Purdue University How Can Informatics Transform Public Health by Virginia Caine Paper

Explanation & Answer length: 900 words

The ASTHO & NACCHO Public Health Informatics Policy Committee Meeting “How Can Informatics Transform Public Health?” Virginia g A. Caine,, M.D.,, Director Indianapolis/Marion County Health Department Past President, American Public Health Association Associate Professor, IU School of Medicine Environment For Public Health Has Changed ¾ ¾ ¾ ¾ ¾ ¾ Invisible to Visible 9-5 Mon – Fri to 24/7 : Results now! Science & politics to Science & Politics Static science to Rapidly evolving science Controlled communication to Information overload National scope to Global involvement Focus On Urgent Issues Not New ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ Avian Flu Pandemic Steps to a Healthy US Tobacco Obesity Infant mortality – Healthy Start Lead Poisoning in Children HIV/AIDS – Ryan White Prostate Cancer Infectious Diseases New Public Health Perspective p • Emerging infectious diseases are spreading faster and f th requiring further, i i rapid id collaborative response • Local problems now viewed as having much wider implications • Naturally occurring infectious disease outbreaks can also impact national security and global economy Addressing Emerging Global Microbial Threats ¾ Importance of strong national and international partnerships ¾ Need for strengthened collaborations among the clinical, laboratory, veterinary, and public health communities ¾ Importance of preparedness planning ¾ Proactive P ti communications, i ti ttraining, i i and d education d ti ¾ Expect the unexpected Key Public Health Questions 1 What is Marion County’s 1. County s Immunization Rate? – Overall rate was 79% for two year olds – “Needle Needle butt” butt babies – High outreach expenditures – Lack of information regarding immunization rates for WIC children 2. Are you screening the same child multiple times? 3 Can 3. C iinspections ti off unsafe f housing h i iimprove identification of lead poisoning in children? 4. Does the AIDS program know the TB and STD coco morbidities of its clients? • In 2000, a shigellosis outbreak in Indianapolis p reported p a total of 1,315 cases. • The largest outbreak of shigellosis in the history of Indianapolis. Public Health Information Network – Vision To transform public health by coordinating its functions and organizations with information systems th t enable: that bl – real-time data flow – computer t assisted i t d analysis l i – decision support – professional collaboration – rapid dissemination of information to public ea t , c clinical ca ca care ea and d tthe e pub public c health, Surveillance approaches for early detection of outbreaks • Informed alert health care provider notifies local or state health department 24/7 contact • “Syndromic Syndromic surveillance surveillance” –healthcare healthcare databases and novel data sources (veterinary labs, retail supermarket sales, business absentee data, etc) analyzed with various aberration detection algorithms – Systematic evaluation of utility of data sources, algorithms, systems needed • Routine state or local public health surveillance system detects an increase in disease specific reporting – National Electronic Disease Surveillance System (NEDSS) Purdue University How Can Informatics Transform Public Health by Virginia Caine Paper,. Purdue University How Can Informatics Transform Public Health by Virginia Caine Paper. • Any “signal” irrespective of source will need confirmation, investigation Public Health Lab Law Enforcement and First Responders Hospital or Health Plan Public Health Information Network (PHIN) Health Department Investigation Team Ambulatory Care CDC and Other Federal Organizations Vaccination Center RX Non-Clinical Sources OTC, 911, etc. Pharmaceutical p Stockpile Public Innovative Information Technologies • Allow more timely and secure reporting of public health data • Reduce the burden of reporting on healthcare providers • Facilitate receipt of easily utilized data to already overworked public health agencies • Provide access to data across governmental and political boundaries The Old Days Program Specific Reports and Summaries HARS STD*MIS STD MIS TIMS MMWR Weekly Tables NNDSS EIP Systems MMWR Annual Summaries PHLIS Statistical Surveys for Chronic Diseases, Injuries and Other Public Health Problems CDC Varied communications methods and security – specific to each system – including diskettes, e-mail, direct modem lines, etc. State Health Depart ment HARS STD*MIS TIMS NETSS EIP Systems PHLIS Reporting by Paper Form, Telephone p and Fax Data Sources Physicians Varied communications methods and security – specific to each system- including paper forms, diskettes, e-mail, direct modem lines, etc. City/County Health Department Chart Review HARS STD*MIS TIMS NETSS EIP Systems* PHLIS *EIP Systems (ABC, UD, Foodnet) STD*MIS (Optional at the Clinic) TIMS (Optional at the Clinic) Lab Reports Compelling Motivators for Change • • • • Inefficiencies of current categorical systems Deficiencies of current systems in general Acquiring data from new sources Proliferation of information systems in the public h lth iindustry health d t • Concerns about security and confidentiality of health information • Purdue University How Can Informatics Transform Public Health by Virginia Caine Paper. Opportunity to transform the practice of public health Integrated Information Systems Marion County Health Department • Data Mart • Community Health Assessment • Vital statistics, hospital data, local, state, and federal health agencies, e.g. Behavioral Risk Factor Surveillance System (BRFSS) • Laboratory Reporting • Insight (Clinical Management Information System) • Immunization Registry electronic link to ISDH • Active Surveillance Integrated Information Systems Marion County Health Department • GIS mapping •Purdue University How Can Informatics Transform Public Health by Virginia Caine Paper.  