Category Archives: Public Health Informatics
A 2012 report from the Robert Wood Johnson Foundation (RWJF) and Trust for America’s Health concluded that if the adult and childhood obesity rates in 2011 continued to increase at their steady paces, then by 2030 nearly two-thirds of U.S. adults would be obese and every single state would have obesity rates above 44 percent.
Data now show that childhood obesity rates have stabilized. In fact, for the first time in a decade the obesity rates among young children from low-income families in many states is trending down.
Helping lead the way in this important public health issue has been the city of Philadelphia, Penn., which has worked to improve access to healthy foods and opportunities for physical activity.
“We were very fortunate in Philadelphia to have colleagues...who have developed a better understanding of childhood obesity,” said Don Schwarz, former Health Commissioner and Deputy Mayor for Health and Opportunity, City of Philadelphia, and will also soon take on the role of director for RWJF’s Demand Team. “What that has meant is that Philadelphia was able to take a body of knowledge and bring it to scale. The partnership in Philadelphia that has allowed that to happen goes across government and between government and the private sector and community organizations—just everyday Philadelphians. So that kind of partnership, that wonderful knowledge base, has I believed turned the corner on childhood obesity, particularly for children who are of disadvantaged communities.”
Schwarz’s comments came during the Tuesday, July 22 Google Hangout TEDMED Great Challenges: A Candid Conversation About Childhood Obesity. The panel was moderated by Richard Besser, Chief Health and Medical Editor for ABC News.
Every member of the panel echoed the importance of partnerships, and Besser succinctly explained their critical role in not just obesity prevention but all public health efforts.
“The more creatively you can think and the wider variety of partners you can pull in, the more likely you are to be successful,” he said.
At the heart of Philadelphia’s success has been the important role that schools play in that community partnership. According to Schwarz, for the past decade the city’s schools have worked to reshape how they approach children’s health and wellbeing, including comprehensive nutrition policies, a new food environment that emphasizes healthy choices and more opportunities for kids to be physically active. One can’t be successful without the other.
As part of an effort to help make sure their residents’ health information is available after a hurricane or other wide-spread disaster, four Gulf states have partnered with six states in the East and Midwest to help relocated patients and their temporary health care providers access critical health information.
State health information exchange (HIE) programs in Alabama, Georgia, Louisiana, Florida, South Carolina, North Carolina, Virginia, Michigan, Wisconsin, and West Virginia worked with the Department of Health and Human Services Office of the National Coordinator for Health IT to create the new system. All of the state HIE programs participating in the initiative have established at least one operational interstate connection and are working with other states including Arkansas and Mississippi. The initiative uses a tool called Direct, created through a collaboration that allows for the secure exchange of health information over the Internet.
The Agency for Healthcare Research and Quality recently published a guide to help primary care clinicians connect their patients’ electronic health records to a local HIE hub and regional health information organizations.
Syndromic surveillance systems are being developed locally, regionally and nationally to aid in tracking disease outbreak, childhood immunizations, or illness during natural disasters throughout communities. The systems are cost-effective ways for healthcare professionals to gather information and confirm diseases before laboratory verification.
The Boston Public Health Commission (BPHC) has spearheaded the expansion of the use of syndromic surveillance, making it an integral part to aid in the sharing of public health concerns in the city of Boston. Julia Gunn, Director of Communicable Disease Control Division at BPHC, believes that “Engaging with communities, schools, daycares, community based organizations, and churches results in a healthier community because primary communication doesn’t occur in the healthcare sector, it occurs in the community.”
Syndromic surveillance assists in this communication across all sectors by detecting the affected areas, informing the public and targeting resources to them.
Read all about BPHC’s efforts on the ePublic Health Blog, NACCHO's new blog to facilitate dialogue among local health department professionals interested in the public health informatics community, while providing an informal venue for regular communications on the latest public health informatics news, resources and promotions.
Recommended reading >> ePublic Health Blog on Syndromic Surveillance
David L. Lakey, MD, Commissioner of the Texas Department of State Health Services, ends his term as president of the Association of State and Territorial Health Officers, (ASTHO)at the group’s annual meeting in Austin this week. NewPublicHealth spoke with Dr. Lakey about his tenure and about his Presidential Challenge to reduce the number of preterm births.
NewPublicHealth: Did anything surprise you during your tenure as ASTHO president?
Dr. Lakey: I don’t think there was a specific surprise. It’s been a very busy year. Perhaps the one surprise might be that four years ago ASTHO started the Presidential Challenge under Judy Monroe, MD (then state health commissioner of Indiana, and now the head of the Office for State, Tribal, Local and Territorial Support at the Centers for Disease Control and Prevention) started this thing called the Presidential Challenge. Dr. Monroe started it as a charge to the state health officers to kind of walk the talk related to physical activity. And now, four years later, the Presidential Challenge really had its own legs and with a lot of support. This year’s challenge—reducing preterm births–became a pretty big initiative. We now have 49 states that have signed on to that initiative.
