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.
Design: 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. Main Outcome Measures: 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.