Consensus Framework for Advancing Public Health Informatics Approved by the JPHIT Board on April 20, 2011 How will public health choose to transform and galvanize itself in light of the historic national health information technology and health care reform initiatives? What capacities, human and organizational, are most critical to supporting these transformative efforts? How can public health ensure that its priorities for population health assessment and improvement are reflected in emerging requirements for health information technology? What informatics strategies, if pursued collaboratively across the public health enterprise, would have the most impact on improving the health and care of individuals and communities? Purpose of the Consensus Framework The Consensus Framework is intended to guide coordinated action across the public health enterprise. The Framework is intended to help ensure that public health agencies are full and valued partners in improving population health through effective use of health IT and health information exchange (HIE). It is not intended as a strategic plan or a set of mandated activities. The Consensus Framework articulates overall goals and specific objectives consistent with the national Strategic Plan for Health IT. The plan is organized as follows: Goals: Four goals identify overall categories for priority action. Objectives: Measurable, time-specific statements of what needs to be implemented to work toward meeting each goal. The objectives are within a two-year period. Example activities for the associations: Possible activities that could be incorporated into the work plans of the various associations, proposals to CDC, etc. The example activities are not meant to dictate priorities and work plans but rather to guide activity selection in a way that could achieve synergy across association activities. Example activities for federal agencies: Possible activities that either can be carried out only at the federal agency level, or are necessary to support association, state and local efforts. Example activities for local and state health departments: Possible activities that would advance informatics capacity in an agency, as well as contribute to nationwide capacity in the public health system.
A Consensus Framework for Advancing Public Health Informatics Page 2 Background Two significant forces could dramatically change the public health landscape over the next few years and beyond: the American Recovery and Reinvestment Act (ARRA), passed in 2009, and the Prevention and Public Health Fund, passed in 2010 as part of the Affordable Care Act. The combination of these two initiatives has provided an unprecedented level of public spending to improve health outcomes for Americans. Funding from ARRA through the Health Information Technology for Economic and Clinical Health Act (HITECH) is designed to stimulate adoption of electronic health records, assure meaningful use of electronic health records, and promote health information exchange all with the overall goal of improving the health status and health care of Americans. The Prevention and Public Health Fund is designed to provide for an expanded and sustained national investment in disease prevention, wellness promotion and public health activities. Both initiatives provide an historic opportunity for public health leaders to work with others to achieve population health improvement. To continue to provide leadership in population health assessment and improvement, public health must transform itself quickly to align with national policy and funding priorities and directions, while seeking opportunities to influence them. From an information perspective, these combined initiatives and investments could significantly enhance the role of public health and the impact of population health improvement efforts. Realizing this historic potential will require public health agencies at all levels of government to reach consensus on a limited number of public health priorities, goals and objectives, to develop a plan for achieving those goals, and to implement that plan in collaborative and effective ways, acting as an enterprise. These significant federal investments have created both opportunities and challenges for public health agencies at all levels of government: The increase in resources is likely to result in increased expectations and accountability for both public health performance and improvements in population health outcomes. Without a clear and compelling national consensus framework for public health informatics, significant resources could be squandered on IT projects that lack a unifying vision, resulting in a further proliferation of stand-alone information systems that lack interoperability with other agency systems and with community partners systems. At the federal level, the Centers for Disease Control and Prevention (CDC) will need to partner with state, local, territorial and tribal public health agencies to ensure public health is united in implementing relevant elements of the HITECH Act. Key to the success of such an endeavor will be collaborative leadership at all levels of government, and the development and effective use of practical guidance and tools to develop effective informatics capabilities. Automated transfer of key information (with and without personal identifiers, depending on context) to public health from electronic health records (EHRs) could vastly increase the amount, timeliness, accuracy and completeness of reportable disease case reports and other information needed by public health agencies to fulfill their mission. Agencies stand to benefit by gaining a more complete picture of disease burden in their jurisdictions, by more effective
