{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T18:13:28Z","timestamp":1772648008995,"version":"3.50.1"},"reference-count":19,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Informatics"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/informatics13030040","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T15:01:07Z","timestamp":1772636467000},"page":"40","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Organizational Characteristics Associated with Health Information Systems Adoption in Local Health Departments During the COVID-19 Pandemic"],"prefix":"10.3390","volume":"13","author":[{"given":"Nardeen","family":"Shafik","sequence":"first","affiliation":[{"name":"Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0954-3418","authenticated-orcid":false,"given":"Gulzar H.","family":"Shah","sequence":"additional","affiliation":[{"name":"Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9275-1842","authenticated-orcid":false,"given":"Timothy C.","family":"McCall","sequence":"additional","affiliation":[{"name":"National Association of County and City Health Officials (NACCHO), Washington, DC 20005, USA"}]},{"given":"Bettye A.","family":"Apenteng","sequence":"additional","affiliation":[{"name":"Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3641-415X","authenticated-orcid":false,"given":"Mansoor","family":"Abro","sequence":"additional","affiliation":[{"name":"Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2353-2854","authenticated-orcid":false,"given":"William A.","family":"Mase","sequence":"additional","affiliation":[{"name":"Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.mnl.2020.08.006","article-title":"Use of the ADKAR\u00ae and CLARC\u00ae change models to navigate staffing model changes during the COVID-19 pandemic","volume":"18","author":"Balluck","year":"2020","journal-title":"Nurse Lead."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"H\u00fcbner, U.H., Mustata Wilson, G., Morawski, T.S., and Ball, M.J. 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