WEEK 9: Public Health Practice Applications

True

True or False: For many years, public health practitioners stated the belief that if nobody thought about public health, then the public health must be doing its job.

True

True or False: The battles that health practitioners waged against infectious diseases such as malaria, tuberculosis and leprosy, chronic diseases and environmental health hazards were often not highlighted in the media.

True

True or False: In recent years, after recent outbreaks of SARS and influenza A virus or (H1N1), dramatic large scale food borne disease outbreaks and the explosion of chronic illnesses that are linked to multiple vectors such as obesity, public health is frequently in the media limelight.

Local public health information and data exchange entities acquire various data in public health

What does this diagram show?

information technology

So to be able to manage this overwhelming deluge of data and information, public health practitioners have tapped into what?

2000-2010

During _______, public health has adjusted information systems to meet its special needs. To better understand and improve the nation’s health, it is important to connect clinical care, clinical care information systems, laboratory systems, and other data sources

C.E.A. Winslow

Who defined public health as science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organization, public and private communities, and individuals?

Public Health

Science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organization, public and private communities, and individuals

Public Health Service (PHS)

Was established in 1798 by the Marine Hospital Service Act

1798

Public Health Service (PHS) was established in ____ by the Marine Hospital Service Act

Marine Hospital Service Act

Public Health Service (PHS) was established in 1798 by the what?

Public Health Service Act

The passage of what broadened the PHS mission to protect and advance the nation’s physical and mental health

IOM’s The Future of Public Health

In this seminal study, the function of public health were described as assessment, policy development, and assurance

1. Assessment

2. Policy Development

3. Assurance

3 Functions of Public Health (according to the IOM’s The Future of Public Health)

Assessment

Function of public health (according to IOM’s The Future of Public Health)

• Includes surveillance (watching for signs of dss), case finding (identifying those sick), and monitoring trends (checking whether inc or dec).

• This is what gov’t health agencies use to make decisions and create health policies

• Checking for outbreaks of diseases like dengue fever, or long term dss in a population diabetes, or heart disease.

• Surveillance

• Case Finding

• Monitoring Trends

What is included in assessment, a function of public health?

Policy Development

Function of public health (according to IOM’s The Future of Public Health)

• Means working together with the community to make health plans and growth

• Invs listening to ppl in the comm, deciding what health problems to address first, and finding resources like money, ppl, supplies

• Examples: rules for safe food handling and storage and clean drinking water policies

Assurance

Function of public health (according to IOM’s The Future of Public Health)

• Making sure health rules and policies are actually carried out.

• PPl get resources need to stay healthy

• Checking what is promised

• Includes access to vaccinations, prenatal care and mental health services

US Public Health Service

Who described the 10 essential services of public health?

10 Essential Services of Public Health

These are the practical steps that supports the three core functions (assessment, policy development, and assurance)

MD IM DELA ER

1. Monitor Health

2. Diagnose and Investigate

3. Inform, Educate, Empower

4. Mobilize Community Partnerships

5. Develop Policies

6. Enforce Laws

7. Link to Services

8. Assure Competent Workforce

9. Evaluate

10. Research

10 Essential Services of Public Health

Monitor Health

10 Essential Services of Public Health

• keeping track of the community's health and identify problems

Diagnose & Investigate

10 Essential Services of Public Health

• finding the cause of health issues and respond to outbreaks

Inform, Educate, Empower

10 Essential Services of Public Health

• Sharing information so people understand and can improve their health

Mobilize Community Partnerships

10 Essential Services of Public Health

• Working with groups and organizations to solve health problems

Develop Policies

10 Essential Services of Public Health

• Creating rules and plans that support health and safety

Enforce Laws

10 Essential Services of Public Health

• Making sure health and safety regulations are followed

Link to Services

10 Essential Services of Public Health

• Helping people get the health care they need

Assure Competent Workforce

10 Essential Services of Public Health

• Training and supporting health professionals

Evaluate

10 Essential Services of Public Health

• Services so checking if health programs are effective and accessible

Research

10 Essential Services of Public Health

• Innovate, looking for new solutions and better ways to improve health

True

True or False: Although there are numerous sources of public health data and information, the sources lack standardization in data organization, nomenclature, and electronic transmission

Public Health Informatics

Defined as the systematic application of information and computer science and technology to public health practice, research, and learning

population

Public health informatics, like public health, focuses on ____.

