Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health


Health Services Research & Administration

First Committee Member

David Palm

Second Committee Member

Brandon Grimm

Third Committee Member

Susan Bockrath


Background: Public health issues are constantly changing and require local health departments (LHDs) to continually evolve in their approaches to address these issues. Advancements in health information technology (HIT), such as electronic health records (EHRs), play an important role in the collection of data that can be used to improve population health.

Objective: The purpose of this project was to assess the current use of electronic health records data by Nebraska’s local health departments and identify the data or tools they are using to address the health needs of the populations they serve.

Methods: In this study, a Mixed-Methods approach was used to collect data, using both quantitative and qualitative methods. A survey questionnaire was administered to all local health departments in Nebraska. Purposive sampling was used to select three Nebraska local health department directors and two Nebraska Health Information Initiative (NeHII) employees for semi-structured interviews.

Results: The study questionnaire garnered responses from 14 local health departments in Nebraska. A majority of respondents (64.3%) indicated that their department currently uses electronic health records data for public and population health activities. Local health departments currently using EHRs data all reported the use of Immunization Registries, followed by 88.9% who used Electronic Laboratory Reporting, and 77.8% who used Syndromic Surveillance Data. Approximately 66.7% of respondents always or often used electronic health records for Health Needs Assessments, Strategic Planning, and Program Planning. In departments not currently using EHRs data, 66.7% had no plans to implement use in the future. The most commonly cited barrier by health departments to the use of such data was the lack of funding needed to implement use, followed by concerns of the department’s capacity or resources to use the data. These were corroborated by interview participants who also cited a lack of funding and resources as primary barriers to the use of EHRs data for public health. The potential for use was seen with most respondents (71.4%) stating that electronic health records had a very useful effect for improving public and population health. The utilization of Nebraska Health Information Initiative tools was seen in most local health departments (64.3%). All departments using NeHII reported having received training in NeHII tools, with more than half reporting using NeHII multiple times a week. A lack of knowledge of NeHII tools was cited as a key barrier to use by departments not using NeHII. Most respondents were favorable of NeHII stating it was important for public health, easy to use, and was a part of workflow.

Conclusion: To better meet the public health needs of Nebraska, it is imperative to identify the current practices of local health departments to determine areas for improvement. The use of electronic health records data is an important technological tool for helping local health departments in Nebraska achieve better health outcomes in the state. Barriers to electronic health records data use must be addressed and a new emphasis placed on securing resources to improve utilization.