How Health Departments Achieve Informatics-Savvy Surveillance

Transcription

1 How Health Departments Achieve Informatics-Savvy Surveillance Findings of a CSTE workshop April 2014 Seth Foldy, MD MPH S&I Framework Public Health Webcast May 6, 2015

2 Participants Council of State and Territorial Epidemiologists (CSTE) US Centers for Disease Control and Prevention (CDC) Association of State and Territorial Health Officers (ASTHO) National Association of County and City Health Officials (NACCHO) National Association of Public Health Statistics and Information Systems (NAPHSIS) American Immunization Registry Association (AIRA) Public Health Informatics Institute (PHII) International Society for Disease Surveillance (ISDS)

3 Participants Jurisdictions AL - Sherri Davidson FL - Janet Hamilton ID - Kathy Turner IA - John Satre KS - Charlie Hunt MA - Gillian Haney MI - Jim Collins NE - Tom Safranek NJ - Teresa Hamby NC - Megan Davies NYC - Annie Fine, Hannah Mandel OK - Anthony Lee OR - Stephen Ladd-Wilson PA - Mark Dittman TN - Erin Holt TX - Doug Hamaker UT - Jon Reid VA - Lesliann Helmus WA - Bryant Karras Associations AIRA - Rebecca Coyle ASTHO - Anita Samuel CDC - Laura Conn, Paula Yoon ISDS - Richard Hopkins NACCHO - Roland Gamache NAPHSIS - Larry Nielsen PHII - Bill Brand, Jim Jellison CSTE National Office Jeff Engel Virginia Dick Meredith Lichtenstein Becky Lampkins Facilitator Seth Foldy

4 Funding This work was supported by Cooperative Agreement Number 5U38HM awarded to the Council of State and Territorial Epidemiologists from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

5 Project Objectives Define characteristics of informatics savvy health departments Identify organizational structures and processes that facilitate surveillance and informatics practice Recommendations for health departments Recommendations for national agencies and associations Strategies to leverage resources for informatics needs

6 Process; Evidence One day workshop, diverse participants Primary focus on communicable disease surveillance Speakers and participants identified: Health Department features that support electronic information collection, management and use Support roles for national associations and agencies Recommendations based on at least one of: Evaluations Lived experience Consensus

7 Public Health Surveillance A core public health (PH) function Ongoing, systematic collection, analysis and interpretation of health data Detect and respond to health threats Statistical basis for population health assessment Evaluate effectiveness of health programs Sources Mandatory or voluntary health care reporting (passive) Active collection by PH staff HIPAA: disclosure allowed for authorized PH functions

8 Key Functions, Requirements DETECT events of concern MONITOR trends CHARACTERIZE distribution (who, when, where) SUPPORT response Data must be: Timely Complete or unbiased ascertainment Consistent (case definitions, data elements) Granular (can ID and manage cases when appropriate) Analyzable Examples: Ebola, births, e-cigarettes, chemical spills

9 Surveillance Disrupted Digitalization of medical records (electronic health records) and laboratory data (LIMS) Fast-changing HIT standards and regulations (e.g., meaningful use) partly outside PH control High stakes incentives for healthcare A broader stakeholder set Health care providers PH agencies Vendors Payers, health information exchange organizations, patients Interconnectedness requires Reliability Interoperability Scalability Security

10 Surveillance Disrupted II Downward pressure on healthcare and public health budgets Pandemics at jet speed Opportunity for real-time information from/to the field Healthcare providers Public health workers The public itself

11 Surveillance Management Challenge Execu ve Leadership Information Providers Epidemiologists & Surveillance Leaders Workforce that Gathers, Protects and Uses Health Informa on Information Users

12 Unfinished Transformation Goals Automate recognition of reportable conditions in EHRs Improve the speed and efficiency of electronic case reporting Reduce time spent on data management and case investigation By health care professionals By public health professionals Free time for prevention. Improve disease control Share information in field, clinic and hospital. Enhance communication with the public. Integrate information across multiple PH systems to Improve epidemiologic analysis Improve case and outbreak management Improve organizational performance

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14 Needed: Public Health Informatics Functional understanding of information science and technology + Familiarity with values, goals, methodologies and workflows of public health work This combination is often obtained on the job Note: this combo often obtained on job (program staff gain tech expertise/is staff learn PH business)

15 Needed: Informatics-Savvy Department Functional understanding of information science and technology + Familiarity with values, goals, methodologies and workflows of public health work Supported by departmental infrastructure: Leadership, planning, information governance, technology investment, workforce development Note: this combo often obtained on job (program staff gain tech expertise/is staff learn PH business)

16 Threats & Opportunities Information Supply EHR adoption Health Information Exchange Public participation Information Demand Governance, infrastructure, workforce, capability

17 Threats & Opportunities Information Supply Granular information now Reuse data downstream Analysis across systems Information Demand Governance, infrastructure, workforce, capability

18 Threats & Opportunities Information Demand Information Supply Governance, infrastructure, workforce, capability More stakeholders Centralized IT shops Systems out of sync w HIT standards Lack sustainable funding Lack strategies to leverage existing assets Lack adequate project management Unrecognized informaticians

19 Recommendations for health departments Vision, Strategy, Governance, Organization HD executives prioritize informatics as mission-critical Executive level informatics leader (PHIO) Information strategic plan Leverage capabilities across multiple programs Broken into opportunity-sized projects Include stakeholders in surveillance system governance Clear decision-making processes; anticipate supply/use effects Strong program-informatics-it staff relationships, with or without reorganization Co-locate informatics with programs Clear frequent communication of goals, objectives, progress Network with HDs doing similar work

20 Recommendations for health departments Workforce development Grow informatics in your existing workforce Increase informatics familiarity across the organization Including executive leadership Leverage academic partners, students and Federal assignees (including CDC PH Informatics and SHINE Applied PH informatics fellows)

21 Recommendations for health departments Funding and Implementation Consult strategic information plan for ALL grant applications Consider Medicaid, CMS Innovation or other new funders Prevent delay: begin project management with grant writing Use System Development Life Cycle and project management Adopt /reuse HIT interoperability standards when appropriate Share info exchange capabilities across multiple programs

22 Recommendations for national organizations Bottom-up governance for national surveillance systems Increase standardization across jurisdictions of reporting ID successful pilots for further development and wider adoption Resume funding for labs linking health departments to academic informatics programs. Foci: Accessing and searching EHR data Triggering reports from EHR Engaging healthcare providers surveillance through the EHR Engaging the public more directly in surveillance Recruit, deploy and support PH professionals on HIT standards and policy workgroups Collaborate on access to informatics education and tools

23 Resources, Report URL The report includes links to many resources related to each recommendation. The report will be downloadable from

24 Workshop led and report edited by Seth Foldy, sethfoldy.com CSTE National Office 2872 Woodcock Boulevard, Suite 250 Atlanta, Georgia