Introduction to Public Health Informatics

Introduction to Public Health Informatics

Music Greetings everybody, and
welcome to the Introduction to Public Health
Informatics, 101 Series. My name Nabil Issa. I’m the Associate
Director for Informatics at the CSELS Division
of Scientific Education and Professional Development. The objective of this
course is to provide you with the capability to explain
the importance of informatics in IT to public health mission. And to describe the
function and role the informatician in support of
these public health informatics practice. And last, but not least,
is to differentiate between public health
informatics and IT. First of all, informatics and
IT is a wide-ranging discipline. It is applied in everything
from space technology to delivering boxes by UPS. However, our focus here
is really public health. So we are going to look
at IT and informatics in the context of public health. So before we do this, the
first thing we’re going to do is take a look at the
public health approach. The public health approach
is simple, logical, very systematic. It starts by first
identifying the problem. And identifying the problem
requires data collection and definition of the problem. This is what CDC takes pride
of saying that they are an evidence-based organization. That means decisions,
interventions, science, and all the CDC product is based on a
very careful data collection and an analysis of the facts. This is what the
role of surveillance is in the public
health approach. Surveillance is about
collecting information about a specific disease
or condition in order to learn and understand the
problem that we are facing. Second, and after
surveillance, data collection is to understand
the risk factors. This comes from
evaluating the data that we’ve just
collected in step one and to define the
cause of this problem. And this is what we
interpret, here at CDC, as the basis for epidemiology. And once the risk
factors are identified, we then are going to have
to evaluate intervention and establish the science
and the methods that can be used in order
to stem this problem, stem the spread of diseases,
and prevent, and hopefully eliminate, 4444444444444444
444444444444444444 the cause altogether. Once we establish the
science and the methods for eliminating this disease
or solving the problem, we will move into
implementation. Implementation really is
simply the application of the science and
the methodology that we have devised
in the real world. And once this is done, of course
we don’t stop right here– and this is what this
chart doesn’t really show you fully– is that we
have to assess and repeat because we may have to re-cylce
back again and then evaluate our problem until
it is there anymore. This is the public
health approach. Well, public health really
depends on core sciences. These sciences are prevention
effectiveness, epidemiology, laboratory, informatics,
and surveillance. I’m going to start basically
this chart that you see in here is not
just the picture, but it’s also directional. And it really goes
counterclockwise. And I’m going to start with
surveillance and informatics. Surveillance and
informatics are very closely tied because both of them
are about data collection, analysis, and definition
of the problem that we are encountering. So that really comes
as the basic science for the public health approach. From there, we will
move into laboratories. In laboratories is where we
identify risk factors– what kind of viruses, what kind of
bacteria, what kind of carrier factor that we are dealing with. So laboratory really is
important in identifying the risk factors that
we’re dealing with. Now that we have the facts,
the data, and the factor, now we move onto the epidemiology. In epidemiology we identify the
preventive methods and science to stem the problem that we have
discovered through surveillance and informatics. Once the science and the
methodology for intervention and prevention has decided
by epidemiologists, then we’ll move on into the
prevention effectiveness and the application of the
science, the guidelines into stemming the problem. And then we continue
the cycle as you can see from counterclockwise. This is basically
the core science that goes into public health. Now we’re going to go
into topic two, which is a definition,
and the component, and the functions
of informatics. The public health
mission which is, “CDC provides crucial
scientific information that protects our nation against
dangerous and costly health threats.” Who do we provide it to? We provide it to health
care providers first. We give them guidelines. We give them science. We give them a response
strategy, et cetera, to be able to deal
with outbreaks, with response to emergencies
that affects the population health in general. We also provide
policymakers with guidelines on, for example, quarantine. So it is not only the
health care providers that CDC services, but also
it services the policymakers who can implement law
that ensure the protection of the public from outbreaks. We, also, provide data and
information and science to the population at large. So they are able to educate
them on how to implement their part of the prevention. And that could include
anything on how to deal with how to
reduce or eliminate the chances or the risk of
catching flu, to eliminate the risk from drinking
water, or eating raw meat et cetera, et cetera. So CDC addresses
the public, as well. CDC, also, provides
science and information to a wide range of
communities, even travelers. Travelers today, if you’re
going somewhere on a vacation or on business, you could
go to the CDC website and find out what are illnesses
