1. 1 Build Your Community Health Information "Design for America“ In the Cloud Brand Niemann US EPA May 17, 2010 http://semanticommunity.net Disclaimer: These slides do not reflect the views of the U.S. Environmental Protection Agency and does not constitute endorsement by the EPA of the standards or products mentioned.

2. 2 Overview The Challenge The Sponsor The HHS Open Government Program The Expert and His Advice The Cloud Tools The Inspiration The Data Sources Other Sources of Data The Process The Results Comments Acknowledgements References

3. 3 The Challenge Are you interested in improving the health performance of your community? Curious about how the quality and cost of healthcare services in your area compare with others? Willing to put your technology talents to work to spur change in our nation’s health system? Then spend a few weeks figuring out how to visualize the most compelling data sets available free of charge at HHS. Aneesh Chopra is U.S. Chief Technology Officer and Associate Director for Technology in the White House Office of Science and Technology Policy. May 3, 2010.Aneesh Chopra http://healthitgov.wik.is/#The_Challenge

4. 4 The Sponsor The Sunlight Foundation, is sponsoring the “Design for America” competition, which is offering a $5,000 prize for the best visualization of community health data. According to Sunlight, “the visualizations should contribute toward the development of community health data dashboards that will enhance usability and understandability of health data for citizens and civic leaders. Entries will be judged based on how effectively, accurately, and creatively they enable users to gain insight about health performance in their communities as compared to others.”Design for America http://healthitgov.wik.is/#The_Sponsor

5. 5 The HHS Open Government Program The Community Health Data Initiative is a collaborative effort among government and non- government partners to establish a network of suppliers and demanders of community health data, indicators, and interventions. Its purpose is to help Americans understand health and health care system performance in their communities, thereby sparking and facilitating action to improve performance and value.Community Health Data Initiative http://healthitgov.wik.is/#The_HHS_Open_Government_Program

6. 6 The HHS Open Government Program The HHS Health Indicators Warehouse that is currently under development will serve as the data hub for the initiative. We consider health indicators to be measurable characteristics that describe the health of a population (such as life expectancy, mortality, disease incidence or prevalence, or other health states); determinants of health (such as health behaviors, health risk factors, physical environments, and socioeconomic environments); and health care access, cost, quality, and use. Depending on the measure, a health indicator may be defined for a specific population, place, political jurisdiction, or geographic area. NCHS is working with data, content, and application experts to develop this interactive system that will represent a major infusion of free, easily accessible HHS data. While the warehouse is under development, we are making several resources available: –Downloadable data sets which form the basis for the content anticipated to be available through the Indicator Warehouse and which will further the success of the Community Health Data Initiative. –A draft set of indicators that may be included is available for review and comment.

7. 7 Downloadable Data Sets http://www.cdc.gov/nchs/data_access/chdi.htm

8. 8 A Draft Set of Indicators http://healthitgov.wik.is/Community_Health_Information/Health_Indicators_Warehouse_Project:_Community_Health_Status_Indicators

9. 9 The Expert and His Advice Edward Tufte Presidential appointment announced by White House, March 5, 2010.announced by White House Tufte's Visual Display of John Snow's Data: –See UCLA Department of Epidemiology, School of Public Health Web Site. Also search for “Community Health”. Web Site“Community Health” "Medical statistics will be our standard of measurement: We will weigh life and see where the dead lie thicker, among the workers or among the privileged", Rudolf Virchow, in Edward R. Tufte, Beautiful Evidence (2006), Graphics Press LLC. Tufte Comment on iPhone interface design: Better to have users looking over material adjacent in space within our eyespan rather than stacked in time. This is especially the case for statistical data, where the fundamental analytical task is to make comparisons. Also see page 159 in the above book reference.Comment on iPhone interface design http://healthitgov.wik.is/#The_Expert

10. 10 The Cloud Tools http://cloud.mindtouch.com/

11. 11 The Cloud Tools http://healthitgov.wik.is/

12. 12 The Cloud Tools http://spotfire.tibco.com/

13. 13 The Cloud Tools http://ondemand.spotfire.com/public/Help/index.htm

14. 14 The Inspiration H1N1 Spread Courtesy of TIBCO Spotfire. See Web Player.Web Player

15. 15 The Data Sources Downloadable Data Sets: –Community Health Status Indicators (CHSI) –County Health Ranking - Mobilizing Action Toward Community Health (MATCH) –Healthy People 2010 (DATA 2010) –Centers for Medicare & Medicaid Services –US Food Environment Atlas –AHRQ National Healthcare Quality and Disparities Reports –The State of the USA (No data yet) Selected Indicator Reports and Initiatives: –America’s Children: Key national indicators of well-being, 2009 –Chronic Disease Indicators –Health, United States, 2009 –Healthy People (Data not available yet) –Older Americans 2008 http://healthitgov.wik.is/#The_Data_Sources

16. 16 The Data Sources http://healthitgov.wik.is/#The_Data_Sources

17. 17 The Data Sources http://data.medicare.gov/ Note: This web site is the most similar to the Mindtouch Wiki / Spotfire Silver Analytics Beta in the Cloud (Web Player) used here.

