population health informatics dme soph 20151006
TRANSCRIPT
Population health informatics: key concepts and trends for health professionals
Population and Global Health in Health Professional Education SymposiumDepartment of Medical Education / School of Population and Global Health
University of Melbourne 6 October 2015
Kathleen GrayHealth and Biomedical Informatics Centre
The University of Melbourne
• What is health informatics and where did it come from?• Don’t health professionals already know this stuff?• Public health meets health informatics: seriously?• ‘There’s never been a better time to be an Australian’ …
population health informatician
What is Health Informatics?
My paraprhase of www.amia.org
Hammond, W. E. 2012. http://www.slideshare.net/HINZ/ehr-the-killer-app
–interdisciplinary field of scientific knowledge & professional practice–that aims to improve human health –by optimising the use of data, information & knowledge –in planning, problem-solving, decision-making, enquiry & learning–across the spectrum…
Why is Health Informatics?
• New knowledge is exponential: …citizen science, stealth research, systematic reviewing…
• Practice is information-intensive: …records, registries, reporting…
• Data processing is complex: … imaging, omics, twittersphere…
• How to describe, collect, store, assure, secure, share, integrate, analyse, visualise, mobilise … optimise?
A potted history of Health Informatics
1960s: Hospital management systems1970s: Expert systems for diagnosis / MEDLINE1980s: Clinical information systems /EHR, RIS / Unified Medical Language System 1990s: Clinical workstations / Visible Human Project / Internet health information2000s: Bioinformatics / Human Genome Project / ontologies / modeling and simulation2010s: Health social media / health analytics / ambient assisted living / precision medicine
Health Informatics & e-health?• Ehealth is “the use of information and communication technologies
(ICT) for health. • Examples include treating patients, conducting research, educating
the health workforce, tracking diseases and monitoring public health.”
...according to the World Health Organization, which has been working to advance ehealth for the past decade.
2010-2013 study of 100 entry-level degrees, all health professions, all States & Territories: K. Gray, A. Dattakumar, A. Maeder, K. Butler-Henderson, & H. Chenery, Advancing Ehealth Education for the Clinical Health Professions Final Report, Australia. Department of Education and Training, 2014. http://clinicalinformaticseducation.pbworks.com
Very few degree coordinators could give a clear account of campus or placement learning, teaching, assessment, quality assurance.
QA ≠ electives, home-brewed subjects, innovations = curriculum developed and reviewed with reference to externally recognised health informatics curriculum guidelinesSome health-profession-specific guidelines exist (e.g. nursing) and there are generic health informatics curriculum guidelines e.g.Certified Health Informatician Australasia Health Informatics Competencies Framework, 1.0, 2013. http://www.healthinformaticscertification.comJ. Mantas, E. Ammenwerth, G. Demiris, A. Hasman, R. Haux, W. Hersh, et al., Recommendations of the International Medical Informatics Association (IMIA) on education in biomedical and health informatics–1st revision. Methods of Information in Medicine 49 (2010), 105-120.
Image credit: timeshigherducation.co.uk
How do health professionals learn about health informatics & ehealth? How well?
Health informatics in CAPHIA curriculum guidelines -Competencies for MPH Graduates in Australia 2009
http://caphia.com.au/documents/Competencies-MPH-Graduates-Australia-ANAPHI-2009.pdf
HI-related keyword search:“informatics”, “ehealth / e-health” ? “electronic”, “comput*”, “technolog*” ? “data”, “information” “knowledge”?
Area of Practice: Monitoring and surveillance Practice Goal: Assess, analyse and communicate population health informationUnit of Competency 1. Monitor and evaluate population health data or indicators
Area of Practice: Disease prevention and control ØArea of Practice: Health protection ØArea of Practice: Health promotion ØArea of Practice: Health policy, planning and management Ø
Area of Practice: Evidence-based professional population health practice Practice Goal: Engage as a professional in population health with knowledge and skills in population health research,
ethical population health practice, stakeholder analysis, information synthesis, effective communication and cultural safety.
