1. HH/NURS 3240 Chapter 34: Public Health Practice Applications Presentation prepared by: Melissa Mcfarlane, Amid Alapour, Stella Nambuusi, & Alexandra Verba

2. Overview of Public Health With the emergence of diseases such as SARS, H1N1 and patients presenting with multiple comorbidities, public health has been combined with technology to combat this surge of information Public health information is collected from a myriad of sources to assist in combating acute or chronic illnesses Public health can now seamlessly exchange and use information from clinical and other sources

3. Public Health Established in the USA in 1798 by the Marine Hospital Service Act An amendment called the Public Health Service Act was established in 1944 to include not only physical health but also mental health Three core functions of public health are: assessment, policy development and assurance Intertwined with the core functions are the 10 essentials of public health which was developed by the Public Health Functions Steering Committee (1994)

4. Essential Services of Public Health Monitor health status Diagnose and investigate Inform, educate, and empower Mobilize community partnerships Develop policies and plans Enforce laws and regulations Link people to needed services / assure care Assure a competent workforce Evaluate health services Research

5. Government Role In Public Health Guided by regulations and laws developed at the local, state/territorial and federal levels And input received from local, state/territorial and federal public health agencies

6. Public Health Informatics Focuses on preventing diseases from occurring in a population Definition: “the systematic application of information and computer science and technology to public health practice, research and learning.” (p.501) Provides a way to standardize the collection, and dispersion of a wide variety of health data about a given population

7. Disclosure The Privacy Rule in Health Insurance Portability and Accountability Act (HIPPA), 2004 explicitly prohibits the release of patient information without consent A clause was added to the Act which allows for the disclosure of health information of individuals when it is deemed necessary to protect the public Patient Protection and Affordable Care (PPACA), 2010 provides provisions to register individuals in public health programs

8. Public Health Nurse Protects the public through the use of nursing and public health sciences Goals: promotes health, prevents disease and disability in a population Governed by 8 principles

9. Eight Principles of Public Health Nursing 1. The client or “unit of care” is the population. 2. The primary obligation is to achieve the greatest good for the greatest number of people or the population as a whole 3. The processes used by public health nurses including working with the client(s) as an equal partner 4. Primary prevention is the priority in selecting appropriate activities 5. The focus is on selecting strategies that create healthy environmental, social and economic conditions in which populations may thrive 6. There is an obligation to actively identify and reach out to all who might benefit from a specific activity or service 7. Optimal use of available resources to assure the best overall improvement in the health of the populations is a key element of the practice 8. Collaboration with a variety of other professions, populations, organizations and other stakeholder groups is the most effective way to promote and protect the health of the people

10. Public Health Informatician Uses informatics to improve population health Possess expertise in information science, computer science, and epidemiology

11. Public Health Nurse Informatician (PHNI) Combines the principles of nursing and public health informatics A meeting of clinical care and technology Implements information science, computer science and technology to public health nursing practice, research and education Uses technology to improve public health surveillance

12. Public Health Electronic Surveillance practitioners gather data on issues such as determinants of health, environmental health risks and hazards investigate the occurrences of health events and health care system activities and their impact on health This helps in the planning of the appropriate intervention In order for health care systems to communicate effectively, there is a need for an easier and faster way to access this data Initiatives such as the Health Information Exchanges (HIEs) and the National Electronic Disease Surveillance System (NEDSS) help decrease barriers related to the sharing and collection of public health data across the organizational levels

13. Three levels of data collecting and sharing : Three levels of data collecting and sharing : Local: ◦ Collaborate with clinicians and agencies, assemble reports of communicable diseases, track and monitor cases, investigate cases and provide essential services such as vaccinations and testing State/Territorial: ◦ establishes regulations and legislations in order to collect reports from the local health departments and then forwards them to the CDC ◦ Implement programs, assign priorities to cases and serve as a liaison between the CDC and the local health department Federal: ◦ CDC presents surveillance summaries and publishes public health recommendations

14. National Electronic Disease Surveillance System (NEDSS) Standards for NEDSS was created in 1999 by CDC, CSTE, state and local health departments Incorporates and exchange and use information between various state and local surveillance systems Electronic transfer of quality and timely health information from clinical systems to public health systems without the involvement of the provider Criteria were developed to make NEDSS compatible with State systems

15. Criteria to Make NEDSS Compatible 1. Browser based for data entry 2. Electronic Laboratory Result (ELR) 3. Single repository for integration databases And… System wide electronic messaging NEDSS-Base System (NBS), a secure system

16. Health Care Providers role, Clinical laboratories and NBS HCPs are responsible for providing care and reporting state designated communicable disease to public health departments As a registered NBS user, HCPs can directly enter case data & laboratory reports into state’s surveillance system at point of care. HCPs can also securely query the database, verify completeness of reporting using analysis tools and ensure compliance with state public health laws. HCPs send electronic health reports using Health level seven clinical document architecture (HL7 CDA) public/ private laboratory staff are required by law to notify public health departments of reportable diseases Timely reports are important to public health surveillance to prompt case/ outbreak investigation