A Consensus Framework for Advancing Public Health Informatics Page 3 and rapid detection of outbreaks, and by gaining access to other clinical data of population health interest. Public health agencies can process this information to provide useful real-time decision support to clinicians using electronic health records. However, to be credible data trading partners and infomediaries, public health will need to increase its capabilities in standards-based data exchange, management and analytics. Effectively managing these initiatives and funds will require clear vision and strong leadership across public health. The rapidly progressing movement to automate all aspects of healthcare through electronic health record systems, personal health records, and Health Information Exchanges (HIEs) further challenges the capabilities of the basic tools used by public health, forcing agencies to re-think their information infrastructure. However and very importantly efforts to upgrade infrastructure and build public health capacity must not be undertaken on an agency-by-agency basis; such business-as-usual will be construed as failure to appropriately respond to Congressional intent and act in the public s interest. Modernizing the public health information infrastructure will require significant and clear federal leadership to re-cast existing programs and directions to function within the larger context of a nationwide e-public Health initiative. A significant challenge exists to shift the public health sector from thinking of each agency, whether local or state, as unique and requiring customized information solutions, to thinking of public health as an enterprise, unified by a common understanding of the priorities and functions of public health. This Consensus Framework seeks to provide a foundation for such concerted, unified and collaborative action. About JPHIT Created in 2008, the mission of the Joint Public Health Informatics Taskforce is to continuously forge a consensus strategy and take coordinated action to achieve a shared informatics framework for public health agencies and their partners. The founding members of JPHIT are: APHL - Association of Public Health Laboratories ASTHO - Association of State and Territorial Health Officials CSTE - Council of State and Territorial Epidemiologists NACCHO - National Association of County and City Health Officials NAHDO - National Association of Health Data Organizations NAPHSIS - National Association of Public Health Statistics and Information Systems PHDSC - Public Health Data Standards Consortium
A Consensus Framework for Advancing Public Health Informatics Page 4 Since its founding, two Affiliate Associations have been added to the JPHIT membership: AIRA American Immunization Registry Association ISDS International Society for Disease Surveillance The Public Health Informatics Institute currently serves as Secretariat for JPHIT, through a cooperative agreement from the Centers for Disease Control and Prevention, Public Health Informatics and Technology Program Office.
A Consensus Framework for Advancing Public Health Informatics Page 5 Goal 1: Informatics capacity* at all levels of public health supports effective stewardship and use of individual and population health data. * Informatics capacity consists of functional capacity (e.g., effective management of information systems and IT operations, strategic direction for informatics, data integrity and security, effective communications) and resource capacity (e.g., skilled staff, adequate infrastructure, policies, legal authority). Objectives 1.1 (Priority objective) Develop a strategy and plan to consistently assess and effectively build informatics capacity at all levels of government. 1.2 Develop survey instruments and other tools to assess and document public health informatics capacity needs. 1.3 By January 2012, build state and local public health workforce capacity by developing/identifying and promoting a suite of tools, training resources, and curriculum available to practitioners for training in applied public health informatics. 1.4 By January 2012, translate the individual informatics competencies into organizational capacities to support planning around agency/organizational capacity building. Example Strategies for Federal Agencies and the Associations Send a letter to the Public Health Accreditation Board offering to consult on developing or refining informatics standards for health department accreditation. Advocate for JPHIT members to be funded to routinely and consistently assess informatics capacity gaps and monitor/evaluate progress. Develop a consistent approach to regularly and consistently assess capacity in data exchange, management, quality, analysis and security, using the findings to drive technical assistance efforts. Collaboratively develop a series of core and ancillary survey questions to assess informatics capacity, so that survey results from different sources can be compared and combined. Ensure availability of applied informatics training resources, tools, certification programs and curricula for working professionals. Deploy the self-assessment Informatics Profile tool for state and local public health agencies to assess informatics capacity which includes, at a minimum: information systems inventory, current level of interoperability, potential data trading partners, and workforce capacity/needs. Agencies are encouraged to send results to their associations. (The Profile is available at www.naccho.org and www.phii.org) Develop sample job descriptions for public health informaticians for use by agencies, including minimum educational requirements, basic skills needed, tasks to be performed, etc. Collaboratively develop a template Enterprise Architecture (EA) framework for public health that includes views from the perspectives of operational roles (who needs to do what), technical requirements (what standards and conventions to follow), and systems and services support (how do these relate to operational needs).
