Informatics and Public Health: Research Challenges Bonnie L. Westra, RN, PhD Assistant Professor, UMN, SON Robert Wood Johnson Executive Nurse Fellow

Purpose Explore the Relationship Between Informatics and Public Health Discuss the Local/ National Context for Informatics Examine Research Challenges

Discipline Science Nursing Science Public Health Science Informatics

Thompson, T.G., Brailer, D.J. (July 21, 2004). The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care: Framework for Strategic Action. ONCHIT: Health Care Problems Health Care Costs - $1.7 Trillion (CMS Est. $3.6 Trillion Estimated in 2014) IOM Estimates 44,000 – 98,000 Die Annually Due to Medical Error 777,000 Injured or Die Annually from Adverse Drug Events $300 Billion – Treatments that May Not Improve or are Redundant or Inappropriate Administrative Inefficiencies Reduced Through EHRs/ IS Could Save $78 to $112 Billion Annually

Thompson, T.G., Brailer, D.J. (July 21, 2004). The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care: Framework for Strategic Action. ONCHIT: NHIN Initiative 1998 National Committee on Vital and Health Statistics (NCVHS) National Health Information Initiative (NHII) 2002 Markle Connecting for Health 2003 Consolidated Health Information (CHI) Executive Order –Office for the National Coordinator for Health Information Technology (ONCHIT) –Dr. David Brailer –E-health Initiative –Strategic Framework for Action –Includes PHIN Clinical Care Personal Care Population/ Health (PHIN) Interconnect Clinicians

CPHIN Architecture. (n.d.) Center for Disease Control. Retrieved June 1, 2005 from Public Health Information Network (PHIN) Define And Document The Systems For Public Health Identify Industry Standards To Make Systems Work Together Develop Specifications To Make Standards Work For Public Health Establish Tools And Components That Support Standards-based Systems Support Certification For Interoperability

Minnesota Department of Health. (January 2005). MN-PHIN Roadmap & Recommendations for Strategic Action, Retrieved May 31, 2005 from Minnesota E-health Initiative –Statewide Public-Private Collaborative –Improve Health and Safety –Accelerate Implementation of Health Technology –Forming One/More Regional Health Information Organizations (RHIO’s) MN-PHIN Strategic Action Plan – January 2005 –Part of E-health Initiative –Focus Is On Public Health Specifically –Public Health Essential Functions Research/ Policy Consumer Public Health MN-PHIN Clinical

Collect and assess data State problem Identify admission problem rating Plan and intervene Identify interim Disch problem rating Evaluate problem outcome Individual Family Community Population Martin, K. Omaha System, 2005

Public Health Nursing Knowledge Human G&D across the lifespan Family development Antepartum /Postpartum Parenting Health promotion: All Ages Chronic disease prevention and management Injury prevention Violence prevention Chemical health issues and/or behaviors Mental Health Death and dying; grief and loss Human sexuality Family planning Nutrition Disaster and bioterrorism response Disease prevention and control, Immunizations across the lifespan Environmental Health and Safety Technical Nursing Skills Medication admin/ mngmt Health determinants Social and market justice

Public Health Intervention Wheel MDH Center for Public Health, 2003

Nursing Data Patient Care Data Set Perioperative Nursing Data Set ABC Codes LOINC Omaha System CCC NANDA NIC NOC ICNP SNOMED Ct NMDS NMMDS

Public Health Data Laboratory (LIMS) Immunization (MIC) Communicable Disease Reporting (NEDS) MCH Data (TANF/ MCH Outcomes) Silos of Data Essential Functions of Public Health – Omaha System Proposed

Public Health Information Systems EHR Vendors State/ National Efforts –LIMS, MIC, NEDS Many Silos No Specifications for Business Processes to Adequately Describe Public Health –PHN

Evidence-Based Practice - PH Scientific Evidence for Public Health Synthesize Into Evidence-Based Guidelines Imbed into Information Systems –Decision-Support Systems –Guidelines –Alerts

Informatics & Knowledge Development Existing Scientific Methodologies –Quantitative –Qualitative Newer Methodologies Emerging –Knowledge Discovery in Databases (KDD) Decision Trees Bayesian Networks Neural Networks Text Mining

Challenges Standardized Terminology for Public Health Identify Business Processes for IS Functional Requirements Evidence-Based Practice Assure Quality Information Reuse Data for Research