Public Health Information in the e-health, Health Reform and Big Data World

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1 Public Health Information in the e-health, Health Reform and Big Data World Public Health Law Preconference Workshop October 15, 2014 Bill Brand, MPH

2 Discussion topics The state of e-health in the US Implications of e-health and health reform for public health and public health law Creating readiness for e-public health

3 Basic premises Laws, regulations and policies around health information exchange, use, disclosure and consent must be re-examined in a digital era Health information technologies hold much promise but are struggling to meet the demands being placed on them Increased focus on population health measurement and improvement brings opportunities and challenges for health departments The need will continue to grow for more informatics-savvy health departments

4 About PHII Transforming health practitioners ability to apply information effectively to improve health outcomes worldwide. Informatics Academy Requirements Laboratory Practice Support Part of the non-profit Task Force for Global Health in Decatur, Georgia

5 The state of e-health

6 Paper Kills

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9 Where are we with HIT today? Current adoption rates Impact of Meaningful Use and EHR certification programs Current limitations in e-health and health reform era

10 EHR Adoption by US Hospitals ONC Data Brief No. 16 May 2014 Adoption of Electronic Health Record Systems among U.S. Non-federal Acute Care Hospitals:

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12 Physician adoption of EHRs PHII.org

13 Impact of MU and Certification Meaningful Use (MU) accelerated trends already underway EHR certification Standardized functionality Increased buyer confidence (somewhat)

14 EHR limitations Not designed as health care improvement and population health management tools Major dissatisfaction with usability Don t match workflows Growing expectations for data entry Challenges in getting data out of the systems Still too many proprietary codes and other idiosyncrasies to be effectively interoperable Need to be re-designed for today s goals

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16 Implications for public health

17 Assumptions Regardless of how ACA gets implemented, the focus on improving health outcomes in populations will continue Increasing focus on big data analytics to better understand social and other determinants of health Healthcare is unlikely to embark on widespread sharing of chronic disease and other data with public health Access to data and analytic capabilities will be through partnerships

18 Public health reporting in an e-health era Data reported to HDs increasingly being collected for other purposes Enter once, use many times Public health as secondary user No longer control the information value chain Must understand the who, what, why of data collection at the source Decreasing interest/ability to interact with stand-alone, external systems

19 EHR-based public health surveillance? Under what authority(ies)? Will healthcare agree to disclose data? Can the data be extracted from EHR systems? Is it standardized? Will it be meaningful for surveillance purposes? New surveillance model? Having access to healthcare data repositories

20 Understanding social determinants

21 Understanding social determinants Sexual orientation Education Financial resource strain Health literacy Negative mood and affect Psychological assets Dietary patterns Social connections and social isolation Exposure to violence

22 An era of e-public health e-public health is the effective use of information and information technologies to monitor and promote the conditions in which people can be healthy

23 Implications for public health Strengthen partnerships around population health data and analytics Work within the world of healthcare standards and health reform Make system functionality seamlessly available to EHR or other systems Integrate public health data sets (not systems) to achieve more comprehensive view Contribute to understanding social determinants

24 Key Capacities of an Informatics-Savvy Health Department PHII.org Informatics Vision & Governance Skilled Workforce Well-designed & effectively used systems Well-articulated informatics vision for how the agency uses information and IT Effective relationship with community partners and with central IT Policies and systems to ensure confidentiality, security, integrity of data Training strategies for improving informatics knowledge and skills across a broad range of staff Informatics unit with agency-wide responsibilities Information systems effectively meet the information needs, workflows and practices of staff and programs. Systems are interoperable with other internal & external systems

25 Policy readiness for e-public health Widespread secondary uses of data Inter-jurisdictional exchange Integration of public health data sets Access to clinical repositories Interaction of different consent requirements Consumer access: right to correct/change data?

26 Thank you! Bill Brand, MPH