Environmental Public Health Tracking Network

Alison Cox & Julia ShumwayHealth Program SpecialistsEnvironmental Epidemiology

How it all began:Pew Report

• September, 2000

• “America’s Environmental Health Gap: Why the Country Needs a Nationwide Health Tracking Network”

• Environmental Health Gap – Lack of basic environmental health information– link hazards and disease, detect trends– measure health problems, conduct programs

Environmental Public Health Tracking

• EPHT Network– Data warehouse: Available September 2008

• “EPHT is the ongoing collection, integration, analysis, interpretation, and dissemination of data on environmental hazards, exposures to those hazards, and health effects that may be related to the exposures.”

National EPHT Partnerships and Collaborations• EPHT is primarily funded by the CDC• Environmental and health agencies

– Federal– State– City

• Academic– Four academic partners

• Professional and non-government groups

Three Main Areas of EPHT Data

• Hazard data– Water Quality

• arsenic• nitrates • disinfection byproducts

– Air Quality • PM2.5 • Ozone

• Exposure data– Environmental Modeling

• Example: estimates the amount of chemical in a person by measuring that chemical in their soil and then using computer and mathematical models to estimate exposure

– Biomonitoring• Example: detecting arsenic levels in

hair, blood or urine

• Health effect data• Example: Lead

Utah EPHT Data PartnershipsHazard Data Partners:• United States Geological

Survey • Federal Environmental

Protection Agency• Utah Department of

Environmental Quality, Division of Air Quality 

• Utah Department of Environmental Quality, Division of Drinking Water

Exposure Data Partners:• Utah Department of Health,

Environmental Epidemiology Program

• Utah Public Health Laboratory

Health Effects Data Partners• Utah Department of Health, Center

for Health Data• Utah Department of Health, Office of

Vital Records and Statistics• Utah Population Database• Utah Birth Defects Network• Utah Cancer Registry• Centers for Disease Control and

Prevention• Utah Health Information Network• Utah Office of Health Care Statistics• Indicator Based Information

Systems for Public Health (IBIS-PH)

EPHT Portals

• National public portal

• National secure portal

• State secure portal (Secure IBIS)

• State public portal (IBIS-PH)

Connecting Public Health Professionals with Relevant Environmental and Health data

Accessing Secure IBIS-PH

Tracking Network Advisory Committee

• An advisory body to give an influence to– data sharing partners,– indicator owners, and– other interested parties

• To encourage awareness and participation

TNAC Charter• The TNAC will fill and advisory role concerning

– data content;– security and accessibility;– risk communication;– marketing and outreach.

• The TNAC will act as an intermediary.• TNAC will supply representatives for the

Scientific Review Board.

Scientific Review Board• Utah Department of Health

– Bureau of Emergency Medical Services– Office of Health Care Statistics– Office of Public Health Assessment– Office of Vital Records and Statistics– Utah Birth Defects Network– Utah Blood Lead Registry– Utah Public Health Laboratories

• Utah Department of Environmental Quality– Division of Environmental Response and Remediation– Division of Drinking Water– Division of Air Quality

• University of Utah– Utah Cancer Registry– Utah Poison Control Center

Standards-based Data Security

• Utah Code 26-3-7: Limitations on disclosing identifiable health data

• Utah Code 26-3-10: Department measures to protect health data

• Utah Rule 380-25: Confidentiality of data received through electronic exchange

• Utah Rule 380-250: HIPAA Privacy Rule Implementation

Granting Access

• Third Party Application for Access to Secure IBIS-PH for Public Health Professionals

• Third Party Application for Access to Secure IBIS-PH for Research Projects

IBIS-PH Secure Query Modules

Finding Secure Data

Metadata aids data discovery.Metadata: “data about data”

Type of EPHT Indicator

Health outcome

Measures 1. Count of elevated blood lead level cases by zip codeDerivation of measure

Numerator: The number elevated of blood lead level tests reported by laboratories to the Utah Department of Health.Denominator: Denominators used to calculate rates among children represent the number of children tested and adults represent the number of persons in the Utah labor force population provided by the Utah Department of Workforce Services.

