Chapter 15

Public Healthcare Informatics

Alex MayerLA04b

Introduction

systematic application of information, computer science, and technology to public health practice, research, and learning.

Population level Focuses on prevention rather then diagnosis and

treatment. Feasible due to rapid decline in cost of software and

hardware.

Public Health Systems

Bio Terror Detection Networks Pedestrian Collision Systems Medical Care Systems Disaster Response Systems Building Codes Waste Systems

Not all public health informatics mediums relate to medical care, but rather the preservation of health in all forms.

Systems

Public Health Systems

Datum such as air quality, patterns in diseases to release alerts, and quarantine individuals to protect the greater good are focused more upon in public health.

Government agencies play an important role to determine level of intervention and what is acceptable through legislation and lobbying.

The National Center for Public Health Informatics (NCPHI) promotes and funds the coordination and implementation of the Public Health Information Network (PHIN).

Systems

Public Health Systems

Epidemiology (study of prevalence and determinants of disability and diseases in populations) .

It is impossible to have a complete record of every disease, injuries, and medical issues in a country, however the CDC (Centers for Disease Control and Prevention) does document birthday and deaths.

Systems

Public Health Systems

3 Core Functions: Assessment of information on the health of

the community. Comprehensive public health policy

development. Assurance that public health services are

provided to the community.

Public Health Systems

Systems

Services

1. Monitor the health status of individuals in the community to identify community health problems.

2. Diagnose and investigate community health problems and health hazards.

3. Inform, education, and empower the community with respect to health issues.

4. Mobilize community partnerships in identifying and solving community health problems.

Services

Ten Essential Services of Public Health

5. Develop policies and plans that support individual and community efforts to improve health.

6. Enforce laws and rules that protect the public health and ensure safety in accordance with those laws and rules.

7. Link individuals who have a need for community and personal health services to appropriate community and private providers.

Services

Ten Essential Services of Public Health

8. Ensure a competent workforce for the provision of essential public health services.

9. Research new insights and innovate solutions to community health problems.

10. Evaluate the effectiveness, accessibility, and quality of personal and population-based health services in a community.

Services

Ten Essential Services of Public Health

One of the oldest systematic activities of the public health sector.

Surveillance refers to ongoing collection, analysis, interpretation, and dissemination of data on health conditions and threats to health.

Surveillance

Immunization Registries

Immunization Registries Are: Confidential, population based, computerized

information systems. Contain data about children and vaccinations. Represent examples for illustrating the

principles of public health informatics. Among the largest and most complex public

health information systems.

Immunization

History of Immunization Registries

Immunization registries were created to enable the exchange information to ensure that children who relocate receive needed immunizations.

Immunization registry development guide was a collaborative development implemented in 1997.

In 2000 a consensus was formed in the 12 needed functions of immunization registries.

Immunization

Controversy – Not in Book

Texas Immunization Registry Controversy 1997 the Texas Department of Health

attempted to use legislation to force all Texas children into the statewide immunization tracking system. Many parents disagreed on the basis of privacy. Requests were made to alternatively obtain

written consent from the parent. A two year legal battle ensued . As of today parents can request to remove

their children from the registry.

Immunization

Key Informatics Issues in Immunization Registries

4 challenging areas:1. Interdisciplinary communication2. Organizational and collaborative issues3. Funding and sustainability4. System design

Immunization

ImmTrac

Developed by the Texas Department of State Health Services (DSHS).

A free and confidential registry which consolidates a child’s immunization records from multiple providers.

For more information about ImmTrac, go to http://www.dshs.state.tx.us/immunize/immtrac/default.shtm

Immunization

Immunization

Interdisciplinary

Communication problems in registry implementation: Lack of a shared vocabulary. Differences in the usage of common terms.

Tensions and anxieties for new system: Change in uncomfortable for everyone. Power shifts associated with new system.

Communication

Organizational and Collaborative

Large number and wide variety of partners Constraints of the private provider environment --

require minimizing time and expense for registry data entry.

