Keep Moving Forward: Health Informatics and Information Management beyond the COVID-19 Pandemic.

OBJECTIVES: To identify gaps and challenges in health informatics and health information management during the COVID-19 pandemic. To describe solutions and offer recommendations that can address the identified gaps and challenges. METHODS: A literature review of relevant peer-reviewed and grey literature published from January 2020 to December 2020 was conducted to inform the paper. RESULTS: The literature revealed several themes regarding health information management and health informatics challenges and gaps: information systems and information technology infrastructure; data collection, quality, and standardization; and information governance and use. These challenges and gaps were often driven by public policy and funding constraints. CONCLUSIONS: COVID-19 exposed complexities related to responding to a world-wide, fast moving, quickly spreading novel virus. Longstanding gaps and ongoing challenges in the local, national, and global health and public health information systems and data infrastructure must be addressed before we are faced with another global pandemic.

Quantifying benefits of using health information exchange to support public health STI reporting and treatment in Western New York.

OBJECTIVE:: To calculate average savings of using health information exchange (HIE) for demographic and treatment requests for chlamydia and gonorrhoea in Western New York, specifically the Erie County Department of Health and its catchment area. METHOD:: We conducted a mixed-method case study. Qualitative methods included interviews, document review, and workflow mapping, which were used as the inputs to identify time savings. Case rates, time savings, and salary averages were used to calculate average savings. RESULTS:: The avoided demographic information requests resulted in time and money savings (range of USD$2312-USD$4624 for chlamydia and USD$809-USD$1512 for gonorrhoea) as did avoided treatment requests (range of USD$671-USD$2803 for chlamydia and USD$981-USD$1635 for gonorrhoea). DISCUSSION:: HIE supported sexually transmitted infection (STI) treatment by making it easier for public health staff to identify and act upon STI diagnoses. Availability of information online resulted in less reliance on provider offices for demographic and treatment information. CONCLUSION:: Results indicated that using HIE to support treatment and management of STIs can save public health staff time spent on obtaining demographic and treatment information. Other public health departments could use HIE for this and other types of disease surveillance activities. Considering public health needs in HIE development and use can improve efficiency of public health services and enhance effectiveness of activities.

Synonym-Based Word Frequency Analysis to Support the Development and Presentation of a Public Health Quality Improvement Taxonomy.

CONTEXT: Researchers and analysts have not completely examined word frequency analysis as an approach to creating a public health quality improvement taxonomy. OBJECTIVE: To develop a taxonomy of public health quality improvement concepts for an online exchange of quality improvement work. DESIGN: We analyzed documents, conducted an expert review, and employed a user-centered design along with a faceted search approach to make online entries searchable for users. To provide the most targeted facets to users, we used word frequency to analyze 334 published public health quality improvement documents to find the most common clusters of word meanings. We then reviewed the highest-weighted concepts and categorized their relationships to quality improvement details in our taxonomy. Next, we mapped meanings to items in our taxonomy and presented them in order of their weighted percentages in the data. Using these methods, we developed and sorted concepts in the faceted search presentation so that online exchange users could access relevant search criteria. RESULTS: We reviewed 50 of the top synonym clusters and identified 12 categories for our taxonomy data. The final categories were as follows: Summary; Planning and Execution Details; Health Impact; Training and Preparation; Information About the Community; Information About the Health Department; Results; Quality Improvement (QI) Staff; Information; Accreditation Details; Collaborations; and Contact Information of the Submitter. CONCLUSION: Feedback about the elements in the taxonomy and presentation of elements in our search environment from users has been positive. When relevant data are available, the word frequency analysis method may be useful in other taxonomy development efforts for public health.

Public Health Quality Improvement Exchange: A Tool to Support Advancements in Public Health Practice.

OBJECTIVES: The Public Health Quality Improvement Exchange(PHQIX) is a free, openly available online community that supports public health practitioners in the rapidly evolving landscape of public health quality improvement (QI). This article's objective is to describe the user-centered development of PHQIX and its current content and examine how elements of a QI initiative may vary by an organization's characteristics or QI experience. METHODS: PHQIX was developed by taking a user-centered iterative design approach, seeking early and continued input from users to gather requirements for the website. We performed an exploratory analysis of the published QI initiative descriptions, reviewing all QI projects that PHQIX users shared as of January 1, 2018. RESULTS: PHQIX features 193 QI initiatives from a variety of health departments and public health institutes using a wide range of QI methods and tools. DISCUSSION: Submitted QI initiatives focus on many public health domains and favor the PDCA/PDSA cycle; Kaizen; and fishbone diagrams, flowcharts, process maps, and survey methods. Limitations include data coming only from users who represent health departments with sufficient time to complete the PHQIX submission template. Additionally, many initiatives were submitted in part to fulfill a grant requirement, which could skew results. CONCLUSION: As the field of QI in public health practice evolves, resources targeted to QI practitioners should build on and advance the available resources. Findings from this study will provide insight into QI initiatives being performed and the types of projects that can be expected as organizational experience and collaboration grow.

