Category Archives: PH Informatics 101

Interoperable: Shares a well-defined interface

 Joe Gibson
Director of Epidemiology
Marion County Public Health Department

Modular systems vs. the Killer App
I am a great believer in having modular, interoperable systems. I have seen too many “Killer Apps;” too many systems that try to do it all, and end up doing their core function well, but most other things badly, like case investigation systems that try to include analysis and reporting, or analysis systems that try to include data capture modules. As much as possible, I want my health department to have a set of distinct systems, where each system does its function very well, and can work with the other systems to support our entire operation. The staff should only have to learn one interface for inputting encounter data, and only one interface for generating reports, just like we have only one application for working with e-mail. Of course, the separate systems have to communicate with each other, so that our encounter data can get into our reports. In other words, the systems have to be interoperable.

True and false interoperability
InteroperabilityWhen people talk about interoperable systems, they often focus on whether the systems share some coding system like SnoMed, ICD10, or LOINC. Under this very limited view of interoperability, two systems would be considered interoperable if they store their information using the same codes, like ICD-9-CM for diagnosis, “M” for male and “F” for female in the Gender field, etc.. If systems were people, this view might consider two people “interoperable” if they had the same native language.

Sometimes discussions of interoperability also include message standards. Message standards define how information is arranged in the messages sent from one system to another. Message standards define what fields should be sent, in what order, with what separators or labels, in what format (HL7, XML, etc.), and with what coding system. Message standards are analogous to grammar; if interoperability were defined as having a shared message standard, two people might be considered “interoperable” if they used valid sentences in the same language.

But interoperability requires much more than this. It is not just having information that is coded in the same way in two systems. It is not just having standard formats for communicating certain kinds of information. It also requires some kind of connection between the systems, just like communication between people requires a telephone, and e-mail system, or being close enough to hear each other. It also requires the message be properly interpreted, so the information can be used for action. And it requires some appropriate, sensible response, often in the form of a confirmation that the message was received and understood, and perhaps an answer, if the original message was a query. We have all had the experience of talking without understanding, despite using valid sentences in a shared language. A productive exchange requires that each side understands the other, and responds in some relevant way.

Interoperable = shared interface
Until recently, when I tried to assess whether two systems are interoperable, I had a hard time organizing all this in my head. I would think about language, message standards, connections, and vague and diverse functions for interpreting information and responding to it. Fortunately, I learned a much more useful way to think about the crux of interoperability from a developer during a recent meeting about collaborative development of immunization registries. He said that to create one software module that will work with the our many, varied immunization systems, we need to define the interface.

An interface is the point of interaction between systems, like the counter at a fast food restaurant. The interface allows systems to connect and exchange something. Think of a fast-food counter: you state your order, the server tells you the cost, you give some form of payment, and the server gives you your food. Each part of the exchange has certain criteria: you may have to order in English or by pointing, and the payment may have to be with cash or credit card. A system interfaces might define how to send an address and get back a geocoded point location from Google Maps, or how to send a laboratory sample ID from an EHR and get back a laboratory result from a LIMS system. A systems interface defines what can cross between the systems, when, in what form, and the allowed responses. The interface does not define the internal operations of system operates, but it does define the inputs and outputs needed for an exchange between the systems. A well-defined interface defines everything that needs to be done for that exchange to occur; to more, and no less. It precisely defines, for a specific function, what is necessary for systems to interoperate.

So now, when I consider whether systems are interoperable, my central question is, “is there a well-defined interface between these systems?” When I think about making two systems interoperable, I see the task being to develop an interface between them.

Why does this matter?
miscommunication_jpegThis concept of interface should be at the core of our conversations about interoperability. I get worried when interoperability discussions are just about language or message format; I worry that public health decision-makers will be misled into investing in systems that are called “interoperable,” when the systems only use the same language or message format, but do not have automatic, built-in functions for communicating and using information from each other. Do not be fooled. Two systems are not interoperable unless they conform to a shared interface. If someone says that a system is interoperable, have them demonstrate how their system sends and receives information from your other systems through a well-defined interface.

Acknowledgements:
Thanks to Nathan Bunker of Dandelion Software and Research for getting me thinking about interfaces this way, the Public Health Informatics Institute for organizing the Immunization Information Systems Joint Development meeting, and the CDC for funding it.

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Public Health Informatics Virtual Event on July 16-18, 2013 – Call for Abstracts!

Connect with colleagues at your own convenience!

ph informatics virtual event

This virtual event provides the opportunity to learn and discuss the latest initiatives in public health informatics with attendees from all over the country and internationally. Call for abstracts is now open and will continue until May 31, 2013. This year’s theme is “Strengthening Public Health – Health Care Collaboration.” Abstract submissions are encouraged in the following areas:

1)  Informatics policy and practice: virtual sessions will focus on national and international policy issues and their implications for public health informatics programs; applied informatics projects for programmatic support; and new initiatives

Examples might include:

  • ICD-10 CM/PCS –deadline for implementations 10/1/2014
  • Meaningful Use & Electronic Health Records
  • Interstate data exchange
  • Data exchange to support ACOs

2)  Research & Innovation: virtual sessions will focus on informatics research and technological innovation to public health and clinical settings.

Examples might include:

  • Applying analytics to new and existing data sources
  • Leveraging Big Data for population and public health
  • Learning health systems to support integration of primary care and public health
  • Novel technologies for population and public health education and communication (mobile, web, social media)

3)  Supporting Public Health Evidence Based through Informatics Practice: virtual sessions will focus on strengthening public health through knowledge sharing, evaluation, visualization and reporting.

