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ALHEChapter19_Public_Health_Informatics.pptxChapter 19: Public Health Informatics
Brian Dixon PhD
Saurabh Rahurkar DrPH
Learning Objectives
After reviewing the presentation, viewers should be able to:
Define public health informatics (PHI)
Explain the importance of informatics to the practice of public
health and the role of informatics within a public health agency
Define and distinguish the various forms of public health surveillance systems used in practice
List several common data sources used in the field of public health for surveillance
Public health: “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.”
Public health informatics: “systematic application of information and computer science and technology to public health practice, research and learning”
Whereas physicians and care delivery organizations focus on the health of individuals, public health focuses on the health of populations and communities.
Definitions
Definitions
Public health surveillance: ongoing systematic collection, analysis, and interpretation of health-related data essential to planning, implementation and evaluation of public health practice, closely integrated with the timely dissemination of these data for prevention and control
Syndromic surveillance: surveillance using health-related data that precede diagnosis and signal a sufficient probability of a case or an outbreak to warrant further public health response
Introduction
The overarching goal of public health has been to monitor a variety of medical diseases and conditions rapidly and accurately so as to intervene as early as possible to detect, prevent, and mitigate the spread of epidemics, the effects of natural disasters, and bioterrorism
To address these challenges, public health organizations conduct a range of activities across three, broad core functions – assessment, policy development and assurance.
Assessment – Public health agencies spend most of their time and resources on investigations of potential threats to the public’s health. Activities include testing and monitoring of water quality, laboratory examination of diseases carried by mosquitoes, tracking food-borne illnesses, testing for environmental hazards (e.g. soil lead levels), monitoring for potential bioterrorism threats, and tracing the contacts for individuals exposed to diseases as well as hazardous chemicals.
Public Health 3 Core Functions
Policy Development – Public health agencies also create policies and regulations to protect the health of populations. For example, children may be required to have certain immunizations before they can attend school to prevent disease outbreaks that would harm children and disrupt family life. Agencies use the evidence they gather from their investigations as well as the scientific literature to advocate for policies that state and federal legislative bodies ultimately adopt for the health of populations and communities.
Public Health 3 Core Functions
Assurance – Once laws and regulations are passed to protect health, public health agencies are tasked with assuring compliance with them. Local health departments may perform housing inspections to assure that landlords comply with rules concerning pest control. Restaurant inspectors typically work for local health authorities, and they assure that those who prepare food wash their hands, wear gloves, and take other precautions to prevent the spread of disease.
Public Health 3 Core Functions
Public Health Surveillance
Public health surveillance (PHS): the systematic collection, analysis, interpretation and dissemination of health-related data, is the bedrock of public health practice.
This is because the surveillance systems capture and manage the volumes of data and information necessary to support the three core functions of public health.
The notion of PHS can be traced as far back as the Renaissance.
Public Health Surveillance Goals
Estimate significance of the problem
Determine distribution of illness
Outline natural history of a disease
Detect epidemics
Identify epidemiological and laboratory research needs
Evaluate programs and control measures
Detect changes in infectious diseases
Monitor changes in health practices and behaviors
Assess the quality and safety of health care, drugs, devices, diagnostics and procedures
Support public health planning
Indicator-based surveillance refers to the monitoring of a specific disease/health condition, or a class of diseases/health conditions that are of interest to public health.
Event-based surveillance monitors data from specific events where a large number of people gather in one place
PHS Types
Case
Syndromic
Sentinel
Behavioral
Integrated disease
Clinical outcomes
Types of Surveillance Systems
Case Surveillance Systems
Collect data on individual cases of a health event or disease with previously determined case definitions in respect to criteria for person, time, place, clinical & laboratory diagnosis
Analyze case counts and rates, trends over time and geographic clustering patterns
Historically, case surveillance has been the focus of most public health surveillance
The NEDSS Base System is an example of a case management system
Syndromic Surveillance Systems
Collect data on clusters of symptoms and clinical features of an undiagnosed disease or health event in near real time allowing for early detection and rapid response mobilization
Data can be obtained through specific surveillance systems as well as existing epidemiologic data such as insurance claims, school and work absenteeism reports, over the counter (OTC) medication sales, consumer driven health inquiries on the Internet, mortality reports and animal illnesses or deaths for syndromic surveillance
Geographic and temporal aberration and geographic clustering analyses are performed with real-time syndromic surveillance data
Syndromic surveillance systems can also be used to track longitudinal data and monitor disease trends
Eight syndromes are monitored:
Botulism-like illnesses
Febrile (fever) illnesses (influenza-like illnesses)
Gastrointestinal (stomach) symptoms
Hemorrhagic (bleeding) illnesses
Neurological syndromes
Rash associated illnesses
Respiratory syndromes
Shock or coma
Syndromic Surveillance
Syndromic data is based on symptoms and not hard evidence such as cultures. Experts try to predict epidemics and bioterrorism based on this early data
Syndromic surveillance is part of Meaningful Use with the goal of submitting reports to public health
ESSENCE is a syndromic surveillance system that is not real time
RODS is similar and being used by a limited number of hospital systems and approaches real time reporting
Distribute is an “influenza-like” syndrome surveillance system
Syndromic Surveillance
This is a CDC web-based program to improve disease detection, monitoring and situational awareness for healthcare organizations by reporting emergency room, pharmacy and laboratory data. Participants include DOD, Veterans Affairs and civilian hospitals
BioSense 2.0 allowed state and local health departments to access data that would support syndromic surveillance systems under meaningful use. A search engine can conduct a query by syndrome, location and date
The goal is to provide a web based clearinghouse where data can be stored, searched and analyzed from and by multiple parties