False: … supporting preventive as opposed to curative intervention

True or False: In public health informatics, population level data and information are collected, analyzed, and disseminated with the ultimate goal of supporting curative as opposed to preventive intervention

Privacy Rule

What provision in HIPAA generally prohibits disclosure of an individual's medical records and payment history without express authorization of the individuals?

2004 Health Insurance Portability and Accountability Act (HIPAA)

The Privacy Rule is a provision in what that generally prohibits disclosure of an individual's medical records and payment history without express authorization of the individuals?

1. Preventing or controlling disease

2. Respond to injuries or disability

3. Conducting public health surveillance

4. Carry out public health investigations or interventions

The law provides for the disclosure of px info to public health without authorization from the patient, for the purpose of:

Public Health Nursing

Focuses on population health through continuous surveillance and assessment of the multiple determinants of health with the intent to promote health and wellness, prevent disease, disability and premature death, and improve neighborhood quality of life.

American Nurses Association (ANA)

Who stated public health nursing practice focuses on population health through continuous surveillance and assessment of the multiple determinants of health with the intent to promote health and wellness, prevent disease, disability and premature death, and improve neighborhood quality of life?

Noted :))

Note the ff:

These population health priorities are addressed through identification, implementation and evaluation of universal and targeted evidence based programs and services that provide primary, secondary and tertiary preventive interventions

1. Universal

2. Targeted

Types of evidence based programs

Universal

Type of evidence based programs

• Targets everyone in a specific group or community

• Example: immunization, sanitation and health promotion campaigns

Targeted

Type of evidence based programs

• Focuses on individuals or groups at higher risk

• Example: a smoking cessation programs for teens, prenatal care for mothers in underserved areas

Public Health Informatician (PHI)

A public health professional who works either in practice, research, or academia and whose primary work function is the use informatics to improve population health

Public Health Informatician (PHI)

• The role requires more expertise than the multi highly functional public health professional that assist with informatics related challenges or supports personal productivity with information technology.

Public Health Nurse Informatician (PHNI)

A public health nurse who has specialized in nursing informatics and the skills in supporting the establishment of systems to improve public health surveillance through access to clinical care information

• PHI

• NI

The proposed role of the public health nurse informatician (PHNI) combines the competencies of:

Public Health Nurse Informatician (PHNI)

• Has advanced skills in using nursing taxonomies and nomenclatures as a tool for NI in public health practice

• Ensure that data needs are adequate to measure performance for multiple determinants of health

population; individuals

The public health mission is to promote the health of the _____ rather than to treat _____.

1. Local

2. State/Territorial

3. Federal

3 Levels of Data Collection and Sharing in Public Health

Silo-like Systems

• Means system doesn’t always connect or share data easily

• Since most funding is based on programmatic need, many information systems have been built to support specific programs, thereby creating this

• Health Information Exchanges (HIEs)

• National Electronic Disease Surveillance Systems (NEDSS) Initiative

Efforts are underway to assist healthcare providers in overcoming barriers to data collection and sharing through the implementation of regional, state or territorial and local what systems which aim to gather comprehensive health information that can be used across many health issues?

• Council of State and Territorial Epidemiologist (CSTE)

• CDC

Each year, what organizations jointly update a list of reportable diseases and conditions?

Council of State and Territorial Epidemiologist (CSTE)

• Recommends that all States and territories enact laws to make nationally reportable conditions reportable in their jurisdiction

Local, City, or County Health Department

• Considered the front line of public health:

  • Interact most closely with clinicians and agencies in the community,

  • Gathers reports of communicable disease,

  • Tracks and monitor cases,

  • Conducts investigation and

  • Often provides direct services such as STD testing, vaccines, contact tracing, directly observed treatment, therapy and case management

CDC

The state health department uses legislation as well as regulations to require reporting by healthcare entities to report certain illnesses, to require vaccinations for school entry, to coordinate statewide disease surveillance, and to monitor incoming reports from counties and then submit those reports voluntarily and minus names to the what organization?

Epidemiologic Surveillance Project

In 1984, the CDC, in cooperation with the CSTE and epidemiologists in six states began testing the what?

1984

Year of Epidemiologic Surveillance Project

Epidemiologic Surveillance Project

• Project goal was to demonstrate the effectiveness of computer transmission of public health surveillance case based data between state health departments and the CDC

1989

By what year, were all 50 states participating in the Epidemiologic Surveillance Project?

National Electronic Telecommunication System for Surveillance (NETSS)

What was the Epidemiologic Surveillance Project renamed to reflect its national scope?

