and local public health agencies can exchange critical information without forcing everyone into the same tool.
Until every state has a mature Health Information Exchange (HIE) and all states are seamlessly connected across state lines in a true national network, the most practical path forward is:
hospitals using hospital-based EHRs built for acute care
public health using public health EHRs built for community services
prioritizing interoperability and data exchange between vendors
Consider a simple, but powerful, example
A mother is receiving Maternal and Child Health (MCH) services through her local health department — home visits, care coordination, nutrition support, postpartum monitoring. If she is unexpectedly admitted to the Emergency Room at the local hospital, it is critical that:
the health department knows
the care team can follow up
services remain coordinated when she returns home
That continuity of care is what protects outcomes for both mother and child.
Continuity of care is absolutely achievable when:
the hospital has a strong acute-care EHR
the health department has a purpose-built public health EHR
data-sharing networks connect both systems
Both systems are equally important — and both play a distinct role in keeping communities healthy.
Why Hospital-Based EHRs Often Fall Short for Local Health Departments
When states adopt systems originally built for hospitals, local public health teams often encounter challenges such as:
1. Limited Support for Public Health Clinics
Public health services—like STI clinics and community screenings—follow a different structure than hospital visits.
2. Inadequate Home Visiting Workflows
Many local agencies provide services in homes, schools, shelters, and community settings — environments rarely reflected in hospital-based templates.
3. Complex Program and Grant Reporting Requirements
Critically, instead of focusing only on individual encounters, local health teams manage caseloads across families and populations.
5. Public Health-Specific Documentation Needs
Hospitals document diagnoses and procedures. Local health document those as well and they document prevention plans, outreach, and community interventions.
A Purpose-Built Public Health EHR: Nightingale Notes
Consequently, this is exactly why Champ Software developed Nightingale Notes — an EHR designed specifically for local health department operations.
Unlike hospital-based systems, Nightingale Notes supports the real workflows public health teams rely on every day:
Champ Software: Trusted Partner to Local Public Health Agencies
Champ Software has spent decades supporting the specialized operational needs of local health departments.
Our focus is not on adapting hospital systems for public health.
Importantly, our focus is on delivering systems that work the way public health works, while also supporting interoperability and continuity of care across partners.
Nightingale Notes helps agencies modernize confidently while ensuring local teams have the tools they need.
Modernization Works Best When Local Public Health Has a Seat at the Table
Statewide health IT investments represent a major opportunity — and local health departments deserve solutions designed around their mission, not made to try to fit into hospital frameworks.
Hospitals need excellent acute-care systems. Public health needs excellent community-care systems. Communities benefit most when both systemsare connected.
Therefore, if your agency is evaluating statewide EHR direction or looking for a system built specifically for local public health, we’d love to connect.
