Public Health Informatics

Electronic Health Records (EHR)

An electronic record of health-related information on an individual that conforms to nationally interoperability standards & that can be created, managed, & consulted by authorized clinicians & staff across MORE THAN ONE healthcare organization

How does the HITECH Act incentivize adoption of EHR?

Offers Medicare and Medicaid payment to healthcare providers and hospitals that use EHR systems to achieve "meaningful use"--a set of standards specified by the Centers for Medicare & Medicaid Services (CMS)

Maine's HealthInfoNet.com

One of the first statewide HIE's at its inception and it will be connected to public health systems

Availability

Preventing interference with system access by authorized users

PHI

Protected Health Information

Data Integrity

Protecting information from unauthorized alteration

Open Access (OA)

Publishing that offers the potential to enable greater access to research articles, for private and public health researchers

Confidential, identifying information collected by a public health organization should possess these qualities--

Relevance, integrity, written purpose, need-to-know access, capacity for correction, and consent of the individual or community from which the information was obtained

Gene Patenting

Repercussions and legal issues are guaranteed to affect medical research and testing

Privacy Act of 1974

Requires federal government agencies to make information in an individual's personnel file available to him or her

HIPPA Privacy Rule

Requires patient consent for disclosure of identifiable records of medical care ("protected health information" or PHI) with exceptions

Biometrics

Retinal scanning, fingerprint scanning, voice identification, hand geometry

"Meaningful Use"

Set of standards specified by the Centers for Medicare & Medicaid Services (CMS)-- for Electronic Health Records

The Patient Protection and Affordable Care Act (PPACA or commonly known as ACA)

Signed in 2010- seeks to change the very natural of clinical practice by changing financial incentives that promote health and wellness versus pay-for-procedure reimbursement

Software as a Service (SaaS)

Software delivery over a network rather than through individually purchased installations-- could greatly reduce IT support costs

Internet Safety

Strong passwords, intrusion detection, proxy servers, firewall, etc.

National Electronic Disease Surveillance System (NEDSS)- 1990s

System that allows integration of public health, laboratory, and clinical data at federal, state, and local levels

Public Health Informatics=

Systematic application of informational and computer science and technology to public health practice, research, and learning

Health Information System

Systems designed for the business of managing and improving the health of individuals and populations

Knowledge

The application of information by the use of rules

Confidentiality

The assurance that information about identifiable persons will not be disclosed without consent (except allowed by law)

Rule of thumb for not disclosing information about a certain individual in a population

The denominator must be greater than 50 in a population, or greater than 10 in a cohort

Health Informatics is built on...

The foundation of data warehousing principals (how you analyze it, etc.)

Security

The mechanisms by which confidentiality policies are implemented in computer systems-- includes provisions for access control, integrity of data, and availability of systems

Health Information Exchanges (HIE)

The mobilization of healthcare information electronically across organizations within a region, community or hospital system.

Health Insurance Portability and Accountability Act (HIPPA) of 1996

The primary goal of the law is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs

Office of the Secretary of Health and Human Services (created in 2004)

The principal federal entity charged with coordinating nationwide efforts to implement and use health information technology and the electronic exchange of health information to improve quality of health care delivery and the patient experience

Example of Knowledge

The public health assessor consults the action levels for thallium as published by the CDC & determines the appropriate remedial actions to be taken at site

Privacy

The right of individuals to hold information about themselves in secret, free from knowledge of others

How do health researchers rely on health informatics?

Those responsible or finding information, info, costs, questions, trends, and for those making critical decisions

National Center for Health Statistics (NCHS)

Through this vital statistics were assured that data was comparable from one state to another

Personlized Medicine

Treatment that is customized or tailored to an individual being based on detailed knowledged gained from specialized testing such as genetic screening

HIPPA Privacy Rule exceptions

Treatment, payment, healthcare operations "TPO"

3 Core functions of public health=

assessment, policy development, assurance

The HITECH Act provided states with..

Funds for the development of health information exchanges (HIEs) to distribute information into comprehensive records

Mobile Technology

Increasingly utilized by private health clinicians for data access and entry during hospital rounds, surveillance, tracking purposes, mapping, disease outbreaks (GPS)

Health Alert Network (late 1990s)

A communication, information, and training system that would support an early warning and response network against bioterrorism and other public health threats

Example of Information

A public health assessor creates a table showing the proportion of the locations exceeding the appropriate max contaminant level for thallium at the site

Example of data

A public health assessor records the levels of thallium at various locations at a toxic waste site

Regional Extension Centers (RECs)

Across the country which help to support local clinical practitioners in using EHRs

Stage 2 of "Meaningful Use"

Advance clinical processes- increased health information exchange (HIE), e-prescribing, and incorporation of laboratory results

Telehealth

Both public and private health consultation and diagnostic services can be provided to remote districts using telecommunication technologies such as this

Stage 1 of "Meaningful Use"

Data capture and sharing-- getting data electronically and in a standardized format and reporting clinical quality measures and public health information

Information

Data placed in context with analysis

Common challenges with health information systems and informatics=

Decisions to build or buy solutions, project management, managing relationships, business impact, ethical and legal issues, confidentiality, technical limitations (standards)

The Health Information Technology for Economics and Clinical Health Act of 2009 (HITECH)

Enacted to foster the adoption and meaningful use of health information technology

Cryptography

Encoding messages so that they are intelligible only to the proper recipient

Authentication

Ensuring that the identity of the user is confirmed

"Public Health Exception"

Exception to HIPPA which allows the release of protected health information (PHI) without consent to public health authorities for public health purposes including surveillance

Some sectors that rely on Health Information Systems=

Health care delivery, health insurance, disability and workers compensation insurance, pharmaceutical companies, etc.

How does the ACA provide incentives to healthcare entities?

Healthcare entities can potentially increase reimbursement by keeping their patients healthier (new focus on prevention)

Health information systems primarily record

Immunizations, birth and death events, cases used for epidemiologic research, health records, payment, billing, etc.

Stage 3 of "Meaningful Use"

Improved outcomes- planned to lead to better outcomes through elevated quality, safety, and efficiency

Personal Health Record (PHR)

Maintained by patient (as opposed to electronic health record)

Data

Measurement or characteristic of the person or the thing that is the focus of an information system

Big Data

New term being brought into the health field-- encompasses 3 V's- volume, velocity, and variety (should also include value)