Unit of Competency 16. Collect, organise, critically analyse and articulate secondary information
…and more detail throughout fourth-level Elements of Competence
University of Melbourne MPH students
21 MPH students have taken the interdisciplinary elective subject ISYS90069Ehealth & Biomedical Informatics Systems since it began in 2011.
‘It is really nice to interact with all the students from different backgrounds.’
‘It was a good overview on biomedical informatics. I have definitely gained new insights in this area.’
‘This subject is an overview of medical science in electronic version and how to integrate this information and get a nice overview of the world.’
Overview, definitions & a specific PHI lecture.Other topics of high interest to MPH students:
1. Clinical research informatics2. Consumer health information3. Decision support for precision medicine 4. Ehealth in low income countries5. Electronic medications management6. Electronic patient records7. Geospatial data in health8. Government ehealth strategies & policies 9. Mobile apps & social media for health10. Patient portals in hospital & primary care11. Self quantification for health12. Telehealth infrastructure and trends
Public health meets health informatics, seriously
Until the mid-1990s introducing electronic data and
information systems, communications tools and monitoring methods
still was seen by many in the public health community as
obscure, complex, impractical, expensive, overly specialized and not obviously useful…
“Public health informatics” was defined first in 1995, in the United States, as the application of information science and technology to practice and research in public health.
Seminal papers in public health informatics Friede, A., Blum, H. L. ,McDonald, M., Public health informatics: how information-age technology can strengthen public health, Annual Review of Public Health, 16(1), 239-252, 1995.
“The combination of the burgeoning interest in health, health care reform and the advent of the Information Age, represents a challenge and an opportunity for public health.
If public health’s effectiveness and profile are to grow, practitioners and researchers will need reliable, timely information with which to make information-driven decisions, better ways to communicate, and improved tools to analyze and present new knowledge.”
Yasnoff, W. A., et al., Public health informatics: improving and transforming public health in the information age, Journal of Public Health Management and Practice, 6(6), 67-75, 2000.
“Development of effective public health information systems requires understanding public health informatics (PHI)…
The current need for PHI arises from dramatic improvements in information technology, new pressures on the public health system, and changes in medical care delivery.
Application of PHI principles provides unprecedented opportunities to build healthier communities.”
Challenges > opportunities include: Information architecture all-sorts > Platforms to scale up data exchange & interoperabilityJurisdiction silos > Whole-of-health IM/IS/IT management & governance Human factors issues > Support for more effective ways to do what needs to be done
Public health > Population healthPublic health goes back a long way, but
by the second half of 20th centuryexpansion of the biomedical model of health overshadows public health.
Emphasises and integrates social, environmental, cultural and physical determinants of healthWidens needs / implications for health informatics
Population health informatics…means that public health informatics extends
from the informatics of core functions such as biosurveillance, outbreak response and electronic laboratory reportingto the informatics of human-health related aspects of agriculture, architecture, climate and ecology.
http://www.scientificamerican.com/article/environmental-exposure/
http://www.atlantamagazine.com/health/mapping-the-exposome/
For example:“Biomedical informatics (BMI) must provide a coherent
framework for dealing with multi-scale population data including the phenome, the genome, the exposome, and their interconnections.
The combination of these more continuous, comprehensive, and personalized data sources requires new research and development approaches to data management, analysis, and visualization. “
Sanchez, F. M., Gray, K., Bellazzi, R., & Lopez-Campos, G. (2014). Exposome informatics: considerations for the design of future biomedical research information systems. Journal of the American Medical Informatics Association, 21(3), 386-390.
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Images: www.cdc.gov http://www.usa.philips.com/healthcare/innovation/thought-leadership/connect-to-healthy-sxsw
Rethinking scope of PHI in view of
ForecastingEdmunds, M., Thorpe, L., Sepulveda, M., Bezold, C., & Ross, D. A. (2014). The Future of Public Health Informatics: Alternative Scenarios and Recommended
Strategies. EGEMS, 2(4).
Not just USA…• Macfadyen, D., Importance of informatics for public health and the work of the World Health
Organization in Europe, in Health in the New Communications Age, M. F. Laires, M. J. Ladeira and J. P. Christensen, Eds., Amsterdam, Netherlands: IOS Press, 27-30, 1995.
