William A. Yasnoff

Public health informatics: improving and transforming public health in the information age.

Development of effective public health information systems requires understanding public health informatics (PHI), the systematic application of information and computer science and technology to public health practice, research, and learning. PHI is distinguished from other informatics specialties by its focus on prevention in populations, use of a wide range of interventions to achieve its goals, and the constraints of operating in a governmental context. The current need for PHI arises from dramatic improvements in information technology, new pressures on the public health system, and changes in medical care delivery. Application of PHI principles provides unprecedented opportunities to build healthier communities.

A consensus action agenda for achieving the national health information infrastructure.

Abstract Background Improving the safety, quality, and efficiency of health care will require immediate and ubiquitous access to complete patient information and decision support provided through a National Health Information Infrastructure (NHII). Methods To help define the action steps needed to achieve an NHII, the U.S. Department of Health and Human Services sponsored a national consensus conference in July 2003. Results Attendees favored a public–private coordination group to guide NHII activities, provide education, share resources, and monitor relevant metrics to mark progress. They identified financial incentives, health information standards, and overcoming a few important legal obstacles as key NHII enablers. Community and regional implementation projects, including consumer access to a personal health record, were seen as necessary to demonstrate comprehensive functional systems that can serve as models for the entire nation. Finally, the participants identified the need for increased funding for research on the impact of health information technology on patient safety and quality of care. Individuals, organizations, and federal agencies are using these consensus recommendations to guide NHII efforts.

A national agenda for public health informatics: summarized recommendations from the 2001 AMIA Spring Congress.

The AMIA 2001 Spring Congress brought together members of the the public health and informatics communities to develop a national agenda for public health informatics. Discussions of funding and governance; architecture and infrastructure; standards and vocabulary; research, evaluation, and best practices; privacy, confidentiality, and security; and training and workforce resulted in 74 recommendations with two key themes-that all stakeholders need to be engaged in coordinated activities related to public health information architecture, standards, confidentiality, best practices, and research; and that informatics training is needed throughout the public health workforce. Implementation of this consensus agenda will help promote progress in the application of information technology to improve public health.

Putting Health IT on the Path to Success

The promise of health information technology (HIT) is comprehensive electronic patient records when and where needed, leading to improved quality of care at reduced cost. However, physician experience and other available evidence suggest that this promise is largely unfulfilled

Disseminating public health practice guidelines in electronic medical record systems.

An evaluation of public health practice guidelines published by CDC was conducted to determine the feasibility of disseminating them through electronic medical record (EMR) systems. Of 1,069 guidelines evaluated, 360 contained at least one recommendation that could be presented as an alert or reminder to the clinician during the patient encounter. These guidelines were in the areas of: HIV (59), sexually transmitted diseases (8), health care associated infections (14), tuberculosis (TB) (25), immunizations/vaccine-preventable diseases (80), other infectious diseases (134), reproductive health diseases (8), cancers (9), diabetes (5), and other chronic diseases (18). Further efforts to disseminate CDC guidelines through EMR systems are in progress.

A national agenda for public health informatics.

The American Medical Informatics Association 2001 Spring Congress brought together the public health and informatics communities to develop a national agenda for public health informatics. Discussions on funding and governance; architecture and infrastructure; standards and vocabulary; research, evaluation, and best practices; privacy, confidentiality, and security; and training and workforce resulted in 74 recommendations with two key themes: (1) all stakeholders need to be engaged in coordinated activities related to public health information architecture, standards, confidentiality, best practices, and research and (2) informatics training is needed throughout the public health workforce. Implementation of this consensus agenda will help promote progress in the application of information technology to improve public health.

Privacy, confidentiality, and security in information systems of state health agencies

OBJECTIVES To assess the employment and status of privacy, confidentiality, security and fair information practices in electronic information systems of U.S. state health agencies. METHODS A survey instrument was developed and administered to key contacts within the state health agencies of each of the 50 U.S. states, Puerto Rico and the District of Columbia. RESULTS About a third of U.S. state health agencies have no written policies in place regarding privacy and confidentiality in electronic information systems. The doctrines of fair information practice often seemed to be ignored. One quarter of the agencies reported at least one security breach during the past two years, and 16% experienced a privacy and confidentiality related transgression. Most of the breaches were committed by personnel from within the agencies. CONCLUSIONS These results raise questions about the integrity of existing privacy, confidentiality and security measures in the information systems of U.S. state health agencies. Recommendations include the development and vigorous enforcement of written privacy and confidentiality policies, increased personnel training, and expanded implementation of security measures such as encryption and system firewalls. A discussion of the current status of U.S. privacy, confidentiality and security issues is offered.

Lessons Learned from a Health Record Bank Start-up

INTRODUCTION This article is part of a Focus Theme of METHODS of Information in Medicine on Health Record Banking. BACKGROUND In late summer 2010, an organization was formed in greater Phoenix, Arizona (USA), to introduce a health record bank (HRB) in that community. The effort was initiated after market research and was aimed at engaging 200,000 individuals as members in the first year (5% of the population). It was also intended to evaluate a business model that was based on early adoption by consumers and physicians followed by additional revenue streams related to incremental services and secondary uses of clinical data, always with specific permission from individual members, each of whom controlled all access to his or her own data. OBJECTIVES To report on the details of the HRB experience in Phoenix, to describe the sources of problems that were experienced, and to identify lessons that need to be considered in future HRB ventures. METHODS We describe staffing for the HRB effort, the computational platform that was developed, the approach to marketing, the engagement of practicing physicians, and the governance model that was developed to guide the HRB design and implementation. RESULTS Despite efforts to engage the physician community, limited consumer advertising, and a carefully considered financial strategy, the experiment failed due to insufficient enrollment of individual members. It was discontinued in April 2011. CONCLUSIONS Although the major problem with this HRB project was undercapitalization, we believe this effort demonstrated that basic HRB accounts should be free for members and that physician engagement and participation are key elements in constructing an effective marketing channel. Local community governance is essential for trust, and the included population must be large enough to provide sufficient revenues to sustain the resource in the long term.

Issues and opportunities in public health informatics: a panel discussion.

A panel was convened at the American Medical Informatics Association Spring Congress to discuss issues and opportunities that arise when informatics methods, theories, and applications are applied to public health functions. Panelists provided examples of applications that connect efforts between public health and clinical care, emphasizing the need for integration of clinical data with public health data and the analysis of those data to support surveillance and informed decision making. Benefits to be gained by both medical informatics and public health at the interface were evident; both encounter the same major issues including privacy, systems integration, standards, and many more.

Medical Informatics and Preparedness

The terrorist attacks of September 2001 and the subsequent deliberate dissemination of anthrax have stimulated public awareness of the need in both the public health and clinical health care systems to quickly detect and respond to altered patterns of disease in communities across the nation. Debate over the capacity of the existing systems to fully respond to these demands has created a sense of urgency for immediate action to improve these functions. Public health resources were taxed to provide early detection and rapid response. The clinical care delivery system faced challenges of emergency response to urban casualties, highlighting the value of clinical information systems that facilitate information management in crisis situations. The effective application of informatics to these data collection, analysis, and dissemination tasks could allow the rapid deployment of systems that would greatly enhance our preparedness. Much of the informatics experience gained in health information system implementation efforts over the past several decades is directly applicable to the new challenges of bioterrorism and emergency response. By utilizing this collective knowledge in areas such as architecture, infrastructure, standards, and knowledge representation, newly created systems are more likely to yield maximum benefits. As an organization, AMIA is already focused on issues of public health informatics, having developed …