Data, Staff, and Money: Leadership Reflections on the Future of Public Health Informatics

Towards the Future of Public Health: Roadmapping Trends and Scenarios in the Post-COVID Healthcare Era

The COVID-19 pandemic, a transformative event in modern society, has disrupted routine, work, behavior, and human relationships. Organizations, amidst the chaos, have innovatively adapted to the evolving situation. However, many countries were unprepared for the magnitude of the challenge, revealing the fragility of health responses due to inadequate leadership, insufficient resources, and poor information system integration. Structural changes in health systems are imperative, particularly in leadership, governance, human resources, financing, information systems, technology, and health service provision. This research utilizes the Technological Roadmapping method to analyze the health sector, focusing on public health, drawing on articles from SCOPUS and PubMed databases, and creating a roadmap extending to 2050. The research presents three long-term scenarios based on the literature-derived roadmap and explores various alternatives, including integrated care, telemedicine, Big Data utilization, nanotechnology, and Big Tech's AI services. The results underscore the anticipation of post-pandemic public health with high expectations, emphasizing the importance of integrating health history access, encouraging self-care, and leveraging technology for streamlined treatment. Practical implications include insights for decision makers and stakeholders to inform strategic planning and adapt to evolving industry demands, recognizing the significance of preventive services and the humanizing potential of technology.

Evaluation of an Emergency Department Visit Data Mental Health Dashboard

CONTEXT

Local health departments (LHDs) need timely county-level and subcounty-level data to monitor health-related trends, identify health disparities, and inform areas of highest need for interventions as part of their ongoing assessment responsibilities; yet, many health departments rely on secondary data that are not timely and cannot provide subcounty insights.

OBJECTIVE

We developed and evaluated a mental health dashboard in Tableau for an LHD audience featuring statewide syndromic surveillance emergency department (ED) data in North Carolina from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT).

DESIGN

We developed a dashboard that provides counts, crude rates, and ED visit percentages at statewide and county levels, as well as breakdowns by zip code, sex, age group, race, ethnicity, and insurance coverage for 5 mental health conditions. We evaluated the dashboards through semistructured interviews and a Web-based survey that included the standardized usability questions from the System Usability Scale.

PARTICIPANTS

Convenience sample of LHD public health epidemiologists, health educators, evaluators, and public health informaticians.

RESULTS

Six semistructured interview participants successfully navigated the dashboard but identified usability issues when asked to compare county-level trends displayed in different outputs (eg, tables vs graphs). Thirty respondents answered all questions on the System Usability Scale for the dashboard, which received an above average score of 86.

CONCLUSIONS

The dashboards scored well on the System Usability Scale, but more research is needed to identify best practices in disseminating multiyear syndromic surveillance ED visit data on mental health conditions to LHDs.

Assessing Public Health Workforce Informatics Competencies: A Study of 3 District Health Departments in Georgia

CONTEXT

Despite the increased recognition of the importance of having informatics-competent public health professionals, the competency level of the public health workforce in public health informatics (PHI) has not been examined extensively in the literature.

OBJECTIVE

The purpose of this study was to assess public health workforce informatics competencies in select Georgia health districts and determine the correlates of PHI proficiency.

METHODS

This study is based on a cross-sectional quantitative study design. We conducted an online self-administered survey of employees from 3 selected district health departments to assess proficiency in foundational PHI competency domains. Three hundred thirty-three respondents completed the survey, with a response rate of 32.5%. A gap score was calculated as a proxy to identify informatics training needs. A path analysis was conducted to assess the relationships among contextual factors and foundational PHI competency domains.

RESULTS

The public health employees participating in this study reported relatively high proficiency in foundational PHI competency. Psychometric testing of the competency assessment instrument revealed 2 foundational informatics competency domains-effective information technology (IT) use and effective use of information. The effective use of IT mediated the relationship between employee-level factors of age and past informatics training and the effective use of information.

CONCLUSION

The study highlights the importance of improving the ability of public health professionals to leverage IT and information to advance population health. Periodic assessment of staff PHI competencies can help proactively identify competency gaps and address needs for additional training. Short assessment tools, such as presented in this study, can be validated and used for such assessments.

A step closer to nationwide electronic health record-based chronic disease surveillance: characterizing asthma prevalence and emergency department utilization from 100 million patient records through a novel multisite collaboration

OBJECTIVE

The study sought to assess the feasibility of nationwide chronic disease surveillance using data aggregated through a multisite collaboration of customers of the same electronic health record (EHR) platform across the United States.

MATERIALS AND METHODS

An independent confederation of customers of the same EHR platform proposed and guided the development of a program that leverages native EHR features to allow customers to securely contribute de-identified data regarding the prevalence of asthma and rate of asthma-associated emergency department visits to a vendor-managed repository. Data were stratified by state, age, sex, race, and ethnicity. Results were qualitatively compared with national survey-based estimates.

RESULTS

The program accumulated information from 100 million health records from over 130 healthcare systems in the United States over its first 14 months. All states were represented, with a median coverage of 22.88% of an estimated state's population (interquartile range, 12.05%-42.24%). The mean monthly prevalence of asthma was 5.27 ± 0.11%. The rate of asthma-associated emergency department visits was 1.39 ± 0.08%. Both measures mirrored national survey-based estimates.

DISCUSSION

By organizing the program around native features of a shared EHR platform, we were able to rapidly accumulate population level measures from a sizeable cohort of health records, with representation from every state. The resulting data allowed estimates of asthma prevalence that were comparable to data from traditional epidemiologic surveys at both geographic and demographic levels.

CONCLUSIONS

Our initiative demonstrates the potential of intravendor customer collaboration and highlights an organizational approach that complements other data aggregation efforts seeking to achieve nationwide EHR-based chronic disease surveillance.

Understanding data use and preference of data visualization for public health professionals: A qualitative study

OBJECTIVE

This study aimed to assess public health professionals' use of data, information, and evidence and to understand perceptions and preferences regarding data visualization to inform future design of data visualization tools.

DESIGN

We conducted qualitative interviews with public health professionals who use data for decision making as part of community health assessment and program planning from state and local health departments across six states.

RESULTS

We identified four themes: 1) collection of data, information, and evidence; 2) management and analysis of data and information to inform decisions; 3) use of data to support public health practice; and 4) preferences for data visualization and how visualization is being used. Public health professionals use data, information, and evidence from various resources for communicating with co-workers, stakeholders, and the public, and decision making regarding their programs and services.

CONCLUSION

Data visualization tools can help public health professionals improve their understanding and communication, their education of stakeholders, and their decision making using data, information, and evidence. Public health professionals believe in the value of using data, information, and evidence. Opportunities exist in ways to support public health professionals' data use by adopting data visualization tools and by mitigating systematic challenges in public health information systems.

Public Health Informatics in Local and State Health Agencies: An Update From the Public Health Workforce Interests and Needs Survey

Objective:

To characterize public health informatics (PHI) specialists and identify the informatics needs of the public health workforce.

Design:

Cross-sectional study.

Setting:

US local and state health agencies.

Participants:

Employees from state health agencies central office (SHA-COs) and local health departments (LHDs) participating in the 2017 Public Health Workforce Interests and Needs Survey (PH WINS). We characterized and compared the job roles for self-reported PHI, “information technology specialist or information system manager” (IT/IS), “public health science” (PHS), and “clinical and laboratory” workers.

Main Outcome Measure:

Descriptive statistics for demographics, income, education, public health experience, program area, job satisfaction, and workplace environment, as well as data and informatics skills and needs.

Results:

A total of 17 136 SHA-CO and 26 533 LHD employees participated in the survey. PHI specialist was self-reported as a job role among 1.1% and 0.3% of SHA-CO and LHD employees. The PHI segment most closely resembled PHS employees but had less public health experience and had lower salaries. Overall, fewer than one-third of PHI specialists reported working in an informatics program area, often supporting epidemiology and surveillance, vital records, and communicable disease. Compared with PH WINS 2014, current PHI respondents' satisfaction with their job and workplace environment moved toward more neutral and negative responses, while the IT/IS, PHS, and clinical and laboratory subgroups shifted toward more positive responses. The PHI specialists were less likely than those in IT/IS, PHS, or clinical and laboratory roles to report gaps in needed data and informatics skills.

Conclusions:

The informatics specialists' role continues to be rare in public health agencies, and those filling that role tend to have less public health experience and be less well compensated than staff in other technically focused positions. Significant data and informatics skills gaps persist among the broader public health workforce.

Public and Population Health Informatics: The Bridging of Big Data to Benefit Communities

Objective:  To summarize the recent public and population health informatics literature with a focus on the synergistic “bridging” of electronic data to benefit communities and other populations.

Methods:  The review was primarily driven by a search of the literature from July 1, 2016 to September 30, 2017. The search included articles indexed in PubMed using subject headings with (MeSH) keywords “public health informatics” and “social determinants of health”. The “social determinants of health” search was refined to include articles that contained the keywords “public health”, “population health” or “surveillance”.

Results:  Several categories were observed in the review focusing on public health's socio-technical infrastructure: evaluation of surveillance practices, surveillance methods, interoperable health information infrastructure, mobile health, social media, and population health. Common trends discussing socio-technical infrastructure included big data platforms, social determinants of health, geographical information systems, novel data sources, and new visualization techniques. A common thread connected these categories of workforce, governance, and sustainability: using clinical resources and data to bridge public and population health.

Conclusions:  Both medical care providers and public health agencies are increasingly using informatics and big data tools to create and share digital information. The intent of this “bridging” is to proactively identify, monitor, and improve a range of medical, environmental, and social factors relevant to the health of communities. These efforts show a significant growth in a range of population health-centric information exchange and analytics activities.