
Public Health Informatics and Information Systems
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J.A. Magnuson is an informaticist with exceptional public health, teaching, research, and management skills. Diverse experience including academia (professor), state public health (health informatics architect), and private industry (Director of Research & Development).
Dr. Paul C. Fu, Jr. is Director, Clinical Informatics, and Director, Pediatric General Pediatrics Inpatient Service at Harbor-UCLA Medical Center. He was previously Chief Medical Information Officer at the Los Angeles County Department of Health Services, one of the largest public health service delivery systems in the country. Dr. Fu also leads the Center for Biomedical and Public Health Informatics at the Los Angeles Biomedical Research Institute.
Content
- Intro
- Foreword
- Reference
- Preface
- Structure and Objective of This Book
- Acknowledgements
- Contents
- Contributors
- Part I: Context for Public Health Informatics
- Chapter 1: Introduction to Public Health Informatics
- Introducing Public Health Informatics
- Principles of Public Health
- History of Public Health
- Public Health Strata in the United States
- The Purpose of Public Health
- Public Health's Unique Challenges and the Promise of Public Health Informatics
- Principles of Public Health Informatics
- History and Background
- Challenges of Public Health Informatics
- Change Is a Constant: The Future of Public Health Informatics
- Driver for Change: Health Reform
- Driver for Change: Advances in Information Technology
- Driver for Change: Big Data
- Driver: Disruptive Innovation
- Conclusion
- References
- Chapter 2: History and Significance of Information Systems and Public Health
- Introduction
- Data, Information, and Knowledge
- The Development of Counting and Counting Machines
- Development of Mechanical Counting Devices
- The Development of Modern Mechanical Measuring Devices
- Stages in Development of Public Health Information Management Systems
- The Age of Observation
- The Age of Analysis
- The Origin of Modern Public Health Informatics
- The Cholera Outbreaks in England
- Public Health Data Collection in the United States
- The Three Waves of Federal-State System Development
- The First Wave: Independent Systems Development
- The Second Wave: Federal Funding of State-Level Systems
- The Third Wave: Integration of the Benefits of State-Level System Development with the Tools of Software Reuse
- Conclusion
- References
- Chapter 3: Context and Value of Biomedical and Health Informatics
- Definition and Context of Informatics
- The Sub-Disciplines of Informatics
- Related Terminology of Informatics
- The Value of Informatics
- Conclusions
- References
- Chapter 4: Governmental and Legislative Context of Informatics
- Overview
- Introduction
- Legal and Regulatory Framework for Public Health Informatics
- Fundamentals of the Policy Process in the United States
- Organization and Authority of the Legislative Branch
- Organization and Authority of the Executive Branch
- Private Sector Role in Policy Development and Implementation
- The Policy Environment for Public Health Informatics
- Health Insurance Portability and Accountability Act (HIPAA)
- National Electronic Disease Surveillance System (NEDSS) and the Health Alert Network (HAN)
- National Agenda for Public Health Informatics
- Office of the National Coordinator for Health Information Technology (ONC)
- Current Policy Context for Public Health Informatics
- HITECH: Infrastructure as a Down Payment on Healthcare Reform
- Meaningful Use
- President's Council of Advisors on Science and Technology (PCAST) Report
- Future Policy Challenges
- References
- Part II: The Science of Public Health Informatics
- Chapter 5: Public Health Informatics Infrastructure
- Overview
- Introduction
- A Technical Architecture for Public Health
- Immunization Records
- Electronic Laboratory Reporting
- Syndromic Surveillance
- Bidirectional Communication
- The Indiana Network for Patient Care: A Real-World Instantiation of a Robust Information Infrastructure Supporting Public Health Processes
- Managing the Public Health Infrastructure: The Role of Organizations
- Business Process Analysis and Redesign
- User-Centered Approach
- Managing the Public Health Infrastructure: The Public Health Workforce
- Public Health Informaticians
- Public Health End Users
- Conclusions
- References
- Chapter 6: Information Architecture
- Overview
- Background
- Interoperability and Information Architectures
- Interoperability and the Problem of Information Silos
- Assessment
- Policy Development
- Assurance
- Information Architecture Components
- Logical Data Model
- Identifiers
- Knowledge Representation
- Applying Information Architecture
- Public Health Reporting
