Presentation on theme: "Date: Thursday, April 30, 2009 Time: 12:00 – 1:30pm EDT"— Presentation transcript:
1 What is public health informatics and what can it do for my local health department? Date: Thursday, April 30, 2009Time: 12:00 – 1:30pm EDTSpeakers: Dr. Arthur Davidson, Denver Public Health,Dr. Anna Orlova, PHDSC & Johns Hopkins University,Moderator: Alastair Matheson, NACCHO,
2 Welcome and overview Why should I care about informatics? Scenarios that are relevant to your workQuestions raised by these scenariosCompelling reasons to get involvedWhat will the benefits be for you?What are some of the issues in informatics?Why is it important for local public health to be involved?What are the next steps?What the stimulus can and cannot do for youWhat should you do now?What is NACCHO doing?There may be a spectrum of listeners and skills in our listeners regarding public health informatics.We hope that this introductory webinar provides a stimulus for the listeners to become more engaged.This short discussion will not solve your jurisdiction’s information problems, but it may begin to point to real opportunities in our field right now.The time is right for you to be an advocate for public health informatics within your jurisdiction and beyond.NACCHO believes that informatics plays an important role in advancing public health and the health care reform agenda.
3 Scenarios Scenario 1: Communicable Disease CDC has activated its Emergency Operations Centers to coordinate the agency’s response to the swine influenza outbreak.Scenario 2: Chronic DiseaseThe mayor/county commissioner/city council person for your jurisdiction made an inquiry about public health efforts to improve cardiovascular disease care and outcomes in your community.Scenario 3: Health Information ExchangeThe local medical society is organizing an effort to respond to the recent incentive packages for physicians and hospitals to adopt electronic health records. The president of the society calls you to see if you would help them determine was meaningful use should be in your community.
4 Scenarios (continued) Scenario 4: - WorkforceNew federal preparedness funding guidance focuses on building connectivity between the personal and public healthcare environments for situational awareness. The state health department (SHD) is encouraging local health departments (LHD) to develop tools for interoperability with the state and the larger health care community regarding biosurveillance systems.
5 How to find needed information? Scenario 1: - Communicable DiseaseCDC has activated its Emergency Operations Centers to coordinate the agency’s response to the swine influenza outbreak.How do you go about answering questions in your jurisdiction regarding:potential sources of infection?comparing current and prior year rates of seasonal flu?How do you acutely improve your surveillance methods?How do you share data and analyses with neighboring jurisdictions and CDC?How are you communicating information to the public?
6 How to find needed information? Scenario 1 – Swine InfluenzaWhat information systems, if any, do you use to support CDC response?What has been your experience to date in getting data and how you are using these information systems?
7 Informaticsa field that helps users (public health professionals, clinicians, etc.) to communicate to developers user needs for information technology (IT) products, so these IT products will be useful in finding information to support public health decisions.Typical paper-based systems are inadequate to match the tasks most LHD and SHD are faced with over the past few days.Answering these questions requires new tools.The public is expecting a measured and balanced response by public health agencies.Getting the info right is the only way to avoid the pressure by the media to promote fear and panic.Learning how to use the data we have to create information and knowledge is the first step.Informatics is the process to help build that knowledge.Informatics is a focused approach on communicating between the end-user and the developer of information systems as described in this definition.
8 Informatics“Informatics is the science that studies the use and processing of data, information, and knowledge”Along the continuum, our public health activities collect data, but the systems need to transform that into information and ultimately actionable knowledge.To answer many of the preceding questions, we are looking for the information toSpeak with certainty about potential sources of infection?Compare current and prior year rates of seasonal flu?Or we are looking for systems that are flexible and can:Ramp up to acutely improve your surveillance methods?share data and analyses with neighboring jurisdictions and CDC?Or we may be looking for tools that help with:communicating information to the public?Van Bemmel JH & Musen MAHandbook of Medical Informatics.Bohn: Springer-Verlag
9 Informatics vs. Information Technology Informatics is NOT Information Technology (IT).Informatics is the field that describes the problem (application domain), e.g., Flu Surveillance, for which an IT solution (application, tool) is needed, e.g., Flu Surveillance Information System to (1) track cases of sick individuals, (2) generate public health alerts, (3) monitor vaccine distribution, etc..Informatics through modeling helps to select best IT solution to address a Problem.So, an IT professional (developer) is an engineer who builds the tool for the solution. Informatician is a user who designs the solution.
