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Introduction to Public Health Informatics

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Title: Introduction to Public Health Informatics


1
Introduction to Public Health Informatics
National Conference on Tobacco or Health November
20, 2002
  • William A. Yasnoff, MD, PhD, FACMI
  • Senior Advisor
  • National Health Information Infrastructure
  • Department of Health and Human Services

2
Overview
  • New IOM recommendations
  • Role of information technology (IT) in public
    health
  • Barriers to public health IT
  • National Health Information Infrastructure
  • What is public health informatics?
  • Role of informatics in promoting healthy
    communities

3
Public Health InformaticsIOM Recommendations,
2002
  • Informatics should be included in the curriculum
    of all MPH programs. (Educating Public Health
    Professionals for the 21st Century, IOM,
    November, 2002)
  • The Secretary of HHS should facilitate the
    development and implementation of the National
    Health Information Infrastructure (NHII) under
    the leadership of the Secretary of HHS. (The
    Future of the Publics Health in the 21st
    Century, IOM, November, 2002)

4
Information is the Core of Public Health
  • Public health has been using information systems
    for many years
  • Full potential of information technology has yet
    to be realized
  • Missed opportunities
  • Public health is facing serious challenges
  • Bioterrorism preparedness response
  • Increasing antibiotic resistance
  • Emerging infectious diseases

5
Public Health Informatics
  • Definition the systematic application of
    computer information science and technology to
    public health practice, research, and learning
  • Key to effective use of information technology in
    public health

6
Public Health Practice Today
Illustration courtesy of John Lumpkin, MD, MPH
7
Barriers to IT in Public Health A. Information
  • Surveillance data
  • Only 15-20 of reportable cases reported
  • Delays of days to weeks
  • Not typically in electronic form
  • Other relevant data not electronically available
  • Environmental, injury, etc.
  • Guidelines
  • Contacts
  • Training materials

8
Barriers to IT in Public Health B.
Infrastructure
  • Information technology
  • Local health departments with high-speed
    continuous internet connections
  • 48.9 (NACCHO, 1999)
  • 68.3 (CDC, 2001)
  • Workforce
  • 83 of local health departments indicate that
    computer training is a key need (NACCHO, 1996)

9
What is National Health Information
Infrastructure (NHII)?
  • Comprehensive knowledge-based network of
    interoperable systems
  • Capable of providing information for sound
    decisions about health when and where needed
  • NOT a central database of medical records

10
What will NHII enable?
  1. Test results and x-rays always available ?
    eliminate repeat studies
  2. Complete medical record always available
  3. Decision support always available guidelines
    research results
  4. Real-time aggregation to detect patterns (e.g.
    bioterrorism detection)
  5. Quality payment information derived from record
    of care not separate reporting systems
  6. Consumers have access to their own records

11
Three Domains of NHII
NHII
Personal/ Consumer
Community/ Public Health
Clinical
12
Elements of NHII (1 of 3)
  • Standards Messaging Content
  • Foundation for remainder of NHII
  • Electronic Medical Record (EMR) Systems
  • Hospital
  • Outpatient
  • Consumer Health Information Systems
  • Personal health record
  • Electronic patient-provider communication
  • Support groups
  • Authoritative information

13
Messaging Standards
  • What information is requested
  • Where is the information in the message
  • Example phone number message
  • Pick up phone
  • Listen for dial tone
  • Dial number
  • If first digit is 1, then long distance,
    otherwise local

14
Content Standards
  • A common, agreed-upon, detailed vocabulary for
    all medical terminology
  • Without a standard
  • high blood pressure
  • elevated blood pressure
  • hypertension
  • With a standard
  • C487231, hypertension
  • Unambiguous meaning for both sender and receiver

15
Elements of NHII (2 of 3)
  • Ancillary health care systems
  • Pharmacy
  • Laboratory
  • Physical therapy
  • Home health
  • Public health reporting
  • Communication/networking systems
  • Information moves with patient
  • Integrated information from all types of
    providers
  • Electronic consultation (telemedicine)

16
Elements of NHII (3 of 3)
  • Decision Support Education
  • Professional
  • Consumer
  • Confidentiality protections
  • Information available on need-to-know basis
  • Authentication of all users
  • Encryption of data in transit
  • Audit trails of all usage
  • Penalties for violations

