State and Local Perspective on Public Health Data Standards

1. State and Local Perspective on Public Health Data Standards Opportunities for Strategic Action Marty O’LaVenture, Public Health Informatics Advisor Minnesota Department of Health, Minneapolis, Minnesota at the Annual Meeting on Public Health Data Standards Consortium, March 16-18, 2004, Bethesda Marriott, Bethesda, MD

2. Topics for Discussion • A State & Local Perspective: Opportunities and Challenges • Opportunities for Strategic Action • Provide senior leadership informatics training • Improve process for meaningful input • Expedite tools for adapting, implementing and maintaining standards • Increase public health Informatics capacity • Support state executive level Public Health Informatician

4. State and Local Perspective-The community, where the work of public health gets done - “Although the development of comprehensive data standards and vocabularies is not trivial, it pales by comparison to the challenge of adapting, implementing, and maintaining standards in our public health agencies and daily use.” - MDH - 2003

5. Local Public Health-The community, where the work of public health gets done - Where the standards, practices, policies, and procedures are made operational, institutionalized, andmaintained, and the work of community public health get done.

6. Significant Decreases in Non-BT Funding Facing a Storm of Needs, an Avalanche of Requirements and a Decrease in Resources Huge Increase • Information Systems • Data Standard Requirements

7. Influenza & Respiratory Surveillance - SARS - Public Unexplained Deaths Veterinary/Animal Health & Vectors West Nile Virus Example Surveillance for Infectious Diseases at MDH Reportable Disease Surveillance Source: Minnesota Department of Health

8. Opportunities for Strategic Action For Developing Public Health Vocabulary and Data Standards • Support informatics training to increase understanding and commitment by senior leadership • Secure meaningfulinputfrom states & counties using strategiccollaborative approaches • Expedite tools for adapting,implementing and maintainingstandards • Increase public health informatics capacity • Support a State executive level Public Health Informatician

9. Support Informatics Trainingfor Senior Leadership Example Activity • Executive leadership training with the Public Health Informatics Institute Approach • Modular, iterative & strategic learning • Practical & adult learning focused • Emphasis on their decision making role in the process

10. Example: Public Health Informatics Institute - Leadership Workshop • Introduction • Informatics Context • Key Best Practices • “Just Do It” • Wrap-Up & Evaluation—All Workshop Agenda

11. Be smart. OrganizationDevelopment Be wise. • Use advanced accountability practices • Effective project management • Strategic IRM planning • Enterprise architecture • Portfolio management • Conduct comprehensive evaluations Implement enhanced role for CIO Ensure governance connects agency and informatics strategies Be good. Leadership & Governance Accountability & Evaluation Key Best Practices – Overview Implement Key Informatics Practices • Manage change pro-actively • Develop informatics competencies

12. Practice Makes Better • This is a facilitated group session intended to help participants apply workshop concepts • Please see session material under the tab marked: Just Do It

13. Introduction Materials Toolkit Resources Glossary Annotated bibliography Slide presentation

14. Practice is the action taken based on our understanding of the knowledge and context for public health use. Using Informatics to Change Practice INFORMATICS implies a disciplined approach to information systems design and implementation that will drive improvements in public health practice Source: Adapted from Bellinger, G. Knowledge Management and the Minnesota Department of Health

15. ResultsParticipant Evaluation

16. Example Comments • “this is the best workshop I have attended in years…” ~ and I have been to a lot…” (county health official) • “Very practical, I will use this tomorrow” (health department director) • “I don’t get it all yet, but this will be very helpful as I work with my county IT staff” (local director)

17. 2. Secure MeaningfulInput Using Strategic Collaborative Approaches Example Activity • Collaborative development around specific needs – lab specifications Approach • Make strategic use of staff input and foster communities of practice • Use a facilitated – collaborative process • Provide national leadership not national control • Stress shared ownership not required liability • Know who you are talking to

18. Perspective & ChallengeDiverse Sets of Agencies & Partner Organizations Affiliated Organizations • ~ 115 Agencies / Professionals • 60 States & Territories health departments • ~ 3000 local heath departments • ~ 100,000+ professionals • ~ 50 disciplines

19. Make Strategic Use of Staff “I have participated in several national {standards} groups…..Unfortunately, most of what takes place is a lot of whining and spinning of wheels and eventually, the people who really do want to get something done, give up and go off and do it themselves”… - State staff – 2003 “…I feel like a token representative….and I have no effective way to get input from peers.….” -State staff-2003