- Leveraging National Platform Independent Models
- Strategies for Adopting a Shared Standards-Based Data and Modular Services Model
- References
- Chapter 7: Data Sources and Data Tools
- Introduction
- Definition of Data and Information
- Definition of an Information System
- Value of Data
- Timeliness
- Accuracy
- Sufficiency
- Relevance
- Cost-Effectiveness
- Data Sources
- Regulatory, Ethical, and Legal Responsibilities and Authority
- Finding Data
- Open Data Movement
- Federal Data Sources
- International Data Sources
- State Data Sources
- Local Data Sources
- Health Information Exchanges
- Data Tools
- Introduction
- Public Health Informatics Competencies
- Cost-Effective "ad hoc" Analyses
- Commonly Used Software Tools
- References
- Chapter 8: Public Health Information Standards
- Overview
- Introduction
- The Value of Standards
- Obstacles to Adoption
- Standards Categories
- Process Standards
- Security Policies
- Data Use Agreements (DUA)
- Metadata
- Data or Content Standards
- Data Format Standards
- Vocabulary Standards
- Laboratory Test and Result Code Standards
- Logical Observation Identifiers Names and Codes (LOINC®)
- Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT®)
- Other Data Content Coding Standards
- Format Standards Paradigm - HL7®
- HL7® Version 2.x Artifacts
- Reporting Observations (ORU)
- HL7® Version 3 Artifacts
- Clinical Document Architecture (CDA)
- Vocabulary Standards - SNOMED CT®
- Concepts
- Concept Identifiers
- SNOMED CT® Descriptions
- SNOMED CT® Relationships
- SNOMED CT® Browsers
- Summary
- References
- Chapter 9: Privacy, Confidentiality, and Security of Public Health Information
- Introduction
- Definitions
- Fair Information Practices
- Relevance
- Integrity
- Written Purpose
- "Need-to-Know" Access
- Opportunity to Correct Errors
- Consent
- Legal Requirements for Privacy and Confidentiality
- HIPAA
- HITECH
- Privacy Policy and Public Health
- Organizational Policies and Procedures to Ensure Confidentiality of Information
- Security
- Passwords
- Smart Cards
- Biometrics
- Cryptography
- Systems Availability and Computer Security
- Web Site Security
- Internet User Security
- Intrusion Detection
- Conclusion
- References
- Chapter 10: Electronic Health Records
- Overview
- The Goals of an Electronic Health Record
- Continuity of Care
- Access and Security
- Reduction of Medical Errors
- Increased Patient Access and Awareness
- Evidence-Based Medicine
- Public Health Reporting
- Achieving Portability
- The Ideal Scenario
- Barriers to Success
- Integration, the evolution of the EHR
- Origins of the EHR
- Interoperability
- Privacy and Security
- Legislation, Regulation, & the Importance of Standards
- Standardization
- Provider Access & Identification
- Executive Order
- Office of the National Health Information Technology Coordinator (ONC)
- Health Information Technology for Economic and Clinical Health (HITECH)
- Meaningful Use (MU)
- Incentives for Adoption of EHRs
- Maintenance
- Extensibility
- Security
- Public Health
- The Future
- Lessons Learned
- The Good News
- References
- Chapter 11: Ethics, Information Technology, and Public Health: Duties and Challenges in Computational Epidemiology
- Overview
- Introduction
- Toward an Electronic Standard of Care
- Appropriate Uses and Users of IT in Public Health
- "Progressive Caution"
- Privacy, Confidentiality and Security
- Information, Consent, and Stigma
- The Case of Bioinformatics
- Decision Support
- Interventions
- Data Synthesis and Computer-Based Research
- Conclusion
- References
- Chapter 12: Project Management and Public Health Informatics
- Overview
- The Importance of Project Management in Public Health Informatics
- Project Management Competencies in Public Health Informatics
- Project Management and the Prevention of Information Systems Project Failure
- Project Management Methodologies
- The Project Management Context: Definition of a Project
- Project Management vs. Operations Management
- The Project Management Knowledge Areas
- The PMI Project Management Process Groups
- Initiating the Public Health Informatics Project
- The Project Charter
- Planning the Public Health Informatics Project
- Developing the Project Schedule
- Factors in Scheduling the Public Health Informatics Project
- Executing the Public Health Informatics Project
- Human Resource Management and Informatics Project Execution
- Communication and Informatics Project Execution
- Monitoring and Controlling the Informatics Project
- Managing the Triple Constraint
- Closing the Informatics Project
- Summary and Conclusions
- Recommended Resources for the Study of Informatics Project Management
- References
- Chapter 13: Evaluation for Public Health Informatics
- Overview
- Introduction
- Evaluation in PHI - Why Evaluate?
