AMIA 2012 Chicago Presymposium - WG-03: Current Issues for Population Health Informatics in Healthcare and Public Health - presentation by Joseph Gibson, MPH, PhD and Catherine Schenck-Yglesias, MHS

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Population Health Informatics in Health Care
and Public Health
Topic Areas:
• Long Term Objectives for Working Population Issues
• Best Practices for Health Registries
• Information Exchange (IEx) for Detection and Monitoring:
Clinical Care to Health Departments
• IEx for Clinical Communication and Coordination:
Health Department to Clinical Care
• Health Departments and HITECH / ACA
• Balancing Personal and Population Privacy Needs
• Social and Mobile Media and Prevention
• Open Source and Cloud for Public and Population Health:

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IEx for Clinical Communication and
Coordination: Health Department to
Clinical Care
Joe Gibson, MPH, PhD
Director of Epidemiology, Indianapolis (Marion County)
Catherine Schenck-Yglesias, MHS
Project Director, Johns Hopkins International
Development Program

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PERSONALLY IDENTIFIABLE AND
NON-IDENTIFIABLE PUBLIC HEALTH
DATA FOR CLINICAL BENEFIT

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Identified PH Data for Clinicians
• What vaccines does this patient need now?
– Pt’s immunization history, compared to recommended
schedule
• Newborn genetic disorder testing results
– Routing heel-stick blood test results to pediatricians &
parents
• Results of special lab tests
– Some tests are usually done at public health
laboratories
• Home visit information from public health nurses
• Rx monitoring program (identify excessive narcotic
use)

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Unidentified PH Data for Clinicians
• Setting the Index of suspicion
– What unusual diseases are around today?
– What is prevalent today, and with whom?
– Examples: TB, syphilis (diseases familiar to MDs)
• Unusual Outbreaks
– What symptoms?
– Where the treatment & follow-up
recommendations?
– What are the prevention recommendations?
– Examples: Monkey pox, pH1N1, contaminated
injectable steroids

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HEALTH AND HUMAN SERVICES
DATA FOR CLINICAL BENEFIT

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Health and Human Services Information
of Use to Clinicians
• Risk
– Data on social service issues of the
community and specific individuals that
represent risk factors, comorbidities or
challenges to preventive health and treatment
plans
• Resolution
– Programs at local health and human/social
services departments that may be able to
assist patients in addressing current and
preventing future clinical issues

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Preventive Health Examples
• Environmental Hazards
– Agency for Toxic Substances and Disease Registry (ATSDR)
Public Health Assessments
• when people have been or are likely to be exposed to a toxic substance
and, usually, how and when they were exposed
• whether the exposures are likely to lead to illness
• recommends ways to protect public health
• Obese patients
– What is his most convenient opportunity for exercise? What
programs are near his home?
– Are fresh fruits and vegetables available at a nearby store?
– Are walking or biking trails near his home?
– What parks are nearest his home? Do they have free or low-cost
physical activity programs?
– Does his neighborhood have sidewalks?

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Potential HHS / Social Service Data Sharing
AGING National Aging Program Information Systems (NAPIS)
BEHAVIORAL HEALTH National Reporting Program for Mental Health
Statistics (NRP)
Treatment Episode Data Set (TEDS)
Uniform Reporting System (URS)
CHILD AND FAMILY SERVICES Adoption and Foster Care Analysis and Reporting
System (AFCARS)
Head Start Program Information Report (PIR)
National Child Abuse and Neglect Data System
(NCANDS)
National Vital Statistics System: Mortality (NVSS-M)
National Vital Statistics System: Natality (NVSS-N)
National Youth in Transition Database (NYTD)
Pediatric Nutrition Surveillance System (PedNSS)
Pregnancy Nutrition Surveillance System (PNSS)
Runaway and Homeless Youth Management
Information System (RHYMIS)
Statewide Automated Child Welfare Information
Systems (SACWIS)
EMERGENCY/DISASTER Emergency Data Exchange Language (EDXL)
Epidemic Information Exchange (Epi-X)
Health Alert Network (HAN)
National Electronic Disease Surveillance System
(NEDSS)
Source: Shank, Nancy C., "Understanding Human Services Utilization: Opportunities for Data Sharing between Federally Funded
Programs” (2009). Nancy Shank Publications. University of Nebraska Public Policy Center. Paper 6.
EMPLOYMENT/
WORKFORCE TRAINING
Workforce Investment Act Data Reporting and
Validation System (DRVS)
FOOD AND NUTRITION
PROGRAMS
Pediatric Nutrition Surveillance System (PedNSS)
Pregnancy Nutrition Surveillance System (PNSS)
Supplemental Nutrition Assistance Program (SNAP)
Women, Infants, and Children Program (WIC)
HEALTH CARE Clinical Reporting System (CRS), Indian Health Services
Continuity of Care Document (CCD)
Continuity of Care Record (CCR)
Medicaid Analytic Extract (MAX) extracted from the
Medicaid Statistical Information System (MSIS)
Medicare Data Files
National Council for Prescription Drug Program SCRIPT
(NCPDP SCRIPT)
National eHealth Collaborative (NeHC)
Nationwide Health Information Network (NHIN)
Ryan White Program
SCHIP Statement of Expenditures (CMS-21)
HOUSING/SHELTER Client Activity Reporting System (CARS)
Form HUD-50058
Low Income Home Energy Assistance (LIHEAP) Program
Performance
Weatherization Assistance Program
INCOME SUPPORT Temporary Assistance for Needy Families (TANF) and
Tribal TANF
PUBLIC HEALTH Disaster Surveillance Forms
Epidemic Information Exchange (Epi-X)
Health Alert Network (HAN)
National Electronic Disease Surveillance System (NEDSS)
Pediatric Nutrition Surveillance System (PedNSS)
Pregnancy Nutrition Surveillance System (PNSS)
Public Health Data Standards Consortium (PHDSC)
Public Health Information Network (PHIN)

