1. A Practical Roadmap to Integrating Public Health (Surveillance) IT Systems Massimo Mirabito, Kumar Batra, Priscilla Chu Sharon R. Burks, William D. Correll, Thomas Sukalac

2. Presenter Disclosures Max Mirabito, Kumar Batra, Sharon Burks  Employed by Northrop Grumman  Own Northrop Grumman Stocks  Currently working on the CDC CIMS Contract supporting CDC/NCHHSTP Thomas Sukalac, William D. Correll  Employed by the Centers for Disease Control and Prevention  Currently support CDC/NCHHSTP Priscilla Chu  Employed by the San Francisco Department of Public Health  Currently supporting the Population Health Division

3. The State of Public Health IT Systems  Public health systems are becoming increasingly integrated  2011 MMWR report “State Electronic Disease Surveillance Systems — United States, 2007 -2010” 22% increase in integrated systems 211% increase in interoperable systems  NCHHSTP is encouraging data integration and harmonization  Surveillance Systems Consultation recommendations Leadership is involved in standardizing public health data Build systems that will break down silos Increase interoperability and harmonize data submission Facilitate collaboration between public health partners Provide guidance and facilitate information exchange Develop Public Health informatics workforce

4. The Importance of Integration  Collecting and aggregating  Deliver efficient and effective services  Shifting from disease specific to integrated systems Unified offering across disease domains  Benefits Improved data sharing and data quality Increase agility and ability to delivery services Detect, monitor, track, identify and correlate

5. Roadmap to Public Health IT System Integration

6. Roadmap: Key Factors

7. Factors Influencing Integration  Leadership priorities Aligned with mission, integrate all diseases, one system, privacy and confidentiality, efficiencies  Public Health Programs and Initiatives Critical, guide and shape  System Design and Architecture Design, resources, security, support, expandability  Integration Data exchange, interoperability, Application Program Interfaces (APIs) Four areas to Focus

8. Roadmap: Organization

9. Organizational Factors  Look Inside Strengths – EPI, surveillance, research, creativity Weaknesses – IT fragmentation, knowledge, siloes, policies and practices  Look externally Opportunities – Healthcare reform, liberating data, increase collaboration Threats/Challenges – Constrained budgets, categorical funding, policies Look closely at your organization

10. Roadmap: IT Environment

11. IT Landscape  Current landscape Invested considerable resources Duplicative systems and outdated technology Systems collect similar data in different formats IT is burdened; more and more to support and maintain  Upcoming landscape Technology has created new expectations New ways of socializing and discovering data Mobility is pressuring IT It’s harder to keep up IT is more complex than 20 years ago

12. Roadmap: Integration Challenges

13. Integration is Difficult  People Communicate vision Balance needs  Complexity Compartmentalization, unique needs Rushing to integrate, lack of requirements  Resources Funding, Infrastructure, Sustainability  Harmonization Concept vs. operationalization Risk is not your enemy

14. Roadmap: Recommendations

15. Recommendations  Align integration to Executive priorities, Public Health programs, Architecture, Integration  Develop your unique blueprint  Involve IT & Informatics early and often  Identify ways to liberate data to increase collaboration Align your solution to your focus areas

16. Roadmap: The San Francisco Blueprint

17. Roadmap: San Francisco Department of Public Health (SFDPH) Population Health Division  Background  Process  Key factors influencing integration  Organization  IT environment and information systems  Lessons learned from integration

18. Background  Program Collaboration and Systems Integration (PCSI) initiative  Syndemic analysis  65+ separate data systems  Decision made by Local Health Officer to move to integrated system Winchester Mystery House Roadmap: The SFDPH Population Health Division

19. Process  Stakeholder engagement  Informatics assessment Conducted 14 focus group interviews Synthesized information into an informatics report  Market solutions report Specific to local criteria  Business case  Software system demonstrations  Software system selection Roadmap: The SFDPH Population Health Division

20. Key Factors Influencing Integration  Strategic Map: Build an integrated information and knowledge management infrastructure  Ability to share data for client-centered holistic and syndemic approach  Increase efficiency: More collaboration Less paper Less duplicate data entry Roadmap: The SFDPH Population Health Division

21. Organization Roadmap: The SFDPH Population Health Division

22. IT Environment & Information Systems  IT’s support of systems IT focused on clinical systems Public health’s outdated systems  Lack of investment in IT Infrastructure, capacity and bandwidth Workforce development – look at future needs Roadmap: The SFDPH Population Health Division

23. Lessons Learned from Integration  Stakeholder engagement is important  Change is everywhere Population Health Division reorganization New Chief Informatics Officer - IT reorganization (4x) Clinical side reorganization  Change management Too much change at once is difficult Speak to the elephant Roadmap: The SFDPH Population Health Division

24. Conclusion  Develop a customized informatics blueprint  Invest in IT (infrastructure and human capital) and increase public health informatics capacity  Consider working with Informatics resources at CDC Integration is lifestyle Integration is a marathon Integration is a team sport

25. Acknowledgments US Centers for Disease Control and Prevention  Gustavo Aquino – NCHHSTP Associate Director for Program Integration San Francisco Department of Public Health  Israel Nieves – Director, Office of Equity and Quality Improvement, Population Health Division, San Francisco Department of Public Health