- The Fundamental Theorem of Biomedical Informatics
- Why Embed Evaluation into PHI Projects
- Formative and Summative Evaluation
- Evaluation or Research?
- What to Evaluate? Using Mental Models to Guide Evaluation
- The Information Value Cycle
- Data-Information System-Context Rings
- Combining the DISC Rings and the IVC Steps to Support Evaluation Design
- How to Evaluate? - By Using Frameworks, Strategies, and Toolkits
- Conceptual Frameworks
- Evaluation Strategies
- Evaluation Toolkits and Methods
- Designing PHI Evaluations
- The Modified CDC Six-Step Evaluation Framework
- Challenges in Implementing PHI Evaluations
- Summary
- References
- Part III: Key Public Health Information Systems
- Chapter 14: Informatics in Disease Prevention and Epidemiology
- Overview
- The Main Components of a Disease Prevention Program
- Public Health Surveillance
- Disease Outbreaks and Clusters
- Laboratory Information
- Field Investigation Information Systems
- Interoperability and Integration in Disease Control Information Systems
- References
- Chapter 15: Informatics in Toxicology and Environmental Public Health
- Overview
- Introduction
- History
- Convergence of Movements with Distinct Origins
- Information to Support the Clinical Encounter
- Information to Support Environmental Public Health
- Underlying Needs
- Scope of Information Required
- Modeling in Toxicology and Environmental Public Health
- Acute Exposure Models
- Chronic Exposure Models
- Computational Toxicology Models
- Systems, Applications, and Databases of Special Interest
- HPAC-Hazard Prediction and Assessment Capability
- Authoritative Information on Individual Substances and Products
- ChemIDplus
- The Hazardous Substances Data Bank
- POISINDEX ®
- Toxics Release Inventory
- Bibliographic Databases
- Poisoning Case Management
- Surveillance
- The Future
- References
- Chapter 16: Public Health Laboratories
- Overview
- Functions of a Public Health Laboratory
- Levels of PHLs
- Differences Between PHLs and Clinical and Commercial Laboratories
- Informatics in the Public Health Lab
- Issues with Interoperability
- Public Health Laboratories' Influence on Informatics Standards
- References
- Chapter 17: The National Vital Statistics System
- Overview
- Introduction
- Milestones in National Vital Statistics [ 1 ]
- Operation of the National Vital Statistics System
- US Standard Certificates and Reports
- Model State Vital Statistics Act and Regulations
- The Vital Statistics Cooperative Program
- Federal Activities in Training State and Local Personnel
- The Interstate Record Exchange Program
- Vital Statistics Data Files
- International Classification of Diseases
- Challenges Confronting the Vital Statistics System at the beginning of the Twenty First Century
- Strategies Undertaken to Meet the Challenges of Timeliness, Quality and Security of the Vital Statistics System
- Achievements in Meeting Twenty First Century Challenges
- Electronic Death Registration Systems (EDRs)
- Electronic Birth Registration Systems (EBRs) and the 2003 Revision of the US Standard Birth Certificate
- Electronic Transfer and Access to Vital Statistics Data to Improve Timeliness and Security
- Re-Engineering Internal NCHS Vital Statistics Systems
- Secure Vital Registration Systems and Practices
- Electronic Health Records (EHR) and Vital Statistics
- Challenges Remain
- Vital Statistics and the Practice of Public Health
- References
- Chapter 18: Risk Factor Information Systems
- Overview
- Introduction
- Risk Transition in the Twentieth Century
- The Nature of Risk Factors and the Causal Chain
- National (United States) Risk Factor Systems
