1. Population Health, Public Health and Big Data Jeffrey Engel, M.D. Council of State and Territorial Epidemiologists

2. Objective How are communities using data to improve health? – Dave Ross and Ivor Horn, co-chairs of the new RWJF initiative, Data for Health – “The Data for Health initiative will be a starting point for identifying what infrastructure is needed to turn this information into an effective tool for improving health nationwide.” Risa Lavizzo- Mourey, RWJF President and CEO

3. My objective is to ask: How can Public Health improve population health using big data?

4. Definitions Public Health: The federal, state and local enterprise of publicly funded governmental agencies whose authority rests in law and rule (mandates) – Environment: water, air, food, vector – Control of communicable diseases: immunizations, isolation and quarantine, certain treatments (TB, STD) – Vital records – Assurance of health services: MCH, nutrition, clinical services (local) Population health: Morbidity, mortality, health and well- being of a defined group of people – public health is synonymous with population health when the denominator is the people who reside in a jurisdiction Preparedness Health Monitoring (Surveillance)

5. National Health Care Reform The Health Information Technology for Economic and Clinical Health Act (HITECH) Act (2009) – Universal EHR by 2015 – Meaningful Use of the EHR: Population Health The Patient Protection and Affordable Care Act (2010) – Access to Care – Prevention Health Care Payment Reform (CMMS) – From Fee for Service – To Pay for Performance

6. Prevention and ACA “ensure that all Americans have access to free preventive services under their health insurance plans and invests in prevention and public health to encourage innovations in health care that prevent illness and disease before they require more costly treatment”

7. Some More Definitions… Prevention Primary Prevention addresses upstream determinants of disease (e.g. nutrition, physical activity, environment) Secondary Prevention addresses clinical interventions (e.g. immunizations, screenings) Tertiary Prevention addresses disease management (e.g. asthma, diabetes, cardiovascular disease)

8. Public Health and Health Care Integration Isolation Mutual Awareness Cooperation Collaboration Partnership Merger IOM (Institute of Medicine). 2012. Primary Care and Public Health: Exploring Integration to Improve Population Health. Washington, DC: The National Academies Press.

9. Public Health 2014 Surveillance (population health monitoring) from the EHR Bi-directional flow of information between the clinic/hospital and the PH agency Community works together for prevention – Public Health notifies clinicians of ongoing outbreaks – Patient referred to smoking cessation services from EHR prompt

10. Two Models of Health Information Exchange Federated Model HIE HospitalPayer Other Eligible Provider Public Health Direct Model Public Health Hospital 1 Hospital 2 Hospital 3

11. Statewide Health Information Network of New York (SHIN-NY)

12. Data Sources and Infrastructure Today there are 10 independent RHIOs

13. Pilot Objectives  1. To develop population level hypertension measures with specifications and to program them using HIE data through Hixny for Albany County  2. To evaluate the quality and completeness of the HIE data through Hixny and to report challenges in calculating each hypertension measure  3. To explore the feasibility of conducting stratified analyses to identify high risk population or communities in urgent need of services Using Health Information Exchange Data to Evaluate Hypertension in Albany County

14. 415,913 Patients 53.8M Lab Results 11M Encounters 1.8M Observations Health Information Exchange = Big Data

15. Pilot Results Calculate 3 Hypertension Measures

16. Findings and Implications for Action  NY Pilot demonstrated population level hypertension measures could be calculated with adaptations using the HIE data through Hixny for Albany County, New York.  Compared with the national or state performance on these hypertension measures, estimates for Albany County were overall much lower.  Data from 3 FQHCs resulted in the hypertension control rates closer to the national and statewide rates.  The NY pilot identified improvement and expansion opportunities included in a successful grant application to CDC.

17. Pilot Objectives  1. To develop population level hypertension measures with specifications and to program them using HIE data through Hixny for Albany County  2. To evaluate the quality and completeness of the HIE data through Hixny and to report challenges in calculating each hypertension measure  3. To explore the feasibility of conducting stratified analyses to identify high risk population or communities in urgent need of services Using Health Information Exchange Data to Evaluate Hypertension in Albany County

18. Health Information Exchange Challenges Governance – Trust – Confidentiality and security Resources – Technology – Workforce Sustainability – Private funds – Public funds

19. Public Health-Health Care Integration An Epidemiologist’s View 2014 Mandated Reporting Registries Electronic Laboratory Reporting Automated Reporting Population Health Metrics Bidirectional Information Flow Public Health: Making Accountable Care Organizations Accountable

20. Acknowledgements Statewide Health Information Network of New York Steven R. Smith NYS Health IT Coordinator Office of Quality and Patient Safety Using HIE to Evaluate Hypertension in Albany County, New York Scott Momrow, MPH Vice President of Marketing & Outreach Hixny Ian Brissette, PhD Director, Bureau of Chronic Disease Evaluation and Research Office of Public Health Feng (Johnson) Qian, MD, PhD Assistant Professor School of Pubic Health, University at Albany