10 Informatics and Modeling Model Development is the Main Informatics MethodInformatics and ModelingInformatics uses models of the problem (application domain) to:capture domain knowledge;precisely specify requirements, i.e. specifications for a solution so that all stakeholders may understand and agree on them;guide the thought process;generate potential system configuration describing a generic structure and meaning;abstract specifications of the essential structure of the system;tell what something does (functional specification) as well as how the function is accomplished (implementation)Rumbaugh et al Unified Modeling Language. Manual.
11 Problem (domain) modeling is FOUNDATIONAL for a successful IT application InformationTechnologyInformaticsCP Friedman. Where's the science in medical informatics?J. Am. Med. Inform. Assoc : 65-67
12 Using Informatics Tool of Modeling Scenario 1: - Communicable DiseaseCDC has activated its Emergency Operations Centers to coordinate the agency’s response to the swine influenza outbreak.How do you go about answering questions in your jurisdiction regarding:potential sources of infection?comparing current and prior year rates of seasonal flu?How do you acutely improve your surveillance methods?How do you share data and analyses with neighboring jurisdictions and CDC?How are you communicating information to the public?Now returning to our scenario, how would you go about modeling the user workflow.Who would do this work?What skills are required?Some of these questions will be addressed as we get to other scenarios, but it is important to begin thinking that modeling is a public health skill set or competency.These are natural tools for a system as complex as public health where we are a very outward facing organization with an incredible network of partners on whom we depend for much of our preparedness and response capacity.Some of these modeling activities are addressed in the series of slides that follow:Modeling User Workflow….
13 Modeling User Workflow Event Detection EHRSNeighboring JurisdictionsHospitalState Public Health Surveillance System1- Report/retrieve symptoms, diagnosis & medication prescription data from EMRs7 – Report on the positive case electronically & by phone2 – Data mining of EMR notesAmbulatory Care3 – Notify on increased number of cases & recommend to order pathogen test4 – Orderpathogen testCDCLocal Public Health Surveillance System5 – Reporttest resultsPUBLIC5 – Reporttest resultsMediaLaboratoryResponse TeamPharmacy
14 Modeling User Workflow Event Monitoring Neighboring JurisdictionsHospitalEHRSState PH Surveillance System3 - Monitor ER visits & hospitalizations data from EMRs1 – Sendhealth alert2 - Monitor newly diagnosed cases & vaccination data from EMRs9 – Send updates on the eventAmbulatory Care4 – Orderpathogen test6 – Send order to activate emergencyvaccinationLocal Public Health Surveillance System5 – Reporttest results10 – Sendhealth alertto the publicCDCPUBLIC5 – Reporttest results7 – Order/ SupplyvaccineMedia8 – MonitorvaccinesuppliesLabResponse TeamPharmacy
15 Modeling User Workflow Event Management Neighboring JurisdictionsEHRSHospitalState Public Health Surveillance System3 - Monitor ER visits, hospitalizations data from EMRs & utilization data1 – SendOutbreak updates2 - Monitor newly diagnosed cases & vaccination data from EMRs9 – Send outbreak updatesAmbulatory Care4 – Orderpathogen test6 – Send Rapid Flu Test Kits10 – Sendoutbreak updatesto the publicLocal Public Health Surveillance System5 – Reporttest resultsCDCPUBLIC5 – Reporttest results9 – Activatecoordinatedresponse7 – Order/ SupplyvaccineMedia8 – MonitorvaccinesuppliesLabResponse TeamPharmacy
16 Output of Informatics Modeling Tools Modeling helps identify and define:ParticipantsActors involved in the information exchanges regarding the swine influenza outbreak:Hospitals, Ambulatory Clinics, Laboratories, Vaccine Supplies and Distributors, Local and State Health Departments, CDC, Schools, MediaInteractionsActions between participants in the information exchangeanswering questions regarding: potential sources of infection, comparing current and prior year rates of seasonal flu, methods to acutely improve your surveillance methods, sharing data and analyses, communicating information to the public
17 From User Needs to System Development Informatics Concepts: Public Health ConceptsProblem / Domain: Flu surveillanceGoal: Help coordinate CDC response on Swine Flu outbreakStakeholders (Actors) Participants in information exchangeFunctions (Actions) Interactions among participants in the exchangeData: Cases by jurisdiction, lab data, vaccine supplies data, etc.Information: Event detection, monitoring, responseKnowledge: Situational awarenessTool (Modeling): Workflow and dataflowFlu Surveillance Information SystemSpecificationsDesignTrial ImplementationDeploymentEvaluation
18 Informatics Applications Adjectives are used to distinguish the field where informatics is applied such asmedicalenvironmentaldentalnursingpublic health....
