Category Archives: Data
Add flu surveillance to the list of casualties of the current government shutdown.
Every flu season, states collect data on flu cases — including case reports and viral specimens — and send those to the Centers for Disease Control and Prevention (CDC) in Atlanta for recording and tracking. That tracking is critical in order to:
- provide information on how well-matched the seasonal flu vaccine is to the flu viruses found in the community;
- identify severe outbreaks that require increased supplies of antiviral medicines for people who contract the flu; and
- identify emerging strains that might require a new vaccine to be developed this season, which is what happened several years ago when CDC identified the H1N1 influenza virus toward the end of the flu season, and quickly ramped up for a new vaccine.
Flu season generally runs October through April, with the peak from about January to March. If the shutdown continues then, “as the flu season goes on, our knowledge of what’s happening will be impaired,” says William Schaffner, MD, Professor of Preventive Medicine and Infectious Diseases, Vanderbilt University School of Medicine, and the immediate past president of the National Foundation for Infectious Diseases.
CDC director Thomas Frieden, MD, MPH, underscored his concern in a tweet on the first day of the government shutdown: “CDC had to furlough 8,754 people. They protected you yesterday, can't tomorrow. Microbes/other threats didn't shut down. We are less safe.”
New York City is currently developing a pilot public health program known as NYC Macroscope — the first domestic effort to aggregate electronic health record (EHR) data into a surveillance tool to inform public health decisions. The population health surveillance system will compile electronic health records from primary care practices to help city health officials monitor—and respond to—the real-time prevalence of conditions that impact public health. The project is the result of a partnership between the New York City Health Department and the CUNY School of Public Health, with support from the Robert Wood Johnson Foundation’s Pioneer Portfolio, and additional support from the de Beaumont Foundation, Robin Hood and the New York State Health Foundation.
NewPublicHealth spoke with Carolyn Greene, MD, Deputy Commissioner of the NYC Department of Health and Mental Hygiene’s Division of Epidemiology, about the plans and goals for the program.
NewPublicHealth: Tell us about NYC Macroscope and how it will work.
Carolyn Greene: NYC Macroscope is going to be New York City’s first electronic health record surveillance system. We have a program here at the health department called Primary Care Information Project (PCIP), and it’s one of the nation’s largest distributed electronic health record networks. PCIP began in 2005. It concentrated on primary care practices in high need areas where the Health Department really wanted to encourage providers to use electronic health records. The program has been extremely successful and they’ve completed many different activities to improve the quality of clinical care.
But in recent years, we’ve been asking the question: Can we use electronic health records for more than just patient care? Can we, in fact, use electronic health records to monitor the health of the population? Here at the Health Department, we have many different ways to conduct population health surveillance. We have surveys that we conduct by telephone, we have disease registries that we host, and we have our vital statistics registry on deaths and births. All these data are very important. But they are costly, resource-intensive and they often have a time lag from when the data are collected to when we can actually find the results from the data, so the advantages of an electronic health record surveillance system are many.
One advantage is that the architecture is already there. If you already have the electronic health records in place, you don’t have to find additional resources to collect the data because you’re already collecting the data through the EHR architecture. Other advantages are that potentially you can collect data in real time and potentially at low cost.
NPH: Do you see any potential disadvantages?
Greene: I think the first one is we always have to ask how representative the data will be in terms of representing the population as a whole. First of all, electronic health records only collect data on people who are in care and, because sicker patients go to the doctor more frequently, there’s a greater likelihood that we may be picking up more information on sicker patients. So we have questions about how representative are the data.
Public Health Law Research’s (PHLR) LawAtlas is a comprehensive content management tool that enables users to track and analyze key laws aimed at improving health and access to health care. From interactive law maps to policy surveillance reports to “reams” of digital data, it offers an expansive view of how health and the law are intersecting throughout the country. In fact, LawAtlas just today released two new data sets, one on Child Restraint Systems and one on Dental Hygienist Scope of Practice Laws.
NewPublicHealth spoke with Scott Burris, Director of PHLR’s National Program Office, and Damika Barr, Legal Analyst and LawAtlas Manager, about what LawAtlas means for the public health community—and their hopes for its future.
