Organizational Characteristics Associated with Health Information Systems Adoption in Local Health Departments During the COVID-19 Pandemic

Background: The COVID-19 pandemic revealed persistent gaps in local health department (LHD) health informatics capacity. This study examines organizational characteristics of LHDs associated with the adoption of six health information systems: electronic case reporting (eCR), electronic disease reporting systems (EDRS), electronic health records (EHR), electronic lab reporting (ELR), health information exchange (HIE), and immunization registries (IR). Methods: We used a mixed-methods design, including multinomial or binary logistic regression analyses of quantitative data from the 2022 NACCHO National Profile of Local Health Departments (n = 441) and thematic analysis of semi-structured interviews with five LHD staff members. Results: About half (49.9%) of LHDs had implemented eCR, while higher proportions had implemented EDRS (78.0%), EHR (62.4%), ELR (57.2%), HIE (92.6%), and IR (92.6%). Workforce size was associated with the implementation of eCR, EHR, and IR. The number of vacant staff positions was associated with a lower odds of IR implementation; compared with medium-sized LHDs, both small and large LHDs had higher odds of IR implementation. Shared-governance LHDs had higher odds of adopting ELR and HIE than state-governed LHDs. Qualitative themes highlighted challenges, including staff burnout, high turnover, pay inequities, role ambiguity, political pressures, rapid changes in informatics, and interoperability problems. Conclusions: Findings underscore the need to improve LHD workforce capacity and governance structures to support a resilient public health informatics infrastructure.