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Appropriate Referral to
Local Health and Social Services
• Adult Mental Health Services
• Adult Protective Services
• Aging Services
• Catholic Charities
• Child Care Services
• Child Welfare Services
• Domestic Violence Service via Abused Persons
Program
• Early Learning and Child Care
• Education through Public School System
• Emergency Assistance
• Environmental Hazard Elimination
• Federally Qualified Health Centers
• Fitness/Wellness Programs
• Foster Care
• Goodwill Services
• Head Start Providers
• Homeless Program
• Housing Stabilization Services
• In-home Aide Services
• Income Support Services
• Jewish Community Center
• Limited English Proficiency (LEP) Services
• Maternity Services
• Medical and Primary Care Services
• Medicaid Enrollment
• Protective Adoption
• Public Health TB Clinic
• Public or Medicaid Provider Mental Health
Treatment
• Senior Centers
• Smoking Cessation Programs
• Supplemental Nutrition Assistance Program
(SNAP), formerly known as Food Stamps
• Special Needs Housing Services
• Substance Abuse Treatment
• Temporary Assistance for Needy Families (TANF)
• Vocational Rehabilitation
• Workforce Investment Act (WIA) Services (training
and employment)
• Women, Infants and Children (WIC) Services
• Workforce Services

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INFORMATICS
INTERVENTIONS

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PH data to clinicians:
Current Usual Practice
• Push to providers: via letters, email,
faxes
– For both identified & broadcast information
• Pull by providers: web sites, media
• Providers log-in to immunization
databases
• Lab results often delivered by mail

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Nascent Electronic Exchange
• Secure email
• Electronic alerts delivered via HIE
– same route as lab. results
• Conditional alerts in EHRs
– During a TB outbreak among homeless,
system prompts for TB tests when homeless
appear at ED
– During syphilis outbreak, patients meeting the
outbreak profile were flagged for testing
• Immunization histories pushed to EHR

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The Future: Knowing a pt’s context
Regarding an obese patient:
• What programs are near his home?
• Are fresh vegetables available nearby?
• Has sidewalks in his neighborhood?
• What support networks are available?

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• What data gets pushed from PH?
• What data gets pulled by EHR?
• Are other modes more effective?
• What data requires provider
authentication?
The Future

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ABC
Residential
& Group
Care
Health &
Disability
Caseworker
Team
Planning &
Resource
Allocation
Financial
Management
Program
Management
Information
Technology
Child Welfare
Aging
Voc. Rehab
Mental
Retardation
Seniors
Centers
Medicaid
Contractor
No
Child
Left
Behind
Goodwill
Services
Developmental
Disabilities
Community
Health
Community
Mental
Health
Workforce
Develop
Medicaid
Income
(TANF, Emerg.
AidMedicaid
Jewish
Community
Center
Catholic
Chairities
Child Care
Courts
Criminal
Civil
Juvenile Justice
Family Court
Divorce
Head
Start
Team-based
Integrated
Intake
Head Start
Providers
Federal Dept.
of HHS
Federal Dept.
of Education
Criminal Justice
Ecosystem
Health & Human Services Ecosystem
State Health &
Human Services
Local Social Service Agencies
Information Technology
State Department
Of Education
Multi-
Discipline
Client Plan &
Review
WIA
Portal
Client data
Provider data
Referral data
Performance
Workflow &
Scheduling
TANF
EBT
Data
Warehouse
BI Tools
EAI Tools
State Tax
Suppliers
One Stop Centers
Multiple Locations
Interdisciplinary
Pre-eligibility Assessment
Emergency Assistance
Child care
Service Delivery (e.g. Empl.)
Facilitate Self-service
Secured
Internet
Police
Banks Clients
United
WayHospitals
Network of
Community Service
Providers
SACWIS
Child Support
Integrated Case
Management
Food Stamps
Child Welfare
Caseworker
Team
Child Support
Collections
Income Sec.
Caseworker
Team
K-12 Education
Ecosystem
Workforce Inv.
Child Welfare
Foster Care
Protective
Adoption
Public Health
Mental Health
Substance
Abuse
Treatment
ERP
Schools
RevMax
Medicaid
TANF
Regional State & Local Client
Plan & Assessment Teams
Productivity &
Collaboration
Integration
Technologies
Provider
Management
Compliance
Management
Human Resource
Management
IT Management
Department
Management
MicrosoftArchitecturalVision

