1. Catherine Staes, BSN, MPH, PhD Faculty, Department of Biomedical Informatics Translating public health informatics curriculum to practice at the University of Utah

2. ‹#› What is public health informatics? Public health informatics is the systematic application of information and computer science and technology to public health practice, research, and learning. Public health practice is data-intensive and dependent on: –Information acquisition –Information management and analysis –Information exchange –Communication with target audiences and the public

3. ‹#› My definition… Public health informatics involves the application of informatics methods and tools to solve public health problems. Sample of informatics methods and tools: –Electronic public health records –Data visualization and risk communication –Record linkage –Information exchange –Ontologies –Vocabulary standards –System analysis/requirements development –Information retrieval –Decision support Surveillance Record management for clinics Registries Environmental health

4. ‹#› 1)Prevent and Control Infectious Diseases 2)Promote Preparedness to Protect Health 3)Promote Health to Reduce Chronic Diseases and Disability 4)Create Safer and Healthier Places 5)Work Together to Build a Healthy World 6)Manage and Market Health Information 7)Promote Cross-Cutting Public Health Research Pg 87 …. ” The need for informatics development has been recognized within all public health disciplines ” Public Health Research Needs- 2006-2015

5. ‹#› The Informatician’s Problem To solve the right problem AND apply the right method or tool………. an informatician needs to understand public health problems and goals! Why is this difficult?

6. ‹#› Problem Public health domain is complex: –involves many organizations, each with their own goals, funding, priorities –Public health priorities are ever changing –Focus on prevention and populations –Funding is limited, thus limiting options Informatics competencies have not been fully integrated into public health training Before 2004, informatics training was focused on clinical environments

7. ‹#› Evolution of NLM-Sponsored Informatics Training 1980s - Clinical Informatics 1990s - Clinical + early Bioinformatics 2000-06 Clinical + Bioinformatics + early Imaging + early Public Health Informatics –2004 NLM/RWJF PHI awards 2007-11 Clinical + Bioinformatics + Imaging + Public Health Informatics + early Engineering + early clinical research informatics

8. ‹#› NLM Informatics Training Programs, 2007 University of Washington (Seattle, Washington) The University of Utah (Salt Lake City, Utah) Johns Hopkins University (Baltimore, Maryland) Columbia University (New York, New York) Four NLM-supported training programs have PHI supplements from the Robert Wood Johnson Foundation (red). Six other NLM-supported training programs also have an emphasis in PHI (blue): Yale, Indiana, Harvard, Oregon, Pitt, Rice

9. ‹#› To solve the right problem AND apply the right method or tool………. an informatician needs to understand public health problems and goals! To solve the right problem and use the right tools, an informatician needs to develop solutions in the problem environment.

10. ‹#› Public Health Informatics Environment in Utah Academic Informatics training Research in Public Health Informatics Practice of Public health

11. ‹#› Public Health Informatics course goal All informatics students….. gain an understanding of public health practice and goals and consider public health implications of their informatics research interests have an opportunity to apply informatics in a problem environment develop basic evaluation skills

12. ‹#› Public Health Informatics Course Didactic component –Include lectures from public health partners Case studies –Modified EIS case studies Field project –Every student evaluates an existing surveillance system –Staged throughout the semester –Potential projects are suggested or students may select their own system –The info is useful to someone!

13. ‹#› Objectives for field project Evaluate a surveillance system from both a public health and informatics prospective Perform a high level system analysis. Become familiar with breadth of existing public health related surveillance systems Interact with public health practitioners. Improve communication skills.

14. ‹#› Methods CDC. Updated guidelines for evaluating public health surveillance systems. MMWR 2001; 50 (RR-13): 1-35. Engage a stakeholder Describe surveillance system Focus the evaluation on 4-6 attributes, including 2 informatics-specific attributes. Gather credible evidence about attributes Summarize and share findings

15. ‹#› System evaluation How does it work? Resources required Population under surveillance Events under surveillance System analysis of entities, processes, and data flow Surveillance methods for establishing threshholds Informatics attributes Data sources Data acquisition & exchange Data management & storage Data analysis Data dissemination

16. ‹#› System evaluation Does it work? System attributes Simplicity Flexibility Data quality Acceptability Sensitivity Positive predictive value Representativeness Timeliness Stability How does it work?

17. ‹#› System evaluation Does it work? Is it useful? Use of information Users Actions taken Meet objectives? How does it work?

18. ‹#› Sample of surveillance systems selected Influenza-like Illness (ILI) using Sentinel Clinics ILI surveillance using National Retail Data Monitor Early Detection of Abnormal CSF Results Varicella (chicken pox) reporting by schools Persons hospitalized with influenza NHANES as a Nutritional Surveillance Tool Cancer registry Quality surveillance Family history questions specific to the Utah BRFSS

19. ‹#› Patient Documentation of clinic visit ILI case definition applied by automated decision support tool Does patient Have ILI? Does patient Have ILI? Re-file chart Abstract age Paper reporting form data warehouse Excel spreadsheet Excel spreadsheet No Automated data extraction Yes Local Health Department compiles data OR UDOH compiles & analyzes data UDOH website CDC compiles & analyzes data MMWR CDC website fax e-mail Excel spreadsheet Excel spreadsheet Excel spreadsheet e-mail Influenza-like Illness Surveillance in Utah using Sentinel Clinics Paper-based clinic data Electronic clinic data Local health department State health department National level - CDC ILI case definition applied by human Patient Documentation of clinic visit University Health Research Network Other Clinics

20. ‹#› Presentation with stakeholders Shared understanding of processes and system complexity Informatics students could share solutions to problems they now understood Brainstorming: – Web-based system that combines the different influenza surveillance systems –Fax Server with OCR --> No paper jam; Search for terms; Automatic forwarding

21. ‹#› Impact in 2007 (year 1) with 7 students Research 2 PhD research projects initiated 3 posters presented at PHIN 2007 Practice Local & state Public health ‘see the elephant’ Supported evaluation to meet bioterrorism grant obligations Improve capacity for faculty and students to function in consultation role Academics Students experience the problem environment and change their attitude Public Health Informatics course required

22. ‹#› Impact in 2008 (year 2) with 21 students Research 2 posters presented at PHIN 2008 Practice Supported evaluation needed to meet grant obligations Provided information for future projects (obesity and occupational surveillance) Academics Students experience breadth of public health

23. ‹#› Impact in 2008 (year 2) with 21 students Challenges: –Balance effort required and benefits for the mentors –Identify projects for working students with limited time and means to travel –Need to think broadly when selecting “surveillance systems” –Need to think about other informatics methods and tools …..

24. ‹#› Conclusion There are many opportunities for future collaborations between public health entities and academic informatics programs Students gain knowledge and skills and appreciate the problem environment in public health practice and can start to apply the right solution to the right problem!

25. ‹#› Questions How can we collaborate to develop: Case studies illustrating real problems Evaluation projects that partner with local or state public health practitioners to: –Create opportunities for students –meet public health needs

26. Thank you Acknowledgements: Robert Wood Johnson Foundation/ National Library of Medicine (Training grant # 1T15LM007124) Contact: Catherine.staes@hsc.utah.edu