- The National Health Interview Survey (NHIS)
- The National Health and Nutrition Examination Survey (NHANES)
- The Behavioral Risk Factor Surveillance System (BRFSS)
- Comparing the Systems
- Risk Factors in Special Populations
- The Youth Risk Behavior Surveillance System (YRBSS)
- Pregnancy Risk Assessment Monitoring System (PRAMS)
- National HIV Behavioral Surveillance System (NHBS)
- International Systems
- Global Burden of Disease, Injuries, and Risk Factors Study
- STEPS
- MEASURE Demographic and Health Surveys (DHS)
- Opportunities in Information Technology
- Integrated Data Dissemination
- CDC WONDER
- CDC WISQARS
- Health Data Interactive
- Vital Stats
- NCHS Data Linkage Activities
- Health Indicators Warehouse
- Emerging Opportunities
- Web-Based Surveys
- Geographic Information Systems
- Electronic Health Records
- Conclusion
- References
- Chapter 19: Setting National Policies and Standards for Immunization Information Systems
- Overview
- Introduction to Immunization Information Systems (IIS)
- IIS and Electronic Health Records Meaningful Use Standards
- IIS Minimum Functional Standards
- IIS Should Support the Delivery of Clinical Immunization Services at the Point of Immunization Administration, Regardless of Setting [ 13 ]
- Vaccine Forecasting & Scheduling
- Reminder and Recall Systems
- IIS Should Support the Activities and Requirements for Publicly-purchased Vaccine, Including the Vaccines for Children (VFC) and State Purchase Programs [ 15 ]
- Vaccine Tracking System
- IIS Should Maintain Data Quality (Accurate, Complete, Timely Data) on all Immunization and Demographic Information in the IIS [ 15 ]
- IIS Should Preserve the Integrity, Security, Availability and Privacy of all Personally- identifiable Health and Demographic Data in the IIS
- Provide Immunization Information to all Authorized Stakeholders [ 15 ]
- Conclusion
- References
- PArt IV: New Challenges and Emerging Solutions
- Chapter 20: New Means of Data Collection and Accessibility
- Overview
- Introduction
- What Is Public Health Data?
- Types of Public Health Data
- The Need to Collect and Access Data Is Built-In to the Ten Essential Services of Public Health
- Categories of Data Elements Mandated for Collection
- Data Elements and Surveillance Systems
- Data Systems
- New York Immunization Information System (NYIIS) Requirements
- Oregon Cancer Registry Requirements
- Florida Trauma Registry Requirements
- Summary of State Examples
- Technical Data Types
- Data Collection in Public Health
- Paper-Based Reporting
- Adaptations of Traditional Reporting: Fax Technology
- Adaptations of Traditional Reporting: OCR
- Electronic Information Exchange: "Fill-able" Electronic Forms
- New Means of Data Collection and Reporting: HL7® Messages
- Structure of an HL7® Message
- Electronic Data Collection and Reporting: Web-Based Interfaces
- New Means of Data Collection: Mobile Health (mHealth)
- Future Trends: EHRs and HIEs as Data Sources
- Challenges to the New Ways of Data Collection
- Public Health Resources and Readiness
- Challenges Associated with Messaging and Data Standards
- New Means of Data Accessibility
- Data Accessibility and Cloud Computing
- The Cloud Service Models
- Software as a Service (SaaS)
- Practical Use of Enabling Technologies for Public Health Data Accessibility
- Summary and Conclusions
- References
- Chapter 21: Geographic Information Systems
- Overview
- Introduction
- The Importance of GIS and Its Contribution to Public Health
- What Is GIS?
- Theoretical Foundations and the Development of GIS
- How Do Geographic Information Systems Work?