Examples might include:

  • Evaluation methodologies and findings
  • Decision support for population health Health status and performance management dashboards
  • Community Health Assessments as part of the community health improvement process
  • Return on Investment (ROI) and Value of Information (VOI) analyses for informatics programs and systems

If any of the items above relate to your area of work, do not miss the opportunity to submit an abstract!

Help us get the word out and share this blog post with your colleagues and friends! And if you’re ready to submit an abstract go straight ahead here.

Meeting sponsors include CDC, NACCHO, and ASTHO.

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 »

Did you miss NACCHO’s Webinar on Public Health IT Preparedness: What LHDs Need to Do Now and Plan for the Future?

The webinar explored opportunities where local health departments can work with their state health departments, clinical partners and federal agencies to increase health IT workforce and technical capacity to achieve public health goals.

The speakers addressed the following questions:

  • What exactly should LHDs be doing to advance ePublic Health & Informatics within their departments and in coordination with health care partners?
  • Where and how can LHDs become more involved and demonstrate leadership?
  • Once an LHD is at the table, what should they articulate?
  • What should LHDs be doing now and planning for later?
  • How can LHDs measure their progress?

Presenters:

Claudia Blackburn, MPH, RNC, Health Director at Sedgwick County Health Department
Jon Rosell, Medical Society of Sedgwick County
James Coates, MS, RS, Informatician at Cuyahoga County Board of Health
Nedra Garrett, MS, Director of CDC’s Public Health Surveillance and Informatics Program Office Division of Informatics Practice, Policy and Coordination

View archived webinar here. Have questions for our speakers? Type in your questions through our comment box and we will be sure to find you an answer.

Focus your Vision for Success in Public Health Informatics

Often local health departments (LHDs) are stretched in multiple directions.  This is in large part due to the traditionally stove piped and programmatic funding of our organizations.

In our recent blog entry – A Vision For ePublic Health & Informatics – featuring Dr. David Ross Director of the Public Health Informatics Institute, LHDs are urged to have a visible and future vision for their informatics solutions.  While that is very important, there is so much happening that folks are often asking, “Where should I start?”  Well I believe you should attempt to find some focus.  It is important to have an overarching vision for informatics so, as Dr. Ross says in the video, you can “be prepared to use emerging technologies when they come”.  But I think once you have that broad vision, it is important to focus your resources on the project you will tackle right now.  Of course you must be flexible as new opportunities and challenges may come along, but you have to practice good project management and can’t be too distracted in your approach.

This takes a very high level of executive sponsorship.  You will have to devote personnel time, money, and may have to ration resources from other projects.  Start with getting leadership to ask the organization to really reflect on the question “What is our business? “Or “What do we want our business to be?”  With the competitive pressures of ACOs, FQHCs, HIEs, and other aspects of health care reform, it is more important than ever that local health departments know what our business is.  Healthcare partners should know when it comes to [Enter Your Health Department Name Here], organizations should contract with you to provide certain services.  These services could be things like Care Coordination, Home Health Visits, Specialty Care (HIV, STD, Dental, TB, Hepatitis, MCH), Primary Care for indigent populations, Surveillance, Environmental Health, Community Health Assessment, etc.

This understanding of your business will play a major part in defining where you should focus your informatics energy – but it isn’t everything.  You now have to account for other pressures like technical infrastructure, workforce, Meaningful Use Requirements, funding etc.  For example, do you have the right staff available for a project, can you receive Medicaid 90/10 funding through your state or Meaningful Use incentives, etc? And ask yourself, how long will this project take?  Set realistic timelines, while being cognizant of any time limitations on your funding.

So now you know what your business focus is, what stressors are constraining you, and what resources may be available.  You should be prepared to make an informed decision on where to focus your informatics efforts.  Like a laser you can develop a meaningful resource for your department that can enhance the work you do and improve efficiencies in your agency.  You can be a valued partner in the community and stake a claim on the work you do.  You can meet or exceed expectations and that will likely produce new resources for your health department in the future.

Let me give you an example.  Let’s say your overall vision for your health department involves creating a dashboard that provides real time information necessary for decision makers.  It may be unlikely that you are able to build this tool all at once to serve every information need of the department.  However, you do the assessment described above – survey your resources and environment to understand who is best suited to begin this project, which information is most needed right now, and which program may have some funding to support the project.  Though you will build the infrastructure of the system to easily accommodate future data source additions, you will have to decide where to focus first.  Let’s say you’ve decided to become a valued partner in the community by helping hospitals meet their IRS required community health assessments and you want the results of those assessments to be dynamically updated, near real time, and available to all pertinent decision makers in the health department, community, and hospitals.  The IRS requirement means your service is likely valuable and may support a line of funding from hospitals or other community partners.  You can now be focused on this project, get it accomplished in proper fashion – with Stakeholder participation and governance, project and risk management, and financing (see NACCHO’s tool – All Systems Go).  In 12 to 18 months you’ll have a success and then be ready to focus on the next part of your vision.

Be visionary, be organized, be realistic, be focused, and you’ll be successful.

Public Health Informatics – Then and Now

Welcome to the ePublic Health Talks blog! Thanks for joining us for our first post. We hope you will learn something new and share it with your colleagues. Your feedback is greatly appreciated and helps us improve the content of our blog. Please leave us a comment.

In this video, Dr. David Ross of the Public Health Informatics Institute gives a historic review of public health informatics and the vision he created 17 years ago. Dr. Ross gives sound advice on planning for the technologies of the future while learning from the past.