19 What is Public Health Informatics? “Public Health Informatics is the application of information science and technology to public health research and practice”Friede A, McDonald M, Blum HPublic health informatics: how information-age technology can strengthen public health. Ann Rev Public Health 16:239-52
20 Lagging National Agenda for PH Informatics Funding and Governance (11 Items)Architecture and Infrastructure (10 Items)Standards and Vocabulary (11 Items)Research, Evaluation and Best Practices (14 Items)Privacy, Confidentiality, and Security (12 Items)Training and Workforce (16 Items)Nearly a decade ago, these important observations were made by public health practitioners. To date, have we really made much progress in these areas.Do you have an understanding of what these items really mean?How would your department begin to address contributing knowledge to these items or benefiting from those who have been working in these areas?Yasnoff WA, Overhage JM, Humphrey BL, LaVenture M. A national agenda for public health informatics. JAMIA 2001; 8 (6):
21 How to find what information we need? Scenario 2 – Chronic DiseaseThe mayor/county commissioner/city council person for your jurisdiction made an inquiry about public health efforts to improve cardiovascular disease (CVD) care and outcomes in your community.What are your sources of data for responding to the following questions:How bad is the problem in our community?Do we know of any ongoing interventions?Where are they being conducted?What have been the results of those efforts?Can we compare current to prior year rates?Do you have any ideas on how to improve surveillance and methods for intervention?A foundation is interested in supporting public health efforts:how would you propose next steps?Again a modeling approach can help define the actors and actions for each of these questions.There may not yet be a good system within your community to address these difficult questions.Some communities may be ahead in these metrics or interventions but most still have not thought globally or in a systems way about this enormous epidemic.Would your approach to the foundation’s interest resort to a specific intervention or should you review what systems would be required to effectively answer the preceding questions
22 CVD Surveillance Modeling User Workflow EHRS P U B L I C Hospital PayorHospitalEHRSState Public Health Surveillance System9 - Monitor ER visits, hospitalizations data from EMRs & utilization data1 – Conduct Routine Check-ups4 – Prescribe Medication and Treatment Plan11 – Send reportsAmbulatory Care12– Conduct Surveys (BRFSS)5 – Monitor Treatment2 – Ordercholesterol test7 – Report Data to Public Health3 – Reporttest resultsLocal CVD Surveillance System10 – Conduct HealthEducationDHHSDescribe the flow here.Then allude to how this may apply to any chronic disease: asthma, obesity, diabetes.The goal of the modeling process is to define the actors and actions for a specific problem or domain but also to see the similarities.The investment in models should seek clearly reusable components.The investment in technology should consider flexible solutions that apply to multiple program areas.PUBLIC6 – Fill Prescription8– CoordinateCareMediaLaboratorySchoolPharmacy
23 Electronic Health Record (EHR) Electronic Health Record (EHR) is information, assembled and maintained in an electronic format which pertains to the health status of an individual and the health services delivered to an individual.EHR is also defined as:standardization in the field of health information and communications technologyto achieve compatibility and interoperability between independent systemsto ensure compatibility of data for comparative statistical purposes (e.g., classifications), and to reduce duplication of effort and redundancies.Introduce concepts and meaning of EHRInternational Organization for Standardization (ISO). URL:
24 Electronic Health Record System (EHR-S) Electronic Health Record System (EHR-S) includeslongitudinal collection of electronic health information for and about persons, where health information is defined as information pertaining to the health of an individual or health care provided to an individual;authorized users;provision of knowledge and decision-support that enhance the quality, safety, and efficiency of patient care; andsupport of efficient processes for health care delivery.Critical building blocks of an EHR system are:the electronic health records (EHR) maintained by providers (e.g., hospitals, nursing homes, ambulatory settings) andthe personal health records (PHR) maintained by individualsKey capabilities of an EHR System.Institute of Medicine. Report. July 31, 2003.URL:
25 Electronic Health Record (EHR) Infrastructure EHR Infrastructure is comprised of:databases,programs,software,hardware,servers,firewalls,access rules,Virtual Private Network (VPN) linkages, andweb browser capabilities of the electronic health record system.Can you reap the benefit of community implemented EHR without more fully understanding the various components?How do they all work and how they might communicate with your health department?If they don’t communicate with your health department will you get any of the benefits described in the modeling process?