Biosense
Sentinel Surveillance Systems
Collect and analyze data from designated agencies selected for their geographic location, medical specialty, and ability to accurately diagnose and report high quality data. They include health facilities or laboratories in selected locations that report all cases of a certain health event or disease to analyze trends in the entire population
Pros: Useful to monitor and identify suspected health events or diseases
Cons: Less reliable in assessing the magnitude of health events on a national level as well as rare events since data collection is limited to specific geographic locations
Behavioral Surveillance Systems
Collect data on health-risk behaviors, preventative health behaviors, and health care access in relation to chronic disease and injury
Analyze the prevalence of behaviors as well as the trends in the prevalence of behaviors over time
Information is most commonly collected by personal interview or examination
Inferential and descriptive analysis methods such as age adjusted rates, linear regression, and weighted analyses are used
Most acute when conducted regularly, every 3 to 5 years
Integrated Disease Surveillance and Response (IDSR)
Incorporates epidemiologic and laboratory data in systems designed to monitor communicable diseases at all levels of the public health jurisdiction, particularly in Africa
Useful for: detecting, registering and confirming individual cases of disease; reporting, analysis, use, and feedback of data; and preparing for and responding to epidemics
Clinical Outcomes Surveillance
Monitors clinical outcomes to study disease progression or regression in a population
Analyzes the rates of and factors associated with clinical outcomes using descriptive and inferential methods such as incidence rates from probability samples
Laboratory Based Surveillance
Collects data from public health laboratories, which routinely conduct tests for viruses, bacteria, and other pathogens
Used to detect and monitor infectious and food-borne diseases based on standard methods for identifying and reporting the genetic makeup of specific disease-causing agents
Commonly used in case surveillance and sentinel surveillance
Strategic vision for how informatics and information technology should support the practice of public health
Everyone in a public health agency needs to know something about informatics and information systems
Information systems should deliver value to the public health agency by supporting the work done by its professional staff.
Public Health Informatics Core Elements
The CDC would like a robust interoperable web based system to integrate all aspects of public health
This will require data standards, security measures and high level funding to succeed
The PHIN Strategic Plan for 2011-2016 can be found on the CDC web site
Public Health Information Network
The capability to electronically transmit immunization data to immunization registries or immunization information systems
The capability to electronically transmit reportable lab results
The capability to electronically transmit syndromic surveillance data from an EHR
The capability to report cancer cases to a state registry from a certified EHR
The capability to report specific cases to a non-cancer state registry from a certified EHR
Meaningful Use and Public Health
Health Information Exchange and Public Health Use Cases
Mandated reporting of lab diagnoses
Non-mandated reporting of lab data
Mandated reporting of physician-based diagnoses
Non-mandated reporting of clinical data:
Public health investigation
Clinical care in public health clinics
Population-level quality monitoring
Mass-casualty events
Disaster medical response
Public health alerting - patient level
Public health alerting - population level
Geographic Information Systems (GIS)
Epidemiologists often characterize data by place, time and person
In 1855, Dr. John Snow created a simple map to show where patients with cholera lived in London in relation to the drinking water source in the Soho District of London
Modern GIS uses digitized maps from satellites or aerial photography
A GIS is a system of hardware, software and data used for the mapping and analysis of geographic data
GIS provides access to large volumes of data; the ability to select, query, merge and spatially analyze data; and visually display data through maps
Using GPS and mobile technology, field workers can enter epidemiologic data to populate a GIS
Geographic Information Systems (GISs)
GIS Map
HealthMap
global avian influenza outbreaks
Partners in Information Access for the Public Health Workforce Resource
County and Local Health Data
State Health Data
Individual State Data
National Health Data
Global Health Data
Statistical Reports
Demographic Data
Geographic Information Systems (GIS)
Training and Education
Health Information Technology and Standards
Tools for Data Collection and Planning
Public Health Data Tools and Statistics
The National Health Interview Survey (NHIS)
The National Health and Nutrition Examination Survey (NHANES)
The National Survey of Family Growth (NSFG)
National Health Care Surveys
Project Tycho
Public Health Data Tools and Statistics
The Association of Schools of Public Health (ASPH) estimates that the field of public health will require 250,000 more workers by 2020 to avert a national public health crisis
University of Washington’s Center for Public Health Informatics developed a list of informatics competencies for public health workers to meet the needs of the evolving public health field as well as for the Public Health Informatician
A Public Health Informatician is “a public health professional who works in practice, research, or academia and whose primary work function is to use informatics to improve population health
PHI Workforce
All of the goals of the US Public Health system also pertain to the international community
The World Health Organization represents world public health with the following goals:
Foster health security
Promote health development
Strengthen health systems
Global Public Health Informatics
WHO Programs
Global Alert and Response (GAR): the integrated infectious disease surveillance program within WHO
International Health Regulations
Early Warning Surveillance: surveillance mechanism to effectively identify disease outbreaks and other health issues immediately following acute emergencies
Global Public Health Intelligence Network: to electronically monitor infectious disease outbreaks
Global Outbreak Alert and Response Network: provide a rapid identification and response to outbreaks and alert the international community
Systems need to integrate diseases that affect animals with human data
Enhance the global response to outbreaks
Improve communication between health entities e.g. the Ebola virus crisis
Better diagnostic tools for earlier detection
PHI Challenges
Public Health Informatics is an important part of Health Informatics
Public Health reporting is part of Meaningful Use
Public Health surveillance is the backbone of public health to detect and track epidemics, natural disasters and bioterrorism
Geographical Information Systems can provide maps with important health data overlays
New public health programs will continue to evolve that will require informaticists to analyze, disseminate and store data
Conclusions
