Bob Hoyt MD CAPT USN (Ret)

impulseverseAI and Robotics

Oct 24, 2013 (4 years and 14 days ago)

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Bob Hoyt MD CAPT USN (Ret)

Director, Medical Informatics Program

University of West Florida


After the presentation, participants should be
able to


Define Public Health Informatics (PHI)


State how PHI is related to other information
sciences


Enumerate well known PHI
-
related programs


Describe how health information technology (HIT)
can potentially assist public
h
ealth


List important sources of public health data


I have no conflicts of interest to report


I will cover only public health informatics in
the United States, however there are many
interesting initiatives outside the US



N.B. “
Technology is not the destination, it is
the transportation




Charles
Safran

MD

4

Health IT Workforce Curriculum
Version 3.0/Spring 2012

Prevents epidemics and spread of disease

Protects against environmental hazards

Prevents injuries

Promotes and encourages healthy behaviors

Responds to disasters and assists communities in
recovery

Assures the quality and accessibility of health services

5

Health IT Workforce Curriculum
Version 3.0/Spring 2012


Best outcome for individuals


Saving lives “1 at a time”

Medicine


Healthy

community


Balance of individual autonomy vs.
limitations on individual


Balance in allocation of resources


Focus on prevention


Encourage healthy behaviors


Saving lives “millions at a time”

Public Health

6

Health IT Workforce Curriculum
Version 3.0/Spring 2012









Individual


Thermometer


Stethoscope


Individual data, medical history

Medicine


Vital statistics: population data


Epidemiology


Surveillance

Public Health

Systematic application of information and
computer science and technology to pubic health
practice, research and learning



7

Biomedical

Informatics

Public Health

Informatics

Health

Informatics

Other

Informatics

Bioinformatics


Major cholera outbreak in London in 1854


Killed 600 people


Dr. John Snow created a hand
-
drawn map


Showed that the source of the disease was a
contaminated water pump




9



Relevant 1854
London Streets


Location of the
deaths from Cholera


Position of 13 water
pumps

10

Population based
orientation rather than
patient based

Systematic application of
geographical information

Added value: Cholera
control

11

12

Public health officials receive data from numerous sources


Notifiable disease reports


Syndromic

surveillance


Environmental monitoring

These data are monitored and analyzed for abnormalities
and potential threats

Alerts are then shared to notify healthcare providers and
the public

190 data sources are being used to collect progress of
Healthy People 2010 health objectives for the nation

National Health
Interview Survey
(NHIS)

National Health
and Nutrition
Examination
Survey (NHANES)

National Vital
Statistics System
Mortality (NVSS
-
M)

National Survey
of Family Growth
(NSFG)

National Hospital
Discharge Survey
(NHDS)

Youth Risk
Behavior
Surveillance
System (YRBSS)

HIV/AIDS
Surveillance
System

Behavioral Risk
Factor
Surveillance
System (BRFSS)

National
Household
Survey on Drug
Abuse (NHSDA)

School Health
Policies and
Programs Study
(SHPPS)

National Vital
Statistics
Systemâ

”Natalit
y (NVSS
-
N)

National Profile of
Local Health
Departments
(NPLHD)

National
Ambulatory
Medical Care
Survey (NAMCS)

United States
Renal Data
System (USRDS)

STD Surveillance
System (STDSS)

Medical
Expenditure
Panel Survey
(MEPS)

National Hospital
Ambulatory
Medical Care
Survey
(NHAMCS)

Continuing
Survey of Food
Intake by
Individuals
(CSFII)

National Crime
Victimization
Survey (NCVS)

1999 National
Worksite Health
Promotion
Survey (NWHPS)

State Tobacco
Activities
Tracking and
Evaluation
System (STATES)

National
Notifiable
Disease
Surveillance
System (NNDSS)

Monitoring the
Future Study
(MTF)

Behavioral Risk
Factor
Surveillance
System

(BRFSS)

