Many of the most important and effective public health strategies in the country depend on a two way communication between elements of the public health system and elements of the health care system. Lead screening programs depend on physicians following protocols, newborn screening programs must inform proactive clinicians to assure short and long term follow-up of out-of-range results, effective vaccine registries must be accessible by the clinicians. Data flow must be bidirectional to be truly effective. Disease reporting, newborn follow up information, and data to populate an immunization information systems all require that information be acquired from, and delivered to, the point of clinical care.

Digital communication between the public health and clinical care sectors would maximize the potential of information systems to improve the health of the nation. Clinical decision support can be enhanced by public health data from newborn screening results to disease surveillance statistics. Unfortunately, the promise of digital communication is limited by the poor penetration of IT into healthcare and public health. Fewer than a third of primary care practitioners use electronic health records, and most of these lack clinical decision support capabilities. Although this is likely to change eventually, the need for rapid communication between clinicians and public health is urgent.

We have developed a prototype technology for delivering just-in-time information into the hands of the clinician and capturing data electronically at the point-of-care for delivery into the public health system. This technology is called adaptive turnaround documents (ATD). While the backend technology is complex and depends on an integrated regional health information organization (RHIO), the front-end (in the clinician’s office) requires only a fax machine. The overall goal of this proposal is to develop a series of public health applications of ATDs to demonstrate the technology’s feasibility and evaluate its effectiveness.