Public Health Informatics

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Public Health Informatics was defined by in a paper published in 2000 by Yasnoff as “the systematic application of information and computer science and technology to public health practice, research and learning.” He also defined four principles on which public health informatics should be followed as a discipline. They are:

  • focus on the information science and technology applications that promote the health of populations.
  • focus on the information science and technology applications that prevent disease and injury by altering the conditions or environment that put populations at risk.
  • explore the potential vulnerable points in the causal chains leading to disease, injury or disability and not to restricted to particular social, behavioral or environmental context.
  • reflect the governmental context in which public health is practiced.

Introduction

The changing practice and importance of the population-based perspective of public health, wellness, and prevention is resulting in the need to enhance information technology applications in public health.

In the current public health environment, a knowledgeable and skilled work-force is needed to support emerging data sharing and communications initiatives designed to improve public health programs, modernize health care, and increase the utility of public health data by linking disparate information systems. The public health workforce includes clinicians, technicians, nurses, epidemiologists, researchers, managers and supervisors, outbreak investigators, health educators, social workers, case workers, health officers, and environmental health specialists.

There are several current initiatives regarding Public Health Informatics. These include: the Public Health Informatics Fellowships, the Public Health Information Network (PHIN), Centers of Excellence in Public Health Informatics, and the Centers for Public Health Preparedness. And there is an array of prior work and research that has depicted public health needs for informatics training. information technology to public health. However this training has been developed in relative isolation, with no consensus as to the specific informatics competencies public health professionals ought to have. To address this issue, a working group of public health informaticians and educators was formed to draft this consensus set of public health informatics competencies. See: http://www.nwcphp.org/resources/key-public-health-competency-sets-and-resources

Public Health Informatics as an Applied Information Science

(Submitted by: Christopher Hollweg)

As an applied information science in the domain of public health, public health informatics combines computer science, information science, and behavioral and management sciences into methods, tools and concepts that lead to information systems that impact health. [1] The other sciences which public health employs include prevention effectiveness, epidemiology, laboratory science and the science of surveillance. All of these sciences are data rich fields and as such, it necessitates the science of public health informatics to be the gears which allows information to flow smoothly and effectively in the public health machine. The functional part of this machine is the public health information system.

Public Health Information Systems

(Submitted by: Christopher Hollweg)

Understanding the key elements of public health information system and how they are put together is integral is assessing its effectiveness. When applied correctly, informatics provides effective surveillance and monitoring, facilities better decision-making and policy creation, and ultimately improves the health of a population. The creation of a public health information system is a complex undertaking requiring several key components.

The arguably most important components are the human resources, key personnel with specific expertise. Analogous to the building of a home which requires a framer, brick layer, electrician, plumber and painter; a public health information system requires a database administrator, network administrator, programmer, web designer and security specialist. To manage and oversee the building of a house there is an architect and developer, likewise it is the informatician who not only manages the processes but designed and created them.

The informatician is an expert in the field, has broad knowledge of public health practice, including policy; proficient in information technology including security and data standards; and in this context able to understand the capabilities, opportunities and limitations of the information system. In addition, a public health informatician is able to troubleshoot problems, apply solutions and has the capacity to innovate to advance the system’s capabilities. In this role the public health informatician is many ways a translator, at the intersection between public health officials and information technology professionals. Much in the same way a clinical informatician facilities cooperation between clinicians and information technology professionals. [2]

Creating a Public Health Information System

(Submitted by: Christopher Hollweg)

The process involved in creating a public health information system can be broken down into 5 steps: [2]

  1. Vision and System Planning,
  2. Health Data Standards and Integration,
  3. Data Privacy and Security,
  4. Systems Design and Implementation,
  5. Visualization, Analysis, and Reporting of Health Data.

As with the creation of any system, a plan must first be established. As the first step, Vision and System Planning, the informatician must see opportunities for intervention, envision solutions, and use information technology to apply those solutions to public health. At this stage it is important to include all stakeholders for input and engagement to ensure future cooperation.