Control of the Public Health IT Physical Infrastructure: Findings From the 2015 Informatics Capacity and Needs Assessment Survey.

BACKGROUND: Despite improvements in information technology (IT) infrastructure in public health, there is still much that can be done to improve the adoption of IT in state and local health departments, by better understanding the impact of governance and control structures of physical infrastructure. OBJECTIVE: To report out the current status of the physical infrastructure control of local health departments (LHDs) and to determine whether there is a significant association between an LHD's governance status and control of the physical infrastructure components. DESIGN: Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County and City Health Officials. PARTICIPANTS: A total of 324 LHDs from all 50 states completed the survey (response rate: 50%). MAIN OUTCOME MEASURE(S): Outcome measures included control of LHD physical infrastructure components. Predictors of interest included LHD governance category. RESULTS: The majority of the control of the physical infrastructure components in LHDs resides in external entities. The type of governance structure of the LHD is significantly associated with the control of infrastructure. CONCLUSIONS: Additional research is needed to determine best practices in IT governance and control of physical infrastructure for public health.

Public Health Staff Development Needs in Informatics: Findings From a National Survey of Local Health Departments.

CONTEXT: Public health practice is information-intensive and information-driven. Public health informatics is a nascent discipline, and most public health practitioners lack necessary skills in this area. OBJECTIVE: To describe the staff development needs of local health departments (LHDs) related to informatics. DESIGN: Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County & City Health Officials. PARTICIPANTS: A total of 324 LHDs from all 50 states completed the survey (response rate: 50%). MAIN OUTCOME MEASURE(S): Outcome measures included LHDs' specific staff development needs related to informatics. Predictors of interest included jurisdiction size and governance type. RESULTS: Areas of workforce development and improvement in informatics staff of LHDs included using and interpreting quantitative data, designing and running reports from information systems, using and interpreting qualitative data, using statistical or other analytical software, project management, and using geographical information systems. Significant variation in informatics training needs exists depending on the size of the LHD population and governance type. CONCLUSION: Substantial training needs exist for LHDs across many areas of informatics ranging from very basic to specialized skills and are related to the size of LHD population and governance type.

Using health information exchanges to calculate clinical quality measures: A study of barriers and facilitators.

BACKGROUND: A key motivation for the large national investment in electronic health record systems is to promote electronic reporting of quality measures that can be used as the basis for moving to value-based payment. Given the fragmented delivery system, robust quality reporting requires aggregating data across sites of care. Health information exchanges (HIEs) have emerged to facilitate exchange of clinical data across provider organizations and, therefore, should be well-positioned to support clinical quality measure reporting. METHODS: By interviewing representatives from 36 HIEs across the United States, we aimed to determine whether HIEs are capable of computing National Quality Forum measures for 6 cardiovascular disease preventive services. RESULTS: Eleven HIEs (30%) reported computing at least one CQM; six computed one or more of the measures, and no HIE computed a measure in each of the 6 areas. Barriers to computing CQMs included data quality, completeness, sharing, and transmission issues; organizational structure, maturity, and sustainability issues; and vendor issues. CONCLUSIONS: The ability to compute CQMs at the HIE level is still yet to be developed; currently, very few HIEs are able to do so for a variety of reasons. As HIE services expand and HIEs mature organizationally, the viability and utility of CQM reporting at the HIE level will increase. IMPLICATIONS: As the healthcare system migrates towards a value-based payment system these broad challenges will need to be addressed. LEVEL OF EVIDENCE: Cross-sectional semi-structured qualitative interviews.

Beacon communities' public health initiatives: a case study analysis.

