public health informatics

public health informatics

The Importance of Public Health Informatics

1. Introduction to Public Health Informatics

Public health informatics is a relatively new field, which links public health and information technology to improve the health of the population. This is achieved by applying information technology and information systems to public health practice and research. The ultimate goal of public health informatics is to apply computer-based and other information technologies to improve public health through surveillance, prevention, and management of disease and injury. Although the field has great potential, it has so far achieved only incremental successes. A most critical insight is the need for a better integration of the human, social and technological aspects of informatics implementations if we are to learn from the successes and failures of the past several decades. Stated simply, we have learned how to build information systems – in public health as well as in other fields. But we need to learn how to build information systems that actually get used. This will entail a whole new array of research methods drawing from the social sciences as well as the technical sciences. And it will require education and training programs to prepare information technologists to work effectively in organizational cultures very different from those with which most are familiar. This essay provides an overview of the current state of public health informatics, and a discussion of key issues and future challenges in the field.

2. Role of Public Health Informatics in Disease Surveillance

Public health informatics has furthered the way in which communicable diseases are tracked and monitored. Today, the National Notifiable Disease Surveillance System (NNDSS) is working towards making notifiable disease data available to public health officials through secure information systems. This system has been developed in conjunction with the Center for Disease Control and has made use of the CDC WONDER system. It is widely known that the complete eradication of diseases such as measles, mumps, and rubella is becoming more of a reality. However, if we are to continue progression in the control of such diseases, then it must be recognized that there is a need for real-time surveillance. This is because the longer the time between data collection and analysis, the less timely the preventive action. Real-time surveillance can be a complex and costly process. An excellent recent example was the method in which the recent SARS epidemic was contained. In the case of communicable diseases, the establishment of electronic laboratory reporting (ELR) through information technology is crucial if real-time surveillance is to become a possibility. ELR systems have been thought to be a more effective means of reporting, reducing both time and the cost to report diseases, improving data quality, and improving the process of follow-up. Public health informatics has also shown its usefulness in the area of bioterrorism. Since September 11, 2001, $3.24 billion of federal funds has been allocated to assist states in the improvement of public health preparedness for bioterrorism. One of the goals of this initiative is the development of an integrated electronic system to detect and respond to the occurrence of illness due to bioterrorism or other public health emergencies. This links back to the NNDSS and shows how public health informatics has become an important influencer in the tracking and monitoring of communicable disease.

3. Utilizing Public Health Informatics for Health Promotion

For each of these steps in the HPDP model, there are tasks that require greater collaboration with other disciplines. For example, the first step in the process is to assess the needs of a community. This first step requires community health workers to research, collect, and analyze existing data. In another article, Green and Kreuter talk about the different competencies that a health worker must have in order to successfully promote health. One of the competencies says “Implementation of any health program is an organizational process that uses the knowledge and skills of many people, often across disciplines”. This is saying that implementing a health program takes the collaborative effort of many different disciplines. Whether it is researching data or implementing a health policy, anything HPDP related will require a collaborative effort involving many disciplines. In both assessing the needs of a community and also taking action, community health workers will find themselves using health informatics on some level to improve their results. The purpose of the assessment step is to understand the community in question and its relation to an issue at hand. Some community health workers may find that they do not need primary data (data collected by them) to accomplish this. There is tons of community health-related secondary data and an easy way to access it is by using the myriad of resources available through the World Wide Web. Data from the U.S Census Bureau, for example, can provide very detailed information about a certain community. Accessing it will be easier for a person who understands how to navigate the internet and use data retrieval tools. The better understanding of a community or the state of a particular health issue, the better that a health program can be tailored to the needs of the community. This, in turn, will increase the likelihood of program success. Any action taken at any phase of the HPDP model will require some kind of behavioral change. A policy may need to be instituted, laws may need to be enforced, people may need to be persuaded to do something or to stop doing something. The ultimate goal is to bring about a behavior that leads to better health. The vast amount of knowledge and plethora of tools available in health informatics will be crucial in making any behavioral change. The most simple definition of health informatics is the study and application of methods to improve the management of information in public health. Despite how general this definition is, it can be applied to an infinite number of scenarios. The knowledge of how to collect and store data will be useful in monitoring the progress of an action. Knowing what has or has not worked can be very important. The information on a particular community and health issue can be used to model the desired outcomes of an action. Let’s not forget that the behavior of individuals is based on their knowledge and attitude. One of the best ways to change one’s behavior is by changing their attitude. A community health worker using methods of psychology may be able to employ a health communications campaign. Creating the right messages and targeting the right audience will eventually lead to attitudinal changes that cause the desired behaviors. This entire process can be greatly refined using various information resources. In the future, it may even be possible to simulate how an action will change the status of a community health issue. Simulation is an area of health informatics that holds much potential, yet has seen little success up to this point. Simulation has been used in other fields to predict the outcomes of complex systems. If it could be used to accurately predict the outcome of a health-related action, then it would be a very useful tool in HPDP.