or conditions and so on that are at your
destination, and what kind of vaccines or
preparations that you need to do to protect your health. So that is one of the services
that CDC provides to travelers. You could take the
range of things. CDC also provides
crucial information to, for example, during
flu outbreaks, even schools could go
to the CDC to find out do they really need to close
the schools and for how long? Now that we defined the
public health mission, we are going to define
what is informatics. So we could tie
informatics and IT to the public health mission. The public health
informatics is really the systematic application of
information, computer science, and technology to the public
health practice, research, and learning. In fact, I want to stretch
this a little bit more. This definition mostly fits
the IT role, rather than exactly the public
health informatician. And I would like to add
that an informatician really envisions and defines the
applicability of IT information science, computer science,
and technology to solving public health problems. OK let’s look at the details. What we are going to do
to explain this process is we’re going to use a metaphor
of building your dream house. So you have an idea
of what kind of house you really want to live in. You don’t go in there and
talk to an electrician about building your house. You don’t talk to a bricklayer. You don’t talk to a framer. You don’t talk to a
plumber, nor a painter, but they are all essential
to building the house. What you do is you go in to
a developer or an architect, and you explain to them
what you really want. The architects know exactly
what bricklayers do, and where, and when they are needed,
same thing with plumbers, electricians, and so on. But they also sit down and try
to understand what kind of life you really want to lead. Is your mother-in-law
going to live with you? You may need a
mother-in-law suite. Do you have kids? Do you not have kids? And so on. So the developer
and the architect has to understand what
your dream house is. And then, they come
up with drawings and envisioning all that you
may aspire for, and create a picture of what your
house is going to look like, but they also the
blueprints for what makes up the technical
part of the house. And that’s when the
architect will communicate with the other builders, whether
it’s bricklayers and so on, to start building your house. Similarly, and to
use that metaphor, if you’re a public health
official or a professional and you have a need for
a system to help you deal with your information–
collect information, analyze information, and
so on– where do you go? You don’t go to the programmers. You don’t go to a
database administrator. You don’t go to the network
administrator, nor a security specialist, or even
the web designer because first you have to have
a vision of what your system’s really going to do. What it is going to look like. You are going to have
to talk to somebody that understands your language. But, at the same time, that
person also understands what can be done and cannot be done
and what is the most suitable expertise required
to build your system. Very much like we explained
in building your house. But the informatician also
needs to know more than about building the software
and hardware for you. What they need to also know
is all about the security, the data standards. There are so many other issues
besides hardware and software that the public health is
really not even aware of, or have expertise in that
they need an informatician– that person that has one
foot in public health and one foot in IT–
to be able to help you determine the design and the
functionality of your system. This is the components, or
the specialty, or expertise, or skills that is needed
to build your public health information application. Based on what I have
explained so far we going to take
a knowledge check. Here is a scenario where we
have a TB outbreak in 10 states. To increase the knowledge
of the health threat and inform the public
and health care providers about
this outbreak, CDC will use information
methods that will inform the nation’s
population about the importance of– A, research, B,
health information, C, security measure. The answer to that
is B. Thank you. Another knowledge check. The public health informatics
uses the public health knowledge to A, broaden the
public health knowledge base through learning. In, other words to
educate the public about the epidemic or the
prevention methods and so on. B, to improve population
health in daily practice, C, further knowledge in public
health research, and D, is all the above. In other words, what is really
informatics intended to do with the A,B, or C? The answer is, all of the above. Topic number three
is we’re going to take a look at
the basic steps for creating information
systems for public health use. So far, we have discussed
the very basic principles of the public health
science and intervention. We also explained,
you know, the basics for building an information
system, or the roles of informatics through the
use of the building a house metaphor. Now, we’re going to
dig a little bit closer into how do we really create
a public health information system. We are going to start by the
roles of the informatician. The informatician, which
is in our metaphor was equivalent to the
architect, is the person that you want to talk
to, or the person who will go to epidemiologists,
who will go to surveillance professionals, and those
who are leading a prevention effort in public health. And he will try
to understand what is really their needs, what is
the problem they are facing? Whether technology has
