Suchergebnisse

The discipline of public health informatics, part of the broader eHealth field, brings methods, knowledge, and theories from computer science and information science to support population health and well-being. This branch of informatics is most often found in governmental public health agencies that focus on population-level activities, including surveillance of disease as well as disease prevention. There are several specialised public health information systems used to prevent or mitigate disease, including syndromic surveillance, electronic laboratory reporting, and population health dashboards. This article defines and describes public health informatics and its role in eHealth. The article further discusses the role of public health information systems and challenges they face for the future. Strengthening public health will require greater investment in interoperability as well as analytics and the workforce. Disease outbreaks like COVID-19, Ebola, and H1N1 demonstrate the need for robust public health informatics applications and methods. Yet there is much work to be done to evolve existing tools and methods to strengthen the public health infrastructure for the next pandemic.

Objectives To survey advances in public health and epidemiology informatics over the past three years. Methods We conducted a review of English-language research works conducted in the domain of public health informatics (PHI), and published in MEDLINE between January 2012 and December 2014, where information and communication technology (ICT) was a primary subject, or a main component of the study methodology. Selected articles were synthesized using a thematic analysis using the Essential Services of Public Health as a typology. Results Based on themes that emerged, we organized the advances into a model where applications that support the Essential Services are, in turn, supported by a socio-technical infrastructure that relies on government policies and ethical principles. That infrastructure, in turn, depends upon education and training of the public health workforce, development that creates novel or adapts existing infrastructure, and research that evaluates the success of the infrastructure. Finally, the persistence and growth of infrastructure depends on financial sustainability. Conclusions Public health informatics is a field that is growing in breadth, depth, and complexity. Several Essential Services have benefited from informatics, notably, "Monitor Health," "Diagnose & Investigate," and "Evaluate." Yet many Essential Services still have not yet benefited from advances such as maturing electronic health record systems, interoperability amongst health information systems, analytics for population health management, use of social media among consumers, and educational certification in clinical informatics. There is much work to be done to further advance the science of PHI as well as its impact on public health practice.

Objective: To categorize and describe the public health informatics (PHI) and global health informatics (GHI) literature between 2012 and 2014. Methods: We conducted a semi-systematic review of articles published between January 2012 and September 2014 where information and communications technologies (ICT) was a primary subject of the study or a main component of the study methodology. Additional inclusion and exclusion criteria were used to filter PHI and GHI articles from the larger biomedical informatics domain. Articles were identified using MEDLINE as well as personal bibliographies from members of the American Medical Informatics Association PHI and GHI working groups. Results: A total of 85 PHI articles and 282 GHI articles were identified. While systems in PHI continue to support surveillance activities, we identified a shift towards support for prevention, environmental health, and public health care services. Furthermore, articles from the U.S. reveal a shift towards PHI applications at state and local levels. GHI articles focused on telemedicine, mHealth and eHealth applications. The development of adequate infrastructure to support ICT remains a challenge, although we observed a small but growing set of articles that measure the impact of ICT on clinical outcomes. Discussion: There is evidence of growth with respect to both implementation of information systems within the public health enterprise as well as a widening of scope within each informatics discipline. Yet the articles also illuminate the need for more primary research studies on what works and what does not as both searches yielded small numbers of primary, empirical articles. Conclusion: While the body of knowledge around PHI and GHI continues to mature, additional studies of higher quality are needed to generate the robust evidence base needed to support continued investment in eHealth by governmental health agencies.

Objective: To develop a conceptual model and novel, comprehensive framework that encompass the myriad ways informatics and technology can support public health response to a pandemic. Method: The conceptual model and framework categorize informatics solutions that could be used by stakeholders (e.g., government, academic institutions, healthcare providers and payers, life science companies, employers, citizens) to address public health challenges across the prepare, respond, and recover phases of a pandemic, building on existing models for public health operations and response. Results: Mapping existing solutions, technology assets, and ideas to the framework helped identify public health informatics solution requirements and gaps in responding to COVID-19 in areas such as applied science, epidemiology, communications, and business continuity. Two examples of technologies used in COVID-19 illustrate novel applications of informatics encompassed by the framework. First, we examine a hub from The Weather Channel, which provides COVID-19 data via interactive maps, trend graphs, and details on case data to individuals and businesses. Second, we examine IBM Watson Assistant for Citizens, an AI-powered virtual agent implemented by healthcare providers and payers, government agencies, and employers to provide information about COVID-19 via digital and telephone-based interaction. Discussion: Early results from these novel informatics solutions have been positive, showing high levels of engagement and added value across stakeholders. Conclusion: The framework supports development, application, and evaluation of informatics approaches and technologies in support of public health preparedness, response, and recovery during a pandemic. Effective solutions are critical to success in recovery from COVID-19 and future pandemics.

OBJECTIVE: To develop a conceptual model and novel, comprehensive framework that encompass the myriad ways informatics and technology can support public health response to a pandemic. METHOD: The conceptual model and framework categorize informatics solutions that could be used by stakeholders (e.g., government, academic institutions, healthcare providers and payers, life science companies, employers, citizens) to address public health challenges across the prepare, respond, and recover phases of a pandemic, building on existing models for public health operations and response. RESULTS: Mapping existing solutions, technology assets, and ideas to the framework helped identify public health informatics solution requirements and gaps in responding to COVID-19 in areas such as applied science, epidemiology, communications, and business continuity. Two examples of technologies used in COVID-19 illustrate novel applications of informatics encompassed by the framework. First, we examine a hub from The Weather Channel, which provides COVID-19 data via interactive maps, trend graphs, and details on case data to individuals and businesses. Second, we examine IBM Watson Assistant for Citizens, an AI-powered virtual agent implemented by healthcare providers and payers, government agencies, and employers to provide information about COVID-19 via digital and telephone-based interaction. DISCUSSION: Early results from these novel informatics solutions have been positive, showing high levels of engagement and added value across stakeholders. CONCLUSION: The framework supports development, application, and evaluation of informatics approaches and technologies in support of public health preparedness, response, and recovery during a pandemic. Effective solutions are critical to success in recovery from COVID-19 and future pandemics.

BACKGROUND: Given the widespread adoption of electronic health record (EHR) systems in health care organizations, public health agencies are interested in accessing EHR data to improve health assessment and surveillance. Yet there exist few examples in the U.S. of governmental health agencies using EHR data routinely to examine disease prevalence and other measures of community health. The objective of this study was to explore local health department (LHD) professionals' perceptions of the usefulness of EHR-based community health measures, and to examine these perceptions in the context of LHDs' current access and use of sub-county data, data aggregated at geographic levels smaller than county. METHODS: To explore perceived usefulness, we conducted an online survey of LHD professionals in Indiana. One hundred and thirty-three (133) individuals from thirty-one (31) LHDs participated. The survey asked about usefulness of specific community health measures as well as current access to and uses of sub-county population health data. Descriptive statistics were calculated to examine respondents' perceptions, access, and use. A one-way ANOVA (with pairwise comparisons) test was used to compare average scores by LHD size. RESULTS: Respondents overall indicated moderate agreement on which community health measures might be useful. Perceived usefulness of specific EHR-based community health measures varied by size of respondent's LHD [F(3, 88) = 3.56, p = 0.017]. Over 70% of survey respondents reported using community health data, but of those < 30% indicated they had access to sub-county level data. CONCLUSION: Respondents generally preferred familiar community health measures versus novel, EHR-based measures that are not in widespread use within health departments. Access to sub-county data is limited but strongly desired. Future research and development is needed as LHD staff gain access to EHR data and apply these data to support the core function of health assessment.

Despite laws that require reporting of sexually transmitted diseases (STDs) to governmental health agencies, integrated surveillance of STDs remains challenging. Data and information about testing are fragmented from information on treatment and outcomes. To overcome this fragmentation, data from multiple electronic systems spanning clinical and public health environments were integrated to create an STD surveillance registry. Electronic health records, disease case records, and birth registry records were linked and then stored in a de-identified, secure server for use by health officials and researchers. The registry contains nearly 6 million tests for 628,138 individuals over a 12-year period. The registry supports efforts to understand the epidemiology of STDs as well as health services and outcomes for those diagnosed with STDs. Specialized disease registries hold promise for collaboration across clinical and public health domains to improve surveillance efforts, reduce health disparities, and increase prevention efforts at the local level.

Indiana faces significant challenges in maternal and infant health, ranking 45th worst in infant mortality with a rate of 6.5 deaths per 1,000 live-births, and 21st in stillbirths. Indiana further has the 3rd highest rate of maternal mortality with 44 deaths per 100,000 live-births. Despite these alarming statistics, comprehensive surveillance of maternal and infant health is absent, and data often remains fragmented across disparate information systems.
In response, the Indiana University Fairbanks School of Public Health and Regenstrief Institute secured a cooperative agreement through the CDC's Pregnant People-Infant Linked Longitudinal Surveillance (PILLARS) program, collaborating with the Indiana Health Information Exchange, Indiana Department of Health, and Marion County Public Health Department. The initiative aims to enhance Indiana's infrastructure for surveillance of maternal and child health (MCH) using electronic health records (EHRs), public health, and administrative data. Key efforts have included development, validation, and application of linkage algorithms across records for mothers and children; integration of case data across data sources; design of routine surveillance reports; and design of longitudinal studies to examine determinants and outcomes in MCH populations. Using deterministic linkage algorithms, we have created over 800,000 mother-infant dyads; this number will expand with the implementation of probabilistic approaches. We also have developed a computational phenotype for identifying cases of pregnancy in the EHR even when not explicitly flagged in the EHR. Future efforts will build on this infrastructure to draw from additional public health data sources and/or expand surveillance efforts to include prioritized MCH outcomes.