17. Public Health Practitioner (PHP) role and NBS Local/ state PHP responds to incoming data on reportable conditions and implements appropriate strategies like tracking and monitoring. Registered NBS user public health practitioners review laboratory and HCP reports for patients residing within their jurisdiction boundaries. Upon receipt of new report, PHP may order a public health field investigation. PHP classifies cases basing on stored data & standard case definitions, then forwards the notifications to CDC using NEDSS, HL7 or NETSS (if no messaging guide exists). NBS data transfer function allows users to notify another jurisdiction when Pt moves and transfer records for follow- up.

18. Privacy Protection and NBS To protect personal information, the NBS requires: ◦ User authentication ◦ Aauthorization ◦ auditing protocols NBS supports user authentication to verify user identify. Once authenticated, NBS authorises access to data based on geographical area, public health events, diseases and user role. An audit file that contains fingerprint trail with a timestamp of the user’s activities is then created by the NBS

19. Public Health Applications Using Informatics in an immunization information system ◦ Immunization Records  1-Paper forms  completed by hand and reported periodically to local health agencies  The procedure was time consuming and vulnerable to wrong data entry  II- Electronic Immunization Information System (IIS)  Confidential and computerized systems where immunization histories are collected and can be accessed by authorized personnel  Funding and human capacity to build and manage the system are the challenges of IIS

20. Public Health Applications Benefits for public: 1.Having a private and secure place to safeguard immunization information from multiple providers 2.Receiving timely reminders 3.Eliminating duplicate immunization Benefits for HCP: 1. Consolidating immunization record from different sources 2. Automatically calculating immunization needs 3. Easily providing official copies 4. Automatic inventory and ordering procedures 5. Flagging high risk patients 6. Tracking vaccines during shortage or recall 7. Assisting with vaccine safety reporting 8. Reducing chart pulls for coverage assessment and HEDIS revises

21. Public Health Applications Using Informatics in a tuberculosis electronic information system ◦ Health care providers in the US are required to report confirmed cases of TB ◦ The following systems are involved in electronic TB reporting:  National TB Surveillance System  TB Genotyping Information Management System  Electronic Disease Notification System ◦ The collected data is used by CDC to report national TB- related performance indicators ◦ Health departments receive these reports electronically. They use the national reports to set performance targets, measure performance, and evaluate the program’s capacity to control and prevent TB.

22. Case Study 1 Immunization registries and emergency response after hurricane Katrina ◦ Most of the 200,000 residents of New Orleans who were evacuated to shelters in Houston did not have their medical and immunization records. ◦ Proof of immunization was necessary if the displaced children wanted to remain in schools in Texas. ◦ Houston-Harris County Immunization Registry (HHCIR), Louisiana Immunization Network for Kids State-wide (LINKS) and their common vendor developed a technological bridge based on HL7 standard to connect their systems and exchange their data ◦ During the next year almost 19,000 records of immunization of displaced children were matched. ◦ That electronic innovation not only saved more than $1.6 million by preventing the unnecessary re-immunization, but also empowered displaced children, their parents and health care providers.

23. Case Study 2 Norovirus outbreak in persons displaced by hurricane Katrina ◦ In September 2005, after hurricane Katrina symptoms of acute gastroenteritis were observed among hurricane evacuees and relief workers. ◦ Data was collected based on a checklist of symptoms and entered into a database on a daily basis. ◦ Analysis of collected data based on reported epidemiologic and lab findings indicated an outbreak of norovirus gastroenteritis in many facilities. ◦ The spread of norovirus is person-to-person and is not the result of contaminated food or water. ◦ The information was used to provide a health alert and to promote treatments and preventive measures.

24. Case Study 3 Using informatics for public health program evaluation ◦ Because TB disease or latent TB in a child is an indicator of recent transmission of the bacteria, it is an important measure in assessment of effective TB prevention and control. ◦ Public health nurses use a Clinical Nursing Information System (CNIS) dataset to account for nursing activities. ◦ Because monitoring standardized nursing activities can help identifying missed opportunities for prevention (Such as TB prevention in children), CNIS dataset could be modified to cover the prevention efforts.

25. Future Directions in Public Health Information Systems Local Agencies and public health practitioners ◦ provide support and leadership in emerging concept of multiagency responsibility for health ◦ Provide health information developers with information about the data needs that are specific to a community Federal Agencies ◦ Help develop consensus on data and health information technology standards for an efficient national public health information system Public health nurse informatician role ◦ improve surveillance by accessing client information, indicating data that is essential for the evaluation for community surveillance and assessing the effectiveness for health services in support of surveillance programs

26. Reference Saba, V. K., & McCormick, A. (2011). Essentials of nursing informatics (5th ed). McGraw-Hill.