a role in helping them resolve the problem
and implement prevention effectiveness. Or maybe there is no role
for technology in there. But this is not the developers
or the database administrators. This is not their role. This is really the role
of the informatician. Again, this is the person that
has a foot in public health and in IT. That person, after
talking to epidemiologist, surveillance specialists,
subject matter experts, will try to envision
and advise and provide a scenario in which technology
can be effectively used to solve this problem. So that person must really
understand the public health functions at least from
a knowledge point of view and explain to
those who are making the decision the capabilities,
opportunities, and limitations of introducing IT to
solve that problem. That’s not really all it
takes, but that person must take into
consideration data security, data
standards, policies on collecting the
data– for example, OMB requirements for
allowing even the CDC to go out and collect data. So that informatician will be
able to tie all of these pieces together and come up
with a proposed solution to that public health problem. One of our major
objectives, here, is to explain the difference,
not only just the functionality or what is needed to do to build
a public health information system, but also the
role of public health, the informatician, and
the IT professional in building that system. This is a very
congested slide in here. But it’s very important. And this is why there is a
separate copy of this slide is going to be provided to
you so you could follow up and you could use it
later after this course. On the left hand side, you
will see that first column. It displays step one
through step five. The very, very
simple, very basic steps that are necessary to
take to build a public health information system. First, you have to have a vision
for and a planning for what that system is going to do. You cannot just start digging
the foundation and building the walls before you know what
kind of dream house you really want. So step one, you have to have
the vision for what is it that you’re trying to solve. Number two, most systems
are all about data. You have to figure
out what data it is that you need to
understand your problem and to devise a solution to it. So you have to determine what
health data that you need. And once you mention data, you
are almost definitely deciding on standard linking
and integration because there is no data
that is an island by itself. It often has to be combined
and integrated and linked with other sets of data
right after it’s collected. Step number three, is
privacy and security. That is not to underestimate
what is federally mandated. That information
that is collected from the public on diseases or
anything else that is collected by public health must comply
with data privacy and security mandates, for example, HIPPA. Step number four, once you
know what the vision is, you know what data you need,
you know all the standards and privacy, and so
on that are required, and the function that you
need to apply to that, now you start
designing your system. And designing your system,
of course, is two steps. One is to determine all the
functionality on that data. What is it you
expect to come in? And how it’s going
to be processed. What’s going to go out? And then, once you have
that blueprint for a system, then you hand it over
for implementation. And that’s where IT
actually takes charge. And once you have
your system, and you start collecting your
data, and now the data is flowing, of course, you’re
doing that for a purpose. And that is to analyze that
data, to visualize that data, and to use it to make
informed decisions. Now we know step one
through five, who does that? Who decides on the vision? Who decides on the
data standards? Who develops these
systems is what we try to explain in
the right three columns. So you have public health,
you have the informatician in the middle, and
on the other extreme you have the information
technology professional. And you could see right
away, without looking at the yellow boxes in there,
that the informatician really has to span– he doesn’t have
to be a fully public health official. You don’t have to understand
the public health functions and missions and practice 100%,
but you have to be aware of it. This is why you will see that
these yellow boxes never cross from one extreme to another. At the same time, an
informatician doesn’t really need to know technology 100%. He or she needs to
be familiar and aware of the functions,
and the capacities, and the capabilities of
information technology in order to connect the public
health mission with the IT solutions. So I’m not going to go
into the details, here, but it’s just to explain
the purpose of this chart here because we’re going
to discuss the details in the succeeding slides. OK, well let’s start with the
vision and system planning. So you have a public
health problem. You say, I have a tuberculosis
outbreak in 10 states. I need to go to the
emergency department, or to clinics, and
so on, and I need to collect the data on patients
that go through these clinics. Well, do you use
paper and pencil? You can. This is how it was
done in the old days. Of course, as you know, and
without going into details, this could be very
time consuming. You could only
collect so much data. Once you come back
home, how are you going to consolidate it and
make it into one big, large list that you could analyze? I mean, you could have
anywhere from thousands to tens of thousands of cases. And that’s not possible to
do that manually or on paper. So you need to figure out some