A Consensus Framework for Advancing Public Health Informatics Page 6 Example Strategies for Health Departments Complete the Public Health Informatics Profile, and use the results to identify gaps and develop a strategy and implementation plan for building both functional and resource capacity (see definitions above). Establish targets for the number of staff who receive public health informatics programmatic and IT training, including those leading to a certificate or degree. Develop an ongoing staff educational program on public health informatics and e-health issues. Explore collaborating with the state Medicaid program on providing/sharing informatics/it training, IT infrastructure information, and informatics expertise. Develop an Enterprise Architecture that defines an IT infrastructure that supports your agency s mission and business processes.
A Consensus Framework for Advancing Public Health Informatics Page 7 GOAL 2: Public health is effectively engaged in health information exchange to improve population health.* *This includes health information exchange among program areas within public health agencies, among health agencies, between clinical partners and public health agencies, and other data sources and consumers. Objectives 2.1 Develop guidelines for interoperability aligned, as appropriate, with national and international HIT standards harmonization efforts. 2.2 Assess, monitor, facilitate and coordinate, as appropriate, efforts to address inter-jurisdictional data exchange issues (policy, technical and legal). (Ongoing) 2.3 By December 31, 2010 establish criteria for selecting and recommending priority public health/population health objectives for meaningful use for 2013 and 2015. [Completed] 2.4 By August 31, 2011 create a meaningful use action plan for 2013 and 2015. 2.5 As required, create and disseminate interoperability specifications for public health priority areas by developing written documentation of the need and advocating for resources. 2.6 By September 1, 2011, conduct an analysis of issues, and develop a communication/dissemination strategy regarding the implications of NHIN for public health agencies. 2.7 By 2015, patient-centric population measures that include medical care data are routinely reported to health departments. (Originally under Goal #1) 2.8 By 2013, develop consensus core data elements for all-payer claims databases. (Originally under Goal #1) Example Strategies for Federal Agencies and the Associations Develop communication and education messaging highlighting key principles and considerations for public health data release, exchange and sharing. Participate in developing and disseminating the public health/population health goals related to HIE. Align organizational priorities and workplans around the Consensus Framework to ensure synergistic efforts. Develop messages around the roles and value of public health agencies in HIE.
A Consensus Framework for Advancing Public Health Informatics Page 8 Example Strategies for Health Departments Convene an agency-wide, cross program taskforce with executive sponsorship to create a clear vision and implementation plan for e-public Health within your agency. Assess current capacity/readiness for HIE in the priority public health areas. Develop an action plan for addressing needs for effective participation in HIEs. Work with the state HIT Coordinator to ensure that public health scenarios (use cases) are part of the strategic and operational plans for the state HIE. Create a liaison position to coordinate efforts between your agency and other healthcare organizations around e-health issues (a Meaningful Use Coordinator, or similar title). Develop clear messages about what value public health brings to the HIE table, and what your agency needs from the other participants in the HIE. Coordinate with the state Medicaid program on meaningful use program implementation. Establish inter-agency workgroups to forge data-sharing strategies and agreements around the Medicaid population, public employees, or other populations served by PH agencies. Explore how public health information systems that are populated largely from clinical data (e.g., immunization registries, disease surveillance, Public Health Laboratory Information Management Systems, Early Hearing Detection and Intervention) could work with and through an HIE.
A Consensus Framework for Advancing Public Health Informatics Page 9 Goal 3: Develop and implement an overall Public Health Information Technology Architecture Objectives 3.1 (Priority objective) By December 2011, convene an expert panel to explore and document the business case for an overall public health information technology architecture. 3.2 As part of the planning in 3.1, develop an overall strategy for modernizing public health information systems to be more standards-based and interoperable, consistent with national standards harmonization efforts as appropriate. 3.3 By 2013, establish a patient/client directory for the public health enterprise to enable person-level matching, identification and re-identification. 3.4 By September 2011, explore the development of certification program(s) for public health information systems. 3.5 By June 2011, create an open source library of business processes and requirements to guide and standardize information system development across public health agencies.