NPH: What specific actions do you think have helped the decline of preterm births?
Hundreds of people in Louisville, Ky., who regularly use an asthma inhaler will soon be doing much more than just helping themselves whenever they take a puff. Through a demonstration project created by Asthmapolis, an innovative technology firm based in Madison, Wisc., data collected by a sensor in the inhalers of the project participants will help Asthmapolis and city leaders in Louisville better understand when and where people with asthma develop symptoms. The goals of the project are to help identify patients who need more help controlling the disease, and to help identify community-wide asthma triggers that can be improved or eliminated. Enrollment in the project began last month and will last for twelve months for each participant.
Asthmapolis was co-founded two years ago by David Van Sickle, a former Epidemic Intelligence Service Officer with the Centers for Disease Control and Prevention, and a Robert Wood Johnson Foundation (RWJF) Health and Society Scholar at the University of Wisconsin School of Medicine and Public Health. Van Sickle did one of the pilot studies of an earlier version of the technology now in use in Louisville during his years as an RWJF scholar and credits the program with the opportunity to do cross-disciplinary work in order to explore the feasibility of the project and collect the initial data. “I also had access to mentors, such as John Mullahy, Stephanie Robert, and David Kindig, at the School of Medicine and Public Health, to get 360 degree feedback on what I was up to,” says Van Sickle.
In addition to a number of academic trials, Asthamopolis has two key projects underway – the one in Louisville and a similar scale-up in Sacramento where the firm has partnered with Dignity Health and the California Health Care Foundation to see how the technology can specifically benefit the needs of the under-served. Interim results could be available in nine months and published results as soon as next summer.
Van Sickle calls the data being collected in the sensors “a vital sign for asthma,” which is critical he says because we need accurate and reliable information, rather than what doctors and communities must typically rely on, which is self-reported information that Van Sickle says is known to be unreliable. “We want to use technology as a fulcrum to make self-management and monitoring more effective, using a bottom up approach” says Van Sickle.
Significant signals the firm will be looking for include inhaler use at night, an indication of more serious asthma, and symptoms both at home and at work and at all times of day and night—signs of uncontrolled or worsening disease.
Why sensors? “Sensors make the absence of data meaningful, where before it was ambiguous,” said Van Sickle.
While the immediate benefit will be for the hundreds enrolled, the value to entire communities is also a key focus of the company, and of the demonstration project underway in Louisville. NewPublicHealth spoke with Ted Smith, the city’s director of innovation and economic development, who is the spearheading the Asthmapolis project.
It's been an exciting year for us at NewPublicHealth! We launched in March, and nine months, nine conferences and 568 posts later, we are ready to ring in the new year.
Here's a glimpse into the inaugural year of NewPublicHealth, and the top posts by popularity.
- Power of Health IT for Public Health: A NewPublicHealth Q&A With Farzad Mostashari. This piece was a conversation with the National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services (HHS), about the evolving public health informatics field.
- Dr. Douglas Jutte: My Patient's Most Pressing Health Concern Was a Broken Carburetor. Dr. Jutte provided a personal commentary on how unmet social needs—like access to nutritious food, transportation assistance and housing assistance—were sometimes the most critical in treating his patients. (Also check out a round-up of reader responses to this post.)
- Public Health and the Community Benefit: A NewPublicHealth Q&A With Abbey Cofsky. The Patient Protection and Affordable Care Act requires that non-profit hospitals, starting in 2012, perform a community health needs assessment, and that the assessment serve as the foundation of an implementation plan to address identified needs. NewPublicHealth spoke with Abbey Cofsky, program officer at the Robert Wood Johnson Foundation, about the public health opportunities this provision offers.
- The National Prevention Strategy: A NewPublicHealth Q&A With Surgeon General Regina Benjamin. Upon its launch, we spoke with the Surgeon General about the nation's plan for increasing the number of Americans who are healthy at every stage of life.
- Teen Birthrates Down in U.S. But Still Lag Behind Other Developed Nations. This article looked at the April Vital Signs report from the Centers for Disease Control and Prevention on the latest stats on teen childbirth, such as, "Girls born to teen mothers are about 30% more likely to become teen mothers themselves."
- Health Literacy: Reducing the Burden of a Complex Healthcare System. During Health Literacy Month, NewPublicHealth caught up with Linda Harris of the HHS Office of Disease Prevention and Health Promotion and Cindy Brach of the Agency for Healthcare Research and Quality about federal efforts to improve health literacy and to reduce the burden of a complex healthcare system.