other means, such as hardware, for example. Do you use a tablet? Do use a mobile device? Do you use a server on
the internet, and so on? Somebody has to
envision that solution. Somebody has to know and
piece all of that together. Software may exist. If there is a
software that exists, then our problem
is less complex. But if software needs
to be developed, we need to know what platforms. Do I have the right
software for the handheld? Do we get it for the
laptop, et cetera? And not to mention
the fact that we also have communication problems. Do we need to communicate
that data directly? Do we have to store
it and then send it to the CDC or a central place
using flash drives, CDs, electronic, over the internet? So there’s many, many
scenarios or situations that you have to envision. What kind of system
that you really need to tackle your problem. And this job really is
the informaticians job, who needs to decide,
and who has to have a knowledge of the capabilities
and the applicability of hardware, the
functionality of the software, and he has to have a
knowledge of the coverage, the throughput, the
geographic availability of the communication medium. So we haven’t gone
into any details. This is very high level
vision and system planning. From there, we go to the next
step, which is really data. It’s all about data. What data do we need
to go and collect? And in what format? And once we collect
data, we don’t want to collect data
we already have. If we already have demographic
data, we go in there and collect data about
patients in a certain area. And we come back, and then we
could link it and integrate it with the demographic
data we have. But to do this, we
have to make sure that the data we are
collecting can inter-operate and can link to other
data that we already have. So if we are collecting
data on TB, for example, we may want to integrate
and then link this with data that we have on HIV. And if we don’t use a standard
method for collecting the data and coding this data, then we
will not be able to link it. So this is not something
that comes after the fact. You have to think about this
before you build the system and start doing data collection. Otherwise, it’s
too late and you’re going to miss a lot on what
you can get out of the data. So health data standards
and integrations are really important. Next, after we decide
what data and what data standards we are
going to use, we have to address
issues because we don’t know if privacy
really applies or not until we determine
what data we need. So we found out
that we really need to know the person’s name, birth
date, address, where they live, and so on. Well, this is
private information. To handle private
information at the CDC, there are mandated
government requirements. There are HIPAA regulations. There are even additional
security and privacy issues that we really need to address
before we start developing the system because they
do affect the design and the development of the
software that comes next. And there is really
no compromise on data security and privacy. And when we talk
about data security, we sometimes interpret it
in the context of privacy. But part of data
security is also integrity, the
integrity of the data. We don’t want to collect
the right information about the wrong person, or
the wrong person associated with the right information. We need to make sure that
this data is accurate. It is, when we collect it, it’s
not susceptible to corruption or loss because that does affect
privacy and security of data, as well. So the quality of that
data is very important and needs to be addressed
before we start actually designing the system
because our system design is going to be impacted,
affected, and shaped by all that we have discussed above. Now that we know the vision for
what the system is going to do, what it’s going to
look like, and what it’s going to consume
in terms of input, and provides in
terms of output, we know the data security,
the coding, the standards and all of that, now we are
ready to sit down and start designing the different
components for the hardware that we’re going to collect. We may need software
for handheld devices to collect the data. And we need hardware
for servers to host the data that is collected
by these mobile devices. So you could see why
these previous steps are necessary to be done
before we get into the data design and implementation. The data design and
implementation, as it says, there really is two steps. One is to design the blueprint
for the components that are going to go into
developing that software. This is usually
an informatician, a systems analyst. This is where the
informatics professional has to have a good
knowledge of the IT. So they don’t need to implement. Just like in our
metaphor, the developer needs to understand what
the bricklayers does, what the electricians
do, and so on in order to the provide them
with this blueprint for the house and
the specifications for them to start implementing. So the first step, the
definition and the design is heavily slanted in the
informaticians role, as well as some IT. The implementation,
on the other hand, once you have the blueprint
for what needs to be done, this is when the bricklayer
and the electrician they use these to
go on their own and start doing
the implementation. And that’s the stage, which
is really very IT heavy. So that is system design
and implementation. Of course, we
finished our system. We developed the software. We tested it. We catered for all the security,
for all the data standards. We started collecting the data. But we do all of
this for one purpose, for eventually
