Chapter 17 by Margaret Ross Kraft and Ida Androwich Using Informatics to Promote Community/Population Health

Objectives Provide an overview of community and population health informatics. Describe informatics tools for promoting community and population health. Define the roles of federal, state and local public health agencies in the development of public health informatics.

Key Terms Defined Behavioral Risk Factor Surveillance System (BRFSS) Bioterrorism Center for Disease Control Community Risk Assessment Behavioral Risk Factor Surveillance System (BRFSS) - An assessment system initially designed to collect information on the movement of mentally impaired persons from state-operated facilities into community settings. The assessments have been expanded to include other populations and are designed to determine the effectiveness of programs in meeting health care needs of as risk populations. Bioterrorism - The use of pathogens or other potentially harmful biologic agents to sicken or kill members of a targeted population. Informatics database applications are used to track strategic indicators such as emergency room visits, disease case reports, frequency and type of lab testing ordered by physicians and/or nurse practitioners, missed work, over-the-counter medication purchases, that may indicate an outbreak that can be attributed to bioterrorism. Center for Disease Control (CDC) - “An agency of the United States Department of Health and Human Services based in unincorporated DeKalb County, Georgia adjacent to the campus of Emory University and east of the city of Atlanta. It works to protect public health and safety by providing information to enhance health decisions, and it promotes health through partnerships with state health departments and other organizations. The CDC focuses national attention on developing and applying disease prevention and control (especially infectious diseases), environmental health, occupational safety and health, health promotion, prevention and education activities designed to improve the health of the people of the United States” (Wikipedia, 2008, ¶ 1); organization that deals with disease control and prevention. Community Risk Assessment (CRA) - Determining the presence of risk factors in community is a key part of a community risk assessment. (CRA) Communities may be concerned about what in the environment affects or may affect the community’s health, the level of environmental risk, and other factors that should be included in public health planning.

Key Terms Defined Epidemiology National Center for Public Health Informatics National Health Information Network (NHIN) Public Health Epidemiology - Literally means identifying things that come upon the people; incidence, prevalence and control of disease; case finding. National Center for Public Health Informatics (NCPHI) - In 2005, the Center for Disease Control (CDC) created a National Center for Public Health Informatics (NCPHI) to provide leadership in the field. This center aims to protect and improve health through PHI (McNabb, Koo, Pinner, & Seligman, 2006). Information is vital to public health programming. The data processed into public health information can be from administrative, financial and facility sources, Included may be encounter, screening, registry, clinical, and laboratory data as well as surveillance data. National Health Information Network (NHIN) - An agency of Health and Human Services charged with the development of a safe, secure, interoperable health information infrastructure. Public Health - Safeguarding and improvement of community and population health; changes the social conditions and systems that affect everyone within a given community. It is because of public health that we understand the importance of clean water, the danger of second-hand smoke, and the fact that seat belts really do save lives (PHI, 2007).

Key Terms Defined Public Health Informatics Public Health Interventions Regional Health Information Exchange Risk Assessment Public Health Informatics (PHI) - represents “a systematic application of information and computer science and technology to public health (PH) practice, research and learning”. (Yasnoff, O’Carroll, Koo, Linkins, & Kilbourne, 2000). This area of informatics differs from others because it is focused on the promotion of health and disease prevention in populations and communities. PHI efficiently and effectively organizes and manages of data, information and knowledge generated and used by public health professionals to fulfill the core functions of public health: assessment, policy and assurance (ATSDR, 2003). Public Health Interventions - Actions taken to promote and secure the well-being of a population or a community. The future of PHI will offer real-time surveillance data available electronically and investigations and emergences will be managed with the tools of informatics (Yasnoff, 2004). “Surveillance data systems, e.g., systems for infectious diseases, store information on exposure or trends in adverse health effects over a specified period of time that can be used by public health officials for planning, evaluation, or implementation of public health interventions”(ATSDR, 2003). “Syndromic surveillance for early outbreak detection is an investigational approach where health department staff, assisted by automated data acquisition and generation of statistical signals, monitor disease indicators continually (real-time) or at least daily (near real-time) to detect outbreaks of diseases earlier and more completely than might otherwise be possible with traditional public health methods”( Buehler, Hopkins, Overhage, Sosin, & Tong, 2004). Regional Health Information Exchange (RHIO) - A regional network of health care organizations and providers who exchange information related to the health of the population. The goal is to work together without duplication to provide cost effective health care and promote community well-being. Population health data must be considered an important part of the infrastructure of all regional health information exchanges (RHIOs) which are the building blocks for a national health information network (NHIN). “These efforts call for collaboration of various organizations and agencies interested in clinical, public health and population health information to promote and protect the public’s health”(PHDSC, 2007). Risk Assessment - Determination of risk or danger such as assessing for risk factors related to heart disease.

