gathered by managed care organizations are weighted toward economic considerations (i.e., for reimbursement purposes) and might not contain medical information necessary for surveillance purposes. Some pilot studies conducted by managed care organizations and public health agencies are trying to determine the quality, accuracy, and availability of data regarding infectious diseases. These studies are showing that diagnostic testing may actually be no less prevalent among providers associated with managed care organizations than among other providers. If it is determined that diagnostic testing is not used because of cost considerations, partnerships between public health laboratories and managed care organizations could be negotiated to ensure that the testing needed for public health purposes is completed. To achieve this goal, public health agencies and managed care organizations need to work with medical information specialists as well as others to develop standards for computer-based patient records to ensure that such records will be useful for population-based health.

Finally, apprehension about the sharing of electronic data records with outsiders, including public health officials, is widespread among health care providers inside and outside of managed care. However, to accomplish their jobs effectively, public health agencies routinely have access to sensitive personal data, such as sexually transmitted disease contacts or sexual or other risk factors for disease. To date, public health agencies have an excellent record of accomplishment in safeguarding patient confidentiality and using these data only for public health purposes. However, fears about confidentiality have been used as an argument against the sharing of electronic medical data even for public health purposes. These concerns underscore the importance of privacy legislation pending before the U.S. Congress.

The field of public health is increasingly interested in expanding the amount and type of data used for surveillance to monitor old, new, or emerging public health problems. Public health officials often struggle to reconcile data about cases of infectious diseases reported by distinct sources and are seeking means of obtaining and linking the data already available electronically. The administrative simplification portion of the 1996 Health Insurance Portability and Accountability Act, which requires the potential use of standards developed by industry, provides additional incentives to work toward these solutions. Public health agencies must include managed care organizations as partners in this effort.

COLLABORATIVE SURVEILLANCE EFFORTS AND MONITORING OF DATA

Presented by Richard Platt, M.D.

Director of Research, Harvard Pilgrim Health Care

HMOs and public health agencies are natural partners in the development of community-based surveillance systems. Harvard Pilgrim Health Care, a mixed



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