A Practical Roadmap to Integrating Public Health (Surveillance) IT Systems

A Practical Roadmap to Integrating Public Health (Surveillance) IT Systems

Massimo Mirabito, Kumar Batra, Priscilla Chu

Sharon R. Burks, William D. Correll, Thomas Sukalac

Presenter Disclosures

Max Mirabito, Kumar Batra, Sharon BurksEmployed by Northrop Grumman Own Northrop Grumman StocksCurrently working on the CDC CIMS Contract supporting CDC/NCHHSTP

Thomas Sukalac, William D. CorrellEmployed by the Centers for Disease Control and Prevention Currently support CDC/NCHHSTP

Priscilla ChuEmployed by the San Francisco Department of Public Health Currently supporting the Population Health Division

The State of Public Health IT Systems Public health systems are becoming increasingly integrated

2011 MMWR report “State Electronic Disease Surveillance Systems — United States, 2007 -2010”

• 22% increase in integrated systems• 211% increase in interoperable systems

NCHHSTP is encouraging data integration and harmonization

Surveillance Systems Consultation recommendations• Leadership is involved in standardizing public health data• Build systems that will break down silos• Increase interoperability and harmonize data submission • Facilitate collaboration between public health partners• Provide guidance and facilitate information exchange• Develop Public Health informatics workforce

The Importance of Integration

Collecting and aggregating Deliver efficient and effective services Shifting from disease specific to integrated systems

• Unified offering across disease domains

Benefits• Improved data sharing and data quality

• Increase agility and ability to delivery services

• Detect, monitor, track, identify and correlate

Roadmap to Public Health IT System Integration

Roadmap: Key Factors

Factors Influencing Integration

Leadership priorities• Aligned with mission, integrate all diseases, one system, privacy and

confidentiality, efficiencies

Public Health Programs and Initiatives• Critical, guide and shape

System Design and Architecture• Design, resources, security, support, expandability

Integration• Data exchange, interoperability, Application Program Interfaces (APIs)

Four areas to Focus

Roadmap: Organization

Organizational Factors

Look Inside• Strengths – EPI, surveillance, research, creativity

• Weaknesses – IT fragmentation, knowledge, siloes, policies and practices

Look externally • Opportunities – Healthcare reform, liberating data, increase collaboration

• Threats/Challenges – Constrained budgets, categorical funding, policies

Look closely at your organization

Roadmap: IT Environment

IT Landscape

Current landscape• Invested considerable resources

• Duplicative systems and outdated technology

• Systems collect similar data in different formats

• IT is burdened; more and more to support and maintain

Upcoming landscape• Technology has created new expectations

• New ways of socializing and discovering data

• Mobility is pressuring IT

• It’s harder to keep up

IT is more complex than 20 years ago

Roadmap: Integration Challenges

Integration is Difficult

People• Communicate vision• Balance needs

Complexity• Compartmentalization, unique needs• Rushing to integrate, lack of requirements

Resources • Funding, Infrastructure, Sustainability

Harmonization• Concept vs. operationalization

Risk is not your enemy

Roadmap: Recommendations

Recommendations

Align integration to Executive priorities, Public Health programs, Architecture, Integration

Develop your unique blueprint Involve IT & Informatics early and often Identify ways to liberate data to increase collaboration

Align your solution to your focus areas

Roadmap: The San Francisco Blueprint

Roadmap: San Francisco Department of Public Health (SFDPH) Population Health Division

Background Process Key factors

influencing integration Organization IT environment and

information systems Lessons learned from

integration

Background

Program Collaboration and Systems Integration (PCSI) initiative

Syndemic analysis 65+ separate data

systems Decision made by Local

Health Officer to move to integrated system

Winchester Mystery House

Roadmap: The SFDPH Population Health Division

Process

Stakeholder engagement Informatics assessment

• Conducted 14 focus group interviews

• Synthesized information into an informatics report

Market solutions report• Specific to local criteria

Business case Software system

demonstrations Software system selection

Roadmap: The SFDPH Population Health Division

Key Factors Influencing Integration

Strategic Map: Build an integrated information and knowledge management infrastructure

Ability to share data for client-centered holistic and syndemic approach

Increase efficiency:• More collaboration• Less paper• Less duplicate data entry

Roadmap: The SFDPH Population Health Division

Organization

Roadmap: The SFDPH Population Health Division

Strengths Weaknesses W

Opportunities O Threats T· Health care reform and

meaningful use· Funding· IT reorganization

· Costs of clinical systems· Decreasing funding

· Leadership support for integration

· Epidemiological/analytical/research capacity

· Siloed systems· Medical record vs. public

health data

Exte

rnal

Fac

tors

Inte

rnal

Fac

tors S

IT Environment & Information Systems

IT’s support of systems• IT focused on clinical systems• Public health’s outdated

systems

Lack of investment in IT• Infrastructure, capacity and

bandwidth• Workforce development –

look at future needs

Roadmap: The SFDPH Population Health Division

Lessons Learned from Integration

Stakeholder engagement is important

Change is everywhere • Population Health Division reorganization

• New Chief Informatics Officer - IT reorganization (4x)

• Clinical side reorganization

Change management• Too much change at once is difficult

• Speak to the elephant

Roadmap: The SFDPH Population Health Division

Conclusion

Develop a customized informatics blueprint Invest in IT (infrastructure and human capital) and

increase public health informatics capacity Consider working with Informatics

resources at CDC

Integration is lifestyleIntegration is a marathonIntegration is a team sport

Acknowledgments

US Centers for Disease Control and PreventionGustavo Aquino – NCHHSTP Associate Director for Program Integration

San Francisco Department of Public HealthIsrael Nieves – Director, Office of Equity and Quality Improvement, Population Health Division, San Francisco Department of Public Health