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Public Health
Addictions &
Mental Health
Medical
Assistance
Programs
Children,
Adults &
Families
SAMHSA
ACF
IHS
RSA
State View: Silo’d Architectures, Funding, Services
Rich Howard – CIO Oregon DHS

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Informatics Linking Health with
Human/Social Services
• Build a common client index or master client index to track overlapping
and unduplicated client load – better anticipate need and improve
service delivery
• Integrate eligibility for all health and social programs federal, state and
local with eligibility requirements
• Ensure compliance with all federal, state and local confidentiality and
privacy protocols
• Digitize all records and move to a paperless environment
• Integrated case management system that allows for public and private
sector users access and use of the system
• Routine data sharing/integration options:
– Real time, two-way integration
– Periodic, two-way integration
– Periodic, one-way integration and
– Periodic, one-way analysis integration
Source: Stewards of Change; Montgomery County Dept of Health and Human Services;
Homeless Management Information System (HMIS) Integration Strategies and Solutions

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POLICY ENVIRONMENT NEEDED
TO SUPPORT THESE
INFORMATICS INTERVENTIONS

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Data Sharing Plans
• Intent and scope
• Risks & benefits of sharing, of not sharing, and monitoring
plan
• Data sharing methods
• Staff roles and responsibilities
• Minimum data elements needed
• Method to ensure confidentiality and security
• How data will be used, published, and retained/destroyed
• Confidentiality agreements
• Knowledge and training requirements
– Annual training for staff accessing identifiable data
Source: Centers for Disease Control and Prevention. Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually
Transmitted Disease, and Tuberculosis Programs: Standards to Facilitate Sharing and Use of Surveillance Data for Public Health
Action. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2011

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Supportive Policy and Practice
Environment
• Information sharing is clearly defined,
meets confidentiality and privacy
requirements, and is integrated in
training and practice.
• Integrated case management is clearly
articulated by leadership and embedded
in operations, procedures, training and
practice.
Sources: Stewards of Change Human Services 2.0™: A Framework for Interoperability

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Supportive Policy and Practice
Environment
Goal:
• A nationally recognized confidentiality policy that enables data
sharing
Current status:
• Different laws and rules apply to different data sources and
diseases
– Communicable diseasas
– Birth & death data
– HIV
– Mental health
– HIPAA, FERPA
Sources: Stewards of Change Human Services 2.0™: A Framework for Interoperability and Alliance of States with
Prescription Monitoring Programs

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TOWARD A CONSENSUS STATEMENT ON
THE POTENTIAL CLINICAL BENEFITS OF
PUBLIC HEALTH INFORMATICS

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Data Sharing Summary
Health Department
Non-identifiable Data
Social Services
Non-identifiable Data
Health and Social Services
Identifiable Data
Data Shared Local community and
relevant subpopulation
statistics (e.g., by race and
ethnicity, SES, risk factors)
in the community (health
statistics)
Available local, state, and
federal programs for health and
human services to respond to
health problems
for populations of varying means
Information on the individual from
health information exchanges, health
department registries and social
service records
Via E-mail, website? E-mail, website? InfoAlert – e.g., same system that
lab results come through. Letter/fax.
Clinician
Action
More effectively target
screening of patients for
specific health problems
Refer patients to the relevant
services
Continuity of care
Informatics
Intervention
Extract/send relevant
population data
Extract/send relevant population
data
Extract/send relevant individual data
or integrate systems
Policies and
Plans
Data Sharing Plans, Confidentiality and Security Policies

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Discussion Questions
• How do we ensure that the right patients get the
right benefits from public health and human
services data sources at the right time?
• Prioritizing the data and information to
communicate
– What content is available?
– What is valued by clinicians and patients?
– When is it needed?
• How do we effectively deliver the information?
– Push by PH to EHR (or other interface)?
– Pull by EHR from PH?
– MD authentication & pt matching for identified data

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Session Title
• Discussion Synopsis: