Public Health Informatics

MPHE 622

Kassim Kamara, M.Phil.

 FUNDAMENTALS OF PUBLIC HEALTH INFORMATICS
Principles of Public Health
There are four principles, flowing directly from the scope and nature of public health,

that distinguish it from other health informatics specialty areas :

• Promote the health of populations as opposed to the health of specific

individuals
• Prevent disease and injury by altering the conditions or the environment
that put populations of individuals at risk
• Explore the potential for prevention at all vulnerable points in the causal
chains leading to disease, injury, or disability
• Should reflect the governmental context in which public health is practiced
 Public Health Informatics — Defined

• PHI came about when public health officials

began leveraging HIT in systematic ways
• PHI Definitions:
– “The science of applying information-age
technology to serve the specialized needs of public
health” (Friede et al., 1995)
– “The systematic application of information and
computer science to public health practice,
research, and learning” (Yasnoff et al., 2000)
– Public health informatics is the systematic
application of information, computer science, and
technology to public health practice, research, and
learning

 
 Public Health Informatics (PHI)
• How is PHI different from other informatics disciplines?
– A focus on prevention in populations
– Use of a wide range of interventions to achieve its goals
– Constraint by operating in a governmental context

Source: (Yasnoff et al., 2000)

 Public Health’s Mission
• Promote Physical and Mental Health and Prevent Disease, Injury,
and Disability”

• This is accomplished through 10 “essential public health services”

organized under three main headings
– Assessment
– Policy Development
– Assurance
 Public Health Approach

Risk Factor Intervention

Surveillance Implementation
Identification Evaluation
 Essential Public Health Services
1.Monitor health status to identify
community health problems
2.Diagnose and investigate health
problems and health hazards in
the community
3.Inform, educate, and empower
people about health issues
4.Mobilize community partnerships
to identify and solve health
problems
5.Develop policies and plans that
support individual and community
health efforts
 Essential Public Health Services
6. Enforce laws and regulations that
protect health and ensure safety
7. Link people to needed personal
health services and assure the
provision of healthcare when
otherwise unavailable
8. Assure a competent public health
and personal healthcare
workforce
9. Evaluate effectiveness,
accessibility, and quality of
personal and population-based
health services
10. Research for new insights and
innovative solutions to health
problems
 PHI Professionals
• Trained in both information technology and public health

• Utilize HIT applications to solve public health problems

 Public Health Informatics: Key Issues
• Internet cafes, computer centers, and mobile devices from cell phones to handheld
gadgets are tools in regular use among many health workers and policymakers.

• The challenge for public health informatics is how to enhance the delivery of high-
quality, contextually relevant content, focused on a broad range of data (such as
disease incidence, immunization rates, morbidity, mortality statistics, practice
guidelines, research findings, protocols, maps and images) so this content can be
used on the ground at the local, district and national levels.
 Potential for public health informatics
• Communication among geographically dispersed health workers and consumers
• Delivery of public-health services by strengthening and streamlining data collection
• Support of primary and secondary prevention via electronic health records and
improved laboratory systems
• Data collection for research studies, such as drug and vaccine trials
• Environmental health interventions, such as biosurveillance, road safety and
geographic mapping systems applications
 Public Health Informatics Impediments
• A lack of integrated, interoperable health information systems to support decision
making at all levels
• System fragmentation at the donor, NGO, ministries of health, clinics and hospital levels
• Capacity shortfalls in technical support and technology availability for day-to-day health
information systems tasks
• Data stewardship challenges, including the need to provide incentives for people to
collaborate on collecting and sharing accurate and useful data.
• The one-way flow of information that is sent upward, but not back to health workers on
the ground
• Too many vertical disease silos across health sectors
• Short donor-funding horizons and investments that are not long-term, coherent or
consistent
• Inconsistencies between “industrial” IT solutions and on-the-ground realities
• A need for national ownership
 Evolution of Public Health Informatics in US
• 1995: PHI was first described as a needed distinct discipline (Friede)
• Late 1990s: The PHI “movement” gained momentum in the late 1990’s and early
2000’s
• 2001: Events of September 11 and subsequent anthrax attacks crystallized the
need for key PHI applications
 Early PHI Applications
Syndromic surveillance
– Definition:
Concerned with “the continuous monitoring of public-health related information sources and
early detection of adverse disease events” (Yan et al., 2008)
– Utilizes information technology, statistical algorithms, data visualization
techniques to identify trends warranting public health attention
 Potential Data Sources for Syndromic Surveillance
• Sales of over the counter drugs
• Visits to the emergency department for certain aliments
• Absentee data from schools
• Physician office visits
• Nurse hotline calls
• Dead bird reports
• Prescription from pharmaceuticals
• Internet searches (i.e. Google)
 BioSense
BioSense is a US national program intended to support early outbreak
detection by conducting near real-time analysis of existing data from
healthcare organizations across the country
• Ambulatory data
• Emergency room diagnostic and procedural information
• Clinical laboratory test orders and results
• Over-the-counter drug sales
Hospitals Participating in BioSense and US Population Density
 Local and State Efforts
• Many local syndromic surveillance systems have been implemented at
the local, county, and state levels
• Many focus on identifying trends indicating a possible bioterrorism
attack
– Anthrax –Tularemia
– Botulism toxins – Brucellosis
– Small pox – Hemorrhagic fever
– Plague – Viral encephalitides
– Q-fever – Staph. enterotoxin-B
 Syndromic Surveillance for Special Events
• Olympic Games
• FIFA World Cup
• G8 summit
• World Series
• Super Bowl
• Kentucky Derby
• H1N1 Pandemic

