Monthly Archives: January 2013

Insights from Kansas Information Management and Exchange Workshop

Recently Vanessa Holley and I were asked to facilitate a workshop with local health departments (LHDs) in Kansas.  We were slated to discuss how to help LHDs make two decisions:

  • Do they need an electronic health record (EHR) system?
  • If/how should they connect to the health information exchange (HIE)?

Through the course of the discussions, it quickly became apparent that the decisions to have an EHR or connect to the HIE were only part of the story and in some ways were over emphasized because they are easier to conceptualize.  But the discussions began to broaden and clarify some of the issues.  As it turns out, I think we actually stumbled upon a pretty good road map for ePublic Health.

Let’s look closer at what I mean.

Before you can effectively take advantage of any technology or HIE option:

  • Step 1: develop the future vision for your LHD and clarify both what value and what services you plan to offer your community.  You first need to determine what services your LHD will be focused on in the new world of healthcare.  This is critical because if, for example, your health department is not going to continue to heavily invest in clinical services, then considering a practice management or EHR system may not be a good investment – despite current needs.  On the other hand if you plan to increase your case management and care coordination role in the community, you’ll want to be sure whatever system you purchase or build takes into account those requirements in order to best support your work.
  • Step 2: is to create or update your statewide collaborative Health Information Management Plan and planning body with a wide representation from LHD, state, and program personnel.  Even if this already exists, ensure that representatives are both well informed and doing a complete job of communicating out decisions that are made.  To begin this step you have to begin to coordinate at a heightened level with your state and neighboring LHDs.  In Kansas, they have had a great relationship with their state and a very active LHD association.  However, they still realized that they could benefit by making a more formal body that is charged with coordinating and collaboratively developing the Health Information Management Plan for public health.  This is different from the statewide HIT plan because it is much more than information technology and is solely focused on creating one public health voice for health departments throughout the state.  This is so critical because your partners need to hear a coordinated and unified voice for public health.  Also, most of the Meaningful Use solutions are designed and managed at the state level.  Therefore it is imperative that LHDs are collaborating with the state to understand how their information needs will be met and how these solutions will interact with their local systems.  There has been so much to keep up with in the fast pace of Meaningful Use that many states have not yet formalized this body and its charge.  However states that have recently created such a coordinating body, like Ohio, report huge successes in making decisions and dealing with unforeseen issues related to the changing world of ePublic Health (See CDC Charter Lite Template).
  • Step 3:  gain a clearer appreciation for your LHDs capabilities, needs, and desires. This can often involve an assessment of the systems you have, the needs that are met and the gaps that exist.  It might even be good for the aforementioned Health Information Planning group to survey LHDs and display results.  This will help LHDs identify peers they can work with and peers who can offer peer assistance or advice about vendors.  It is important that this not be done from a standpoint of competition or condemnation, but rather of bettering each health department.
  • Step 4: delineate the benefits of practice management and EHR systems. Though clinical operations and responsibilities for LHDs can vary wildly, most LHDs have some sort of specialty clinics that they run (examples include STD/HIV, TB, Maternal and Child Health, etc).  And though the state is often preparing systems to meet Meaningful Use requirements, LHDs must come up with their own solutions for meeting the demands of these clinics.  Complicating matters, LHDs often have cross over between local clinic information needs and programmatic reporting to state or federal partners.  In our discussions in KS, we discovered that even with smaller programmatic clinics there are good reasons to deploy one or both of these types of systems.  Especially since costs have decreased dramatically in the past 5 years.  Benefits include more efficient programmatic reporting, increasing overall clinic efficiency resulting in a higher volume of visits, increased recovery of costs and billing, decreased need for record space, etc.  Once you have determined that the benefits offered by these systems fit within your LHD vision, conduct a review of specific systems based on your unique requirements, and understand the costs and benefits you can expect, then you can make an informed decision as to which system you should deploy (see NACCHO’s All-Systems-Go tool).
  • Step 5:  know your requirements for exchange and assess/pursue your local HIE options to support those requirements. For this final step, our discussions in KS turned to the HIE options that exist in their state.  Since they have been a leader in Health Information Exchange and LHDs have been heavily involved, they have a couple of really nice options.  In their state, LHDs can get basic HIE services for free, which include direct secure messaging and access to a provider web portal.  And KS LHDs are finding really interesting ways to use these services – like using the web portal for case investigations and sending follow-up testing requests and outbreak summary reports to physicians using direct secure messaging.  The state health department is working to connect their reporting systems to LHDs through the HIE, but work remains to make local and state systems interoperate in this fashion.  It also came to light that there were other exchange requirements that the LHD had that aren’t a part of their “free” set of services, but have enough value that they will want to understand the costs/benefits and pursue those options.  For example, local clinic managers would like to perform clinical assessments on their clients and provide test results and other clinical notes to the referred provider or receive visit summary documents when the referred visit is complete.  Though there is still much work to do, what was clear was that in the not so distant future one could imagine LHDs in KS having an efficient and interoperable connection to the state and other community based systems through their HIE.  In order to have this sort of success, it is critical that your LHD get involved, stay involved, or increase involvement locally with your HIE options.  Be aware of what services your HIEs provide, how these services can benefit your LHDs vision for the future, and see if you can negotiate special rates for LHDs.