The second step is Health Data Standards and Integration. This is an ongoing challenge in the field of public health as with many of the health science fields. There is often no consensus with regards to data standard use, this limits interoperability and ability to integrate disparate systems. Also, within this step is the construction and design of databases, data formats and keys for linking tables and data to support defined health data standards and integration.

The third step is Data Privacy and and Security. The implementation of health data privacy and HIPAA regulations is just as integral as is the application of information technology security functions and enforcing data, systems and communication security.

The fourth step is Systems Design and Implementation. This is where the rubber hits the road with regards to process creation. The informatician along with the informatics team must create the process by which data and information flow, all well as the methods for public health functions, define data elements, define case definitions and design message mapping. Information technology must then implement these processes into the public health information system.

The last step, step 5 is Visualization, Analysis, and Reporting of Health Data. Here in lies the core functions of public health. To accomplish this task the informatician must be fluent in public health practice, business intelligence, critical decision making and the use of analytic software. It as at this stage the data, becomes information and transformed into knowledge.

Types of Public Health Information Systems

(Submitted by: Christopher Hollweg)

Public health information systems come in many different varieties.

  • Surveillance systems provide information on disease clusters, infectious disease incidence, outbreaks of food-borne illness, and injuries.
  • Environmental monitoring systems provide information with regards to airborne pollutants or toxic chemicals exposure.
  • Registries contain vital statistics on birth, death and immunization.
  • In the US, an example for a successful public health information system of the surveillance variety, was in the creation of the CDC’s FluView. [3] This is a weekly influenza report with regard to incidence, prevalence and comorbidity related to influenza infection. This information has proved vital for the public health community, clinicians, scientists and the general public as a whole.
  • Another powerful system is that of the development of immunization registries across nearly every state, where nearly 90% of all children in the US are included.
  • Internationally, public health information systems have been used for human resource allocation. The Public Health Informatics Institute in cooperation with the Mozambique Ministry of Health created a system which allocates available health care workers around the country. This system has shown to be a necessity in optimizing access to care where there is significant shortages in health care workers. Their particular focus is in the testing and treatment of HIV. [4]
  • There are also other systems focused on determining the most common causes of death in children in developing nations. This incorporates disease surveillance centers to gather data which is then used to inform child mortality prevention programs which operate in these countries.[1]


Centers for Disease Control and Prevention(CDC)

Centers for Disease Control and Prevention (CDC)'s National Center for Public Health Informatics (NCPHI), located within the Coordinating Center for Health Information and Service (CoCHIS) provides leadership in the application of information and computer science and technology to public health practice, research, and learning. (See http://www.cdc.gov/ncphi/.) The Centers of Excellence in Public Health Informatics include two Centers funded in FY05 at Harvard Medical School (including the Children's Hospital of Boston) and University of Washington and three Centers funded in FY06 at the University of Utah, Johns Hopkins University, and the New York City Health Department.

The CDC Public Health Information Network (PHIN) is a national initiative to improve the capacity of public health to use and exchange information electronically by promoting the use of standards, defining functional and technical requirements. PHIN strives to improve public health by enhancing research and practice through best practices related to efficient, effective, and interoperable public health information systems. See: http://www.cdc.gov/phin/about.html

CDC’s role in PHIN is:

  • Supporting the exchange of critical health information between all levels of public health and healthcare,
  • Developing and promulgating requirements, standards, specifications, and an overall architecture in a collaborative, transparent, and dynamic way,
  • Monitoring the capability of state and local health departments to exchange information,
  • Advancing supportive policy,
  • Providing technical assistance to allow state and local health departments to be full and facilitating a network of active, engaged participants active PHIN participants, and
  • Facilitating communication and information sharing within the PHIN community.