Source: (Chen et al., 2010, p. 30.)

 Syndromic Surveillance for Special Events
• Olympic Games
• FIFA World Cup
• G8 summit
• World Series
• Super Bowl
• Kentucky Derby
• H1N1 Pandemic

Source: (Chen et al., 2010, p. 30.)

 Syndromic Surveillance for Special Events
• Olympic Games Swine flu infections and deaths by
county June 2009
• FIFA World Cup
• G8 summit
• World Series
• Super Bowl
• Kentucky Derby
• H1N1 Pandemic

Source: (Chen et al., 2010, p. 30.)

 Future of Syndromic Surveillance
• Take advantage of EHR data
• Connect with NHIN
• Expand beyond “early detection” and provide data for:
– Situational awareness
– Other routine public health practices
Electronic submission of “reportable” diseases
MRSA occurrence tracking
 MRSA stands for Methicillin (pronounced Meth-ih-sillin) Resistant Staphylococcus (pronounced
staff-ill-oh-cock-us) Aureus (pronounced oar-ee-us), a dangerous drug resistant infection
 Emerging PHI Applications
• Geographic Information System (GIS)

• SMS Text messaging

Geographic Information Systems
 SMS Text Messaging

Has been used for

public health purposes
including:
• Behavior change
support
• Disease prevention
• Contact Tracing
• Health Education
Campaigns
• Data Collection
 Summary

• The use of PHI applications may raise

– Ethical issues
– Social issues
– Political issues

• Ongoing transparency and open debate will likely resolve

many concerns and allow PHI to enable more efficient and
effective public health practice
Creating a Public Health Information System
 The Informatician

Understands ideas

Understands
Envisions innovative capabilities,
scenarios opportunities, and
limitations

Policy
Security Data Standards
 Creating a Public Health Information System

CMS = Centers for Medicare and Medicaid Services; EHR = electronic health record; ELR = electronic laboratory record; HIE = health information exchange; HIPAA = Health
Insurance Portability and Accountability Act; HL7 = Health Level 7; ICD = International Classification of Diseases; SNOMED = Systematized Nomenclature of Human
Medicine; SQL = structured query language.
Step 1 — Vision and System Planning

Hardware

Software

Communication
Technology
 Step 2 — Health Data Standards and Integration
•

Health data standards and

integration are required when
defining the data.
Step 3 — Data Privacy and Security

Data privacy and security must

be identified, prescribed, and
implemented throughout the
data lifecycle.
Step 4 — Systems Design and Implementation

• Define or design methods for public

health functions, data elements, data
flow, case definitions, and message
mapping

• Implement information technology for

defined public health functions, data
elements, data flow, case definition,
and similar needs
Step 5 — Visualization, Analysis, and Reporting of Health
Data

Visualization and
implementation of the required
analysis, reporting, and
meaningful use of the data
collected and managed by the
system.
Informatician, Public Health Official, and Information Tech.
At the Intersection of the Informatician, the Public Health Official, and
the Information Technologist
Common Knowledge and Skills

Broad knowledge of public health practice, proficiency in

information technology, and capacity for innovation

Expertise in health data standards, database design, and data linking

and integration across health systems

Expertise in relational/SQL databases

and unstructured data design and
management

Knowledge of health data privacy

Understanding information technology security

functions

Expertise in health systems and

data interoperability

Expertise in managing information

technology systems development

Expertise in public health practice, business

intelligence, decision making, and use of
analytic software
Step 4 — Creating a Public Health Information System

Expertise in health systems and

data interoperability

Expertise in managing information

technology systems development
Combined Disciplines — The Informatician and the
Information Technologist
The Role of the Informatician in Public Health
• Plans, designs, and defines functional
requirements for public health information systems
• Evaluates the application and impact of
information systems in support of health goals
• Serves as a liaison between multidisciplinary
teams
• Uses data standards to support interoperability of
data between systems
• Ensures confidentiality, security, and integrity
standards
• Is knowledgeable about health data standards,
sources, and meaningful use of health data
The Role of the Information Technologist in Public Health

• Plans technology projects and milestones, develops

software, and maintains and operates systems
• Evaluates the performance and availability of
information systems
• Designs, implements, and administers database
architecture, privacy, security, and backup
procedures
End

THANKS