Introduction to Public Health Informatics

Introduction to Public Health Informatics

William A. Yasnoff, MD, PhD, FACMISenior Advisor

National Health Information InfrastructureDepartment of Health and Human Services

National Conference on Tobacco or HealthNovember 20, 2002

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OverviewOverview

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

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

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Public Health Informatics:IOM Recommendations, 2002Public Health Informatics:IOM 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 Public’s Health in the 21st Century, IOM, November, 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 Public’s Health in the 21st Century, IOM, November, 2002)

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Information is the Core of Public Health

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

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

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Public Health InformaticsPublic 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

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

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Public Health Practice TodayPublic Health Practice Today

Illustration courtesy of John Lumpkin, MD, MPH

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Barriers to IT in Public Health A. InformationBarriers 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

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

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Barriers to IT in Public Health B. InfrastructureBarriers 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)

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)

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What is National Health Information Infrastructure (NHII)?

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

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

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What will NHII enable?What will NHII enable?1. Test results and x-rays always available

eliminate repeat studies2. Complete medical record always available3. Decision support always available:

guidelines & research results4. 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

1. Test results and x-rays always available eliminate repeat studies

2. Complete medical record always available3. Decision support always available:

guidelines & research results4. 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

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Three Domains of NHIIThree Domains of NHII

Personal/Consumer

ClinicalCommunity/Public Health

NHII

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Elements of NHII (1 of 3)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

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

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Messaging StandardsMessaging 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

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

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Content StandardsContent 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

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

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Elements of NHII (2 of 3)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)

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)

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Elements of NHII (3 of 3)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

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

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Benefits of NHIIBenefits 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

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

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Why hasn’t NHII already been done?Why hasn’t 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

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

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NHII activities in HHSNHII 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

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

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Barriers to IT in Public Health C. InformaticsBarriers 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

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

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Public Health Informatics TopicsPublic Health Informatics Topics

1. Information Architecture*2. Avoiding Information Technology

Disasters*3. Networking & the Internet4. Databases & Database Design5. Standards6. Privacy, Confidentiality, & Security7. Computer Expertise

1. Information Architecture*2. Avoiding Information Technology

Disasters*3. Networking & the Internet4. Databases & Database Design5. Standards6. Privacy, Confidentiality, & Security7. Computer Expertise

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1. Information Architecture1. 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

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

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Imagine building a house …Imagine building a house … without any architectural plans with only general sketches as to how it’s 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.

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Information ArchitectureInformation 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.

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.

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An information architecture …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.

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.

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2. Avoiding IT Disasters2. 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)

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)

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Paradigm for I.T. Project SuccessParadigm for I.T. Project Success Behavior Modification

managementusers

Minimize increments of change Use intermittent positive

reinforcementprovide real benefits to userswhat they want, NOT what you

want

Behavior Modificationmanagementusers

Minimize increments of change Use intermittent positive

reinforcementprovide real benefits to userswhat they want, NOT what you

want

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Informatics: Key to Healthy Communities

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

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

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PHI TextbookPHI Textbook

Springer-Verlag October, 2002 824 pages, $79.95

[note: royalties of CDC authors go to CDC Foundation]

Springer-Verlag October, 2002 824 pages, $79.95

[note: royalties of CDC authors go to CDC Foundation]

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THANK YOU!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; 8:535-545.

Contact information: William A. Yasnoff, MD, PhD Department of Health and Human Services William.Yasnoff@hhs.gov 202/690-7100

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; 8:535-545.

Contact information: William A. Yasnoff, MD, PhD Department of Health and Human Services William.Yasnoff@hhs.gov 202/690-7100