TCC Presentation- From Numbers to Outcomes: Data Resources for Public Health

From Numbers to Outcomes: Strengthening Informatics in Public Health

"Let the dataset change your mindset."- Hans Rosling

Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 established funding for sharing specified EHR data with public health authorities (part of AARA)

Intersections- Iowa Health Information Network

Dataset Catalog Contents

Health Insurance Portability and Accountability Act of 1996 (HIPAA) Standards for Privacy of Individually Identifiable Health Information (Privacy Rule) established national legal authority permitting, though not requiring,

“covered entities” to transmit individually identifiable health information from EHRs and health care transactions to public health authorities

Significant potential exists to better assess healthcare utilization, community health, tracking of medical treatments and interventions, the burden of disease, as well as to support substantial improvements in healthcare and in identifying cost-effective treatments through the use of data available through the IHIN.

Incentives for the Use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator 2004

Description

Legal authority to collect and release

Data owner

Location stored

Confidentiality/ICD codes

Publications

Year(s) available

In the next several years, efforts should be focused on enrollment in the IHIN and use of IHIN data for purposes of improving clinical healthcare for individual Iowans.

Develop a nationwide interoperable health information technology infrastructure that:

(a) Ensures that appropriate information to guide medical decisions is available at the time and place of care;

(b) Improves health care quality, reduces medical errors, and advances the delivery of appropriate, evidence-based medical care;

(c) Reduces health care costs resulting from inefficiency, medical errors, inappropriate care, and incomplete information;

(d) Promotes a more effective marketplace, greater competition, and increased choice through the wider availability of accurate information on health care costs, quality, and outcomes;

(e) Improves the coordination of care and information among hospitals, laboratories, physician offices, and other ambulatory care providers through an effective infrastructure for the secure and authorized exchange of health

care information; and

(f) Ensures that patients’ individually identifiable health information is secure and protected.

What are the responsibilities of Public Health?

What are the responsibilities of Healthcare?

In the meantime, stakeholders and policymakers should monitor the use of the IHIN data for clinical improvement of healthcare at both the system and community level to ensure that the system is positively contributing to population-based improvements in the local delivery healthcare delivery system.

Strategic, Operational and Intentional Planning

1) Population coverage

1) Requires new legal authority

What about Healthcare?

2) Reporting standardization

2) Data and transmission standards

Once the IHIN approaches a completely functioning exchange with a sufficient majority of the State’s population and providers invested in the technology, system, and processes, policymakers should conduct a thorough evaluation of the

feasibility of developing either a centralized query or repository system to enable access to IHIN data for research, and the costs associated with its development and ongoing operation.

3) Reporting on individuals over life course

3) Public and political acceptance of new uses of electronic health records

4) Standard measures of factors influencing population health must exist

4) Capacity to receive and analyze and release data

1) Structure

Establish core team

Lead (Data Management Coordinator), data users and program staff

Secure long-term administrative support and oversight

Bi-weekly administrative team setup in 2011 continues today

2) Cataloging

Datasets

Applications

Disaster recovery

References

If We Do This, What Will Come...

Strategic, Operational and Intentional Planning

http://www.ted.com/playlists/56/making_sense_of_too_much_data.html

Stellar

IDSS

Public Health Tracking

CDR

Public Health Tracking

IDSS

e-HARS

HIV/AIDS

I-Smart

IRIS

Newborn

screening

e-HARS

HIV/AIDS

U.N. sued for “bringing cholera to Haiti,” causing outbreak that killed thousands. (n.d.). CNN. Retrieved October 29, 2013, from http://www.cnn.com/2013/10/09/world/americas/haiti-un-cholera-lawsuit/index.html

BBC. (2010). The Joy of Stats. Wingspan Productions.

Calman, N. (2012). Strengthening Public Health and Primary Care Collaboration Through Electronic Health Records. American Journal of Public Health, 102(11), e13. doi:10.2105/AJPH.2012.301000

Ellsworth Fritz, J., Rajamani, P., & LaVenture, M. (2009). Minnesota Public Health Informatics Planning Toolkit. Public Health Informatics Institute.

