Healthcare Provider Model
Some health departments are using HIV surveillance data to inform and assist healthcare providers in contacting patients to facilitate linkage to or re-engagement in care rather than contacting the individuals directly. These collaborations tend to be limited to certain providers or facilities, rather than jurisdiction-wide. For example, health departments might collaborate with providers of Ryan White-funded care by providing lists of patients who do not have laboratory evidence of a recent care visit and encouraging the Ryan White providers to re-engage these patients.
Ryan White providers also might collaborate with HIV surveillance programs by sending a list of patients they have not seen in their clinics for more than 6 months, which the health department matches to HIV surveillance data and other data sources, such as CAREWare and ADAP databases. Then, the health department informs the healthcare providers whether the match does or does not indicate that individual patients are receiving care from another healthcare provider. The healthcare providers then can prioritize contacting people whose last visit was more than 6 months ago and who do not appear to be in care elsewhere (1). This approach also might require varying degrees of effort to build relationships and partnerships focused on implementation, which might be formalized through memoranda of understanding (2, 3).
Health departments might be able to assist healthcare providers who use electronic medical records in conducting linkage and re-engagement activities in a more automated way. This could be accomplished by developing a secure, bidirectional system for exchange of data between the state-wide HIV surveillance database and a facility’s electronic medical record system. The bidirectional communication could alert providers that a patient they are seeing for a non-HIV-related care visit potentially has fallen out of HIV care or never entered care. The providers then could offer assistance with re-engagement or linkage to HIV care.
Health departments might use such a system to prompt a healthcare provider accessing the records of an HIV-diagnosed person who has not had a recent care visit to discuss and deliver HIV care to the patient, or to refer the patient to an HIV specialist. Consider this type of approach when it is possible to integrate HIV surveillance and a clinical information system, but will require resources to operationalize the technical aspects and careful formative work before implementation. This work might include:
- An ethics review,
- A review of legislation to assess the legal environment related to sharing public health information,
- An assessment of physician and patient acceptability (4),
- Solicitation of input from physicians and public health personnel to design the system, and
- Engagement of stakeholders to build consensus and a commitment to protecting patients and public health (5).