• Frisch, L. E., et al., Public health informatics in Canada, in Public Health Informatics and Information Systems, J. A. Magnuson and P. C. Fu, Eds., London, England: Springer, pp. 603-618, 2014.
• Qi, Xet al.(2015). Cross-sectional survey on public health informatics workforce in China: issues, developments and the future. Public health. DOI: http://dx.doi.org/10.1016/j.puhe.2015.03.002
• Richards, J., Douglas, G., and Fraser, H. S., Perspectives on global public health informatics, in Public Health Informatics and Information Systems, J. A. Magnuson and P. C. Fu, Eds., London, England: Springer, pp. 619-644, 2014.
http://earthzine.org/category/informatics-theme/
Global PHI: the big picture gets bigger…Health Metrics Network hosted by the World Health Organization
MOVE-IT & SWISH programs www.who.int/healthmetrics/en/
PHI: the evidence baseAmerican Medical Informatics Association
Annual Symposium 2013, first ever PHI ‘Year in Review’ session
https://www.amia.org/applications-informatics/public-health-informatics
2013-2014: 65+20 PHI articlesKey themes:
meaningful use, syndromic surveillance, immunization registries, electronic laboratory reporting, geospatial data, natural language processing, data quality, chronic disease prevention and management indicators, screening systems, policy and infrastructure decision support and bidirectional communication, consumer online behaviors, PHI workforce and training
Many good editorials, e.g. • Cimino, J. (2014). Consumer-mediated health information exchanges. Journal of biomedical informatics, 48, 5-15.• Mandl, K. (2014). Ebola in the United States: EHRs as a public health tool at the point of care. JAMA, 312(23), 2499-2500.• Yasnoff, W. (2014). Proposal for Financially Sustainable Population Health Organizations. Pop health mgmt, 17(5), 255-256.
However…. original research reports in PHI are scarce.
PHI: specialised disciplinary & professional expertise
Core competencies for public health informatics specialists were formulated in 2009.
Relatively recent, compared to other health informatics subspecialities (such as imaging informatics, nursing informatics, pathology informatics, etc.)
Karras, B., et al., Competencies for Public Health Informaticians, Atlanta, USA: University of Washington Center for Public Health Informatics and Centers for Disease Control and Prevention, 2009.
http://www.cdc.gov/InformaticsCompetencies/
Two-year, competency-based training program - 3 examples of PHIFP assignments from http://www.cdc.gov/phifp/about.html :
1. The US Environmental Public Health Tracking program supports a national network of aggregated environmental hazard, human exposure, and health outcomes data. A fellow developed an application ontology and co-designed a content management database. The result streamlined the input of new data sources and visualizations.
2. The Health Workforce Information System of an African nation has been in place for several years, yet its positive impacts on planning and practice have not been formally documented. To identify and document impacts, a fellow led a team to review policy documents, interview senior officials at two Ministries of Health and four health professional regulatory bodies, and analyze data from the system.
3. The US Laboratory Efficiency Initiative supports State and Local Public Health Laboratories to maintain services during budget cuts. A fellow developed an assessment tool to help laboratories assess their informatics capabilities. The fellow also developed guidelines to help bridge the identified gaps.
PHI conferences
Whole conference specifically on public health informatics 2003-11 annual; 2014ff biennialRegularly over 1000 attendeesCo-sponsors: National Association of County and City Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC) http://phiconference.org/
A conference theme in 2014: New opportunities, new technology, new leaders…. New technologies provide challenges and opportunities in public health, so how do we use these efficiently and effectively?
www.phaa.net.au/documents/43rd_Annual_Conf_Call_For_Abstracts.pdf
Prof Ray Willshttp://webcast.gigtv.com.au/Mediasite/Catalog/
catalogs/phaa-annual-2014
The current Australian context – example 1Communicable Diseases Intelligence reporting
The National Health Security Act 2007 (National Health Security Act , No 174) authorises the exchange of health information, including personal information,between jurisdictions and the Commonwealth.