- The County Health Rankings 2011: Mobilizing Action to Improve Health. NewPublicHealth's very first post announced the second annual County Health Rankings, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute that provides a standard way for counties to see where they are doing well and where they are not so they can make changes to improve health.
- What to Expect at the Health Data Initiative Forum: A Q&A With Todd Park. The Forum, presented by HHS and the Institute of Medicine, convened more than 500 people to showcase how health data can provide a rich seeding ground for new tools to support more informed decision-making by consumers, healthcare systems and community officials. NewPublicHealth spoke with Todd Park, Chief Technology Officer at HHS, to get his take on health innovation.
- HHS Leading Health Indicators: Health By Some New Numbers. NewPublicHealth was on the ground at the APHA Annual Meeting covering top news, including the announcement of the latest Leading Health Indicators from HHS, a set of the top national high-priority health issues and actions that can be taken to address them.
- Housing Policy is Health Policy: A NewPublicHealth Q&A With HUD's Raphael Bostic. Raphael Bostic of the U.S. Department of Housing and Urban Development (HUD) spoke with NewPublicHealth about the role of housing in health, and new collaborations across sectors that recognize that providing healthier, more affordable housing can lead to significant health outcomes.
Runners up included Q&As with CDC Director Thomas Frieden and Virginia Comonwealth University researcher Steven Woolf; a post on public health mobile phone apps and a commentary on the popular movie Contagion.
These were just a handful of the conversations that captured our readers' interests this year. Keep reading in 2012 for the latest in public health and new ways to prevent disease and health crises where they begin—in our communities.
Thanks for reading and for your always insightful comments. Have a happy, healthy New Year and we'll see you in 2012!
The birth rate for U.S. teens age 15 to 19 years hit a record low in 2010, according to a report from the Centers for Disease Control and Prevention (CDC). According to the CDC, the birth rate for teenagers in this age group has declined for the last three years and 17 out of the past 19 years, falling to 34.3 births per 1,000 teenagers in 2010. That’s a 9 percent decline from 2009 and the lowest rate ever recorded in nearly seven decades of collecting data. And birth rates for younger and older teenagers and for all race/ethnic groups reached historic lows in 2010, according to the report. Read more on teen pregnancy.
By 2050, the number of people 90 and older may reach 9 million, according to a report from the U.S. Census Bureau, commissioned by the National Institute on Aging. In 1980, there were 720,000 people aged 90 and older in the United States. By 2010, there were 1.9 million people aged 90 and older. Read more on the health of older adults.
More than 100,000 primary care providers have signed up to adopt certified electronic health records with help from Regional Extension Centers, according to a release from the U.S. Department of Health and Human Services' Office for the National Coordinator for Health Information Technology (ONC). ONC is supporting investment in electronic health record in hopes they will help improve quality of care and ultimately lower health care costs. Read more on health technology and public health informatics.
The National Association of County and City Health Officials (NACCHO), with support from the Centers for Disease Control and Prevention, conducted needs assessments to find out how informatics has fared at the local level, and to identify any needs and gaps in current informatics capacity at local health departments.
Gulzar H. Shah, Ph.D., M.Stat, M.S.S., Lead Research Scientist at NACCHO, presented the results of two needs assessment surveys and accompanying focus groups from the last two years at this week's Public Health Informatics Conference. The 2010 survey looked at overall informatics capacity, while the 2011 survey honed in on use of meaningful use-certified electronic health record (EHR) systems. Shah noted that the response rate was down in 2011, likely due to budget cuts and staff resources, however preliminary results were promising.
Among the 134 local health departments that responded, 62% were able or planning to receive data from meaningful use-certified EHR systems, with more large health departments responding positively (89%) than small ones (45%). Fewer than half of respondents were already receiving and processing data for immunization registries, electronic lab reporting and syndromic surveillance – the three public health requirements under meaningful use of EHRs.
Not surprisingly, among those not yet receiving meaningful use data from EHRs, top reasons included a lack of funding and not having an EHR system in place locally from which to receive data. However, a significant number also said they needed more technical assistance to be able to receive the data. More than three-quarters of these respondents were not aware that they could be receiving technical assistance from the state level.
When it came to general informatics, in focus groups some discussed the merits of the terminology used by the field. "Colleagues think it's just a nonsensical buzz word," said one participant. Some even suggested changing the term "public health informatics" to something simpler, like "e-public health" (though one session attendee noted that public health informatics is an ingrained term, and is really just one slice of the broader topic of e-public health).