20. Example of Collaborative Development Process -LIMS • Development of the Requirements Document for Public Health Laboratory Information (LIM) Systems • 16 public health labs • Structured time limited process • October 2002 • “…a great jump start”

21. 3. Expedite Tools For Adapting,Implementing and MaintainingStandards Example Activity • Immunization Registry and HL7 implementation guide Approach • Provide a variety of tools & techniques to support implementation • Encourage incremental steps (paths) to a solution not only the “home run” • Understand & address issues of organization change

22. External* Organization Process Internal Organization Process Identifying Best Practices** (Acquire, Develop, Disseminate) Using Best Practices ( Adapt, Implement & Evaluate) 1. Adapt C. Disseminate 2. Implement B. Develop Organizational Context Information System Architecture A. Acquire 3. Evaluate Figure 2: Model for Identifying and Using Best Practices for Immunization Registries Best Practices** Knowledge Successful Practices Revised 9/23/ 03 - LaVenture

23. Example Tool for Adapting & Implementing Standards - CIRSET (Committee on Immunization Registry Standards for Electronic Transmission) • Created the Implementation Guide for HL7 • Peer organization, 40 immunization registry projects, state, local, CDC, and vendors. • Action oriented; works on vocabularies & data structures • Ex.: CVX, LOINC, XML,HL7

24. 4. Increase Informatics Capacity Example Activity • Informatics Competencies for Public Health Approach • Leverage new and existing resources • Imbed expectations & authorization in grants • Manage standards and vocabulary as a type of data and knowledge

25. Organizational Development Principles in Practice – Managing Change Key Best Practices – Organization Development Informatics Competencies Informatics Competencies for Public Health Professionals describes: • Three classes of informatics competencies • The use of information • The use of information technology • The development, deployment, and maintenance of information systems • Required levels of proficiency vary by job • Front-line staff • Senior-level technical staff • Supervisory and management staff

26. Organizational Development Principles in Practice – Managing Change Key Best Practices – Organization Development Organizational Capacity The sum of individual competencies does not necessarily equal organizational capacity Changes may be needed in your organization to ensure that information is managed strategically and information systems development is done coherently and professionally Goal: to achieve an informatics – savvy organization

27. 5. Support an Executive Level Public Health Informatician Example Activity • Director of Public Health Informatics Approach • Provide funding for senior level person with advanced informatics skills and knowledge for every state health department. • Ensure support through grants and requirements

28. Who do you Call?Who has Agency Wide Responsibility for Public Health Informatics? • Agency director (e.g commissioner) • State health officer • State epidemiologist (Infectious disease, Chronic disease, Injury etc. • State laboratory director(s) • Web master • State CIO?/CTO/CSO • Project director (e.g. MCH,STD,Imm,Injury control) The perspective on informatics standards and interoperability will vary by responsibility

29. State Public Health Informatician Responsibilities • Agency wide accountability & responsibility • Ensure adherence to standards and a commitment to interoperability • Monitor and support activities inside and outside the agency • Monitor and participate in PHIN and NHII strategic directions • Develop and support a state wide health information infrastructure

30. Bottom Line Implications… If we want to accelerate the development and use of public health data standards, it is time to…. Implement better approaches and practices that will more effectively utilize the capacities of local public health and pay greater attention to supporting informatics actions at state and local public health departments

31. Summary Action Needed • Expedite informatics training to increase understanding and commitment by senior leadership • Secure meaningful input from states & counties using strategic approaches • Assure the process includes tools for adapting, implementing and maintainingstandards • Increase public health informatics capacity • Support an executive level state Public Health Informatician

32. State and Local Perspective-The community, where the work of public health gets done - “Extraordinary people doing amazing things with little money, facing great challenges, and getting the work of Public Health done every day”

33. Thank You Questions?Marty LaVentureMinnesota Department of Healthwww.health.state.mn.usmartin.laventure@health.state.mn.us612-590-0898

34. Acknowledgements • Dave Ross, Public Health Informatics Institute • Dennis J. Michaud, Massachusetts Department of Public Health & CIRSET Chairperson 2003 • Warren Williams, Informatics/registryTeam, CDC • Aggie Leitheiser, Minnesota Department of Health • Bill Brand, Minnesota Department of Health