A Consensus Framework for Advancing Public Health Informatics Page 10 Example Strategies for Federal Agencies and the Associations Explore and document the business case/value proposition for an overall public health information technology architecture, identifying guiding principles, relevant domains, major components, areas of overlap with the Medicaid Information Technology Architecture, and sequenced next steps. Establish learning network around patient/client directories and person-level matching, similar to what the National Association of State Medical Directors created. Collaboratively establish priorities and standards for information management and use. Collaboratively establish priorities for standards adoption or development. Identify/create a compendium of current relevant standards for public health. Identify areas that require standards development. Collaboratively develop template requirements for public health information systems, and make the requirements readily available in an online open source library or repository. Encourage federal agencies to allow funding to be used for ongoing maintenance, licensing and upgrades of information systems, as well as for acquisition and development. Advocate for federal agencies to create funding streams to support Enterprise Architecture planning. Engage federal agencies to support greater integration and interoperability of information systems. Collaboratively develop best practice guidelines and standards for data management and quality. Collaboratively develop an overall public health data quality management model based on similar work done for healthcare. Develop a nationwide certification program for public health information systems. Develop and adopt consistent language for CDC cooperative agreements authorizing funds to be used for information system modernization (i.e., more standards-based and interoperable). Example Strategies for Health Departments Create agency-wide architectures that support secure, reliable and agile exchange of appropriate information with community partners and within an agency. Develop criteria for determining priority systems to modernize at your agency, beginning with those identified as part of CMS EHR incentive program (i.e. meaningful use), specifically IIS, Labs, and syndromic surveillance. Explore opportunities to optimally link modernizing public health information systems to state Medicaid Information Technology Architecture plans and funding. Leverage state Medicaid architecture planning documents and funding wherever appropriate in implementing an agency Enterprise Architecture. Increase knowledge/skills in HL7 messaging standards.
A Consensus Framework for Advancing Public Health Informatics Page 11 Goal 4: Public health information technology policy is effectively influenced through coordinated public health advocacy efforts. Objectives 4.1 (Priority objective) By December 31, 2011, at least two additional public health representatives will be appointed to federal health IT-related advisory bodies, certifying bodies or Standards Development Organizations. 4.2 Support public health representatives to federal advisory bodies by providing timely and relevant information on the priorities, strategies, and messages developed by JPHIT and other stakeholders. [Ongoing] 4.3 Consistently respond to federal requests for policy input from public health representatives with coordinated, harmonized messages that have been vetted by the JPHIT membership [Ongoing] 4.4 By December 2011, advocate for federal agencies to create consistent language and requirements for cooperative agreements to financially support greater integration and interoperability of information systems, consistent with the emerging Public Health Information Technology Architecture (Objective 3.1) and national standards harmonization efforts. 4.5 At least annually, provide a progress report to the JPHIT Board and CDC on the Consensus Framework for Public Health Informatics, identifying and prioritizing new issues/objectives to consider adding to the Framework. [Ongoing] Example Strategies to Guide CDC and the Associations Conduct an analysis of public policy committees, advisory groups and certification bodies to assess impact on public health, and determine which should have a representative from public health. Develop and implement a recruitment and nomination process to ensure public health representation on standards development and policy bodies. Identify methods of collaborating with the ehealth Initiative to ensure public health engagement and representation. Continue the relationship with HIMSS Government Relations to ensure effective communication and coordination between industry and public health. Example Strategies to Guide Health Departments Coordinate with professional associations to develop key policy messages and actions. Designate staff to monitor HIE policy developments and provide briefings/communication to agency staff. When feasible, support the participation of agency staff in national public policy committees, advisory groups and certification bodies.