Variables contained

YearAge groupBlood lead levelSexZip code

Variable definitions

Year: Year of diagnosisAge group: The age group of the individual at time of blood lead level measurementBlood lead level: Level of lead in blood by microgram per deciliter (µg/dL)Sex: Sex of individual with elevated blood lead levelZip Code: The zip code where the individual with elevated blood lead resides at the time

of measurement.Variables to group by

YearAge groupBlood lead levelSexZip code

Chart graphic types

Vertical barHorizontal barStacked vertical barAreaStacked areaPieLine

Unit Patient with elevated blood leadGeographic Scope

Utah

Geographic Coordinates

West: -114.042925East: -109.041501North: 42.001718South: 36.997693

Geographic scale

Zip codes

Time Period 2002-2006Updated AnnuallyTime Scale Single yearsRationale The Utah Blood Registry (UBLR) within the Utah Department of Health functions to

identify residents of Utah with elevated blood lead levels. The UBLR provides risk assessment to help the individual limit and remove their risk of lead exposure. The UBLR serves as a resource for physicians, hospitals, local health departments, and researchers. The UBLR provides blood lead data to national agencies for generating national statistics and to state and local agencies for identifying high risk areas. The UBLR provides an educational and data resource for physicians, nurses, and other institutions to help protect Utah’s population.

Use of the Measure

Limitations of the MeasureData Sources Blood lead data is provided to the Utah Department of Health, Utah Blood Lead

Registry, from laboratories, hospitals, health clinics and physicians.Utah Population Estimates Committee (UPEC) and the Governor’s Office of Planning and Budget (GOPB), 2008 Baseline Economic and Demographic Projections (Revised on 7-23-2008).

Reporting Protocols

Under the Injury Reporting Rule R386-703, specific to the injury of an Elevated Blood Lead (≥ 10µg/dL), a reportable injury evaluated or treated at a hospital shall be reported by that hospital. Reportable injuries not evaluated at a hospital shall be reported by the involved physician, nurse, other health care practitioner, medical examiner, or laboratory administrator. Each case of injury shall be reported to the Utah Department of Health or to the local health department responsible for the geographic area where the injury occurred. The local health officer shall forward all original reports to the Utah Department of Health. Because the Utah Blood Lead Registry falls under the definition of a public health entity, the Injury Reporting Rule takes precedence over the recent legislation called HIPAA, the Health Insurance Portability and Accountability Act. For more information regarding public health, including blood lead reporting and HIPAA, please go to the Centers for Disease Control and Prevention website at: http://www.cdc.gov/od/science/regs/privacy/index.htm

Additional Details to consider

All population estimates and projections apply to July 1 of the selected year.

Citation Blood lead data provided by the Utah Department of Health is funded in part by a contract with the National Institute for Occupational Safety and Health and the Centers for Disease Control and Prevention, Preventive Block Grant Award.

Contact Metadata created by:Health Program SpecialistEnvironmental Epidemiology ProgramUtah Department of HealthPO Box 142104Salt Lake City, UT 84114-2104801-538-6191eep@utah.govhttp://health.utah.gov/epi/enviroepi/

Creation Date August 13, 2009

Research Projects Public Health Professionals

1. Cover sheet

2. Secure IBIS-PH Access Request

3. Data-use Agreement Form

4. Research Proposal

5. IRB Approval

6. Letters of Support

1. Secure IBIS-PH Access Request

2. Secure IBIS-PH Access Agreement Form

Annually renewable upon verification that access is still necessary for work.

Secure IBIS-PH Application

Public Health Professionals

1. EPHT Program receives the application (electronic and paper)

2. EPHT Program forwards the electronic to the SRB

3. The SRB may require additional information, explanations, etc.

4. EPHT Program will create a login for the researcher and provide a memorandum of instruction.

Monitoring Data Access and Use

• Periodic status reports

• Individual access review

• Publications and presentations

• Review of data use