the final purpose. And this is to start analyzing
and visualizing and tracking that information. And that final step
really is not so much IT. You may use IT tools to do
this, but the visualization and the analysis
of data, what if. And recognizing patterns
in the data and so on. This is when the
informatician can help. But, also, it’s a
public health function where you have
statisticians, and then you have epidemiologists and
public health officials who will be using these
analytical tools to do the data. With all of these
five steps, we have completed a very simple public
health information system. Let’s take an
example, for example, of an application that
was developed by the CDC for tracking the flu. FluView is one of
CDC’s software that gives you a clear cut way to
share national influenza data. And that is really needed by
the public health community– by clinicians, by scientists,
and the general public. And I would add on to this
list, also, communities. Communities meaning the
school administrators. As I gave an example before,
in case we have the flu, do we need to close
the school or not? And that’s where CDC
provides the information to make their decisions
and their recommendations to make the decisions
by the school officials easier to achieve. How do we do that? Of course, here is the way
that scientific data is not easy to understand by
the general public. So this data has to be, once
we collect it and we track it on a daily basis, we have to
present it to decision makers at all levels in a way
that is the digestible, easy to understand. One example of this and
one really prominent way of presenting data are maps. And you take, for example, this
is a very realistic map that shows the influenza cases
between 2012 and 2013. And you can see how it is
very easy to look at this data and find out where is the
high presence of influenza. As you can see, in Texas,
in the south here somewhere, up in the Midwest, and so on. So that is just
an example of how data that is
collected by the CDC could be published for use
by a wide range of users. Well, we are at a
knowledge checkpoint here. On the basis of what
you have learned so far about creating an information
system to help solve a public health problem,
which of the following does an informatician
consider first when identifying technology
to use for sharing national malaria data? That FluView that you’ve
seen, in other words, what was the first step taken
to develop such a system? Health data standards
and integration? Vision and systems planning? System design and
implementation? Obviously, the answer is
B because first you really have to have a vision of
what the system is going to look like– what
is it supposed to do, who is going to be using it and
so on– before you dig deeper into the details of data
standards and development and implementation. Another knowledge check. Informatics is used to create a
program– such as CDC’s FluView as we showed you a very, very
brief snippet of that– which of the following
three disciplines must work together
to visually represent the data in an effective method? In other words, what would
you use to visualize the data? Is it computer
science, epidemiology, and public health? B, technology, computer
science, and applied information methods. C, technology, surveillance
system, and epidemiology. This is a very
tricky question that could be really interpreted
in several ways. But what we’re trying
to say, here, it’s really technology and computer
science and applied methodology that is used to produce,
for example, the map that you just have seen. OK, the last topic
that we have is at the intersection
of the informatician, the public health official, and
the information technologists. It’s a very interesting topic,
but it’s a topic that has been, and up until today,
is very confusing to many people in public health. Where does public
health start and end before informatics starts and
ends before IT starts and ends? So people are confused. Who is really the
informatics professional? Who is the IT professional? And who is the public
health professionals? It overlaps, there Is no doubt. And we feel that
this is long overdue that we attempt to
explain the difference and where do these
specialties really intersect. That’s what really is important
because it’s not clear cut. It is not a black
and white line that says this is the public
health informatician. This is what they know. This is what they do. And then the
informatics and the IT. There is definite
overlap and you will see that in the next slide. In this slide, which
you already have seen that presents the
five steps for building a public health
information system, now what we’re
going to do is we’re going to explain the
yellow boxes, which says of all these steps– one
to five– how much public health knowledge do we really need? How much informatics
knowledge do we need? And how much technology do
we need or is really involved in performing this step? On the vision and
system planning, we need a person that
has a broad knowledge of the public health practice. You don’t have to be
an epidemiologist. You don’t have to be a
surveillance professional. You don’t have to be a
public health advisor. But you need to
know what they do. You need to know what the
public health practice is about, but you don’t have to be
a professional in there to be able to envision
an IT solution that solves public health problems. That person also doesn’t
need to be a developer, doesn’t need to be a
system administrator that is able to service
and maintain hardware, nor that person needs to be able
to design and develop software. But they need to know what the
software can and cannot do. They need to know