INTRODUCTION: The Beacon Communities for Public Health (BCPH) project was launched in 2011 to gain a better understanding of the range of activities currently being conducted in population- and public health by the Beacon Communities. The project highlighted the successes and challenges of these efforts with the aim of sharing this information broadly among the public health community. BACKGROUND: The Beacon Community Program, designed to showcase technology-enabled, community-based initiatives to improve outcomes, focused on: building and strengthening health information technology (IT) infrastructure and exchange capabilities; translating investments in health IT to measureable improvements in cost, quality, and population health; and, developing innovative approaches to performance measurement, technology, and care delivery. METHODS: Four multimethod case studies were conducted based on a modified sociotechnical framework to learn more about public health initiative implementation and use in the Beacon Communities. Our methodological approach included using document review and semistructured key informant interviews. NACCHO Model Practice Program criteria were used to select the public health initiatives included in the case studies. FINDINGS: Despite differences among the case studies, common barriers and facilitators were found to be present in all areas of the sociotechnical framework application including structure, people, technology, tasks, overarching considerations, and sustainability. Overall, there were many more facilitators (range = 7-14) present for each Beacon compared to barriers (range = 4-6). DISCUSSION: Four influential promising practices were identified through the work: forging strong and sustainable partnerships; ensuring a good task-technology fit and a flexible and iterative design; fostering technology acceptance; and, providing education and demonstrating value. CONCLUSIONS: A common weakness was the lack of a framework or model for the Beacon Communities evaluation work. Sharing a framework or approach to evaluation at the beginning of implementation made the work more effective. Supporting evaluation to inform future implementations is important.

Self-reported fever and measured temperature in emergency department records used for syndromic surveillance.

Many public health agencies monitor population health using syndromic surveillance, generally employing information from emergency department (ED) visit records. When combined with other information, objective evidence of fever may enhance the accuracy with which surveillance systems detect syndromes of interest, such as influenza-like illness. This study found that patient chief complaint of self-reported fever was more readily available in ED records than measured temperature and that the majority of patients with an elevated temperature recorded also self-reported fever. Due to its currently limited availability, we conclude that measured temperature is likely to add little value to self-reported fever in syndromic surveillance for febrile illness using ED records.

An informatics agenda for public health: summarized recommendations from the 2011 AMIA PHI Conference.

The AMIA Public Health Informatics 2011 Conference brought together members of the public health and health informatics communities to revisit the national agenda developed at the AMIA Spring Congress in 2001, assess the progress that has been made in the past decade, and develop recommendations to further guide the field. Participants met in five discussion tracks: technical framework; research and evaluation; ethics; education, professional training, and workforce development; and sustainability. Participants identified 62 recommendations, which clustered into three key themes related to the need to (1) enhance communication and information sharing within the public health informatics community, (2) improve the consistency of public health informatics through common public health terminologies, rigorous evaluation methodologies, and competency-based training, and (3) promote effective coordination and leadership that will champion and drive the field forward. The agenda and recommendations from the meeting will be disseminated and discussed throughout the public health and informatics communities. Both communities stand to gain much by working together to use these recommendations to further advance the application of information technology to improve health.

A web-based intervention to support increased physical activity among at-risk adults.

Physical inactivity is an important contributor to the development of numerous chronic conditions and alone is an independent risk factor for diabetes, cardiovascular disease, and depression and yet, most Americans consistently fail to achieve the recommended amount of physical activity. As part of Project HealthDesign, we designed and prototyped a personal health record application (PHA) that delivers and supports a highly individualized, behaviorally based lifestyle physical activity intervention for sedentary adults. Through a user centered design approach, we engaged consumers, health care providers, and personal trainers for multiple facilitated group discussions and structured interviews to determine their needs and wants related to an activity PHA. The PHA was developed to include elements of evidence-based approaches which help participants adopt cognitive and behavioral skills such as goal-setting, self-monitoring, accepting social support, cognitive restructuring, contingency management, decisional balance, and relapse prevention. This PHA demonstrated the potential for research-based behavioral interventions to be delivered via a web portal. This finding is important for both consumers and their providers who have the desire to implement physical activity recommendations, but lack the tools to facilitate or undertake such interventions.

NHIN, RHIOs, and Public Health.

Public health plays a critical role in forming the building blocks for community or regional health-information sharing, which is essential to the long-term viability of a Nationwide Health Information Network (NHIN) and the Regional Health Information Organizations (RHIOs). By contributing to its visions, policies, processes, standards, and needs/requirements, public health will close the loop within an NHIN and the RHIOs environment. In this article we illustrate public health's essential role in an NHIN and the RHIOs by examining the mutual benefits to healthcare and public health.