27 How to find what information we need? Scenario 3: Health Information ExchangeThe local medical society is organizing an effort to respond to the recent incentive packages for physicians and hospitals to adopt electronic health records. The president of the society calls you to see if you would help them determine was meaningful use should be in your community.What are issues that you should consider as a member of the planning team?Who on your staff would best serve as a liaison to the group?What would you want to be an outcome from your LHD involvement?
28 Health IT Strategic Framework President Bush 2004 Launch Goal 1:Inform Clinical PracticeIncentivize EMR adoptionReduce risk of EMR investmentPromote EMR distributionto rural andunderserved areasGoal 3:Personalize CareUse of personal health recordEnhancement ofinformed consumer choicePromote telehealth systemsStrategicFrameworkGoal 2:Interconnect CliniciansFoster regional collaborationDevelop Nationwide HealthInformation Network (NHIN)Coordinate federal healthinformation systemsGoal 4:Improve Population HealthUnify PH surveillancearchitectures,Streamline quality and healthstatus monitoringAccelerate researchand dissemination ofevidence into practiceThe steps to developing a health information exchange have been evolving over the past decade.Significant investments by the federal government started about 5 years ago but more substantial investments are being realized through the recent ARRA.A strategic framework was introduced during the last administration. It may be valuable to visit some of the processes, components and progress in that area of health information exchange.Notice the emphasis in Goal 4: improve population health.The federal government considered the need to unify PH surveillance architectures, streamline quality and health status monitoring and accelerate reseratch and dissemination of evidence into practice. All of these are important pieces and directly relate to our operational definition of a LHD.
29 Federal Vision Build a Nationwide Health Information Network (NHIN) regional health information organizations (RHIOs) and exchanges (RHIEs)RHIOs and RHIEs would in turn be formed by:health care providers (HCPs)integrated electronic health record systems (EHRS) to improve patient safety and deliver quality carepersonal health recordspayersancillary services (labs, pharmacies, radiology)Thompson TG and Brailer DJ. The Decade of Heath Information Technology to Deliver Consumer-centric and Information-rich Health Care. Framework for Strategic Action. US DHHS, July 21, URL: URL:
31 American Health Information Community National Health IT Landscape Executive Branch HIT InitiativesAmerican Health Information CommunityBusiness needs and prioritiesUse CasesNHINNetwork service providersArchitecture specificationsCertificationCriteria developmentTestingCyclesStandardsInteroperability SpecificationsBusiness DeploymentSustainable business modelsState / regional partnershipsSoftware and EvaluationHIEHIORHIOPoliciesState laws and regulationsFederal leadershipSource: ONC, Second Nationwide Health Information Network Forum, Oct 2006
33 Scenario 1: Vaccine and Drug Administration and Reporting Perspectives/RolesInformation Sources & RecipientsMay be one or more of those listed below:Section 7.1ClinicianSection 7.2Public HealthSection 7.3ConsumerSection 9.0Information ExchangeSection 7.4RegistriesImmunization Knowledge Providers7.1.1 Incorporate immunization schedules into clinician systems1Health Information ExchangeORPoint-to-point exchangeSpecialty NetworkCapabilities as needed in context:9.3 Subject-data matching9.2 Data retrieval9.1 Data delivery9.4 Data provisioning9.5 Support for personally controlled health records9.6 Emergency access17.4.1 Incorporate immunization schedules into registries7.3.1 Provide available immunization information134Health Registries27.3.2 Request immunization information2Individuals Requiring Intervention - Public Health Case Reporting Use Case57.4.2 Provide vaccine or drug administration information2Health Care Organizations7.1.2 Identify individuals to receive vaccine or drug247Other Immunization Information Systems7.4.3 Retrieve vaccine or drug administration information37.1.3 Administer vaccine or drug7.3.3 Receive Vaccine Recall Information83Payors7.1.4 Report administration information to registries7.4.4 Receive vaccine or drug administration information55Public Health Agencies7.2.1 Identify individuals needing prioritized interventionThis is the flow diagram for one aspect of the immunization and response management use case.It is a very high level view of what we do every day in our local