what is the difference between a server and a PC,
a mobile device, a laptop. And what are the opportunities
of using them to solve the public health problem. At this stage, at
the first step, which is the
envisioning a system and finding out what is
in technology can be used for that particular
public health problem, the informatician has a really–
and it’s not a one person problem, remember. The this is a
multi-disciplinary approach, so therefore, an
informatician has to know a little
about public health, but they have to consult and
get the public health officials or professionals input
into this process, as well as a
technologist because they need to rely in some details
about the capabilities and capacity of the different
hardware and software and communication solutions. So you could see that
for the first step, we need a broad spectrum
of expertise that goes into the defining the
vision and planning the system. The next step, which is
the health data standards, really has two aspects to it. One is to define, obviously,
what data do we need and what coding
standards do we need. Do we use ICD-9? Do we use HL7? Do we go to health
information exchange? And we need to understand
what electronic health records they maintain or what
electronic lab reports that they get and so on. So all of this is
really not something that the IT professionals– in
other words, the programmers, and the software developers,
and the system administrators and so on– they don’t really
understand what that is. They are not up to
knowledge as far as ICD or HL7 is
concerned and so on. This is really between the
public health professionals and the informatician. But, of course,
with some, in fact, if I have anything
to do with this, I will even shrink that
yellow box a little bit and show less
technology involved in this step– less
information technology involved in completing this
sub-step in number two. The second stage of this step,
once we have defined the data standards and so on, we
have to design and develop the tables that are going to
go into storing this data. We may have files. We may have what they
call SQL Servers that consist of tables that link
together with columns and rows and so on that are needed to
receive and store our data. So this is really mostly not
a public health professional skills required skill or knowledge. This is very much between the
public health informatician and the IT professional. And only a certain segment
of the IT professionals, which is really mostly
database administrators that are involved in determining
the design of the database that is going to receive the data
fields or the data columns that have been decided
by the informatician and the public
health professionals. So that’s the range of
skills and expertise you can see here that is
required to perform step two. Step three, which is really
data privacy and security, it definitely takes a knowledge
of the Health Information Portability and
Accountability Act. That is not something that
the information technologists really understand at all. And when it comes to
getting OMB compliance, or permission to
collect the data, or determining whether this
is privately identifiable information or not, is really
up to the epidemiologists, the surveillance professionals
and the informatician to sit down and decide what
data privacy, data quality, what kind of policies,
sharing of this data. You cannot just collect the
data and put it on the web for everybody to
see, for example. There are conditions on how
this data is going to be used. This is not an IT issue. This really spans the
public health and, then, the informatics domain
or skills knowledge. However, to implement
the security– like putting user
IDs, passwords, sometimes encryption,
sometimes limitations on who can access and
not access the data and so on– the implementations
of security is really in the IT domain, fully in the IT domain. They just simply have
the key to the vault. It’s simply the system
administrators, the software developers, the
database administrators. Those are the people that have
very low access to just about everything, the lowest level in
both the software and the data spectrum. So the implementation of
data privacy and security. Then, once it’s the
decided and determined by public health
and informatician, goes into the IT
professionals to implement. System design and
implementation, all the functionality that
goes into the data– converting data, data flow, case
definition, case definition is really mostly a
public health function. The public health officials,
or the epidemiologists, or the surveillance
professional will determine what constitutes a flu case. How do you identify a flu case? That is not something the
informatician– although it looks like it’s heavily focused
on the informatician area– it should really stretch more
towards the public health. Data interoperability,
and so on, in that portion of
the system design really belongs between
the public health and the informatician. Once the blueprints are drawn
for what the data should look like and the functionality
and how the data should flow and how the data should be
secured and accessed and so on, then it is handed over to
the technologists– who have the knowledge and expertise
in managing information, developing the system,
creating the databases and so on– to perform that. At that stage, we are really
done with the development of the system. And then, we go into the vision
and analysis and reporting of the health data. What this really
requires is, this is mostly a person who is
most likely a statistician, or a person that is able to
synthesize and report data. So the expertise in