18. 18 Other Sources of Data Other Sources of Data: –EPA Report on the Environment (2008): Human Exposure and Health –Annual Statistical Abstract (2010) Births, Deaths, Marriages, and Divorces Health and Nutrition –More in progress http://healthitgov.wik.is/#Other_Sources_of_Data

19. 19 Other Sources of Data http://federaldata.wik.is/Statistics

20. 20 The Process The Basic Steps: –Inventory Data Sources and Plan Application –Prepare and Import Data and Metadata –Implement Layout and Analytics –Add Bookmarks and Create Data Stories –Publish and Test in Web Player –Get Feedback and Improve http://healthitgov.wik.is/#The_Process

21. 21 The Process The Overall Strategy: –Do at least one example for each of the Downloadable Data Sets and Selected Indicator Reports and Initiatives and then do the most analytics for the “best”. –Deal with the problems in the data sets that require some reformatting in Excel first. E.g., Spotfire Analytics just wants the data – mark all other rows “ignore” and put them in the metadata. –Create a data dictionary if one does not exist. –Do Exploratory Data Analysis (EDA) and select some data stories to create visualizations for. http://healthitgov.wik.is/#The_Process

22. 22 The Results Spotfire on the Desktop http://healthitgov.wik.is/#The_Results

23. 23 The Results Spotfire Silver Analytics Beta in the Cloud (Web Player)Web Player

24. 24 The Results CHSI: DATA ELEMENT DESCRIPTION & DEFINED DATA VALUE Note: The Community Health Status Indicators (CHSI) have an excellent Data Dictionary (two tables in Spotfire) and Metadata (10 links to the Wiki).

25. 25 The Results County Health Ranking - Mobilizing Action Toward Community Health (MATCH): Virginia Note: Fredericksburg stands out with the highest values by both County and Deaths!

26. 26 The Results Centers for Medicare & MedicaidServices-Home Healthcare Compare_Revised_flatfiles Percentage of patients who get better at getting in and out of bed versus Percentage of patients whose bladder control improves by Type of Ownership Note: More mobility leads to better bladder control independent of Type of Ownership.

27. 27 The Results Health, United States, 2009 Table 150. Persons without health insurance coverage, by state United States, average annual 1995–1997 through 2005–2007 Texas had the highest percentage of persons without health insurance coverage, annual average 2005-2007.

28. 28 Comments The analyses of these data and the Other Sources of Data from the EPA Report on the Environment (2008): Human Exposure and Health, and Census Annual Statistical Abstract (2010): Births, Deaths, Marriages, and Divorces and Health and Nutrition will continue. Please use the Add Comment feature at the bottom of this wiki page to provide feedback and suggest additional analyses you would like to see. To use the Add Comment feature you first need to register by providing your email address. Your privacy will be respected and your email address will not be available to others or used for any other purpose. You can also download the Spotfire file from this Wiki and a 30-day free evaluation copy from http://spotfire.tibco.com and reuse these analyses, add your own data to this file or to new Spotfire files that you create. Have fun and give us your feedback! http://healthitgov.wik.is/#Comments

29. 29 Acknowledgements The author acknowledges gratefully Dean Allemang, Cory Casanave, Sean Connors, Mills Davis, Li Ding, David Eng, Lee Feigenbaum, Aaron Fulkerson, Jim Hendler, Ralph Hodgson, Kevin Kirby, Kevin Jackson, Bob Marcus, John McMahon, Richard Murphy, Brand Niemann, Jr., Barry Nussbaum, Matthew Phoenix, Tony Shaw, Jeff Stein, George Strawn, George Thomas, Pete Tseronis, and Edward Tufte. http://healthitgov.wik.is/#Acknowledgements

30. 30 References Brand L. Niemann, Put Your Desktop in the Cloud to Support the Open Government Directive and Data.gov/semantic, April 19, 2010, Semantic Universe. Semantic Universe Brand L. Niemann, Build Your Own Data.gov and EPA Microsite with Semantics and Statistics in the Cloud, May 15, 2010, Slides.Slides Edward R. Tufte, Beautiful Evidence (2006), Graphics Press LLC. Graphics Press LLC http://healthitgov.wik.is/#References