Public Health Informatics & Population Informatics: Susan H. Fenton



so I'm going to talk about public health informatics and population informatics and about some of the differences between them so the first thing I did was define it for you and I've already talked with Joanna and we're gonna try to get you PDF versions of all of the slides that you've seen here today as as usual as as usual we were all working on this you know yesterday right so but we do have the slides now we've got them loaded and so so we can get them to you so public health informatics we're very familiar with public health where we're talking about surveillance prevention preparedness health promotion public health is extremely broad it can also include things where we're bringing in the environment are working in living spaces so when we talk about public health informatics we're talking about all of that that extremely broad everything that would impact the public health if you go if you I know the School of Public Health where I got my PhD from because I have a PhD in health services research they actually had one of the old-fashioned water pumps sitting there because still if on him from a public health perspective that was one of the biggest contributions that was ever made to our public health was clean water so we're still searching for the next Silver Bullet that was like clean water population informatics differs from public health because it's usually not all people in a geographic area but they're grouped by some other characteristic and we're going to talk about health care and population informatics and how that's changing how we look at what we do so back to public health we typically have two types of data we have the identifiable or the individual data that would be your immunization histories your infectious disease reporting so forth and so on it occurs at the local health district Harris County has a very active Public Health Department okay your smaller counties your less populated counties would not necessarily then obviously we do it at the state level and of course at the federal level with the CDC we're going to talk about some tools that the CDC has available and then again we have the aggregate data mortality disease prevalence all of those reports that the CDC puts out that's aggregate and we'll talk a little bit about search engine trends and how that's helping in terms of aggregate data and how they're using it for Public Health so categories of public health informatics we're gonna study and describe different complex systems we want to try to understand models of disease transmission okay so we remember avian flu came across the Mexican border into Texas and then watching how it how it moved throughout the country so the models of disease transmission or it could be something like a public health nursing workflow how what are we doing there what's the most effective down on the border with the colonias and we're sending in community workers how does that impact the public health in in those areas so then we're also looking for opportunities to improve the efficiency and effectiveness of our public health systems and we want to do innovative data collection or use the information in innovative ways so now of course they talk about the food deserts and the rise of obesity and things like that so that's all related to the public health informatics and then of course implementation and maintenance of processes and systems to achieve the improvements so how are we putting in place the processes and systems that are going to help us maintain those improvements but also make additional improvements and understand our public health data collection method methods around public health informatics I've just given you a few here so of course we have the surveys if you're wanting to work in the informatics and you haven't gone out to the CDC and you haven't looked at all of the data that they collect you definitely need to do that I've just given you two examples right here the national hospital discharge survey the NHD s and the National amatory Medical Care Survey the Nemesis and those are have varying levels of tell data but one is focused on hospital care in the US and one is focused on ambulatory there are statistical representations there very rigorously collected and those are just two examples they're all there's also like the in hand in Haynes so tons and tons of data out there for you and this doesn't even touch on things like the H cup the healthcare utilization project from AHRQ or the Maps the Medical Expenditure panel survey so if you're wanting to work in this area you really need to sort of get busy on finding those data sources and then CMS is now making a lot of their data available ok hersa has the area resource file if you're looking at if you're looking at healthcare and you're looking at resources and trying to tie public health with the availability of physicians hersa has something called the area resource file that they compile yearly it's publicly available you can download it you don't have to pay for it so tons and tons of resources that you could combine in different ways if you're looking at Public Health we have the semi automated data collection so this one is the Ned's where it we're collect we're doing disease surveillance in a semi automated fashion so I'm going to talk a little bit about meaningful use in electronic health records but now they're trying to automate that collection where it's not your infectious disease nurse calling it in where they're pulling it out of the electronic health record and transmitting it automatically and that's something that's being done with immunizations here in the state of Texas so that is expanding to as far as our Public Health search engines so how many people know that you can track flu by doing by looking at the googles yeah ok so and the social media too so these are good for pub these are great for Public Health especially the social media though brings up questions of do the people understand what they're sharing so there are some interesting issues there about if you're looking especially at like 23andme and some of those social media those community sites do they understand that once they put it out there it's forever out there you can never retract it you can it's it will always be somewhere in the internet and then of course we want to bring in other so maybe we want to use the census or some economic data or environmental data from the EPA if we're talking again if we're talking about the public health informatics so lots and a lot of lots of data in public health this is actually one this is not totally new but within the last decade the the use of geographical information systems and so this is one that I actually just created last night you can do this online so this is for Texas and this is our fine particulate matter and you can see where the worst counties are and where the best ones are and we're surprisingly not one of the worst ones in Harris County so we're right here and we're in the second group okay so very easy to do again lots of tools out there to help you do this type of looking at public health and the one that was on the previous page I actually created at this the wonder online date database through the