title: Experience of using information systems in public health practice: findings from a qualitative study.
abstract: OBJECTIVE
  Data collection and management by local health departments (LHDs) is a complex endeavor, complicated by system level and organizational factors. The purpose of this study was to describe the processes and use of information systems (IS) utilized for data collection, management, and sharing by LHD employees.
  
  
  METHODS
  We interviewed a purposive sample of 12 staff working in the key public health practice areas of communicable disease control, immunizations, and vital records from three LHDs in different states. Our interview questions addressed job descriptions, daily activities, and the use and perceptions of both data and IS in support of their work. A content analytic approach was used to derive themes and categories common across programmatic areas.
  
  
  RESULTS
  Local public health involves the use of mix of state-supplied and locally implemented IS supported by paper records. Additionally, each LHD in this study used at least one shadow system to maintain a duplicate set of information. Experiences with IS functionality and the extent to which it supported work varied by programmatic area, but inefficiencies, challenges in generating reports, limited data accessibility, and workarounds were commonly reported.
  
  
  CONCLUSIONS
  Current approaches to data management and sharing do not always support efficient public health practice or allow data to be used for organizational and community decision making. Many of the challenges to effective and efficient public health work were not solely technological. These findings suggest the need for interorganizational collaboration, increasing organizational capacity, workflow redesign, and end user training.
authors.affiliation: Center for Healthcare Informatics & Policy, Division of Quality and Medical Informatics, Department of Public Health, Weill Cornell Medical College.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Vest
authors.affiliation: Community Health Sciences Division, School of Public Health, University of Illinois at Chicago.
authors.forename: L Michele
authors.initials: LM
authors.lastname: Issel
authors.affiliation: Community Health Sciences Division, School of Public Health, University of Illinois at Chicago.
authors.forename: Sean
authors.initials: S
authors.lastname: Lee
keywords: Public Health Informatics; immunization; information systems; public health administration; vital statistics