Emergency room physician alerts for Syphilis • Chronic Disease Management – Public Health Nurse visits for diabetic patients • Early Discharge Post-partum visits and neonatal screenings • Electronic medical records – Bellflower Clinic • Schools and School-based Clinic BMI screenings eg. Learning Well, Inc. ICareConnect • In October 2002, 2002 public health organizations organizations, hospitals, providers, researchers, employers, and networks established a local health electronic information structure called ICareConnect. • Early seed funding provided by Health and Hospital Corporation of Marion County ICareConnect’s Goal To use information technology and shared clinical information to improve the quality, safety, and efficiency of health care in the state of Indiana. Indiana Health Information Exchange ICareConnect later collaborated with the five major Indianapolis hospitals, economic development p g groups, p , and Regenstrief Institute to evolve into Indiana Health Information Exchange (IHIE). What is happening with disease p surveillance? specific • Web entry: case information available to local & state health departments immediately on entry (no paper, no mail) • Supports case investigation by state and local health dept • Clinical electronic laboratory results reporting (ELR) – NE sees 3 fold increased number of cases; data at state within days instead of weeks • Lab results can be shared electronically between state public health lab & state surveillance p • standardized data sent electronically to CDC • Same application for over 140 diseases, replacing disease specific “stovepipe” stovepipe applications Integrated Information Systems New Initiatives • ESSENCE • RWJ Lead Poisoning state-local health d department t t project j t • Indianapolis Healthy Communities – Quality of Life Indicators • Foodbourne and Housing Inspections -wireless peripheral devices initiative Community Information System (Data Linkages Strategy via SAVI) How do we get there from here? • We don’t have the ideal technology, but there is much we can do NOW • Purdue University How Can Informatics Transform Public Health by Virginia Caine Paper. Standards and tools can help • Leverage funds, hardware, software, technical expertise Let’s s do as well tracking the public’s public s health as UPS does • Let in tracking our holiday parcels ! • We must develop and utilize integrated public health i f information ti systems t (i.e. (i Insight) I i ht) • We need to develop core competencies in public health informatics for our workforce. PHIN Coordinated Functions • Detection and monitoring – support of disease and threat surveillance, national health status indicators • Analysis – facilitating real-time evaluation of live data feeds, turning data into information for people at all levels of public health • IInformation f ti resources and d knowledge k l d managementt reference information, distance learning, decision support • Alerting g and communications – transmission of emergency alerts, routine professional discussions, collaborative activities recommendations • Response – management support of recommendations, prophylaxis, vaccination, etc. A “Day in the Life” of the MCHD • 8:30 a.m., a few years from now • Start your computer, screen directs you to place your thumb on the scanner • Recognized R i d and d llogged d iin, th the computer t says “Good Morning”, launches your calendar and • Working draft of obesity initiative A “Day in the Life” of the MCHD (cont.) • Alert pops up: Insight has detected an unusual g incidence of resistant shigella • You are presented with several options: surveillance data learning resources data, resources, and communications • You select surveillance data • Presented with a table and chart of recent cases of shigella A “Day in the Life” of the MCHD (cont.) • Click MAP button, a GIS map is displayed of cases • Click TIME series button, classic epi-chart, with associated statistics are shown • You send an alert to primary care clinicians and hospital infection diseases control staff. • You send an electronic food borne illness questionnaire to your “sentinel sentinel event” event network of providers A “Day in the Life” of the MCHD (cont.) • You instruct your computer to do a videoconference with yyour state health department p director and state epidemiologist. • Locate and download prevention guideline data from Centers for Disease Control (CDC) on resistant s ge os s shigellosis • Go to on-line learning resources and note availability of several interactive, full motion video courses Potential Services Increasingly structured clinical data Major urban hospitals Non-hospital labs Pharmacies Ph sician offices Physician Biological samples Pa ors Payors Patient data 1 Results delivery Applications & tools 2 Decision-support 3 Disease management & community health improvement p 4 Public health lab reporting 5 Public health surveillance 6 Research 7 Clinical trials screening & management Direct support of patient care Research 8 Credentialing 9 Claims clearing 10 Eligibility/referrals/pre-certification Key question: How to orchestrate infrastructure build to target areas of highest value? Admin functions
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