CDC okay so you can get it in table form and it'll even map it for you you can do it national you can do it a state-level you can do it at the county level so lots and lots of data lots and lots of ways to manipulate it and much of this is publicly available and downloadable and you can combine it again with other data in new and different ways so population health informatics this again it remember now we're talking about a group of people based on some type of characteristics okay and we get the data for population health informatics from our EHRs our pH our s our devices or even our consumer focused internet-based tools or what we might term patient portals okay for Meaningful Use they're talking about them in terms of patient portals all right so our health information technology we will define and identify our populations and subpopulations of interest it can be everyone we're taking care of so the UT physicians would look at it as everyone they're taken care of so would Memorial Hermann so would other integrated health care delivery systems but then within that we may have subpopulations we may want to track our diabetics for something in our heart disease for something else so we're we're going to want to keep we may keep defining down into our populations but yet we want to understand our overall population that we're interested in so not everyone in Harris County but the people who are under our care all right so we're going to describe their health status and needs we're going to figure out how can we improve their health or how can we help them maintain their health so we're changing from let's just treat them – let's take better care of them and then of course we want to evaluate the services provided typically one thing we're seeing a lot of is many many registries in different organizations I know the Veterans Health Administration is doing this a lot and other providers are too so this is where you're trying to collect uniform data so that you can use it with that group of people and registries again can be for a lot of different purposes so it's much like Todd was saying with it data governance where you would want to define that as you're setting up the register you would want to say what's our goal in doing this and then hopefully you could extract that registry out of existing data but not always sometimes you have additional data needs that you could collect for that that registry and just again – real simple examples diabetes and heart disease so why are we doing all of this this is why we're doing all of this if you look at this graphic over on the left we started with stage 1 meaningful use and we're just in the process now of moving from stage 1 meaningful use for electronic health records to stage 2 meaningful use for electronic health records and you can see where we started with ok yes we want privacy and security only want some basic EHR functionality now we're saying in stage 2 it's mandated for providers that they have patient portals and that they show that a specific percentage of their patients are actually using the patient portals alright so patient engagement care coordination that you're using those Peter called it an extract a subset of data out of that he was going to transmit between Herman and UT that's the care coordination that you're actually transmitting that data back and forth between the providers to help ensure that the care is being coordinated okay next we're looking at these are the patient-centered medical homes and we're see we're build that we just keep building so now we're talking about patient self-management where we're trying to help them and then we want the data to improve delivery and outcomes we move over here and we have the accountable care organizations and stage three meaningful use which we expect those regs the draft of those regs to come out within the next several months but you can see it just keeps getting what we want to do with the data and information just keeps getting more and more ambitious where now we're talking about enhanced access and continuity and we want to improve our overall population health okay so and how are they going to do that they're gonna do that because they're trying to shift the healthcare business model alright so everything on the left is the old way and this is what we're trying to move it to and I don't have time to go through all of them but in essence if you wanted to say you know if you wanted your elevator soundbite it would be we're moving from volume to value okay our healthcare system used to be how many widgets can you push through now how many patients widgets can you push through the more you do the more you get paid to value now how well are you taking care of them are you helping them maintain their health are you meeting the quality outcomes are you doing the preventive that you're supposed to be doing with them all of that so in a nutshell volume to value quality improvement these next couple of slides are just again examples so if you want to do care delivery and coordination you might use registries you might have automated patience so the clinical decision support that Peter talked about and obviously the decision support tools measuring your population to understand what's going on so I actually was speaking with a doctor who works in the ONC and also still does his private practice a couple of weeks ago and he he works in the g i– and he said i would have told you i I was taking care of my patients nine you know ninety percent I was hitting all the targets he said and when I looked at the numbers twenty five percent okay so even someone like that who's really informed who's really thinking they're doing everything right once you start doing the numbers and the benchmarking reports big it's it's a real eye-opener for oh maybe I'm not doing as well as I thought of us and that's how the data can help in terms of the population and quality improvement these are some different registries that you can look at if you just want to see what's going on so the American Hospital Association has get with the guidelines they're available online same with the main health and the NCCN so a lot going out on out there in terms of different registries and tools and what-have-you how can librarians help data creation and management resources related to new technologies so we need to be able to find data and information about the evolving technologies reviews or compilations of websites and tools okay because not everyone has all the time and knowledge to go through and do that kind of curation themselves and I'll leave you to come up with other ideas I'm sure you've got about a million of them so in summary public health informatics reporting on and helping to improve health of persons in a specific geographical area and then population describes and hopefully improves and the health of a specific population or sub population

2 Comments

  1. rhonda mckenzie said:

    Awesome this video help me to understand more about informatics. Thanks

    May 22, 2019
    Reply
  2. NAIF MURAYSHID said:

    thanks a lot and really appreciated this effort , we need so many of lecture like that about public health informatics

    May 22, 2019
    Reply

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