public health practice is definitely needed because
we don’t really know. We may be looking for a specific
spike somewhere in that data. For example, certain
symptoms being reported. So this only can be determined
by the public health professional. But the implementation
of the logic, and the software, and
the use of the systems– like SAS, or R, or even
writing customized software– that is going to really
require the informatician and the IT
professionals to cater for these special
analytical needs. But when it comes
to analyzing data, then you really need a
wide spectrum of expertise. Definitely public health,
definitely IT, in case there is a specific analytics
things that we need to do. And then the informatician
straddles both the IT and the public health on that. That really
summarizes, basically, all that we have
been talking about, which is the steps to
create a public health information, and
then the skill set, and the competencies
that are needed. More specifically the
overlapping skills and expertise needed
across the public health, informatician or informatics,
and the information technology. So let’s summarize
really the difference. We are going to have a
text that you can walk away with that you could refer to–
rather than going into all the details that we have
discussed so far– that will explain to you what
is an informatician, or an informatics
professional, and what is an IT professional,
or a technologist. Let’s start with the role of the
informatician in public health. And you’re going to note there
is some repetition in here, but this really is
a snippet of text or a summary of all
of the functions that are performed
by the informatician. Of course, number one is
to plan, design, and define functional requirements for
public health information system. That is what we refer to as
having the vision to what is needed and how do we go
about defining the boundaries in the scope for such a system. The number one is to evaluate
the application and impact of information systems
in support of the goals. Just because we have
technology, doesn’t mean that we have a solution. Understanding and
knowing the technology and being able to communicate
with the technologists, you have to be able to see is
there an opportunity in using technology, what technology,
when, and where, and so on. The informatician also
serves as a liaison between a
multi-disciplinary team. The informatician has to be able
to understand the public health language and the IT language. And there is a big
divide in here. Many times in our systems,
we spend lots of money and where systems go wrong
is in the misinterpretations of requirements. The technologists think
that you said, football. And they developed a
soccer game for you. We want to eliminate
that misunderstanding by bringing somebody
who is really aware of the language that is
spoken by both disciplines. Use data standards to
support interoperability of data between systems. Who is really going to
be on top of knowing, for example, how
do we code gender? Do you do we use M for
male and F for female? And what do you use for other? Do we use O? Or maybe somebody says,
no, we cannot do that. We have to use zero
and one, and no. My God what is no really? It is a nothing,
but it’s a concept that technologists
may understand, but public health
don’t really relate to. So there is lots of
data standards and data coding issues that are necessary
to not only get the right data, but also to be able
to link and make more meaningful
use out of the data once it’s collected
and brought in. So the informatician is
really just the right person to be the person who really
understand all the data codings and standards. Ensure confidentiality,
security, and integrity standards. You can’t really rely
on technologists– especially today
technologists art is mostly an
outsourced profession. You may have a contractor
working on your system today, once it’s done, or even
halfway into the process, this person is gone. So there is somebody that
has to carry that torch. And the person who
really should be on top of the security, and
confidentiality, and integrity issue is the informatician. And the informatician
also should be knowledgeable about health
data standards, sources, and meaningful use
of health data. For example, we know
that there is plethora of health information exchange. And there are what they call
health data aggregators now. They are coming
all over the place. I mean there is
electronic health records, electronic lab reports,
even social media is getting into the health
data domain and so on. Who is going to keep
track of all if these? Where the data flows. How does it flow from hospital,
to local health departments, to state health? Understanding that whole
system is really not– Of course, in their
own specific domain, the public health
professionals may need to understand some of that. The technologist, or
the IT professionals don’t really understand
the National Health systems and where data is. There’s a certain
specialty in there and certain skill it
takes to understand how the national
data is collected, where it’s a stored, how it
flows, how it’s being used, and so on. That is really the major
role of the informatician. And now to explain the
role of the technologist or the IT professional, which
is the programmers, the database administrators, the web
developers or designers as we call them, the
communication specialist, the system administrators, all
of these buzz words in there that make up the technologists
or the information technology professionals. Their role really is to
plan technology projects and milestones, develop
