intro to PHI health information

Public health information

Introduction to Public Health Informatics: Health Information Systems Principles

and Building blocks

Sherrilynne Fuller, PhD Professor, Biomedical and Health Informatics, School of Medicine

Co-Director, Center for Public Health Informatics School of Public Health

University of Washington, Seattle, USA

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

What Does This Have to do With Health Information Management?

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

What Does This Have to do With Health Information Management?

ISOLATED DATA – in Silos

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Pharmacy

Patient Records

Laboratory Facilities Data

Community Health Data

Souce: Rear Admiral Patrick O’Carroll, Region 10 Health Administrator

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Global Health Challenges

for the Next Decade

• New viruses that can travel more rapidly, transforming local

afflictions into worldwide epidemics; new and re-emerging

infectious diseases (70% of which are zoonoses)

• A modern lifestyle that travels just as fast, contributing to

swelling epidemics of non-communicable diseases

• A human resources crisis is directly linked to transnational labor, economics and migration

• The growth of vertical (e.g HIV/AIDS, TB, malaria) initiatives has pushed advances for specific diseases but has also put

pressure on individual countries’ public health systems.

– This underscores the need to work to

improve those systems, and highlights the need to improve both the human and

technical competencies used to manage

them.

Reduce need to access health care providers

Support PH underlying prioritization and policy setting

Patient ability to enter healthcare system once intervention needed (financial means, logistical access)

Identifying underlying condition and needed intervention Catering

diagnostics for regional needs

Administration of medical care Reduction of health care expense for populations

Tracking health of patients,

populations and compliance with treatment regimens Tracking efficacy of new treatments

Health Systems Dimensions

Prevention Access Diagnosis Delivery Monitoring

Health care delivery system

Efficiency Relative population health improvement for each dollar invested

Equity Ensure good health outcomes are shared by entire population regardless of income or education

Quality Relative effectiveness of healthcare system and medical interventions

Public health organizations, governments, R&D, donors

Source: WHO

Source: Karl Brown, Rockefeller Foundation

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Health Information Systems “Silos”

Broad range of initiatives, but few integrated interventions

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Telemedicine diagnosis

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HealthNet Eritrea for health information

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Antiretroviral Therapy Information System (ARTIS)

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Uganda Health Information Network (UHIN)

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AMREF remote clinical diagnosis by specialists Mosoriot medical record system

EMR for AIDs and TB care (2)

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Cell-Life clinic workers remotely monitor health patient problems EMR for AIDs and TB care HealthNet information network (3)

Monitor Vitamin A distribution Voxiva disease survelliance system in Tamil Nadu Remote eye diagnostics East Bhutan Tele-ECG Telediagnostics

Telepatholog y

Assess availability of HIV/AIDS-related services

AMREF remote clinical diagnosis by

specialists Regional HIV data

center

Web based clinical information system for researchers PIH-EMR electronic medicalrecord supports TB and HIV

SICLOM delivery ARV treatment

Teledermatology District public health tracker GENNET forum for gender issues

On Cue SMS drug reminders for TB

patients

EMR for AIDs and TB care

(2) HealthNet info network (6) HealthNet info network (8)

Health Metrics Network

Global

/

Regional

WHO GoE GOARN Weekly EPI Record (WHO) NEDSS (CDC)

Antimicrobial inform bankFluNet and RABNETAPEC EINET Health InterNetwork (US) Roland Koch Institute

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Karl Brown Rockefeller Foundation

Health Information Systems Challenges:

Vietnam 2007

Huong PTM, Hue VTK Vietnam HIT Case Study NBR Center for Health & Aging 2007 1-5.

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Medical Informatics

… the discipline that concerns the management

of medical (clinical) information and the

conversion of the information into useful

knowledge for decision making…

Norris, T, Fuller SS, Goldberg HI,

Tarczy-Hornoch, P eds Informatics in Primary

Care: Strategies in Information Management for the Healthcare Provider, Springer,2002.

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Public Health Informatics

The systematic application of information science, computer science and

technology to public health (individual and population) practice, research and learning*

“prevention informatics”

*O’Carroll et al Public Health Informatics and

Information Systems NY, Springer, 2003Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Health Informatics: Approach to

Design and Implementation

• Focus is on the APPROPRIATE use of data, information and

communications technologies to promote health

•Collect data once (e.g at time of patient encounter – use many

times – for following patient over time; for reporting for analysis and evaluation; for research; and for generating statistics for population health monitoring and evaluation

• Develop approaches to understanding the capabilities and

limits of technology in improving health

• Develop approaches to appropriately use computers to complement human skills and human needs

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Health Information Systems: Approach to

Design and Implementation

• The hardest part of implementing useful

health information systems Is ensuring that users of those systems actually USE the

systems!