Continuing
Survey of Food
Intake by
Individuals

(CSFII),
1994â

“96

HIV/AIDS
Surveillance
System

Medical
Expenditure
Panel Survey

(MEPS)

Monitoring the
Future Study

(MTF)

National
Ambulatory
Medical Care
Survey

(NAMCS)

National Crime
Victimization
Survey

(NCVS)

National Health
and Nutrition
Examination
Survey

(NHANES)

National Health
Interview Survey

(NHIS)

National Hospital
Ambulatory
Medical Care
Survey
(NHAMCS)

National Hospital
Discharge Survey

(NHDS)

National
Household
Survey on Drug
Abuse

(NHSDA)

National
Notifiable

Disease
Surveillance
System (NNDSS)
and National
Electronic
Telecommunicati
ons System for
Surveillance
(NETSS)

National
Notifiable
Disease
Surveillance
System (NNDSS)
and National
Electronic
Telecommunicati
ons System for
Surveillance
(NETSS)

National Profile of
Local Health
Departments
(NPLHD)

National Survey
of Family Growth

(NSFG)

National Vital
Statistics System,
Mortality

(NVSS
-
M)

National Vital
Statistics System
-

Natality

(NVSS
-
N)

1999 National
Worksite Health
Promotion
Survey (NWHPS)

School Health
Policies and
Programs Study

(SHPPS)

State Tobacco
Activities
Tracking and
Evaluation
System (STATE)

STD Surveillance
System

(STDSS)

United States
Renal Data
System

(USRDS)

Youth Risk
Behavior
Surveillance
System (YRBSS)

13


Partners In Information Access for The Public
Health Workforce (links to >125 web sites)


County and local health data


State health data


Individual state health data


National health data


Global health data


Statistical reports


Demographic data


GIS


Tools for data collection and planning


Training & education




Public Health Surveillance is the organized
collection, examination, and analysis of data used
for planning, implementation, and evaluation of
public health performance.


Surveillance can be a warning system for health
emergencies.


Public Health Surveillance allows priorities to be set
and a strategy to be developed

19


Case definitions


Historically low
compliance


Laboratory
confirmation can be
slow


(NYCDOH, 2010)

20

Health IT Workforce Curriculum
Version 3.0/Spring 2012


Pre
-
diagnostic indicators of disease


Readiness scenarios: bioterrorism, pandemics


In US consists of multiple disparate programs:
ESSENCE, RODS, EARS, BIOSENSE,
etc


Typical Process


21

Health IT Workforce Curriculum
Version 3.0/Spring 2012

Public Health IT
Biosurveillance

Collect
data

Process &
code data

Establish
baseline

Identify
outbreak

Sound
alarm


Syndromes to watch:


Botulism like illnesses


Illnesses with fever


GI symptoms


Hemorrhagic illnesses


Neurological syndromes


Rash associated
illnesses


Lymphadenitis


Respiratory illnesses


Shock or coma


The CDC created this cloud
-
based program in 2003
and upgraded to 2.0 in 2011. It will collate data from
ERs and inpatients from civilian, DOD and VA
hospitals. Slow roll out.


Users can
modify
searches using demographics; view
statistical analytics and data displays by counts and
compare
different
timelines


Intended for state and local health departments


Goal is to link to EHRs, labs, etc using HL7 feeds






2009
-
2010 H1N1 Flu Pandemic


2010
Deepwater

Horizon Gulf Oil
Spill


2011 US Heat Wave


2011 Japanese Tsunami and Nuclear Disaster


2012 Dengue fever in Florida and Hawaii


Syndromic surveillance data for meaningful
use (reimbursement for EHR adoption)




NEDSS
-
National Electronic Disease Surveillance System


NEDSS is an internet based system to communicate
and share information


It is a much faster source for entering data, and
replaces snail mail to send reports to the CDC


The information can be shared locally, throughout the
states, and on a national level.



Google.org uses Google searches to monitor and predict flu
trends all over the world.


