Public Health Informatics Workshop - Maximizing Data for Chronic Disease Programs

1. Informatics—Tools for Communicating an Emerging Field Barbara Park, NACDD Piper Hale, PHII Bill Brand, PHII

2. Welcome and Introductions • Tell us who you are and what state you are from. • How long have you been working in chronic disease prevention and health promotion? • What do you hope to learn from participating in this course? • During the session write down some “take-away” items – we will ask you to share them later.

3. Learner objectives Define public health informatics, its goals and uses in the context of a CDC program. Identify three ways in which informatics capacity is critical to the effectiveness of a CD program in an e-health era. Apply informatics principles, methods and tools in planning for a EHR-based CD surveillance program. Learn from each other.

4. Defining and demystifying informatics

6. Why Informatics? Right information Right people Right time

7. What do Informaticians do?

8. What is Public Health Informatics? Public health informatics is pragmatic, progressive,dexterousandadaptive.

9. Informatics is Cross-Disciplinary The public health informatician has knowledge and skills in many areas, some of which overlap with other roles and some of which are unique. Epidemiologist Public health informatician Any of these types of staff can become effective informaticians, but they do not replace the need for one.

10. How are you already using public health informatics?

11. Elements of an informatics-savvy chronic disease program http://phii.org/infosavvy

12. So what can informatics do for your program? • Serve as translator (and sometimes mediator) between your program, central IT, vendor, data suppliers and other stakeholders to ensure these different sectors are on the same page. • Improve use of potentially limited resources around data quality, information system functions, value on investment, and vendor contracts or central IT levels of service, among other areas. Improve your program’s capacity to adapt to changing needs and respond to new public health challenges.

13. FrameWorks Guide to Communicating Informatics http://phii.org/what-is-informatics

14. The critical role of informatics in an e-health era

15. Basic assumption for this workshop You are interested in accessing/harvesting digital data from EHRs or other sources. Then informatics is your ally….

16. Drivers for CD e-surveillance • EHR adoption trends; impact on public health • Accelerated under Meaningful Use

17. EHR Adoption Trends, Hospital and Office-based Clinical Settings % Sources: *Charles, D. et al. ONC Data Brief no. 23 (2015) **Furukawa, M. et al. Health Affairs Vol. 33 No. 9 (2014)

18. Drivers for CD e-surveillance • EHR adoption trends; impact on public health • Accelerated under Meaningful Use • Moving from Data and Information to Knowledge and Wisdom to Outcomes

19. Using Informatics to Improve Public Health Practice

20. Slow Down or Not? Data or information?

21. Drivers for CD e-surveillance • EHR adoption trends; impact on public health • Accelerated under Meaningful Use • Moving from Data and Information to Knowledge and Wisdom to Outcomes • Focus on population health measurement and improvement • Payment reform models: results and outcomes • Payment reform models: results and outcomes • Including information from outside of health care and other traditional public health data sources

22. The Biggest Driver Moving to outcome-based accountable care and community integrated health care will be critically dependent on mobilizing and re-using information.

23. phii.org/ehrtoolkit Online tools and resources to help public health agencies access and use EHR data Adaptable to a wide range of conditions Built around comprehensive planning questions, sound informatics principles Free!

24. Surveillance Information Life Cycle Making the Value Case Optimizing Data Quality and Use Clarifying Legal & Policy Issues Implementing Data Exchange Forming Partnerships Analyzing Technical Options Analyzing Clinical Data & Workflows

25. Surveillance Approaches Also, consider a “Collaborative Model”: Public health agencies partner with providers and community entities to jointly define population health questions, share analyses and design interventions.

26. BREAK

27. Making the Value Case

28. Questions addressed in this section What public health problem does the proposed program address? How do you best articulate the value case for your partners and senior leaders within the context of your agency’s priorities?  Who among your community partners are natural allies or supporters of the outcomes you want to achieve?  What are the outcomes, outputs, rules, inputs, etc., that could build a logic model for your program? How do you identify and document hidden costs of system development and maintenance?

29. Value Case Exercise How do you best articulate the value case for the health care organizations that would provide the data for this program? How do you frame that value case in terms of their priorities and drivers? How you will ensure that data capture minimally impacts workflows, systems or both in the health care setting?

30. A case study A collaborative regional project that uses EHR data to monitor public health trends and to measure the efficacy of public health interventions.

31. With CHORDS, public health officials can: Source: CHORDs web site • Monitor health indicators (e.g., community Body Mass Index [BMI], community diagnosis and control of cholesterol and/or hypertension) across populations. • Identify demographic characteristics and geographic areas at higher risk of poor health behaviors and outcomes. • Support policy, clinical and community health-based initiatives to prevent or intervene around specific behaviors or diseases by tracking clinical measures over time.”

33. Exercise Write the value case for health care to participate in a new surveillance program of your choosing.

34. Analyzing Clinical Data and Workflows

35. Questions addressed in this section What are the indicators to surveil for a condition, disease or risk factor of interest? What data elements are necessary for those indicators? Are those data captured in the EHR in standardized, consistent ways? If not, can they be mapped to a single standard vocabulary? Who collects/records the data and for what purpose(s)? How might the clinical workflows impact the quality and utility of the data for surveillance purposes?

37. Data and Workflow Exercise • Go to https://db.tt/j5OAsevw for the worksheet. • Select a CD condition or indicator you want to work with. • Respond to the worksheet questions as best as you can. • Note where you are not sure of the answer. What are possible risks of not knowing? • Share any insights or questions.

38. Final Thoughts • The meaning of “population health” is evolving. • Public health is increasingly understanding they can’t always control the data. • What are the advantages of moving the logic to the data (as opposed to moving the data to the health department)?

39. Wrap-up • What are some “take away” nuggets that you learned from today’s session? • What are some opportunities for promoting the use of informatics in your state? • What more can we/should we be doing as leaders in chronic disease prevention and health promotion on this topic? • Did this course meet your expectations? • What other questions do you have for our faculty?

40. Thank you for attending! http://phii.org/NACDD. Learn more and access resources and tools at Please don’t forget to fill out the evaluation form.