CINCINNATI – The H1N1 virus outbreak should be a reminder that public health needs to be a part of the discussion surrounding "meaningful use" of electronic health record systems, said Trudi Matthews, director of policy and public relations for HealthBridge, a community Health Information Exchange (HIE) that operates in the Greater Cincinnati-Northern Kentucky region.

Health information exchanges can provide value not only by monitoring lab results for positive cases of a virus, but also by monitoring electronic medical record data to detect flu-like symptoms, Matthews said.

HealthBridge's system has reported cases of salmonella in the past, but so far hasn't been tested for the H1N1 virus or any other reportable disease on large scale. Kentucky and Ohio have had less than 10 reported cases of the H1N1 virus combined, but Matthews pointed out that if the cases multiplied by 10 or 20,  the manual process would be extremely time-consuming and taxed.

The ability to do it electronically would be "absolutely critical," she said.

In 2005, HealthBridge began working with the Hamilton County health commissioner to develop a capability within its physician communication link system that enabled 14 city and county health departments to issue public health alerts to a certain number or all of the hospitals and physician offices in the county. The functionality also allowed hospitals to send reports to public health organizations as soon as a reportable disease was detected.

In 2007, HealthBridge developed a beta system for three of its member hospitals to provide automated disease reporting.

Since 2007, HealthBridge has been working to expand automated disease reporting for all 26-plus reportable diseases, but Matthews noted that broad-scale disease reporting has its limitations and challenges. For one, public health departments' systems, standards and processes are different from those of health systems, and it's very expensive to send information with current system connectivity.

Matthews acknowledged that grant funding might be needed to build capacity. Still, she noted, "We can't wait until the next outbreak. We have to have a pipeline in place to communicate effectively."

Despite the advances made by health information exchanges such as HealthBridge, Matthews said, "We still have a long way to go," linking everything on the clinical side, let alone linking clinical systems to public health systems.

Still, with 95 percent of lab data flowing through HealthBridge in electronic form, the HIE can support public health monitoring and reporting. HealthBridge is feeding - in real time - emergency room complaint data to a local university health system and is linked to the Centers for Disease Control to ensure the safety and security of its community, Matthews said. "We still want to monitor public health," she said. "We just need to do more."