4. Challenges and Opportunities in Public Health Informatics

Despite these challenges, there has been rapid growth and a variety of developments in the field of public health informatics. Globalization has brought and will continue to bring both new opportunities and new challenges. The recent global SARS scare is a prime example of a global challenge which could be met more effectively with a global informatics solution. There is a growing need for trained informatics professionals in the public health field. Law and ethics will continue to evolve in the information age. It is crucial that public health policy keeps pace with scientific knowledge and that policy making and analysis are an informed process. E-government has opened doors for more effective and efficient use of technology. The recent economic stimulus package includes provisions for information technology and infrastructure. If taken advantage of, this can be a great opportunity to further public health goals in utilizing information technology.

The full potential of informatics has yet to be realized in the public health sector. The growth in tools and technologies has brought many opportunities as well as challenges to the field. Public health informatics has great potential but needs to overcome some critical challenges to truly capitalize on that potential. The biggest incentive for adopting an informatics system is to improve efficiency and effectiveness in the public health process. At the same time, numerous factors such as system costs and the fear of new technology can make it a difficult transition. Public health practitioners are often not accustomed to thinking in terms of information and informed decision making; by nature they are more concerned with taking action than assessing situations. Education and training are needed to integrate new technologies into the public health arena. Often the decision to begin an informatics project is made without the technical resources to see the project through to the end. Sometimes projects are undertaken without establishing long-term goals and plans. This can often lead to patchwork solutions which can only be sustained in the short term. These are the concepts of interoperability, sustainability, and scalability, without which projects can actually impede efficiency. Failure to adopt a method of information standardization is another factor which can impede the efficacy of an informatics tool. Accurate and timely data is crucial in epidemiology. Standardized information makes analysis and interpretation simpler and more reliable.

5. Future Directions in Public Health Informatics

Investigation by use of telephone surveys confirmed the illness, and its estimated incidence was 7.3% of the households in the community. Emergency room data during the same time period revealed 2.5 times the normal rate of gastrointestinal illness. Emergency room physicians were contacted and confirmed an unusual increase in patients with gastrointestinal complaints. Subsequent tracking of ER data led to the development of a reporting system that is being evaluated for use as a possible waterborne disease indicator. This would have never been noticed if the emergency room data was not available for comparison.

An example of this occurred in the summer of 1993, where the Milwaukee Health Department discovered the potential for using emergency room data to track possible waterborne disease in the community. After a severe water contamination incident in April 1993, many area residents became sick after drinking city tap water. Comparison of dates and types of illnesses were used to discover an acute gastrointestinal illness in the community.

Syndromic surveillance is an investigational approach where potential outbreaks are tracked before specific diagnoses are made. The concept of syndromic surveillance is a new one on the scientific scene, with great potential tied to the use of modern computer technology. The routine collection of data from specific sources, such as hospital emergency rooms, is used to track changes in the health of a community. The data is then used to determine public health action in the form of investigations.