Key Terms Defined Suicide Prevention Community Assessment Tool (SPRC) Surveillance Surveillance Data Systems Syndromic Surveillance Suicide Prevention Community Assessment Tool (SPRC) - Risk factor systems are used throughout the country and may be local, regional or national in scope. Specific risk assessment tools exist for specific health issues such as the Suicide Prevention Community Assessment Tool (SPRC) which addresses general community information, prevention networks, and the demographics of the target population as well as community assets and risk factors. Other risk assessment tools include the Youth Risk Behavior Surveillance System (YRBSS) The Behavioral Risk Factor Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey (NHANES). Surveillance - The act of watching for trends in health related data for early detection of health threats. Uses health-related data that signal a sufficient probability of a case or an outbreak that warrants further public health response. Although historically syndromic surveillance has been utilized to target investigations of potential infectious cases, its utility to detect possible outbreaks associated with bioterrorism is increasingly being explored by public health officials (CDC, 2007). Early detection of possible outbreaks can be achieved through timely and complete receipt, review, and investigation of disease case reports, by improving the ability to recognize patterns in data that may be indicative of a possible outbreak early in its course and through receipt of new types of data that can signify an outbreak earlier in its course. Surveillance Data Systems - A networked computer system designed to use health related data trends to predict the probability of an outbreak of a contagious or infections disease, or to detect morbidity and mortality trends in a geographic area as a precursor to public health planning or response. The future of PHI will offer real-time surveillance data available electronically and investigations and emergences will be managed with the tools of informatics (Yasnoff, 2004). “Surveillance data systems, e.g., systems for infectious diseases, store information on exposure or trends in adverse health effects over a specified period of time that can be used by public health officials for planning, evaluation, or implementation of public health interventions”(ATSDR, 2003). Syndromic Surveillance - A specialized system of data collection to detect trends in the incidence and severity of a specific disease or health related syndrome and plan the public health response. It has been utilized to target investigations of potential infectious cases, its utility to detect possible outbreaks associated with bioterrorism is increasingly being explored by public health officials (CDC, 2007). Early detection of possible outbreaks can be achieved through timely and complete receipt, review, and investigation of disease case reports, by improving the ability to recognize patterns in data that may be indicative of a possible outbreak early in its course and through receipt of new types of data that can signify an outbreak earlier in its course. New types of data might include identification of absences from work or school, increased purchases of health-care products, including specific types of over-the-counter medications, presenting symptoms to health-care providers, and laboratory test orders (CDC, 2007). A comprehensive surveillance effort supports timely investigation and identifies data needs for managing the public health response to an outbreak or terrorist event.

Key Terms Defined Youth Risk Behavior Surveillance System (YRBSS) Youth Risk Behavior Surveillance System (YRBSS) -An epidemiologic survey conducted by the CDC to identify and track the most common health risk behaviors that lead to illnesses and mortality among youth.

Using The Foundation of Knowledge Model Population Health Data Need for Timely Information The Field of Public Health Florence Nightingale- A Pioneer The collection and processing of population health data creates the information that becomes the basis for knowledge in the field of public health. There is an ever increasing need for timely information about the health of communities, states and countries. “Public health is a field that encompasses an amalgam of science, action, research, policy, advocacy and government”( Yasnoff, Overhage, Humphreys&, LaVenture, 2001). Florence Nightingale should also be recognized as an early public health informaticist.

Using The Foundation of Knowledge Model Collecting Statistics Health Information Systems Changes in Public Health PHI Her efforts led to a total reorganization of how and what healthcare statistics should be collected (Dossey, 2000). Health information systems address the collection, storage, analysis, interpretation and communication of health data and information. Public health changes the social conditions and systems that affect everyone within a given community. PHI addresses the data, information, and knowledge that public health professionals generate and use to meet the core functions of public health (PHDSC 8, 2006).

Using The Foundation of Knowledge Model The Institute of Medicine of Medicine Functions of Public Health The Institute of Medicine of Medicine (IOM) defines the role of public health as “fulfilling society’s interest in assuring conditions in which people can be healthy”(IOM, 1988). Functions of public health include prevention of epidemics and the spread of disease, protection against environmental hazards, promotion of health, disaster response and recovery, and providing access to health care (PHDSC 1, 2006)

Community Health Risk Assessment Public Awareness A Risk Assessment What is a "threat” ? As the public has become more aware of harmful elements in the environment, risk assessment tools have been developed. A risk assessment may also be called a "threat and risk assessment." “A "threat" is a harmful act such as the deployment of a virus or illegal network penetration.

