title: Characteristics of Local Health Departments Associated with Implementation of Electronic Health Records and Other Informatics Systems.
abstract: OBJECTIVE
  Assessing local health departments' (LHDs') informatics capacities is important, especially within the context of broader, systems-level health reform. We assessed a nationally representative sample of LHDs' adoption of information systems and the factors associated with adoption and implementation by examining electronic health records, health information exchange, immunization registry, electronic disease reporting system, and electronic laboratory reporting.
  
  
  METHODS
  We used data from the National Association of County and City Health Officials' 2013 National Profile of LHDs. We performed descriptive statistics and multinomial logistic regression for the five implementation-oriented outcome variables of interest, with three levels of implementation (implemented, plan to implement, and no activity). Independent variables included infrastructural and financial capacity and other characteristics associated with informatics capacity.
  
  
  RESULTS
  Of 505 LHDs that responded to the survey, 69 (13.5%) had implemented health information exchanges, 122 (22.2%) had implemented electronic health records, 245 (47.5%) had implemented electronic laboratory reporting, 368 (73.0%) had implemented an electronic disease reporting system, and 416 (83.8%) had implemented an immunization registry. LHD characteristics associated with health informatics adoption included provision of greater number of clinical services, greater per capita public health expenditures, health information systems specialists on staff, larger population size, decentralized governance system, one or more local boards of health, metropolitan jurisdiction, and top executive with more years in the job.
  
  
  CONCLUSIONS
  Many LHDs lack health informatics capacity, particularly in smaller, rural jurisdictions. Cross-jurisdictional sharing, investment in public health informatics infrastructure, and additional training may help address these shortfalls.
authors.affiliation: Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, GA.
authors.forename: Gulzar H
authors.initials: GH
authors.lastname: Shah
authors.affiliation: de Beaumont Foundation, Bethesda, MD.
authors.forename: Jonathon P
authors.initials: JP
authors.lastname: Leider
authors.affiliation: de Beaumont Foundation, Bethesda, MD.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Castrucci
authors.affiliation: Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, GA.
authors.forename: Karmen S
authors.initials: KS
authors.lastname: Williams
authors.affiliation: East Carolina University, Greenville, NC.
authors.forename: Huabin
authors.initials: H
authors.lastname: Luo
mesh_terms: D057171:American Recovery and Reinvestment Act; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D057286:Electronic Health Records / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D018166:Health Care Reform / Q000379:methods / Q000458:organization & administration* / Q000706:statistics & numerical data; D063005:Health Information Systems / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006801:Humans; D009111:Local Government; D015999:Multivariate Analysis; D011795:Surveys and Questionnaires; D014481:United States