NewPublicHealth: What are you learning about the value of LawAtlas to the public health and law communities?
Scott Burris: I think there are two things that people really like about this. One is getting law as data. So, we take law and it’s a bunch of words that people in health often don’t want to cope with or don’t really appreciate. It’s not what they do. We turn it into data that they understand, that they can use, that fits right into their broader lifestyle, as it were. Meeting the needs of people doing epidemiology and science, that’s one part of it. The other part is just a great demand to see law laid out in this geographical way so that everyone can see what states have what laws and how any particular policy is progressing across the states.
Damika Barr: We’re finding that this is eye opening because you can finally see the dimensions of the law across jurisdictions over time with your own eyes, and it’s really easier for our researchers or the public health law communities and providers to see the dimensions as compared to looking at a long table with many columns. Researchers can start to ask more detailed questions or about more dimensions of the law than they would have if they were just limited to a table.
NPH: We’ve seen a couple of the ways that LawAtlas is being used already, including the study by Hosea Harvey that looked at youth sports concussion laws. What are some other innovative ways you’re seeing LawAtlas being used in research?
Burris: I think it’s not so much “innovative ways" as what important things can LawAtlas show us? LawAtlas in itself was an innovation in that it allows people to more efficiently code the characteristics of the law and more easily publicize it, but what we’ve learned in recent research is how you can answer important questions with it.
The National Institutes of Health’s Office of Emergency Care Research (OECR), established in 2012, will now be under the leadership of Jeremy Brown, MD. Brown was recently appointed as the first permanent director of OECR, which is housed in NIH’s National Institute of General Medical Sciences.
Before joining NIH, Brown was an associate professor of emergency medicine and chief of the clinical research section in the Department of Emergency Medicine at The George Washington University. Additionally, he served as an attending physician in the emergency department of the Washington, D.C., VA Medical Center. According to the acting director of the National Institute of General Medical Sciences, Judith H. Greenberg, PhD, “Brown brings an impressive mix of clinical expertise, research experience, management abilities and communication skills to this important new position.”
Part of Brown’s research includes how to introduce routine HIV screening—a public health intervention—in hospital emergency departments. Previous studies have found these screenings to be cost-effective and frequently welcomed by patients. This is just one of the many ways in which steps could be taken in the emergency room setting to help improve the data available to assist public health efforts across the country. By using emergency departments as sites for collecting data on the status of the public’s health, more targeted efforts for prevention can be implemented.
NewPublicHealth spoke with Dr. Brown on the evidence that shows support for the collaboration between emergency departments and efforts to improve public health, as well as his new role and what he sees for the future of emergency departments.
NewPublicHealth: How is the transition into this new position going so far and how are you pulling from previous experiences to help with new challenges in this position?
Jeremy Brown: This is the beginning of my fourth week here; it is a new program and a new project really for both me as its first permanent director and for the NIH as well. They’ve never had an office that has addressed this particular part of our nation’s health and I think it’s going to be a learning experience on both sides.
So far, I’ve been really struck by the extremely warm reception that I’ve had from people within institutes and centers with whom I’ve had meetings. Currently, my agenda is really to meet with as many people as possible within NIH whose work touches on emergency medicine and other time sensitive medical issues.
In terms of the latter, I started a brand new HIV screening project from scratch at GW, it hadn’t been done there previously and it really had only been done in a couple of places in the U.S. before. That required the marshaling of a lot of different aspects of both the hospital, the nursing staff, and emergency physicians to get that up and running.
NPH: What other public health initiatives do you think emergency departments can take the lead on to improve public health?
The final plenary session at this year’s NACCHO Annual included a talk by Christopher Murray, MD, DPhil, director of the Institute for Health Metrics and Evaluation at the University of Washington on how data is used to measure health, evaluate interventions and find ways to maximize health system impact. Dr. Murray was a lead author on three pivotal studies published last week that used data to assess the state of health in the United States compared with 34 other countries and county level data on diet and exercise. One of the key findings is that Americans are living longer, but not necessarily better—half of healthy life years are now lost to disability instead of mortality; and dietary risks are the leading cause of U.S. disease burden.
