title: Governance's role in local health departments' information system and technology usage.
abstract: OBJECTIVE
  The purpose of this article is to explore the relationship between local health departments' (LHDs') governance structures and their use of information systems (IS) and information technologies (IT). As the US health system moves toward more integrated models of delivering care, LHDs have been identified as key nexus for information exchange. Therefore, understanding how LHDs' governance facilitates or inhibits the adoption and use of such IS and IT tools is critical.
  
  
  METHODS
  The 2008 survey of the National Association of County and City Health Officials' members included a set of questions dedicated to the use of IS/IT and its relationship to governance structures. Ordinal logistic and Poisson regressions are used to identify significant relationships among the variables. The survey sample's results (n = 473) are extended to the national sample (N = 2794) using the variable weightings included in the study design.
  
  
  METHODS
  The 2 dependent variables examined are IS and IT use. The IS variable captures the software and analytic tools used in LHDs. The IT measure primarily captures hardware and infrastructure capabilities.
  
  
  RESULTS
  Overall, the use of IS/IT by LHDs is low. Generally, LHDs that have shared governance structures with other state and community bodies tended to have greater IS/IT use. Similarly, larger LHDs with leaders that have higher educational levels used IS/IT in greater amounts.
  
  
  CONCLUSIONS
  With their current IS/IT capability levels, LHDs will struggle to play a meaningful role in the integration and exchange of health information. Given that LHD also serve at-risk populations in disproportionate numbers, this digital divide may become a real divide in the access to high quality care for some communities.
authors.affiliation: Health Policy & Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA. jvest@georgiasouthern.edu
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Vest
authors.forename: Nir
authors.initials: N
authors.lastname: Menachemi
authors.forename: Eric W
authors.initials: EW
authors.lastname: Ford
mesh_terms: D006801:Humans; D007256:Information Systems / Q000706:statistics & numerical data*; D007373:Interinstitutional Relations; D009111:Local Government; D024382:Professional Role; D011635:Public Health Administration; D018581:Technology Transfer; D014481:United States