health departments.We may at times play the role of the clinician or the public health department.Our perspectives may be multiple.The key point is that again the modeling approach and detailed analysis of information flow, with actors and actions is imperative if we are to build systems either internally or in a large community that effectively exchange data to benefit population health.This modeling approach looks at the actors as perspectives or roles along the top and potential information sources or recipients of information along the column on the right.Each of the data flows are represented by an arrow that points to an action. All of these are highly detailed in the implementation specifications provided by HITSP (the Standards Panel) and then passed along to the Certification Commission for evaluation of functional capacity in the products that vendors sell to clinicians in our communities.If we don’t clearly state our particular perspective well during these use case efforts, our public health or populations health needs may not be possible with the major investments by providers.67.1.5 Monitor for adverse events7.4.5 Provide vaccine recall information7Emergency Response Entities8VAERS / Public Health Case Reporting Use Case6Schools7.1.6 Receive vaccine recall informationEmergency PrioritiesContextualFocusLegendSupply Chain8
34 HITECH ActPolicies, new technologies, and approaches for protecting privacy and security of health informationStrategies to enhance use of HIT to:improve quality of carereduce medical errors, reduce health disparities, improve public health, increase prevention and coordination with community resourcesimprove continuity of care among health care settingsSpecific plans to ensure that technology is designed to be appropriate for populations with unique needs
35 HITECH – 2009: Implementation Framework Federal Health IT Strategic Plan2 Goals:Patient-focused health carePopulation health4 “themes”Collaborative governanceAdoption of electronic health recordsInteroperabilityPrivacy and security 2004 GoalsInform clinical practiceInterconnect cliniciansPersonalize careImprove population health
36 ARRA Funding Many Sources, Many Purposes Appropriations for Health ITNew Incentives for Adoption$2 billion for loans, grants & technical assistance for:National Resource Center and Regional Extension CentersEHR State Loan FundWorkforce TrainingResearch and DemonstrationsNew Medicare and Medicaid payment incentives for HIT adoption$20 billion in expected payments through Medicare to hospitals & physicians$14 billion in expected payments through Medicaid~$34 billion expected outlays,Appropriations for HIECommunity Health CentersAt least $300 million of the total at HHS Secretary’s discretion for HIE developmentFunneled largely through States or qualified State-designated entitiesFor planning and/or implementationA key point in this chart is that to date there has been no clear direct funding for PH activities.Yes there are funds for community health centers and these are typically under and uninsured and part of our safety net mission but for most of the other 10 essential services, we have no clear guidance or funding stream identified.Thus, LHD need to be ready to join with those who are the beneficiaries of this HITECH funding$1.5 billion in grants through HRSA for construction, renovation and equipment, including acquisition of HIT systemsBroadband and Telehealth$4.3 billion for broadband & $2.5 billion for distance learning/ telehealth grants
37 HITECH Components: Implications State planning/implementation grant(s) (2009)Matching funds may be required 09-10, will be required 2011State EHR adoption loan fund (2010)Competitive grant to statesMatching requiredProviders must agree to submit quality reporting, use EHR for exchange, submit plan for sustainabilityExtension Program ( )All providers in regionPrioritize public/nonprofit, Federally Qualified Health Centers, rural, primary careResearch and consulting, assist with implementation, adoption/ maintenance, facilitate HIE, develop curricula for HIT education50% of annual capital and operating budget for 2 years, optional afterThe implications for action by your health department are significant. Each state is to be awarded some funding for HIE – some may be working on planning others on implementation.If you are unclear who will be receiving these funds, it might be a good time to check with your governor or state health department.Funds are to be received by states or a state-desginated agency. All of these activities are to be highly accountable and tranparent.In its 2005 National Profile of Local Health