Case report 1Health Care Services Division, Louisiana State University, Baton Rouge, Louisiana, USA 2Louisiana Public Health Institute, Health Systems Management-HIV/AIDS Programs, New Orleans, Louisiana, USA 3Louisiana Ofﬁce of Public Health, STD/HIV Program, New Orleans, Louisiana, USA 4Health Policy and Systems Management, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA 5Louisiana Ofﬁce of Public Health, Maternal and Child Health Program, New Orleans, Louisiana, USA 6Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, DC, USA Correspondence to Jane Herwehe, LSU HCSD, 1901 Perdido Street, Suite 7103, New Orleans, LA 70112-1393, USA; jherwe@lsuhsc.edu Received 31 May 2011 Accepted 4 September 2011 Published Online First 28 October 2011 This paper is freely available online under the BMJ Journals unlocked scheme, see http:// jamia.bmj.com/site/about/ unlocked.xhtml 448 Implementation of an innovative, integrated electronic medical record (EMR) and public health information exchange for HIV/AIDS Jane Herwehe,1 Wayne Wilbright,1 Amir Abrams,1 Susan Bergson,2 Joseph Foxhood,3 Michael Kaiser,1 Luis Smith,1 Ke Xiao,4 Amy Zapata,5 Manya Magnus6 ABSTRACT Louisiana is severely affected by HIV/AIDS, ranking ﬁfth in AIDS rates in the USA. The Louisiana Public Health Information Exchange (LaPHIE) is a novel, secure bi- directional public health information exchange, linking statewide public health surveillance data with electronic medical record data. LaPHIE alerts medical providers when individuals with HIV/AIDS who have not received HIV care for >12 months are seen at any ambulatory or inpatient facility in an integrated delivery network. Between 2/1/ 2009 and 1/31/2011, 488 alerts identiﬁed 345 HIV positive patients. Of those identiﬁed, 82% had at least one CD4 or HIV viral load test over the study follow-up period. LaPHIE is an innovative use of health information exchange based on surveillance data and real time clinical messaging, facilitating rapid provider notiﬁcation of those in need of treatment. LaPHIE successfully reduces critical missed opportunities to intervene with individuals not in care, leveraging information historically collected solely for public health purposes, not health care delivery, to improve public health. INTRODUCTION Louisiana is severely affected by the HIV/AIDS epidemic, with a rate of 19.4 new AIDS cases per 100 000 population in 2009.1 Its two most popu- lous metropolitan areas (Baton Rouge and New Orleans) rank second and ninth in AIDS case rates, respectively, among large metropolitan areas in the USA.1 Statewide data estimate that over a third of HIV-infected individuals do not receive HIV specialty care.2 Without treatment, infected indi- viduals experience disease progression more rapidly and are at increased risk of transmitting the disease to others.3 4 Current studies5e7 demonstrate that successful maintenance in care with antiretroviral treatment for HIV-infected patients is critical in slowing the epidemic as well as for individual health, yet challenges in identifying and retaining patients in treatment remain. Electronic health information exchange (HIE) offers a provider- acceptable means of utilizing information from multiple sources8e15 and could help overcome the challenges of engaging HIV patients in care. As a part of its efforts to reduce HIV transmission, a novel public HIE was developed in Louisiana, using public health surveillance and electronic medical record (EMR) data to identify, in real-time, HIV-infected patients without adequate clinical monitoring. EMR-based alerts notify providers whenever these individuals access care for any reason at one of the participating healthcare facilities, enabling immediate linkage into HIV treatment. In 2007, the Louisiana Ofﬁce of Public Health (OPH) partnered with the Louisiana State Univer- sity Health Care Services Division (LSU HCSD) to determine if individuals not receiving CD4 or viral load monitoring for >12 months were seeking medical care for non-HIV-related conditions. The analysis revealed that w1100 such individuals had received at least one non-HIV related service at LSU HCSD hospitals’ emergency departments or clinics since their HIV diagnosis. During clinical encoun- ters, the patient’s HIV diagnosis information was not readily available to the clinicians, suggesting visits were missed opportunities to deliver appro- priate care or referral to HIV specialty care while the person was in the healthcare setting. LSU HCSD is an integrated delivery network (IDN) of seven safety-net hospitals providing over 1.4 million outpatient encounters and over 70 000 inpatient admissions each year. It is Louisiana’s largest provider of inpatient and ambulatory HIV medical treatment, serving an estimated 60e75% of individuals receiving HIV medical care in Louisiana. Based on the 2007 match study, OPH and LSU HCSD hypothesized that bi-directionally exchanging information between healthcare providers and public health systems would be an effective means of identifying and linking hard-to-reach HIV-infected individuals into care. CASE DESCRIPTION The Louisiana Public Health Information Exchange (LaPHIE) is a secure bi-directional public health informatics application (an HIE in a broad sense, as deﬁned by Dixon et al16), linking statewide public health surveillance data with patient-level EMR data. The exchange functions in real-time throughout the IDN’s emergency departments, primary care and specialty ambulatory clinics, and inpatient units. LaPHIE represents an innovative exchange harnessing and integrating public health data to trigger real-time clinical decision support (CDS) to avoid missed opportunities for clinical and public health intervention. METHODS Approach Work ﬂow analyses identiﬁed opportunities for creating comprehensive linkage of information J Am Med Inform Assoc 2012;19:448e452. doi:10.1136/amiajnl-2011-000412