Environmental Public Health Tracking Network Alison Cox & Julia Shumway Health Program Specialists Environmental Epidemiology

How it all began: Pew Report September, 2000 “America’s Environmental Health Gap: Why the Country Needs a Nationwide Health Tracking Network” Environmental Health Gap – Lack of basic environmental health information –link hazards and disease, detect trends –measure health problems, conduct programs

Environmental Public Health Tracking EPHT Network –Data warehouse: Available September 2008 “EPHT is the ongoing collection, integration, analysis, interpretation, and dissemination of data on environmental hazards, exposures to those hazards, and health effects that may be related to the exposures.”

National EPHT Partnerships and Collaborations EPHT is primarily funded by the CDC Environmental and health agencies –Federal –State –City Academic –Four academic partners Professional and non-government groups

Three Main Areas of EPHT Data Hazard data –Water Quality arsenic nitrates disinfection byproducts –Air Quality PM2.5 Ozone Exposure data –Environmental Modeling Example: estimates the amount of chemical in a person by measuring that chemical in their soil and then using computer and mathematical models to estimate exposure –Biomonitoring Example: detecting arsenic levels in hair, blood or urine Health effect data Example: Lead

Utah EPHT Data Partnerships Hazard Data Partners: United States Geological Survey Federal Environmental Protection Agency Utah Department of Environmental Quality, Division of Air Quality Utah Department of Environmental Quality, Division of Drinking Water Exposure Data Partners: Utah Department of Health, Environmental Epidemiology Program Utah Public Health Laboratory Health Effects Data Partners Utah Department of Health, Center for Health Data Utah Department of Health, Office of Vital Records and Statistics Utah Population Database Utah Birth Defects Network Utah Cancer Registry Centers for Disease Control and Prevention Utah Health Information Network Utah Office of Health Care Statistics Indicator Based Information Systems for Public Health (IBIS-PH)

EPHT Portals National public portal National secure portal State secure portal (Secure IBIS) State public portal (IBIS-PH)

Connecting Public Health Professionals with Relevant Environmental and Health data Accessing Secure IBIS-PH

Tracking Network Advisory Committee An advisory body to give an influence to –data sharing partners, –indicator owners, and –other interested parties To encourage awareness and participation

TNAC Charter The TNAC will fill and advisory role concerning –data content; –security and accessibility; –risk communication; –marketing and outreach. The TNAC will act as an intermediary. TNAC will supply representatives for the Scientific Review Board.

Scientific Review Board Utah Department of Health –Bureau of Emergency Medical Services –Office of Health Care Statistics –Office of Public Health Assessment –Office of Vital Records and Statistics –Utah Birth Defects Network –Utah Blood Lead Registry –Utah Public Health Laboratories Utah Department of Environmental Quality –Division of Environmental Response and Remediation –Division of Drinking Water –Division of Air Quality University of Utah –Utah Cancer Registry –Utah Poison Control Center

Standards-based Data Security Utah Code : Limitations on disclosing identifiable health data Utah Code : Department measures to protect health data Utah Rule : Confidentiality of data received through electronic exchange Utah Rule : HIPAA Privacy Rule Implementation

Granting Access Third Party Application for Access to Secure IBIS-PH for Public Health Professionals Third Party Application for Access to Secure IBIS-PH for Research Projects

IBIS-PH Secure Query Modules

Finding Secure Data

Metadata aids data discovery. Metadata: “data about data” Type of EPHT Indicator Health outcome Measures 1.Count of elevated blood lead level cases by zip code Derivation of measure Numerator: The number elevated of blood lead level tests reported by laboratories to the Utah Department of Health. Denominator: Denominators used to calculate rates among children represent the number of children tested and adults represent the number of persons in the Utah labor force population provided by the Utah Department of Workforce Services. Variables contained Year Age group Blood lead level Sex Zip code Variable definitions Year: Year of diagnosis Age group: The age group of the individual at time of blood lead level measurement Blood lead level: Level of lead in blood by microgram per deciliter (µg/dL) Sex: Sex of individual with elevated blood lead level Zip Code: The zip code where the individual with elevated blood lead resides at the time of measurement. Variables to group by Year Age group Blood lead level Sex Zip code Chart graphic types Vertical bar Horizontal bar Stacked vertical bar Area Stacked area Pie Line

Unit Patient with elevated blood lead Geographic Scope Utah Geographic Coordinates West: East: North: South: Geographic scale Zip codes Time Period Updated Annually Time Scale Single years Rationale The Utah Blood Registry (UBLR) within the Utah Department of Health functions to identify residents of Utah with elevated blood lead levels. The UBLR provides risk assessment to help the individual limit and remove their risk of lead exposure. The UBLR serves as a resource for physicians, hospitals, local health departments, and researchers. The UBLR provides blood lead data to national agencies for generating national statistics and to state and local agencies for identifying high risk areas. The UBLR provides an educational and data resource for physicians, nurses, and other institutions to help protect Utah’s population. Use of the Measure Limitations of the Measure Data SourcesBlood lead data is provided to the Utah Department of Health, Utah Blood Lead Registry, from laboratories, hospitals, health clinics and physicians. Utah Population Estimates Committee (UPEC) and the Governor’s Office of Planning and Budget (GOPB), 2008 Baseline Economic and Demographic Projections (Revised on ).

Reporting Protocols Under the Injury Reporting Rule R , specific to the injury of an Elevated Blood Lead (≥ 10µg/dL), a reportable injury evaluated or treated at a hospital shall be reported by that hospital. Reportable injuries not evaluated at a hospital shall be reported by the involved physician, nurse, other health care practitioner, medical examiner, or laboratory administrator. Each case of injury shall be reported to the Utah Department of Health or to the local health department responsible for the geographic area where the injury occurred. The local health officer shall forward all original reports to the Utah Department of Health. Because the Utah Blood Lead Registry falls under the definition of a public health entity, the Injury Reporting Rule takes precedence over the recent legislation called HIPAA, the Health Insurance Portability and Accountability Act. For more information regarding public health, including blood lead reporting and HIPAA, please go to the Centers for Disease Control and Prevention website at: Additional Details to consider All population estimates and projections apply to July 1 of the selected year. Citation Blood lead data provided by the Utah Department of Health is funded in part by a contract with the National Institute for Occupational Safety and Health and the Centers for Disease Control and Prevention, Preventive Block Grant Award. Contact Metadata created by: Health Program Specialist Environmental Epidemiology Program Utah Department of Health PO Box Salt Lake City, UT Creation DateAugust 13, 2009

Research Projects Public Health Professionals 1.Cover sheet 2.Secure IBIS-PH Access Request 3.Data-use Agreement Form 4.Research Proposal 5.IRB Approval 6.Letters of Support 1.Secure IBIS-PH Access Request 2.Secure IBIS-PH Access Agreement Form Annually renewable upon verification that access is still necessary for work. Secure IBIS-PH Application

Public Health Professionals 1.EPHT Program receives the application (electronic and paper) 2.EPHT Program forwards the electronic to the SRB 3.The SRB may require additional information, explanations, etc. 4.EPHT Program will create a login for the researcher and provide a memorandum of instruction.

Monitoring Data Access and Use Periodic status reports Individual access review Publications and presentations Review of data use