Departments, NACCHO found that only 29% of LHDs had implemented electronic medical records. LHDs need to be able to harness the potential of integrated systems with clinical and public health providers.While the EHR adoption loan fund may not apply to you, it may if you provide primary care services. These funds may be a crucial resource to promote adoption by LHD.In particular the extension program may be of interest of a method for you to get involved in assuring that curricula for HIT education focuses not only on those capacities for EHR implementation but the informatics skills to assure that the environment being built is suitable to address the population health needs after the EHR systems are deployed.Here may be opportunities to work with FQHC in your communities who will be receiving large amounts of funding as described in the previous slide.
38 HITECH: “Meaningful Use” (as we speak) To receive incentives, providers must meaningfully use a certified EHR:Use electronic prescribingBe connected in “a manner that provides for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination”Submit information on clinical quality measuresOthers: public health reporting (biosurveillance, disease surveillance), outbreak management, immunizations, electronic lab reporting, bidirectional communicationWhile NACCHO and ASTHO and many others actively try to influence the decision at a national level about meaningful use, the final decision may be a smorgasbord to pick from.Unless your health department advocates locally or in a coalition statewide for those meaningful use activities more tightly aligned with public health, the outcomes in your community may not be all that beneificial to our mission.Meaningful use must intentionally provide public health with the full range of data and reports needed to assess and act on threats to the public’s health.If the definition of meaningful use is inclusive of public health, the potential exists to improve the response to emergencies and outbreaks.A broader interpretation or implementation of meaningful use may also support exchange with patients and their lay care givers to improve primary and secondary prevention programs.The current swine flu outbreak offers a stark example of the need for timely information exchange among these parties that can be analyzed and acted upon by public health officials.
39 Alert: patient with symptoms in outbreak region After entering his chief complaints of cough and fever, along with vital signs, a new BPA appears. This BPA has been set to trigger with chief complaint of cough for patients presenting at our Parkchester center only.
40 How will public health be integrated into NHIN? Public Health in a NHINWhat should be the relationship between NHIN and US public health agencies?andHow will public health be integrated into NHIN?
41 Public Health in a NHINCurrently, CDC researchers and colleagues around the country are making significant progress and working on the exciting concept of a public health grid. The grid is a network of network that is organized to provide seamless integration of data and services all in a very secure environment.Public health is not alone in this concept. Many of the other circles represented on this conceptual diagram are also pursuing the grid connectivity that provides vocabulary services to assure a common meaning to terms across all domains. These eventually will all be hooked up (see the upper left hand corner) with the RHIOs and providers (lower right) around the country.We may look at the grid as something serving to public health, but another perspective may look at it serving their role or need. The key point is that ultimately to benefit from this interoperability and connectivity, public health (from the federal agencies on the lower left) to the state and local agencies (in the upper right) all need to begin to see themselves as players in this environment.
42 Vision: PH Surveillance under NHIN Percent of Children Tested for Lead with BLL>10 µg/dL in the USASource: Eileen Koski. Quest Diagnostics. PHIN-2004, May, Atlanta GA
43 How to find what information we need? Scenario 3: Health Information ExchangeThe local medical society is organizing an effort to respond to the recent incentive packages for physicians and hospitals to adopt electronic health records. The president of the society calls you to see if you would help them determine was meaningful use should be in your community.What are issues that you should consider as a member of the planning team?Who on your staff would best serve as a liaison to the group?What would you want to be an outcome from your LHD involvement?