Whatever we call it, most of the 309 survey respondents said that their staff have an adequate level of physical infrastructure needed to do their jobs. That said, very basic barriers emerged in informatics capabilities, with budget and staff time and training again topping the list. One of the biggest challenges is that in order to work on public health informatics efforts, resources would have to be diverted from on-the-ground programs.
“It was a choice: use the people to give vaccines, or use the people to put the information in computers,” said one focus group attendee.
The Public Health Informatics 2011 Conference has come to a close in Atlanta, where over 1,000 people attended in person, and 1,600 more joined the conversation online through the Virtual Conference. One theme throughout the conference was making new connections – connections from EHRs to public health surveillance systems, from public health departments to health care and social services, and more. Different technical systems need to be able to work together, which requires standards and ways to bridge different terminologies.
That goes for making IT systems interoperable, but the same is also true for making connections between different fields, which often seem to speak a different language. Coming together at a conference like Public Health Informatics is certainly a step in the right direction.
Here are some highlights from NewPublicHealth coverage of the conference this week:
- Dr. Farzad Mostashari, Director of the National Coordinator of Health Information Technology in the U.S. Department of Health and Human Services comments on the enormous potential for meaningful use to impact public health.
- Local health departments share how they put the “public” back in public health by collaborating directly with folks from their communities to plan for emergencies and tell public health stories through social media.
- Health departments find ways to integrate health and social services on very little budget, so there can be “no wrong door” to access a multitude of services, from food stamps to flu shots.
- Conference attendees tell their stories on using technology to support public health – from monitoring pregnancy risks across the country to bringing disease surveillance systems to former Soviet countries
All of the content captured during the live event that was not made available during the conference will be be re-released September 7, 2011 at the Virtual Conference site, thanks to conference co-sponsors the Centers for Disease Control and Prevention and the National Association of County and City Health Officials. When posted, many of the sessions will then feature a live chat with the speakers. All of the plenaries, sessions, videos, downloads and other materials will be available on this site for 3 months.
Catch up on the rest of the NewPublicHealth coverage of the Public Health Informatics Conference here.
More than 800 health department employees, public health officials and informatics professionals gathered in Atlanta, GA this week for the Public Health Informatics 2011 conference. NewPublicHealth stopped just a few to ask them their thoughts on informatics, how health information technology can support public health, and more.
Aspy J. Taraporewalla, M.S., IT Project Manager
Pregnancy Risk Assessment Monitoring System (PRAMS), Centers for Disease Control and Prevention
What brings you to the Public Health Informatics Conference?
For me, mainly it’s about networking and to gain some insights for the project I'm working on.
What is the project you're working on?
I’m an IT project manager revamping the software systems for PRAMS [CDC's Pregnancy Risk Assessment Monitoring System]. We have 38 states participating in the program, and we survey moms pre-partum and post-partum. Data collection is done by the states, and then comes to CDC for analysis and weighting of data. States use the data to discover what the problems are in the community, and to find out solutions.
What was your favorite session at the conference so far?
The opening session with Todd Park. I enjoyed that, mainly about how to accelerate our work. I started participating in this conference back in 2005. I feel like we have stepped a couple of years back now because technology has moved so far ahead and public health hasn't caught up to it yet. It’s a slow process. We were talking about EHRs way back then. What I liked about his talk is the reminder that you need to be careful in thinking about how you can scope out technology for public health projects. I can’t get state of the art software because I need to make sure everybody I work with can use it.
What do you think is the greatest opportunity for health information technology to support public health prevention?
Merging the two [technology and public health] and providing a common platform to do that. And then making sure you’ve captured all the requirements in an accurate and complete way. Many times you jump into the software without capturing the requirements first. What I’ve done with my program is to start by asking what the states what they need rather than what is the technology to accomplish that. Whatever you need, there are tools that can do it.
Montra May, B.S., M.B.A., P.M.P., Director
What brings you to the Public Health Informatics Conference?
Health informatics, and to learn more about it as it relates to health information exchange.
What was your favorite session so far?
All of them have been good. My favorite was the very last one I attended where ONC [U.S. Department of Health and Human Services Office of the National Coordinator of Health Information Technology] was talking about harmonization and standards across the board for public health reporting, and that conversation has a lot of merits. They’re asking us for input for all of the standards, to look at from the international and national levels. There’s a lot of opportunity there.
What do you think is the greatest opportunity for health information technology to support public health prevention?
I think the greatest opportunity is to find standard ways to provide interoperability between all systems that work together need to communicate. In a real way I think that’s a great opportunity and as we work together we will realize that.
What is your organization doing with health information technology?
I have an enterprise technology background and for the last several years I’ve been focusing on health IT research at the Ph.D. level on adoption of EHRs, meaningful use, and cloud technology. My professional background is in supporting health information exchange.