Written by James Buehler, M.D., Philadelphia Health Commissioner
I authored a commentary that is part of the eGEMs and Frontiers’ series on information needs and the role of informatics in public health while I was a university faculty member, but I am writing now as the health commissioner for Philadelphia, the fifth largest city in the United States. As I read these papers, I was struck by how much easier it is to envision the future we would like to occupy than it will be to get there, by the number of things the authors of these papers advise that health departments should be doing, and by the challenges in balancing attention to the day-to-day situations versus attention to cultivating opportunities and capacities that will assure our future success. It is exciting to think about new sources and ways of using information that will arise from the expanding uses of electronic health records (EHRs) and electronic information exchange, but it is daunting to consider the hurdles that must be overcome to fulfill that promise, especially for public health agencies, as several authors noted.
Yet, this is a dynamic time to be working in public health, especially in a place like Philadelphia where our health department operates a network of primary care clinics that have installed an EHR system, so we can now see the health care and public health sides of population heath “up close and personal.”
In addition, Philadelphia is privileged to be surrounded by academic medical centers, a robust network of federally-qualified health centers, and partners from multiple sectors working to promote health in our neighborhoods; and we live in a state where Medicaid expansion is under way and Medicaid managed care providers and health care systems are testing new ways to engage their patients.
Many authors in the series commented about differing perceptions of the term “population health,” but a key unifying reality is that our health is shaped not just by the health care we receive, but also by our families, communities, and opportunities. In a city like Philadelphia, which has the highest poverty rate among the nation’s largest cities, those opportunities are often constrained by economic forces that adversely affect jobs and schools. This is not news, of course, but the population health provisions of the Affordable Care Act (ACA) and the federal program to expand the use of EHRs create new requirements and incentives for health care providers to address health care-community connections. They also create new opportunities for public health agencies to play a leadership role in building connections between health care and community services. A critical example is the ACA requirement that not-for-profit hospitals conduct periodic community health needs assessments, including recently updated guidance that they consult with at least one governmental public health agency. Like many health departments, ours has developed a city-wide health assessment and a community health improvement plan, both requirements for public health accreditation. We have an opportunity to point hospitals to that plan as they develop community benefit programs that must be informed by their needs assessments.
So where do we go from here? Personally, I plan to keep this set of papers close at hand as a reminder of the new opportunities and challenges now facing public health. The Philadelphia Department of Public Health will not be able to do everything the authors envision, but the authors have provided a valuable framework for navigating in our new world.