44 Public Health in HIE: Issues to Consider Public health nowadays is:AgencyHealthcare providerLaboratoryPurchaserPayerPharmacyResearch
45 Public Health in HIE: Issues to Consider Public health nowadays is:AgencyHealthcare providerLaboratoryPurchaserPayerPharmacyResearchPublicly-delivereddirect care, so EHR adoption issues are the same as for clinical care
46 Public Health in HIE: Issues to Consider Public Health Agency: Core FunctionsAssessment,Policy Development andAssuranceThere are local, state, and federal public health agencies.Their activities are organized by disease-specific programs.
47 Responsibilities of State PH Agencies: 2001 %State public health authority97Medical examiner21Public health laboratory79State mental health authority19Rural healthState public health licensing agency17Children with special healthcare needs77State mental institution or hospitalMinority health72Partial/split responsibility for MedicaidInstitutional licensing agency60Medicaid state agency15State health planning & development agency53Lead environmental agencyPartial/split leadership of environmental agency51State tuberculosis hospitalPublic health pharmacy34Health insurance regulationState nursing home28Source: Beitsch LM et al. Structure and functions of statepublic health agencies. APHA. 2006:96(1):167-72
48 Personal Health Services Population Level Services Responsibilities of Local PH Agencies: 2003Personal Health Services(%)Population Level ServicesAdult Immunizations91Communicable Disease Control94Childhood Immunizations89Health Education87Tuberculosis Testing88Epidemiology and Surveillance84STD Testing and Counseling65High Blood Pressure Screening81HIV Testing and Counseling64Tobacco Use Reduction68EPSDT59Cancer Screening58Family PlanningDiabetes Screening53WIC55Cardiovascular Disease Screening50Prenatal Care41Injury Control37Dental Care30Violence Prevention22HIV Treatment25Occupational Safety and Health13Primary Care18Source: Scutchfield, F.D., & Keck, C.W. Principles of public health practice, 2nd ed , Thomson/Delmar Learning: Clifton Park, NY.
50 Public Health in HIE: Issues to Consider All public health activities are supported by customized information systems (databases, registries) developed to address the programmatic needs.
51 Number of Public Health Information Systems Public Health in HIE: Issues to ConsiderNumber of Public Health Information SystemsTotal number of programs:23 programs in the Local Health Departments (HDs)19 programs in the State Health DepartmentsThere are 3000 local HDs and 50 State HDs in the US23 x 3000 (Local HD) = local programs/systems19 x 50 (State HD) = 950 state programs/systemsThere may be as many as 70 thousand public health information systems-- all of them are customized, siloed systems.
52 Electronic Health Record – Public Health Systems Interoperability Public Health in HIE: Issues to ConsiderElectronic Health Record – Public Health Systems Interoperability
54 Public Health Reporting Currently most data are sent as paper reports (forms) from a provider office to a public health program via mail, fax, or phone.This requires data entry at every clinical setting as well as every public health setting.Duplicative data entry activities cause errors and inefficient use of resources.Customized legacy systems that utilize their own data formats, vocabularies, and often software products cannot be interoperable to transmit data across these systems.
55 Public Health Reporting: Local Health Agencies Health Education/Risk ReductionProvider 1Communicable DiseasesProvider 2ImmunizationEPSDTProvider 3Injury ControlSchool HealthProvider 4Chronic CareBiosurveilance, BT, PreparednessWICProvider XOccupational Safety and Health
56 Public Health Reporting: State Health Agencies Genetic DisorderVital StatisticsCommunicable DiseasesProvider 1ImmunizationLead and Environmental EpidemiologyProvider 2Injury ControlProvider 3School HealthProvider 4Chronic CareBiosurveilance, BT, PreparednessWICPublic Health LaboratoryProvider XHEDISCancerSource: Beitsch et.al Structure and Function of State Public Health Care Agencies” / AJPH, January, 2006.