- Spatial and Attribute Data
- Map Projections and Coordinate Systems
- Scale
- Representations of Spatial Data
- Functionality: Mapping and Spatial Analysis for Health Applications
- Spatial Statistics
- Visual Display of Spatial Data
- Grouping Data into Classes for Mapping
- Appropriate Use of Symbols for Choropleth Mapping
- GIS Implementation: Software and Hardware
- Spatial Data Access and Development
- Web-Based GIS
- GIS Training
- Social and Institutional Issues
- Protected Health Information and HIPAA
- Security and Data Access
- Coordination with Other Agencies
- Organizational Politics
- GIS Limitations
- Accuracy and Completeness of Spatial Data
- Accuracy and Completeness of Attribute Data
- Currency and Time Period of Data Content
- Address Matching Issues
- Use of ZIP Codes
- Scale and Precision of Location
- Proximity vs. Exposure
- Summary
- References
- Chapter 22: Public Health Informatics and Health Information Exchange
- Introduction to Health Information Exchange in the Context of Public Health
- History of Health Information Exchange (HIE)
- Background to Public Health Information Exchange
- Early HIEs, CHINs, RHIOs
- Nationwide Health Information Network (NwHIN)
- Health Information Exchanges (HIEs)
- Public Health and Health Information Exchanges
- ARRA and HITECH Provide HIE Resources
- The Patient Protection and Affordable Care Act (PPACA)
- Accountable Care Organizations (ACOs)
- Meaningful Use Incentive Program
- Public Health Meaningful Use Objectives
- Immunization Information Systems (IIS)
- Electronic Laboratory Reporting (ELR)
- Syndromic Surveillance (SS)
- Reporting to a Cancer Registry
- Standards for Reporting to Public Health
- State HIE Cooperative Agreement Program
- Models for Building State HIE Infrastructure
- HIE Information Models
- Public Health Benefits
- Challenges
- Sustainability
- Future Collaborations between HIEs and Public Health
- Conclusion
- References
- Chapter 23: Decision Support and Expert Systems in Public Health
- Overview
- Introduction
- An Example of the Use of Decision Support Systems: Childhood Immunization Forecasting
- Sources of Complexity in the Immunization Domain
- Encoding IMM/Serve's Immunization Knowledge
- Tabular Knowledge
- Rule-Based Knowledge
- Procedural Knowledge
- The Development Process
- Testing
- Automated Tools for Knowledge Testing
- Testing with Hand-Crafted Sets of Test Cases
- Testing with Pilot Use
- Implementation
- Local Customization
- Maintenance
- Design Considerations
- Knowledge Representation
- Tables
- Rules
- Flowcharts
- Semantic Networks
- Model-Based Knowledge
- Procedural Knowledge
- Interface with Data Sources
- System Development Strategies
- Criteria for Determining the Desirability of Decision Support and Expert Systems
- Illustration of the Criteria
- References
- Chapter 24: Delivery of Preventive Medicine in Primary Care
- Overview
- Introduction
- Preventive Health Services
- Using Information Technology for Preventive Service Delivery
- The Electronic Health Record (EHR)
- Reminder Systems
- Using Information Technology for Preventive Care Measurement and Reporting
- Patient Registries
- Using Information Technology for Preventive Care Consumer Engagement
- Interactive Voice Response Systems
- mHealth
- Challenges
- The Future
- References
- Chapter 25: Case-Based Learning in Public Health Informatics
- Overview
- Background
- The Case for Case-based Learning (CBL) in PHI
- Key Concepts in Case-Based Learning (CBL)
- CBL in an Applied PHI Training Program
- Summary
- References
- Case Supplementary Reading
- Part V: Case Studies: Information Systems and the Strata of Public Health
- Chapter 26: Local and Regional Public Health Informatics
- Preface: The Local Public Health Informatician
- Overview
- Introduction: The Local Health Department
- Informatics Needs
- Technological Capacity
- Knowledge, Vision, and Priorities
- Funding
- Alignment of Informatics to Programmatic Activities
- Architecture
- Information Technology and Informatics
- Leveraging the Community
- Case Study: Southern Nevada Health District (SNHD)
- Executive Planning
- Identifying the Business Need
- Gathering Requirements
- Defining the System
- Implementation
- Conclusion
- References
- Chapter 27: Public Health Informatics in High Population States: New York and Ohio
- Overview
- New York State Public Health Informatics
- State Perspective on Public Health Informatics
- Statewide Health Information Network of New York (SHIN-NY)
- Electronic Clinical Laboratory Reporting System (ECLRS)
- Child Health Information Integration (CHI 2)
- Public Health Informatics Challenges, Strategies, Solutions
- Going from As-Is to Desired State
- Establish Effective Governance
- Technology and Data Barriers to Data Integration and Information Sharing
- Financial Barriers
- Informatics Capacity Building
- State Experience: Biggest Triumphs and Ongoing Challenges
- Ohio Public Health Informatics
- Introduction to the Ohio Department of Health
- State Perspective on Public Health Informatics
- The Ohio Public Health Informatics Committee (TOPHIC)
- Ohio Public Health Information Gateway (OPHIG)
- Public Health Informatics Challenges, Strategies, Solutions
- Financial Barriers
- Establish Effective Governance
- Informatics Capacity Building
- State Experience: Biggest Triumphs and Ongoing Challenges
- References
- Chapter 28: State Public Health Informatics: Perspective from a Low Population State
- Overview
- Introduction
- The Low Population Public Health Context: What is "Rural"?