Image: http://en.wikipedia.org/wiki/Mycobacterium
CDI reporting covers
• Arbovirus and Malaria surveillance• Childhood Immunisation Register • Gonococcal surveillance• Meningococcal surveillance• Paediatric surveillance• Creutzfeldt-Jakob Disease Registry• the Sentinel General Practices Research Network (influenza-like illness,
gastroenteritis, chickenpox, shingles)• HIV/AIDS surveillance • Invasive Pneumococcal Disease surveillance• lInfluenza surveillance• Notifiable Diseases surveillance (60+ different diseases)• OzFoodNetas well as including • Tuberculosis notifications • Mycobacterium Reference Laboratory Network • Rotavirus surveillance
Each scheme has evolved its own paper-based / electronic / internet-based system of data collection and analysis.Details: https://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-surv_sys.htm#nndss
2014 discussion paper:
… the system needs a “re-boot” for the 21st century…• Over the longer term, virtual data networks or health
information grids allowing real-time exchange of health data by multiple parties could transform the surveillance landscape – highlighting the need for a system prepared for change.
• Partnering with health informatics specialists to improve current systems and support design of new systems is essential.
• Information technology specialists who understand public health processes and requirements could identify ways to, for example: share data across different platforms; link new datasets to existing systems; generate algorithms to detect unusual patterns in health events; and display analysed data in an accessible and understandable format.
• Communicable disease surveillance must keep pace with changes to the way the world captures, stores, transfers, uses and disseminates information.
The current Australian context – example 2 AIHW
The Australian Institute of Health and Welfare is the repository for national metadata standards for health. www.aihw.gov.au/publication-detail/?id=10737422826
METeOR is an example of a nationwide information infrastructure initiative – data set development.
A National Health Information Standards and Statistics Committee is responsible for:
• overseeing the development of data standards for inclusion in the National Health Data Dictionary (NHDD);
• mandatory national minimum data sets for national implementation; and • best practice data set specifications for inclusion in the NHDD.
AIHW Corporate Plan 2015–16 to 2018–19http://www.aihw.gov.au/publication-detail/?id=60129551938
Aims re significant activities that support whole-of-government initiatives include:
• cloud computing• open data initiatives • connections with other key agencies• cyber security
“Our key challenge in this context is to provide an information and communication technology (ICT) capability that supports high quality, effective and timely data collection, analysis and reporting.”
Priorities 2015-16:1. Geospatial data2. Data linkage3. Value-added feedback to data providers4. Filling primary health care information gaps 5. Diverse product formats6. Predictive modelling and analysis7. Data quality8. Supporting information needs in federated system
More examples of scope for Australian population health informatics: Commonwealth public health regulatory policies
http://www.health.gov.au/internet/budget/publishing.nsf/Content/2013-2014_Health_PBS_sup1/$File/2013-14_DoHA_PBS_2.01_Outcome_1.pdf
The policy The data / information / knowledge management requirement
Develop food standards and food regulatory policy Management and evaluation of a new food labeling system
Establish the Australia New Zealand Therapeutic Products Agency
Joint Adverse Event Notifications Systems
Assess the risks of industrial chemicals and provide information to promote their safe use
Registration of identified introducers of industrial chemicals and provision of regular information updates, including optimal use of international information
Protect the health and safety of people and the environment by regulating dealings with genetically modified organisms (GMOs)
Records of GMOs and maps of field trial sites and public availability online
There’s never been a better time to strengthenAustralian population health informatics –
identity, community, evidence
• The research literature in public health informatics in Australia is diffuse.
• Since the 1980s the Australian and New Zealand Journal of Public Health has published fewer than 20 papers which make any reference to informatics and only a handful in which this is a major focus [1].
• Of the 2,350 publications indexed in PubMed between 1990 and 2005 that were written by authors with Australian affiliations, only 17 clearly related to public health informatics [2].
• However a Google Scholar search shows that among nearly 3,000 papers published worldwide 2005-2014 that mention public health informatics, mention of Australia co-occurs in nearly 20% of papers.
• Much research activity occurring in this field is unidentifiable as such – so far.
What happens next is up to you [1] Australian and New Zealand Journal of Public Health. 2014. Home page. http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291753-6405. Accessed on March 1, 2014.[2] Mendis, K., Health informatics research in Australia: retrospective analysis using PubMed, Informatics in Primary Care, 15(1), 17-23, 2007.
