Chapter 19: Public Health Informatics

Sentinel Surveillance Systems Part 1

Collect and analyze data from designated agencies selected for their geographic location, medical specialty, and ability to accurately diagnose and report high quality data. They include health facilities or laboratories in selected locations that report all cases of a certain health event or disease to analyze trends in the entire population

Syndromic Surveillance system Part 1

Collect data on clusters of symptoms and clinical features of an undiagnosed disease or health event in near real time allowing for early detection, rapid response mobilization and reduced morbidity and mortality Data can be obtained through specific surveillance systems as well as existing epidemiologic data such as insurance claims, school and work absenteeism reports, over the counter (OTC) medication sales, consumer driven health inquiries on the Internet, mortality reports and animal illnesses or deaths for syndromic surveillance

Behavioral Surveillance Systems

Collect data on health-risk behaviors, preventative health behaviors, and health care access in relation to chronic disease and injury Analyze the prevalence of behaviors as well as the trends in the prevalence of behaviors over time Information is most commonly collected by personal interview or examination Inferential and descriptive analysis methods such as age adjusted rates, linear regression, and weighted analyses are used Most acute when conducted regularly, every 3 to 5 years

Case Surveillance Systems

Collect data on individual cases of a health event or disease with previously determined case definitions in respect to criteria for person, time, place, clinical & laboratory diagnosis Analyze case counts and rates, trends over time and geographic clustering patterns Historically, case surveillance has been the focus of most public health surveillance

Laboratory Based Surveillance

Collects data from public health laboratories, which routinely conduct tests for viruses, bacteria, and other pathogens Used to detect and monitor infectious and food-borne diseases based on standard methods for identifying and reporting the genetic makeup of specific disease-causing agents Commonly used in case surveillance and sentinel surveillance

Public Health Informatics Workforce

A Public Health Informatician is "a public health professional who works in practice, research, or academia and whose primary work function is to use informatics to improve population health

Global Public Health Informatics

All of the goals of the US Public Health system also pertain to the international community The World Health Organization (WHO) represents world public health with the following goals: 1.Foster health security 2.Promote health development 3.Strengthen health systems

Geographic Information Systems (GIS)Part 1

Epidemiologists often characterize data by place, time and person Using GPS and mobile technology, field workers can enter epidemiologic data to populate a GIS

Public Health Surveillance Goals

Estimate significance of the problem Determine distribution of illness Outline natural history of a disease Detect epidemics Identify epidemiological and laboratory research needs Evaluate programs and control measures Detect changes in infectious diseases Monitor changes in health practices and behaviors Assess the quality and safety of health care, drugs, devices, diagnostics and procedures Support public health planning

Geographic Information Systems (GIS)Part 2

GIS is a: system of hardware, software and data used for the mapping and analysis of geographic data Modern GIS uses digitized maps from satellites or aerial photography provides access to large volumes of data; the ability to select, query, merge and spatially analyze data; and visually display data through maps Most bio-survelliance programs utilize GIS.

Syndromic Surveillance Systems Part 2

Geographic and temporal aberration and geographic clustering analyses are performed with real-time syndromic surveillance data Syndromic surveillance systems can also be used to track longitudinal data and monitor disease trends

WHO Programs

Global Alert and Response (GAR): the integrated infectious disease surveillance program within WHO International Health Regulations Early Warning Surveillance: surveillance mechanism to effectively identify disease outbreaks and other health issues immediately following acute emergencies Global Public Health Intelligence Network: to electronically monitor infectious disease outbreaks Global Outbreak Alert and Response Network: provide a rapid identification and response to outbreaks and alert the international community

Integrated Disease Surveillance and Response (IDSR)

Incorporates epidemiologic and laboratory data in systems designed to monitor communicable diseases at all levels of the public health jurisdiction, particularly in Africa Useful for: detecting, registering and confirming individual cases of disease; reporting, analysis, use, and feedback of data; and preparing for and responding to epidemics

Health Information Exchange and Public Health Use Cases

Mandated reporting of lab diagnosis physician-based diagnoses Non-mandated reporting of lab data Non-mandated reporting of clinical data: Public health investigation Clinical care in public health clinics Population-level quality monitoring Mass-casualty events Disaster medical response Public health alerting - patient level and population level

Clinical Outcomes Surveillance

Monitors clinical outcomes to study disease progression or regression in a population Analyzes the rates of and factors associated with clinical outcomes using descriptive and inferential methods such as incidence rates from probability samples

Sentinel Surveillance Systems Part 2

Pros: Useful to monitor and identify suspected health events or diseases Cons: Less reliable in assessing the magnitude of health events on a national level as well as rare events since data collection is limited to specific geographic locations

Conclusions

Public Health Informatics is an important part of Health Informatics Public Health reporting is part of Meaningful Use Public Health surveillance is the backbone of public health to detect and track epidemics, natural disasters and bioterrorism Geographical Information Systems can provide maps with important health data overlays New public health programs will continue to evolve that will require informaticists to analyze, disseminate and store data

Syndromic Surveillance

Syndromic data is based on symptoms and not hard evidence such as cultures. Experts try to predict epidemics and bioterrorism based on this early data Syndromic surveillance is part of Meaningful Use with the goal of submitting reports to public health ESSENCE is a syndromic surveillance system that is not real time RODS is similar and being used by a limited number of hospital systems and approaches real time reporting.

Meaningful Use and Public Health

The capability to electronically transmit immunization data to immunization registries or immunization information systems The capability to electronically transmit reportable lab results The capability to electronically transmit syndromic surveillance data from an EHR The capability to report cancer cases to a state registry from a certified EHR The capability to report specific cases to a non-cancer state registry from a certified EHR

Public Health Informatics

The overarching goal of public health has been to monitor a variety of medical diseases and conditions rapidly and accurately so as to intervene as early as possible to detect, prevent, and mitigate the spread of epidemics, the effects of natural disasters, and bioterrorism Traditionally, public health reporting and surveillance consisted of physicians, hospitals and clinics sending paper reports to local health departments, who forwarded information to state health departments who sent the final data to the Centers for Disease Control and Prevention (CDC) via mail or fax and finally to the World Health Organization (WHO) for certain diseases

Public Health Reporting

With the advent of the Internet and various other technologies, the goal is to report changes in public health as close to "real time" as possible. Bioterrorism, epidemics and natural disasters have intensified the need for fast reporting at all levels Meaningful use fully supports public health surveillance and reporting EHRs are necessary to make the process possible; paper reporting is inadequate

Public health surveillance

ongoing systematic collection, analysis, and interpretation of health-related data essential to planning, implementation and evaluation of public health practice, closely integrated with the timely dissemination of these data for prevention and control

Syndromic surveillance

surveillance using health-related data that precede diagnosis and signal a sufficient probability of a case or an outbreak to warrant further public health response

Public health informatics

systematic application of information and computer science and technology to public health practice, research and learning Definitions

Public health

the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals monitor a variety of medical diseases and conditions rapidly and accurately so as to intervene as early as possible to detect, prevent, and mitigate the spread of epidemics, the effects of natural disasters, and bioterrorism