Governance issues Large projects involving multiple partners often

require multiple committees. Legislative and regulatory issues

Confidentiality, data submission, and liability. HIPAA

Issues

Community- and state-based immunization registries overcome these ongoing challenges by providing automated immunization information tools that decrease record scattering, enable providers to easily implement strategies known to improve coverage, decrease unnecessary immunizations and missed immunization opportunities, and increase office efficiency.

Issues

Immunization

http://www.dshs.state.tx.us/immunize/docs/Electronic_Transfer.pdf

Immunization

http://www.dshs.state.tx.us/immunize/docs/Electronic_Transfer.pdf

Immunization

http://www.dshs.state.tx.us/immunize/docs/Electronic_Transfer.pdf

Advantages for NHII now and later

Potentially increased involvement of patients in their care.

Better clinical decision making through connecting patient-specific information with the best clinical evidence.

Increased efficiency and potential cost savings.

NHII

NHII Barriers and Challenges Confidentiality of Electronic Medical Records

HIPAA Misalignment of Financial Incentives

Costs out weight Benefits Benefits accrue to payer ROI Uncertain

Legal and Regulatory Barriers Loopholes for Payment Fraud Abuse

Lack of interoperable Medical Records System

NHII

To promote the collaboration and to promote NHII is through demonstration projects in communities.

A demonstration can include establishing clear examples of the benefits and advantages of comprehensive health information systems in communities.

NHII

Demonstration Projects

Scope of the NHII

There are 3 main focus areas for the NHII. These include:

Personal Health – it will create a personal health record that can be controlled by the individual or their family.

Health Care delivery – information such as provider notes, clinical orders, DSS’s, digital prescribing programs, and practice guidelines.

Public Health – enables the sharing of information such as vital statistics that can be used to monitor population health risks and disease registries.

NHII

Alert for medication errors, drug allergies, etc.

Personal Health-includes a personal health record that is created and controlled by the individual or family.

Healthcare providers will retain responsibility for their own patients' medical records.

Advantages for NHII now and later

NHII

Implementation:

Reasons for selecting a community-based strategy

Existing models of health information infrastructures are based in local communities

Keeping projects small within the community will not become disproportionate and complex

It is not necessary to take a national approach to achieve desired end results because NHII can be created effectively by connecting with communities that have developed local health information infrastructures

NHII

Measures to Evaluate Progress

To measure the progress will be to define the end state of the project

NHII

NHII and Homeland Security

NHII would allow doctors to make more definite

diagnoses of such cases

NHII would provide information regarding suspicious

patterns caused by rare diseases.

NHII would allow officials to use the information

provided to allocate resources to manage it.

NHII

Challenges

There are many challenges to implementing a system such as NHII. These include:

Differing views on collected samples depending on the department. (Ex. Law enforcement would collect evidence, while health organizations would be gathering specimens)

Differing terminology between departments which will cause issues with interdepartmental communications.

The creation of new systems that have never been tested before such as disease detection and coordination.

NHII

(HII) Health information infrastructure

 A comprehensive knowledge-based network of interoperable systems of clinical, public health, and personal health information.

Technologies, standards, applications, systems, values, and laws that support all facets of individual health, health care, and public health.

 NOT a centralized database of medical records or a government regulation.

HII

 Lack of Standards prevents interoperability and sharing of data.

 To improve healthcare quality. sharing of information to improve the clinical

management of populations of patients such as vital statistics.

(HII) Health information infrastructure

HII

Establishing Standards

Laboratory Results Names.

Messaging Standards.. Demographics. Lab Result Contents. Units of Measure Immunizations. Medications. Interventions/Procedures

Approaches to accelerating HII Progress

HII

Anatomy Diagnosis/Problem

Lists Nursing Financial/Payment Genes Clinical Encounters Text Based Reports Chemicals

Vision for HII in Homeland Security

NHII would allow any medical information relevant to public health and safety to be reported to the system in near real-time.

Reports could be generated using this data to track any disease trend that may be suspicious. This would allow officials to track the development of a potential outbreak.

The system can also generate reports detailing what resources are available and this can be used to effectively manage and distribute resources according to need.

The system could also be used to monitor and track normal disease trends such as the flu.

HII