Public Health Data Standards Consortium. (n.d.). Retrieved from http://www.phdsc.org/

Office of the National Coordinator for Health Information Technology. (2013). Adoption of electronic health record systems among U.S. non-federal acute care hospitals: 2008-2012 (No. 9). Retrieved from http://www.healthit.gov/sites/default/files/oncdatabrief9final.pdf

Friedman, D. J., Parrish, R. G., & Ross, D. A. (2013). Electronic health records and US public health: Current realities and future promise. American journal of public health, 103(9), 1560–1567.

Lenert, L., & Sundwall, D. N. (2012). Public health surveillance and meaningful use regulations: A crisis of opportunity. American Journal of Public Health, 102(3), e1–e7. doi:10.2105/AJPH.2011.300542

Rosling, H. (2006). Making sense of too much data. TED. Retrieved from http://www.ted.com/playlists/56/making_sense_of_too_much_data.html

Hsiao, C.-J., & Hing, E. (2012). Use and characteristics of electronic health record systems among office-based physician practices, United States, 2001-2012. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Retrieved from http://198.246.124.29/nchs/data/databriefs/db111.pdf

Making the Transition

CAReS

CAREWare

EMS Patient

Registry

EMS

Registry

CAReS

CAREWare

IRIS

Newborn

screening

PNSS

PRAMS

3) Policy development

Research and Ethics Review Committee

Data management policy

4) Long-term planning

Iowa Department of Public Health Blueprint for Data Management

Ties into Department strategic plan

Defined action steps

Inpatient/ Outpatient

Database

Information Broker

PRAMS

Information Consumer

Brain, Spinal,

Farm Injury

EHDI

Inpatient/Outpatient

Database

EHDI

Birth

Registry

Trauma

Registry

Death

Registry

Child Death

Registry

Death

Registry

Child Death

Registry

IWIN

IRCID

WHIS

IRCID

SHR/SEER

WHIS

SHR/SEER

CFY

What system changes are needed for public health agencies to meet effectively the information needs of its community partners?

How do we keep pace with the growing demands to electronically exchange information with physicians, hospitals, and other public health agencies?

And how do we, within the public health agency, ensure we are

maximally collecting and utilizing data to provide our best community service?

CFY

Creating a Common Understanding

What we have in the Public Health Tracking Portal

IDPH has worked to establish common definitions and understanding of data management and informatics terminology. These terms are define in policy, promoted in training, and iterated in conversations.

Water Quality

Birth Death BRFSS

SID Census

Poverty

Air Quality

Housing

Dataset: A dataset is a collection of records, electronic or paper-based, organized for a particular purpose. Some small datasets could logically be grouped together. For example, several datasets about food-borne outbreaks could be grouped together because, even though each dataset tracks an independent outbreak, all of the datasets contain essentially the same kind of information.

Cancer

Child Blood Lead

Birth Defects

Data Owner: The data owner may authorize or deny access to certain data within IDPH, and is responsible for accuracy and integrity of the data and timely response to data inquiries.

Data Steward: responsible for providing data content, context, and associated rules for interpretation of each data source. The data steward(s) serves as an intermediary between the data owner and data custodian. Data stewards have the responsibility of ensuring that the appropriate steps are taken to protect the data and that respective policies and guidelines are being properly implemented. Data Owner and Steward might be the same person.

SID

Birth

Death

Census

BRFSS

What we had in the warehouse

Data Custodian: Responsible for the technical environment and database structure that hosts data. The custodian for IDPH data may be indicated by statute (i.e., State Registrar of Vital Records); however, the physical custodian for the majority of IDPH data is the Bureau of Information Management and Bureau of Health Statistics.

Informatics in the Public Sector

Definitions were drawn from peer-review publications, national public health organization and informatics resources, including examples from states with successful programs such as Minnesota and Utah.

Interoperability

The ability of information technology systems from various programs and software applications to communicate, to exchange data accurately, effectively, and consistently, and to

Public Health Informatics

The systematic application of information and

computer science and technology to public health

practice, research, and learning.

Information System

This term refers to a business application of the computer. It is made up of the database, application programs, as well as manual and machine procedures. It also encompasses the computer systems that do the processing. The database stores the subjects of the business (master files) and its activities (transaction files). Application programs provide the data entry, updating, query, and report processing. Examples of public health information systems include cancer surveillance, immunization registries, disease surveillance, and vital records.