58 Public Health Data Reporting Genetic DisordersCommunicable DiseasesProvider 1On average49% of casesgot reported(CDC, 2006).ImmunizationProvider 2Vital RecordsProvider 3Injury ControlProvider 4School HealthChronic CareBiosurveilance, BT, PreparednessProvider XHEDIS
59 EHR-based Public Health Data Reporting Health InformationExchanges (HIEs)HIEGenetic DisordersHL7Vital StatisticsProvider 1Communicable DiseasesCDA2Provider 2ImmunizationEnvironmentalHealthX12Provider 3Injury ControlSchool HealthProvider 4Chronic CareNCPDPBiosurveilance,PreparednessWomen & ChildrenProvider XPublic Health LaboratoryIHEQuality Improvement
60 EHR-based Public Health Reporting EHR-PH systems will enable electronic data transmission from a provider office to a public health programs via a Web-based interface.Data entry will be done once at the point of data generation, i.e., clinical setting, where EHR system will be installed.Public health programmatic resources will be used not on data management activities but programmatic activities, e.g., case management, care coordination, health education for prevention.System will be interoperable because they will utilize standardized data formats and vocabularies, messaging standards and software products that will support interoperability of EHR systems.
61 Public Health Informatics – National Context Scenario 4: - WorkforceNew federal preparedness funding guidance focuses on building connectivity between the personal and public healthcare environments for situational awareness.The state health department (SHD) is encouraging local health departments (LHD) to develop tools for interoperability with the state and the larger health care community regarding biosurveillance systems.What internal resources have your LHD to begin to address some of these interoperability questions?Does anyone on your staff have the skills to participate in the planning process with the SHD?How can you be sure these individuals are sufficiently trained and qualified to address the planning needs?
62 Role of PH Professionals as Informaticians Building interoperable information systems for public health will require working with:Public Health CommunityCliniciansVendors
63 Role of PH Professionals as Informaticians Working with Public Health Community toUnderstand interactions between public health data systems within a health department and across health departmentsUnderstand commonalities of data and data system architectures across public health data systemsDefine common public health needs in EHR-based health information exchanges
64 Role of PH Professionals as Informaticians Working with Clinicians toDefine public health needs in EHR-based health information exchangesUnderstand interactions between clinical care and public health data systemsUnderstand commonalities of data and data system architectures across clinical and public health data system
65 Role of PH Professionals as Informaticians Working with Vendors toKnow computer-based tools available to public health professionalsCommunicate public health needs for interoperable EHR-based health IT applications and non-EHR IT applicationsBe able to participate in the design of information systems in public health under a NHIN
66 Vendors involved in Health IT Points to highlight: IHE has not only healthcare industry professionals, but also software and hardware professions from the computing industry involved, including organizations such as IBM, Oracle and Microsoft.
67 Role of PH Professionals as Informaticians Public health professionals as informaticians have to be able to develop / critique IT technical documents including:Business Process DocumentsFunctional Requirements SpecificationsInteroperability SpecificationsIntegration ProfilesContent ProfilesImplementations Guides, etc.
68 Providers, PUBLIC HEALTH and Software Developers Integrating the Healthcare Enterprise (IHE)Providers, PUBLIC HEALTH and Software DevelopersWork Together to DeliverInteroperable Health Information Systemsin the Enterprise and Across Care Settings
69 Local PH Strategic Planning Business processes System requirements DrivesInfluencesPortfolio Performance ManagementInformationInformationITInvestment ManagementIT Governance & Management ProcessesTechnologyTechnologyInvestmentInvestmentManagementManagementSupported byImproved byEnterprise ArchitectureEnterprise ArchitectureEnterprise ArchitecturePublic Health Informatics Institute
70 What is NACCHO doing? Running webinars such as these. Developing tools and templatesFunding demonstration sites to show that it can be done.Advocating for local public health informatics at a national level.
72 Questions for our listeners What do you believe might/should be your next step?Do you feel you have adequate information to take any step regarding public health informatics at your local level?Is this format of information sharing helpful to you or your LHD?What might the NACCHO Informatics Workgroup do to support further information sharing or helping your department get more involved in the near future?