If LHDs earnestly and systematically pursue these five steps, I believe they will have a thriving and successful transition into becoming an efficient LHD of the ePublic Health future.  At NACCHO, we’re working with our ePublic Health workgroup to develop more detailed tools that will support LHDs who go through each of these steps – so stay tuned.  I want to give a special thanks to the Kansas Health Foundation, Kansas Association of Local Health Departments, and Kansas Department of Health and Environment for allowing me into their rapidly developing world of ePublic Health.

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The Flu Strikes Back – 7 Free Online Tools to Guide You through the Flu Season

If you look around the office, it’s no surprise that more coworkers are out sick. Regions across the U.S. are experiencing an early influenza season, with activity elevated nationally.

Be informed and share these tools with your community to stay strong against the flu this season.

flu view scrnshot1. CDC Flu View  is a flu activity and surveillance site that provides weekly influenza surveillance in the Unites States. In addition to the website, its mobile app gives you options to: explore Influenza-Like Illness (ILI) Activity Levels across the US; view ILI trends over several weeks; and get on-demand access to state health department websites for local surveillance information.

2. CDC Influenza Application for Clinicians and Health Care Professionals gives the latest recommendations and influenza activity updates on your iPad, iPhone or iPod Touch (Android support will be added in a future update). The app will automatically update information and content when your device is connected to the Internet. With this application, you can:

  • View updated information on national flu activity
  • Find influenza vaccination recommendations endorsed by CDC and the Advisory Committee on Immunization Practices (ACIP)
  • Obtain information on diagnosis and treatment of influenza, including antiviral treatment recommendations by CDC and the ACIP
  • Obtain information on laboratory testing for influenza
  • Find CDC recommendations on influenza infection control
  • View videos of CDC subject matter experts discussing influenza topics
  • Order official CDC designed print products for posting in the workplace or distributing to patients.

3. MappyHealth is the winner of the “Now Trending – #Health in My Community” challenge hosted by the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response, mines Twitter data to show diseases trending in communities. The data is presented through several visualizations which include maps and graphs. For more information on MappyHealth, see our interview with them here.

google flu trends scrnshot4. Google Flu Trends  aggregates search terms in real time to estimate flu activity around the world. Google notes on their Flu Trends page that searches using flu related terminology have a close correlation to people having actual flu symptoms, according to a study published in the journal Nature. The current map (as of 1/17/13) of the U.S. shows mostly “intense” flu activity.