Selected Organizations Related to Public Health

Association Mission/Constituency
Association of State and Territorial Health Officials (ASTHO) represents the state and territorial public health agencies of the United States, the U.S. Territories, and the District of Columbia. members are the chief health officials of these jurisdictions
American Public Health Association (APHA) represents a broad array of health officials, educators, environmentalists, policy-makers and health providers at all levels working both within and outside governmental organizations and educational institutions
Council on Education for Public Health is an independent agency recognized by the US Department of Education to accredit schools of public health and certain public health programs offered in settings other than schools of public health.
National Association of Community Health Centers (NACHC) represents the nation’s network of over 1,000 Federally Qualified Health Centers (FQHCs)
National Association of Community Health Centers (NACHC) represents the nation’s network of over 1,000 Federally Qualified Health Centers (FQHCs)



Association of Public Health Laboratories (ASTPHLD)

www.aphl.org/ Membership includes state and local public health laboratories, environmental laboratories and others that conduct testing of public health significance.


Council of State and Territorial Epidemiologists (CSTE) Association

over 1050 public health epidemiologists working in states, local health agencies, and territories.


Association of Schools of Public Health (ASPH)

www.asph.org National organization representing the deans, faculty and students of the accredited member schools of public health and other programs seeking accreditation as schools of public health.

National Association for Public Health Statistics and Information Systems (NAPHSIS)

National association of state vital records and public health statistics offices. The mission is to provide national leadership and advocacy on behalf of its members to ensure the quality, security, confidentiality and utility of vital records and health statistics, as well as their integral role within health information systems, for monitoring and improving public health.

Public Health Informatics Institute

http://www.phii.org/about/

The Institute brings public health professionals together so that they can learn from each other and share best practices. Through a collaborative approach, we facilitate requirements public health information systems.

Association of State and Territorial Local Health Liaison Officials (ASTLHLO)

/www.astlhlo.org/

Comprised of representatives from each state and territory having the responsibility of overseeing and providing support to local health agencies.

National Association of County And City Health Officials (NACCHO)

www.naccho.org/ National organization representing local health departments.


National Association for Public Health Information Technology (NAPHIT)

National non-profit organization that provides leaders in public health information technology (IT) with a venue to exchange ideas and experiences, discuss and shape current public health information policy, and learn about tools and technologies that help them better support public health.

National Association of Local Boards of Health

www.nalboh.org/ Represent the grassroots foundation of public health in America, actively engaging and serving the public by empowering boards of health through education and training. NALBOH will continue to expand its influence.


National Association of State Chief Information Officers (NASCIO)

www.nascio.org/ Represents state chief information officers and information technology executives and managers from the 50 states, six U. S. territories, and the District of Columbia. State members are senior officials from any of the three branches of state government who have executive-level and statewide responsibility for information technology management.

Public Health Data Standards Consortium (PHDSC)

http://www.phdsc.org/ a non-profit membership-based organization of federal, state and local health agencies; national and local professional associations; academia, public and private sector organizations; international members, and individuals. Their goal is to empower the agents of health and healthcare with public health information standards to improve individual and community health.

Journals

The National Library of Medicine (NLM) has prepared a bibliography of articles related to public health informatics. During the time period January 1996 through December 2000 they have 441 Citations. See: http://www.nlm.nih.gov/archive//20061214/pubs/cbm/phi2001.html

  • OJPHI Online Journal of Public Health Informatics

Populations served by Public Health Informatic Programs

References

  1. 1.0 1.1 “Defining Public Health Informatics.” Public Health Informatics Institute. http://www.phii.org/defining-public-health-informatics
  2. 2.0 2.1 Centers for Disease Control and Prevention. Introduction to Public Health Informatics. https://www.cdc.gov/publichealth101/documents/introduction-to-public-health-informatics.pdf
  3. Centers for Disease Control and Prevention. FluView: A Weekly Influenza Surveillance Report. http://gis.cdc.gov/grasp/fluview/main.html
  4. The business of building robust public health systems. February 2016. Public Health Informatics Institute. http://www.phii.org/blog/business-building-robust-public-health-systems

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