software, and maintain and operate systems. They don’t necessarily
define requirements. They don’t necessarily define
the flow or the components or the blueprint for a
public health application. But they certainly do
take that blueprint and they implement it. They develop all
the nuts and bolts that it takes to make that
blueprint work in real life. Once the system is developed,
you don’t throw away the key. You have to operate. And the information technology
specialist, they evaluate. They are constantly
monitoring the performance, the availability, the uptime
of the servers, the throughput of the communication
links, and so on, lots of things that
must happen to make sure that this system that has been
developed is up and running and accessible by those
people that need it. The third is really the designs,
implements, and administer database architecture,
privacy security, and backup procedures. These are all examples of
what the IT professionals do following the instructions
and the specifications of the informatician and the
public health professional. I could understand where there
may be some gray areas still between a technologist and
a public health informatics specialist, but at
least if you are able to see where the
focus in their role we would have achieved or
purpose from this course. OK, now a knowledge check. One of the United Nations’
Millennium Development Goals is to substantially reduce
infant mortality worldwide. A system has been developed
that will display the data and track the progress
of attaining this goal. Which of the following
professionals work with health data
standards and sources and ensures the integrity
and security of standards? Who is the person who really is
the custodian, in other words, of the privacy and
integrity of the data? It is the informatician. The information
technologist will implement and puts the bolts–
in other words, GM will build the car for
you, you’ve got to drive it. You’ve got to keep it safe. You are going to
clean it and so on. If there’s something
broken with it, you could take it back to
the factory to be fixed, but you’re in the driver’s seat. So the informatician will build
all the capabilities for you, but there is somebody that
has to have the oversight and the control over that. Another knowledge check. Which of the following
is NOT– it’s in capital letters– is NOT
a function of a public health informatician? Use data standards to
support interoperability of data between systems. Ensure confidentiality,
security, and integrity standards. Designs, implement,
and administer the database architecture,
privacy, security and backup procedures. Is knowledgeable about health
data standards, sources and meaningful use
of health data. Tricky question. Note the NOT in here. Which one of the A,B,C, D the
informatician does not do? Number C. The informatician
doesn’t really implement. They don’t program. It is just like the
architect doesn’t sit down and build walls and
put wires through the walls and do plumbing and so on. The architect simply
draws the blueprints and manages that
everything is being implemented properly before they
hand the house to the customer. The actual implementation and
ditch digging and wall building and wire installations
and so on this is not the informatician, as
indicated here in number C. OK, so this really
concludes the course. And to summarize of
what I have attempted to explain to you, hopefully. One is to explain the
importance of informatics to the public health mission. I think my question
on this is, do you think you could really
do public health today without information or
information technology? Is it really possible to
track, collect data, assess, evaluate, intervene, and
so on, and disseminate the right information to health
practitioners, the public and so on without
information technology? I think we probably somewhat
touched base with the fact that informatics and
information technology really do solve problems
in public health. And we also explained
and described the role of the informatician
in public health practice. This is really a
fairly new profession because we always
knew public health and we always knew that
there were IT professionals. And somehow somewhat
systems were very basic. You brought a
programmers and they developed some specific
procedure for you. Well, information systems
are getting very complex. You need a multi-disciplinary
IT specialty. The database administrators do
not program, believe it or not. And programmers are not
really that proficient in designing data
models and databases. Same thing with communication. There are communication
specialists. Now we have information
system security officers. Those are very specialized
professions in IT and so on. So I hope that I was able
to explain and hopefully the role of the
informatician– and that is the person who has a foot in
IT and a foot in public health. And then finally, and this is
what we did in the last section in this yellow
boxes, we have been able to not draw black and
white lines between what is an informatician and
what is an IT professional, but at least you are
able to differentiate the roles between public
health informatics and information technology
roles or skill set. And with this, we conclude
our Informatics 101. Thank you for taking the
time to listen to that.

5 Replies to “Introduction to Public Health Informatics

  1. The content is interesting, level and depth of information is just right. I know enough to understand concepts but not getting bogged down in details. The questions were really helpful to capture. Look forward for more Health Informatics topics!!

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