5. Flu Near You and Vaccine Finder are administered through HealthMap of Boston Children’s Hospital in partnership with the American Public Health Association and the Skoll Global Threats Fund. Flu Near You is a popular tool among the public health community and gives a weekly reporting of influenza like symptoms (also an open data set), and shows where people are reporting symptoms within their community. A component of Flu Near You is Vaccine Finder which helps users find locations offering flu shots. Per the website, Flu Near You allows the user to do the following:

  • Complete quick surveys to advance our collective understanding of the flu
  • See flu activity in your area at the regional or state level
  • Explore flu trends around the world with Google Flu trends
  • Use the Flu Vaccine Finder to find nearby locations offering flu shots or nasal spray flu vaccine
  • Connect to local public health links
  • Receive customized email disease alerts at your location
  • Learn more about flu news, information, and resources at flu.gov
  • Explore the RSS feed on updates on nearby flu outbreaks and related flu news
  • Browse the Disease Daily to discover summaries of important outbreaks and expanded coverage through the Outbreaks 101 news section

6. Flu.gov is a Department of Health and Human Services site that has all the resources you need from print materials to widgets you can add to your website. Flu.gov provides information on symptoms, treatments, and vaccination locations for influenza.

7. Flu Defender is the third place winner of CDC’s Flu App Challenge and is a iOS app that raises awareness about influenza while providing useful information on: vaccine finder, flu activity, symptom identifier, etc. The app uses the following data sources: CDC Weekly Flu Activity Report, RSS Feed of Influenza Updates, RSS Feed of Influenza Podcasts, CDC.gov/flu website and print materials, CDC Flu Twitter feed and the Flu.gov website.

Do you know of other free online flu tools? Let us know by leaving a comment.

What is informatics, and why should I care? – Joseph Gibson, MPH, Ph.D.

From 2003 to 2006, I struggled to get a firm grasp on what people meant by “informatics”. Since understanding it, I have struggled to find a good way to explain its importance to my public health colleagues. But I think I finally have it.

Informatics skills are what you need to avoid wasting a lot of money, effort, and goodwill when implementing information systems.

Have you ever tried to implement software or some application, only to have it fail because it did not perform as you expected, it was not accepted by the end-users, it did not work with your other systems, or maintain it requires more resources than you could afford? That is a failure of informatics. Has some state or federal agency ever imposed technology or software upon you that captured the information they needed, but made your operations more difficult? That is the result of poor informatics. Does your agency has many program-specific applications that may work well for each program, but which are only sustained by one person’s special skills or which cannot exchange or consolidate information across your whole enterprise? Good informatics planning can lead to more robust, interoperable systems.

Effective use and management of information requires a combination of technology and work processes. Too often, we have viewed software solutions as the “silver bullets”; thinking that installing the right software will automatically improve our processes. But just as you need skill and strength to use a saw, you need training and content knowledge to make effective use of software. Informatics creates a bridge between technology and work processes, to assure good match. But it is not simple. Good informatics requires a significant resource investment in selecting and implementing solutions. Like most prevention, it is easy but risky to skip.

Important informatics skills include change management (not just IT change management, but culture and process change management as well), business analysis, stakeholder engagement, project management, requirements development, strategic thinking to place projects into a larger vision, building for inter-operability, translating between IT & business, system life cycle, Communications, ) A good informatician can speak the language of both IT staff and program staff, and should be a good communicator and group facilitator.

Informatics skills are not necessarily present in IT departments. A programmer may be very skilled in writing a program to do what he wants, but is rarely skilled in getting the thorough understanding of what users need. The database administrator may be very skilled in structuring a database to run very quickly, but usually does not understand the content well enough to create operational definitions that address what program managers want to know. And even if an IT department has good informatics skills, agency leadership often requires implementation timelines that short change the informatics-intensive phases of a project, like the homeowner who paints a room without first prepping the walls and trim.

Why should you try to get more informatics skills in your health department’s workforce? Why should you consider creating an informatics director position? Because, in the long run, it will save you money, effort, and will earn you goodwill, rather than reputation for having failed or hard to use systems that do not meet user needs. You will spend more time preparing for new systems, but less time fighting with those systems after they are implemented.

Read Dr. Gibson’s bio »