The Power of Health IT for Public Health: A NewPublicHealth Q&A With Farzad Mostashari
In the summer of 2011, nearly 800 public health and informatics professionals from across the country convened in Atlanta for the Public Health Informatics 2011 conference.
Around the conference, NewPublicHealth spoke with Farzad Mostashari, M.D., S.c.M., Director of the Office of the National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services, to get his perspective on how health information technology can impact public health, and how the public health informatics field is evolving.
NewPublicHealth: The Public Health Informatics Conference is coming up this month. For those who aren't familiar with the field, what exactly is public health informatics?
Dr. Mostashari: I think that I’m a little bit of a student of public health informatics myself, and an avid follower. In the early days it was about building better systems – disease surveillance and outbreak detection systems. The second phase was building the connection between those systems and clinical systems, and using clinical information systems as primary data sources for public health. The third stage is about how public health informatics systems can embed within them a public health consciousness. I think about having a Tom Frieden [Director of the Centers for Disease Control and Prevention (CDC)] on the left shoulder of every physician to help inform clinical decisions from a public health perspective, as enabled by health information technology.
NPH: What is the role of the Office of the National Coordinator (ONC) in advancing public health informatics?
Dr. Mostashari: We are responsible for the nationwide adoption and use of health information systems. We take our role very seriously and through our relationship with the CDC, we aim to build in prevention to those systems, to set up standards to facilitate the flow of information, and to bring together public health and clinical systems through technology.
NPH: Last year, ONC established the Beacon Community Program to help demonstrate how the adoption of health information technology can improve health and health care. What has ONC learned from this program so far?
Dr. Mostashari: The goal of the program is to start with outcomes and work backwards – we've learned that that’s an incredible gift, to have very specific goals not for a hospital or for a clinic but for an entire community. We want to reduce asthma admissions – we start with that goal and work backwards to how do we do that? Then we can start looking at better decision support, care managers to identify those at highest risk, the concept of looking at the denominator of the entire community population and not just those who come in to the clinic – and yes, it’s going to mean collaboration with public health. If there’s an issue around smoking cessation, around heart disease, around vaccination, the reality is that to really impact these issues the public health and health care systems really need to work together. I’ve heard some say the technology is a good servant and a terrible master. If you know what you want to use it for, technology will yield incredible dividends. If you start with the technology you’re in for disappointment.
NPH: A lot of the discussion around health information technology has focused on improving health care delivery. What is the connection of this work, particularly adoption of EHRs, to prevention and public health?
Dr. Mostashari: I gave a talk with CDC’s epidemiology ground rounds on this very issue. I was so proud of my public health brethren – they got 28,000 online views. It was a very good session. Basically, you can start by thinking about meaningful use [the adoption of electronic health records in a meaningful way that will impact health, tied to a set of standards and requirements]. The cornerstone of what the HITECH Act has done is to provide tens of millions of dollars in incentive payments, tied to specific meaningful use requirements. If you look at what those requirements do for prevention and public health – including requirements around notifiable electronic lab reporting, syndromic surveillance reporting, and reporting to immunization registries – the impact is huge. Public health departments are inundated with data now instead of begging hospitals for this information. That’s been the major influence.
But what I want to convey is that meaningful use is actually about so much more than reporting. If you look at avoidable deaths from heart disease and what can we do to address them – aspirin, blood pressure, cholesterol, smoking cessation – clinical care makes a huge difference, and they’re all required as part of meaningful use. Right now only about half of people are getting the clinical preventive services they need. You can’t fix what you can’t see, but meaningful use offers a way to measure the quality of care. Quality control, clinical decision support, registry functions, providing ways for basic data to be collected in a standardized way – all of that is a part of meaningful use. Also improving the safety of care and reducing medical and prescription errors. There are huge connections all throughout what we’re doing and public health. I got into this business because I believe in the power of health information technology to advance prevention and public health.
Finally, a big part of what happens in people’s health is dependent on their behaviors. Health information technology gives patients the information they need – after-visit summaries, copies of their own records – to help them to be more active in their own health care. It’s about helping people make healthier decisions through better information.
NPH: What can state and local health departments be doing now to engage in public health informatics?
Dr. Mostashari: My message to health departments is summarized by the William Gibson quote, “The future is already here – it’s just not evenly distributed.” Let’s just get the basic stuff done first. Let’s implement public health reporting requirements that are part of meaningful use. The public health community can’t afford to let meaningful use not live up to its possibilities. The hospitals and healthcare providers are now looking to connect their data to public health departments. Meet them half-way. Let’s not let that energy dissipate. We all need to be willing participants in this transaction.
There will be some states that will be far ahead – providing and connecting with outpatient syndromic surveillance, physician case reporting, cancer registries, vision screening. Those states need to step up to show that what they’re working on can be scaled and set the standards for those activities. These are areas where we are just at the beginning of understanding the public health impact, and we need those innovators to fearlessly innovate, to fail and share their failures, and to succeed and share their successes. We need those pockets to grow, like what we did in New York, and others did in Boston and North Carolina. But each public health department should connect with health information technology at the level they can. At the very minimum, we need to make sure meaningful use succeed. For those who are ahead of the curve, bless you, keep innovating and be willing to fail forward.
NPH: As the field evolves quickly, different skills and entirely new job functions will be required. What are the demands on the public health workforce, and what are the solutions?
Dr. Mostashari: Worforce is a critical issue for public health, particularly given the state and federal budget situation. We need to make maximum use of the workforce we have, and train them in new areas. I’m not sure workforce needs to be duplicated in each different area of public health informatics – there’s an opportunity to create a core of informatics capability in public health departments. There are challenges to that, funding silos and so forth, but we have to be smarter and more efficient. A big part of this will be the development of training programs that can help people who are already in jobs to develop the new skills they’ll need to help their health department step into the future.
>>This year, the CDC and the National Association of County and City Health Officials will also be offering a pilot Public Health Informatics Virtual Conference including select streaming sessions for those who can't attend.