• Understanding social and political issues is a VERY important part of health informatics

• In this course we will bring the social,

political, cultural contexts together with the

technical to provide a comprehensive

framework for creating effective health

information systems

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Clinical Decision Support Systems

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Public Health Decision

Health Workers

Data and Statistical

Collections

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Key Public Health Information Systems:

Monitoring for Prevention

• National Vital Statistics systems – births, deaths

• Disease occurrence data :

– Outbreak investigation and mapping

– Prevalence– magnitude & burden of disease at a particular time

– Incidence – new cases over a time period and indicator of need for or success of preventive efforts

• Risk factor analysis – e.g water quality, sanitation, malaria outbreak prediction

• What are some of the public health information

systems in use in Veitnam?

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Public Health Informatics: From Disease

Surveillance to National and International Health

Information Systems

National disease surveillance information systems

National health

information

systems

Regional disease surveillance information systems

International disease

surveillance information systems

Source: Karl Brown, Rockefeller Foundation

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

“The ability to communicate and exchange data accurately,

effectively, securely and consistently with different information technology systems, software applications and networks in various settings so the clinical or operational purposes and meaning of the data are preserved and unaltered” (1)

(1) National Alliance for Health Information Technology - NAHIT

Interoperability in Public Health: MBDS Course Mahidol University and University of Washington February 2010

Building “vertically” in the US health system

created data silo issues that are still being

addressed today

CDC report (1995):

“A single patient may be treated by

multiple providers, each with its own record

system

•it has been collected in incompatible formats,

using different definitions, personal identifiers,

classification systems, or sampling strategies;

•the communications infrastructure is not in

place through which data can be accessed,

aggregated, and transferred; and

•policies, legislation, and organizational

practices although needed for the protection

of confidentiality may unnecessarily impede

access to, and sharing of, information.

•Since it is so difficult to join these data

together, partners in the public health system

cannot fulfill all of their information needs or

efficiently manage the delivery of services.”

United States GAO report (1999):

•“In 1993, the lack of integrated systems

impeded efforts to control the hantavirus

outbreak in the Southwest Data were

locked into separate databases that could not

be analyzed or merged with others, causing

public health investigators to analyze paper

Hospital 1 data formatStandard

Data can flow freely in interoperable systems

Source: Karl Brown, Rockefeller Foundation

To avoid stovepipes, need to ensure data can be

communicated and merged across several

dimensions

• Data and Information Drives Systems

Design

And/Or “resources”

And/or “resources”

And/Or Resources

Health Records: Building Blocks for Health Information Systems

Electronic Medical Record

Health-related information on an individual that can be created, gathered, managed, and

consulted by authorized clinicians and staff within one health care organization.

Electronic Health Record

An electronic record of health-related information on an individual that conforms to nationally

recognized interoperability standards and that can be created, managed, and consulted by

authorized clinicians and staff across more than one health care organization

Personal Health Record

An electronic record of health-related information on an individual that conforms to nationally

recognized interoperability standards and that can be drawn from multiple sources while

being managed, shared, and controlled by the individual

Family Health Record

An electronic record of health-related information about all family members including information about individual family members (gathered from their individual records) as well as relevant information about the family’s home and community environment

Interoperability in Public Health: MBDS Course Mahidol University and University of Washington February 2010

Management of the project

Pressure of time to spend the

money = lack of attention

Political pressures

“buying a solution” instead to

investing in a deep change of IS

Adapted from slide by: Dr Rafael Lozano, Institute for Health Metrics and Evaluation –University of Washington

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

Center for Public Health Informatics University of Washington

Center for Public Health Informatics University of Washington,

Seattle Washington, USA

University of Washington Center for Public Health Informatics

UW for Public Health Informatics*

Administrative Core A

Epidemiology &

Biostatistics Core

Informatics

Core C

Knowledge Management

Dept of Health

Regional ,National and International Health Organizations

Center for Public Health Informatics University of Washington,

Seattle Washington, USA