A Practical Roadmap to Integrating Public Health (Surveillance) IT Systems
Massimo Mirabito, Kumar Batra, Priscilla Chu
Sharon R. Burks, William D. Correll, Thomas Sukalac
Presenter Disclosures
Max Mirabito, Kumar Batra, Sharon BurksEmployed by Northrop Grumman Own Northrop Grumman StocksCurrently working on the CDC CIMS Contract supporting CDC/NCHHSTP
Thomas Sukalac, William D. CorrellEmployed by the Centers for Disease Control and Prevention Currently support CDC/NCHHSTP
Priscilla ChuEmployed by the San Francisco Department of Public Health Currently supporting the Population Health Division
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
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
Roadmap to Public Health IT System Integration
Roadmap: Key Factors
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
Roadmap: Organization
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
Roadmap: IT Environment
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
Roadmap: Integration Challenges
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
Roadmap: Recommendations
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
Roadmap: The San Francisco Blueprint
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
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
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
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
Organization
Roadmap: The SFDPH Population Health Division
Strengths Weaknesses W
Opportunities O Threats T· Health care reform and
meaningful use· Funding· IT reorganization
· Costs of clinical systems· Decreasing funding
· Leadership support for integration
· Epidemiological/analytical/research capacity
· Siloed systems· Medical record vs. public
health data
Exte
rnal
Fac
tors
Inte
rnal
Fac
tors S
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
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
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 lifestyleIntegration is a marathonIntegration is a team sport
Acknowledgments
US Centers for Disease Control and PreventionGustavo Aquino – NCHHSTP Associate Director for Program Integration
San Francisco Department of Public HealthIsrael Nieves – Director, Office of Equity and Quality Improvement, Population Health Division, San Francisco Department of Public Health