NCDHHS' Hospital-Based Public Health Epidemiologist (PHE) Program is celebrating its 20th anniversary this year. NCDHHS' Division of Public Health (NC DPH) developed the program in 2003 to increase the surveillance of significant events in public health by placing public health epidemiologists in the state's largest hospital systems. The partnerships between NC DPH and the state's hospitals have had a profound effect on communicable disease surveillance and have enhanced the protection of North Carolinians.
PHEs have often provided our first indication of public health issues and outbreaks. They have been a critical part of NCDHHS' routine work and throughout many emergency responses. Data from the PHE network have been critical for helping the department track COVID since the beginning of the pandemic and the PHEs have played many other roles in that response.
The program was born from a gap identified during the Oct. 2001 anthrax outbreak in the United States. A man who was visiting his daughter in North Carolina began to feel ill on the last day of his visit. Shortly after returning to his home in Florida, he was diagnosed with inhalational anthrax and, sadly, passed away from the illness. Given that an incubation period is generally 2-7 days, the question arose as to whether he had been exposed to anthrax while in NC.
NC DPH, the FBI, and CDC wanted to know if there were other potential anthrax cases hospitalizations in North Carolina. Communication and coordination between hospitals and NC DPH was a gap that needed to be urgently addressed, not only from a legal standpoint when hospital legal teams had to come to agreements with public health departments, but also in terms of resources. Hospitals did not have dedicated staff to perform analysis on hundreds of medical records.
An idea emerged to create a public health network to bridge disease surveillance and prevention and facilitate interaction between public health and healthcare organizations. The epidemiologists that would take part in this network had to be hospital-based and considered part of the hospital staff. Positions had to be funded through NC DPH to ensure that necessary public health-related activities were conducted.
With increased funding through the Public Health Preparedness and Response for Bioterrorism Cooperative Agreement with the CDC, NC DPH instituted a novel program, while also strengthening its established public health preparedness program. The hospital-based public health epidemiologist (PHE) program began in 2003 and seeks to “enhance communication among clinicians, hospitals, and the public health system; assist with the development of a surveillance method for monitoring and detecting infections, as well as detection and response to potential bioterror events; provide education and heighten awareness for diseases of public health importance.”
To fulfill its mission, the PHE program is composed of 13 individuals – the program director and 12 PHEs at eight locations. Considerations made in selecting hospitals include bed size, emergency department volume, and characteristics of the population served. Participating hospitals cover a wide geography of North Carolina and include medical schools and major medical centers, representing approximately 39% of general/acute care beds and 30% of emergency department visits in our state. PHEs bring a variety of expertise to the program. The majority hold nursing degrees, while others have master’s degrees in public health, science and business administration.
Although the program falls under the Communicable Disease Control Branch of NC DPH, each PHE has a supervisor within the hospital in addition to the PHE director. PHEs became the official, easily identifiable “public health” figures in their hospital systems, and their hospital colleagues routinely contact them regarding any public health issues. PHEs have access to a variety of hospital data sources that were not available to public health authorities in the past. With the new EPIC software utilized by all major hospital systems, PHEs have access to inpatient and outpatient hospital system data. PHEs' communicable disease reporting improved further after all PHEs were granted access to the North Carolina Electronic Disease Surveillance System (NC EDSS) by the local health departments (LHDs). Improvement in communicable disease reporting is consistently described by the LHDs as a benefit of the program, as there is one point of contact for patient information, they have access to close to real-time information and reporting, and there are quicker responses to LHD inquiries.
North Carolina has taken advantage of a unique opportunity to enhance communication and collaboration between health departments and local hospitals by implementing the hospital-based PHE program. The program has been an innovative means to improve North Carolina’s ability to prepare and respond to public health threats in our community. The benefits of the program have also served a greater goal of improving the public health infrastructure of North Carolina.