- Definitions of the Term "Rural"
- Comparing Urban and Rural Capacity
- Rural-Urban Commuting Area (RUCA): An Alternative Taxonomy
- Rural Versus Low Population
- The Information Systems Context for Rural Public Health Informatics
- Rural Public Health and the Hardware Component
- Rural Public Health and the Software Component
- Challenges Associated with Application Complexity and Usability
- Requirement to Master Multiple Applications
- Rural Public Health and the Data Component
- Rural Public Health and the Procedures Component
- Technical Support and Informatics: The People Component
- The People Component and Support for Analytics
- Summary and Recommendations
- References
- Chapter 29: National Public Health Informatics, United States
- Overview
- Historical Framework
- Variability of Health Departments and Public Health Work
- The Information Supply Chain
- Federal Role in Information Management and Standardization
- Federal Agencies with Important Informatics Roles
- Cross-Agency Coordination
- The Department of Health and Human Services
- Other Organizations of Note
- Conclusion
- References
- Chapter 30: Public Health Informatics in Canada
- Introduction: What Makes Canada Unique
- Factors Affecting Public Health and Public Health Informatics in Canada
- The Canadian Institute for Health Information
- The Global Public Health Intelligence Network (GPHIN)
- GPHIN Architecture
- GPHIN: Management of Information
- GPHIN Value
- GPHIN Challenges
- GPHIN Summary
- Leveraging Electronic Health Records for Public Health
- HealthLink BC
- Telehealth for Public Health Surveillance and Response
- Summary
- References
- Chapter 31: Perspectives on Global Public Health Informatics
- Overview
- Introduction
- Global Health
- Global Health Informatics
- The Influence of Global Health Policy
- Health Information Systems in PEPFAR
- Case Studies of Health Information System Implementation
- A Decade of Public Health Informatics in Malawi
- Background
- Issues and Solutions
- System Description
- Supporting HIV Care and Treatment
- Beyond HIV
- A Model for Sustainability
- Lessons Learned
- False Starts and Experience Gained
- Exemplars for Sustainability
- Keys to Success
- The Past is Prologue
- Public Health Informatics in Rwanda: The OpenMRS EMR Project
- Background
- History of Partners in Health Informatics Projects in Rwanda, 2005 Onward
- Technical, Organizational and Functional Description of the OpenMRS
- Current Status and Uses of OpenMRS at IMB
- Current Status and Uses of the System at MOH
- Informatics-Related Issues Faced and Challenges Overcome During the Implementation
- Improving Reporting Tools
- Clinical Evaluation
- Capacity Building and the EHSDI Training Program
- Vocabulary Management
- The Future for the System
- Supporting a Broader Range of Diseases
- Rwanda eHealth Enterprise Architecture
- Hospital Information Systems Based on OpenMRS
- Broader International Rollouts Based on Rwanda Experience
- The Way Forward
- References
- Part VI: Epilogue
- Chapter 32: Public Health Informatics: The Path Forward
- Overview
- Perspectives
- Domains and Competencies
- Core Competencies
- Education and Training
- Conclusion
- References
- Index
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