17
Benefits of NHII
  • Monitor and Protect Public Health
  • (e.g. rapid disease detection)
  • Improve Patient Safety
  • IOM 44,000-98,000 preventable deaths/year (more
    than motor vehicle accidents, breast cancer, or
    AIDS)
  • Estimated cost of medication errors alone is over
    76 billion/year
  • Improve Quality of Care
  • Effectively Share Decision Support
  • Understand Health Care Costs
  • Better-informed Health Care Consumers

18
Why hasnt NHII already been done?
  • Health care information is very complex ? IT
    systems more expensive and difficult to build
  • Health care is highly fragmented
  • Organizational and change management issues from
    IT systems are difficult to manage in clinical
    environment
  • Physicians are independent contractors
  • Lack of incentives for information sharing
  • Difficult to generate capital needed for IT
    investment
  • IT is regarded as an add-on cost, not an
  • investment for competitive advantage

19
NHII activities in HHS
  • Senior Advisor, NHII
  • Inform
  • Disseminate NHII vision
  • Catalog NHII activities
  • Disseminate lessons learned
  • Collaborate with Stakeholders
  • Convene
  • National meetings on NHII
  • Start in 2003
  • Voluntary process no new regulations

20
Barriers to IT in Public Health C. Informatics
  • Public Health Informatics is the systematic
    application of computer information science and
    technology to public health practice, research,
    and learning
  • Management skills
  • IT projects expensive and high risk
  • Interdisciplinary teams required
  • New skills needed by public health managers

21
Public Health Informatics Topics
  • Information Architecture
  • Avoiding Information Technology Disasters
  • Networking the Internet
  • Databases Database Design
  • Standards
  • Privacy, Confidentiality, Security
  • Computer Expertise

22
1. Information Architecture
  • Information systems are complex (like a building)
  • Detailed plans required
  • Alignment of parts
  • Flow of data
  • Information flow, storage, processing
  • Interfaces to users, other systems
  • Independent layers
  • Organizational discipline and control

23
Imagine building a house
  • without any architectural plans
  • with only general sketches as to how its
    supposed to look, or only detailed diagrams for
    wiring, plumbing, etc.
  • with each subcontractor doing whatever they
    thought best, without consulting with the owner
    or other contractors
  • with no specialized functions for the rooms
    (e.g., every room has its own little stove, bed,
    bathtub)
  • where the house had to be torn down to remodel
    one room
  • S.O.P for building information systems in
    public health.

24
Information Architecture
  • A metaphor for a systematic approach to building
    enterprise-wide information systems.
  • Information architecture refers to the totality
    of the data, processes, and technology used in a
    given enterprise, and the relations between them.
  • It includes databases, applications, standards,
    procedures, hardware, software, networks, etc.

25
An information architecture
  • Returns locus of control and decision making to
    the executive level, away from the IT
    community.An information architecture provides
    the basis of business control over the
    distributed development of information systems.

26
2. Avoiding IT Disasters
  • I.T. project failure rates high
  • 1/6 succeed, ½ partial success, 1/3 total failure
  • Sources of risk in I.T. projects
  • High level of abstraction
  • Unrealistic expectations
  • Management often non-intuitive
  • Keys to success
  • Interdisciplinary teams
  • Clear requirements definition (e.g. iterative
    prototyping)

27
Paradigm for I.T. Project Success
  • Behavior Modification
  • management
  • users
  • Minimize increments of change
  • Use intermittent positive reinforcement
  • provide real benefits to users
  • what they want, NOT what you want

28
Informatics Key to Healthy Communities
  • National Health Information Infrastructure
  • Health care information always available when and
    where needed
  • Latest guidelines and research applied
    immediately to patient care
  • Closer integration of medical care and public
    health using IT
  • Protection from disease through
  • Earlier detection of outbreaks
  • More effective monitoring of disease patterns

29
PHI Textbook
  • Springer-Verlag
  • October, 2002
  • 824 pages, 79.95
  • note royalties of CDC authors go to CDC
    Foundation

30
THANK YOU!
  • Questions?
  • Additional References
  • Yasnoff et al. Public Health Informatics
    Improving and Transforming Public Health in the
    Information Age. J Pub Health Management
    Practice 2000 6(6)67-75.
  • Yasnoff et al. A National Agenda for Public
    Health Informatics. J Am Med Informatics Assn
    2001 8535-545.
  • Contact information
  • William A. Yasnoff, MD, PhD
  • Department of Health and Human Services
  • William.Yasnoff_at_hhs.gov
  • 202/690-7100
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