Since people tend to search about the flu when it is flu season,
Google counts the amount of search queries to estimate how
prominent the flu is in some places.



Electronic health records


Health information exchange


Geographic information systems


Adoption rates are moderately high


Entries are legible and electronic, making
searches and sharing more feasible. Forms can
auto
-
populate and be sent to public health


Data should be structured/discrete, although
natural language processing may be game
changer


EHRs must share data with other systems,
otherwise: paper silos electronic silos


Submit electronic data to immunization
registries (core)


Identify
and report cancer cases to a State
cancer
registry (menu)


Identify and report specific cases to a
specialized registry (
menu
)


Submit
electronic syndromic surveillance data
to public health
agencies (
menu
)


(Must have 17 core and 3/6 menu)



34

The Primary Care Information Project (PCIP) uses
different EHR data sources to conduct & pilot
syndromic

surveillance activities


Influenza
-
like Illness (ILI)


Fever


Gastrointestinal (GI)

Some syndromes tracked using EHR data are:


Chief Complaint


Measured Temperature


Diagnosis (ICD
-
9
-
CM Code)

Case definitions for these syndromes based upon
text in these structured fields:

35


Disease outbreaks


Medication or vaccine
recalls


Environmental hazards


Provide means to
collect and disseminate
information




37


Definition: “any system that captures, stores,
analyzes, manages, and presents data that
are linked to location”


GIS programs overlay data on a map system
such as Google Maps


GIS now used by a variety of fields, to include
medicine


Result is valuable to consumers, health
planners, epidemiologists, emergency
preparedness and public health organizations


Demonstrates disease/event
-
geographic
correlations


The path a disease takes while spreading


The kind of people affected


Areas that need protection or attention


The possible placement of facilities


Future issues that can occur






Environmental exposures (Ex. pollution)


Natural disasters (Ex. earthquakes)


Tracking (Ex. child immunizations)


Conducting research (Ex. health policies and
establishing service areas)


Socioeconomic status (Ex. low income areas)



Raster: overlay into a
grid





Vector: overlay into
points, lines or
polygons

HealthMap
is global project to integrate infectious
disease news and visualization using an Internet
geographic map


National Program of Cancer Registries
-
Advancing E
-
cancer reporting and Registry
Operations (NPCR
-
AERRO)


Public Health Alerting in Electronic Health Record
Systems

Project


Epi

Info ™ 7.0 (December 2012)


Epi
-
X


Health Alert Network (HAN)


Outbreak Management System (OMS)


Distribute




Epi

Info
is
currently available for

Microsoft
Windows.
The program allows for electronic
survey creation, data entry, and analysis. Within
the analysis module, analytic routines include t
-
tests, ANOVA, nonparametric statistics, cross
tabulations and stratification with estimates of
odds ratios, risk ratios, and risk differences,
logistic regression (conditional and
unconditional), survival analysis (Kaplan Meier and
Cox proportional hazard), and analysis of complex
survey data. The software is in the public domain,
free, and can be downloaded
from”

http://www.cdc.gov/epiinfo


Data


exist in silos: paper
vs

electronic


lack standards and interoperability


PH reporting using paper is slow, not suitable
for responding to bioterrorism and emerging
infectious diseases


Major gaps exist between public health and
the average medical practice


Electronic health records and health
information exchange hold great promise but
major challenges exist e.g. $$






50

EHRs:

Office

Hospital

Public Health

Dept.

State & local

CDC

Local , State & National Reports

PH alerts

HIE

Biosense


A variety of opportunities await in the
classroom or online


MPH in Public Health Informatics


Certificate


GIS PHI


Credit Non
-
Degree


CDC Fellowship


Public health will be aided greatly by health
information technology tools


We must overcome issues of interoperability


I
n
the future we will likely have an
integrated
system
of electronic health records and
public health systems so that we are all
connected


When we develop faster diagnostic tests, we
will be alerted real time about bioterrorism
and infectious disease epidemics