NewPublicHealth spoke with Dr. Murray about the study findings, their impact and upcoming research that can add to the data public health needs to improve the health of all Americans.
NewPublicHealth: Tell us about the three studies that were published this week using the Institute’s research.
Dr. Murray: The study in JAMA [Journal of the American Medical Association] is an analysis of a comprehensive look at the health of the United States in comparison to the 34 OECD [Organisation for Economic Co-operation and Development] countries. The study looks at both causes of death and premature mortality through over 290 different diseases and puts them all together in a comprehensive analysis of what the contributors are to lost healthy life. That study also looks at the contribution to patterns of health in the U.S., from major environmental, behavioral, and metabolic risk factors. In each of those categories, there are important findings:
- The U.S. spends the most on healthcare but has pretty mediocre outcomes and ranks about 27th for life expectancy among its peer countries.
- For many large, important causes of premature death, the U.S. does pretty poorly. And we also see a big shift towards more and more individuals having major disability—from mental disorders, substance abuse, and bone and joint disease.
- On the risk factor front, the big surprise is that diet is the leading risk factor in the U.S. It is bigger than tobacco, which is second and then followed by obesity, high blood pressure, high blood sugar, and physical inactivity. Diet in this study is made up of 14 subcomponents, each analyzed separately and then put together.
This year’s Health Datapalooza closed out its fourth annual conference today in Washington, D.C. The confab features new and emerging uses of data by companies, startups, academics, government agencies and individuals, and was borne out of a decision by the U.S. Department of Health and Human Services to release some of the health data it collects. This year, the conference included a community health track that looked at emerging tools to improve population health, and recommendations from key public health experts on what’s still needed.
>>For more on the conference, read "Dispatches from Datapalooza" and other conference-related updates over at the Pioneering Ideas blog from the Pioneer Portfolio at the Robert Wood Johnson Foundation.
The session had a world class moderator at the helm in Edward Sondik, PhD, who recently retired as director of the National Center for Health Statistics who set the stage for the session by telling the standing room only audience that “previously most health data applications were focused on the individual, but now we’re seeing data initiatives that can do a great deal to give us more information at the community level.”
Data-sharing resources for community health presented at the session included:
Today’s plenary speaker at the 2013 Keeneland Conference is William Roper, MD, MPH, dean of the school of medicine, vice chancellor for medical affairs and CEO of the UNC Health Care System at the University of North Carolina at Chapel Hill. Earlier in his career, Dr. Roper was senior vice president of Prudential HealthCare, president of the Prudential Center for Health Care Research, director of the Centers for Disease Control and Prevention and administrator of the Health Care Financing System, the precursor to the Center for Medicare and Medicaid Services.
NewPublicHealth spoke with Dr. Roper on his way to the Keeneland Conference about the drive to better use data, instead of anecdotes and personal beliefs, to drive decision-making.
NewPublicHealth: What were some of the early efforts you were involved in that set the stage for the field of public health services and systems research we know today?
Dr. Roper: I didn’t do this by myself; I did it with a lot of other people, but one of the critical early efforts was the publication of Medicare mortality information on all American hospitals beginning in 1986 and continuing for a number of years thereafter. Another was creation of the Agency for Healthcare Policy and Research in 1989, which has since been renamed the Agency for Healthcare Research and Quality. Another was the launching of the Prevention Effectiveness Initiative at CDC in the early 90s. And then subsequently, work that I’ve done at the University of North Carolina, first at the School of Public Health and then at the School of Medicine using the tools of health services research broadly in health care and in public health.
NPH: What are some of the fruits of those efforts?
A new Census Bureau tool, OnTheMap for Emergency Management, was created to help prepare communities for an emergency. The tool provides information about the potential affected population size and characteristics of the people, such as age, occupation, and place of residence. In an event like Hurricane Sandy, the tool was able to trace the path of the hurricane and update data predictions of potential impacts as the storm's path changed. Communities can use these statistics to know how many people live and work in an area where there is a disaster. Knowing these numbers and related demographics helps communities set aside resources and identify vulnerable populations that will need additional assistance, such as the elderly or disabled.
>>Read more about the OnTheMap for Emergency Management tool.