Community Health Risk Assessment A "risk" Health risk assessment Hazard identification A "risk" is the expectation that a threat may succeed and the potential damage that can occur” (PCMAG, 2007). “Health risk assessments are used to estimate whether current of future exposures will pose health risks to a broad populations” (CEPA, p 4) and are used to weigh the benefits and costs of various program alternatives for reducing exposure to potential hazards. Health risk assessment is a constantly developing process based in sound science and professional judgments. Hazard identification seeks to determine the types of health problems could be caused by exposure to a potentially hazardous material.

Community Health Risk Assessment Exposure Assessment Dose-Response Risk Characterization Specific Risk Assessment Tools Exposure assessment is done to determine the length, amount, and pattern of exposure to the potentially hazardous material. Dose-response is an estimation of how much exposure to the potential hazard would cause varying degrees of health effects. Risk Characterization is an assessment of the risk of the hazardous material causing illness in the population (CEPA, 1998). Specific risk assessment tools exist for specific health issues such as the Suicide Prevention Community Assessment Tool (SPRC) which addresses general community information, prevention networks, and the demographics of the target population as well as community assets and risk factors.

Community Health Risk Assessment Additional Risk Assessment Tools Assessing Risk Other risk assessment tools include the Youth Risk Behavior Surveillance System (YRBSS) The Behavorial Risk Factor Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey (NHANES). Determining the presence of risk factors in community is a key part of a community risk assessment.

Agency Support of Epidemiology and The Monitoring Disease Outbreaks The Availability of Information Technology Comprehensive Surveillance Effort Processing Public Health Data Using a Standardized Vocabulary The availability of information technology today challenges all stakeholders in the health of the public to adopt new systems to provide adequate disease surveillance and challenges us to improve outmoded processes. A comprehensive surveillance effort supports timely investigation and identifies data needs for managing the public health response to an outbreak or terrorist event. In order to appropriately process public health data, PHI has a need for a standardized vocabulary and coding structure. A standardized vocabulary must address local language use versus universal language usage for public health.

Agency Support of Epidemiology and The Monitoring Disease Outbreaks What is vital to public health programming? Where does the data processed into public health information come from? Vital Statistics Data Information is vital to public health programming. The data processed into public health information can be from administrative, financial and facility sources. Data on vital statistics from state and local governments are also used for public health purposes.

Applying Knowledge to Health Disaster Planning and Preparation Availability of data Speed of data collection Special Data Collections Syndromic surveillance The availability of data and speed of data exchange can have a significant impact on critical PH functions like disease monitoring and syndromic surveillance. Special data collections are needed to address specific public health issues and investigations and emergencies are addressed and managed with paper. “Syndromic surveillance for early outbreak detection is an investigational approach where health department staff monitor disease indicators continually to detect outbreaks of diseases earlier and more completely than might otherwise be possible with traditional public health methods”( Buehler, Hopkins, Overhage, Sosin, & Tong, 2004).

Informatics Tools to Support Communication and Dissemination The Revolution in IT Two-Way Communication in Healthcare PH Information Systems Dissemination of Information IT solutions The revolution in IT has made the capture and analysis of health data and the distribution of healthcare information more achievable and less costly. Two-way communication between public health agencies, community: clinicians and clinical laboratories can identify clusters of reportable and unusual diseases. PH information systems represent a partnership of federal, state and local public health professionals. Dissemination of prevention guidelines and communication among PH officials, clinicians and patients has become a major benefit of PHI. IT solutions can be used to provide accurate and timely information that will guide public health actions.

Using Feedback to Improve Responses and Promote Readiness Improvement of Community Health Population Health Data RHIO/NHIN Improvement of community health status and population health depends on effective public and healthcare infrastructures. Population health data must be considered an important part of the infrastructure of all regional health information exchanges (RHIOs) which are the building blocks for a national health information network (NHIN). A RHIO/NHIN can also support public health goals through broader opportunities for participation in surveillance and prevention activities, improved case management and care coordination, and increased accuracy and timeliness of information for disease reporting (LaVenture, 2005).

Using Feedback to Improve Responses and Promote Readiness Public Health Informatics Standardization of Data Public health informatics strives to ensure that health data systems will meet the data needs of all organizations interested in population health as national and international standards are dev eloped for healthcare data collection. This includes standardization of environmental, socio-cultural, economic and other data that are relevant to population health (PHDSC, 2007).

Thought Provoking Questions Imagine that you are a public health informatics specialist and you and your colleagues have determined that the threat of a new strain of influenza indicates a need for a mass inoculation program. What public health data would have been used to determine the need for such a program and What data will be collected to determine the success of such a program?