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Spring, 2005 Public Health and Informatics Transcript
of a plenary presentation by Dave Ross, Director of the Public
Health Informatics Institute, at the 2004 Annual Meeting of
the American Public Health Association. This plenary session acknowledges an important fact of life for public health people today. We are an information business driven by information age technologies that feed an information hungry public. I want to thank Dr. Caine for her leadership of APHA and for her insight about the subject of informatics. You might be asking: Why did he use this [Public Health and Informatics I intend to answer a few of these questions but mostly want to present some of the challenges public health faces and point out that judicious application of information technologies will assist the work of public health and can help us achieve important health goals. Public health informatics differs from medical informatics in several ways. Public health informatics stands on the same technical ground as does medical informatics, but public health’s population-based focus adds some interesting needs and challenges to how we conceive, design, and deploy information systems technologies in service of the public’s health. Let me explain… Public health leaders are challenged with a multiplicity of problems. We are an aging population. In a few years the baby boomers hit retirement age and the consequential pressure on Medicare will be felt in the form of higher rates of diabetes and other chronic diseases. The data on obesity are frightening. As obese children mature, we see higher rates of diabetes and other chronic conditions. Uninsured populations present major challenges to improving health status in the U.S. Racial disparities in health continue to be a focus of concern and attention. The past few years have shown that infectious diseases remain a threat through emergence of new organisms as well as through man-made threats, and that control and containment efforts must go forward vigorously. The environment continues to be a causative agent in many conditions and much remains to be done. Occupation hazards remain a significant source of health hazard and harm. And, of course, mortality and morbidity resulting from intentional and unintentional injury place significant challenges to community planning and prevention efforts. In every one of these problem domains, information technologies can be used to help inform policy makers, improve the reach and specificity of surveillance, support service delivery, coordinate case management, and empower research. The potential of public health informatics to improve is large. Public health informatics can support and improve:
My point: We’re here to help you do your job better. Think of it this way. You’ve heard the commercials for BASF… We don’t make the things you use; we make the things you use better. Informatics is similar to that. Informatics doesn’t make people healthier. It supports the people who make the decisions – personal or population-based – that make you healthier. The events of September 2001 demonstrated what many in public health knew: Our information infrastructure was woefully lacking to the challenge of large-scale threat response. While the public health community was working for many years to improve its information infrastructure, it did so within the context of rigid categorical funding and a mandate never to use the word “infrastructure.” 9/11 focused attention, but much remains to be done. Eye on the prize: Information technologies can impact public health only if we focus them on worthy problems and make sure we understand the business case driving the application of the technology to the problem. By business case I mean the rationale for how IT can help solve a problem or improve a process. This rationale can be expressed in quantitative terms, or as is more often the case in public health, in terms of social value. However it is phrased, a clear and convincing argument should be made to explain why we’re spending money on a tool. This argument or business case helps to focus the logic for how the tool impacts a worthy problem. Requirements through collaboration – to design and build or to acquire any information system we need requirements – are statements of exactly what the system must be able to do. To get this right we have to examine very carefully who does the work and how it is done and why they do it the way they do it. Sorting through the answers to these questions, guided by proven methods, yields requirements. I argue that the best requirements for public health result from collaboration among the many potential users and the informaticists. You – the program managers, the concerned and affected beneficiaries of the tool – must not relinquish your ownership of the system’s end value. Health care is at the threshold of the decade of HCIT. EHR’s have become the object of intense focus as a vehicle to improve quality and safety and to drive health care costs down. The NHII or NHIN movement supported through a network of RHIO’s received Presidential recognition and led to the creation of the ONCHIT, reporting directly to the Secretary of HHS and having broad policy overview. The movement to interconnect health care through interoperable systems and standardized data has profound implications for public health. Public health needs an information infrastructure capable of making the handshake. This means:
But most importantly, program-oriented public health professionals need to become instrumental in the dialogue of data standards and translating programmatic goals into requirements that drive information system design. You cannot let the IT people decide your fate. Finally, understanding the rationale for a system and establishing requirements is a natural step toward identifying the performance measure, the ways we know it’s working for us and doing what we need the system to do. Remember the old joke about making bacon and eggs. The chicken is involved, but the pig is committed. This metaphor helps make the point I want to leave you with: The IT people are involved. Informatics is like the chicken. We can help make the meal. We can help make the meal better. We can help make the meal richer. But you, the public health officials and professionals, you the citizens whose health is at risk, you the MCH director, the laboratorian, the epidemiologist … You are committed. It’s your programmatic goals that must be met. It’s your programmatic purpose that must be served. You are committed. My title slide said “Don’t go away. This might be important!” Now you see my reasoning. It’s important because we’re talking about offering you tools that improve what you know about threats to health, when you know about those threats, how you communicate important information and prevention guidelines. All of the things you care about can be improved through informatics ONLY if you understand that you are committed. Therefore, I ask you to make sure that your health promotion and disease prevention strategies drive informatics rather than the reverse. HOME | SITE MAP | CONTACT US | SEARCH | PRIVACY POLICY
©2005 Public Health Informatics Institute
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