National Electronic Telecommunication System for Surveillance (NETSS)

• Includes 22 Core Data elements for reportable disease conditions.

• The CDC analyzes these data and disseminates them in the Morbidity and Mortality Weekly Report (MMWR)

Morbidity and Mortality Weekly Report (MMWR)

NETSS

The CDC analyzes these data and disseminates them in the what?

National Electronic Disease Surveillance System (NEDSS)

NETSS

This overwhelming volume of data to be managed by health departments led to the what which provides guidance for the technical architecture and standards for nationally reportable condition reporting?

• NETSS was case-based while NEDSS was person-based

• NETSS is used for proprietary codes

How does the NETSS differ from the NEDSS?

NETSS

NETSS or NEDSS:

Case-based

NEDSS

NETSS or NEDSS:

Person-based

NETSS

NETSS or NEDSS:

Used for proprietary codes

National Electronic Disease Surveillance System (NEDSS)

• Uses standards to advance the development of efficient, integrated, and interoperable surveillance systems at the state and local levels.

• This initiative facilitates the electronic transfer of information from clinical information systems in healthcare, reduces the provider's burden of providing data, and enhances the timelines and quality of information provided.

False; NEDSS initiative

True or False: States were funded to assess their current systems and develop plans to implement criteria compatible with the NETSS initiative.

Electronics Laboratory Results (ELR)

NEDSS

• The criteria include browser based system data entry and what system for laboratory staff to report results to health departments as authorized and a single repository for integrated databases from multiple health information systems

NEDSS Base System (NBS)

The CDC developed what platform for public health surveillance functions, processes and data integration in a secure environment?

True

True or False: As a registered user of the NBS, a healthcare provider can directly enter data from case and laboratory reports into the state's electronic surveillance system at the point of care

Health Level 7 Clinical Document Architecture (HL7 CDA)

Healthcare Providers Role and the NBS

• Healthcare providers can send electronic case reports using the what format when their electronic health records is equipped to report in the standard format?

Noted :))

Note the ff:

Clinical Laboratories and the NBS

• Staff members in public and private laboratories are required by law to notify public health departments of state reportable conditions.

• Registered laboratory users of the NBS system enters reports directly using the web-based laboratory report function of the NBS.

• So this report is then readily available to the public health NBS users to conduct the investigation

Noted :))

Note the ff:

Public Health Practitioner Role and the NBS

• Public health practitioners who are registered users of the NBS may review reports from laboratories and healthcare providers for patients residing within their jurisdictional boundaries.

• The public health practitioner may create an alert function for new data received in the NBS, such as for reports of meningococcal disease

• Clinical, laboratory, epidemiologic, and follow up data are entered at point of care and stored in the NBS.

• Stored data can be read, analyzed, and shared.

• The public health practitioner classifies the case based on stored data and standard case definitions and forwards the notification to CDC using the NEDSS messaging format, which is the HL7 or the NETSS (if no messaging guide exists).

• A data transfer function in the NBS allows users to notify another jurisdiction when the patient moves and to transfer records for follow up

False; state

True or False: The capabilities of the NBS support public health investigations and interventions at the city level and allow reporting of nationally notifiable diseases in a more complete and standardized manner and in near real time for analysis by CDC program areas.

Morbidity and Mortality Weekly Reports (MMWR)

The data from the NBS are disseminated through the what?

Custom authentication

To verify the identity of the user, the NBS supports this

Noted :))

Note the ff:

Privacy Protection and the NBS

• In order to protect personally identifiable information, the NBS requires users authentication, authorization and auditing protocols 

• to verify the identity of the user, The NBS supports custom authentication,

• once authenticated, the NBS application authorizes access to data based on user role, geographical areas, disease, public health events, and actions.

  • for example, a local public health practitioner may be assigned access to foodborne and diarrheal investigations and laboratory reports for a public health jurisdiction.

  • The supervisor can be assigned access to multiple public health jurisdictions across multiple families of diseases, for example foodborne and diarrheal or FDD and hepatitis

• The NBS creates an audit file containing a fingerprint trail with a timestamp of the user’s activities

Immunization Information System (IIS)

Are confidential computerized information system that allow for the collection of vaccination histories and provide immediate access by authorized users to a child’s current immunization status

CAER HAFA

1. Consolidating immunization records from different sources

2. Automatically calculating the immunizations needed

3. Easily providing official copies of immunization records

4. Reducing chart pulls for coverage assessments

5. Healthcare Effectiveness Data and Information Set (HEDIS)

6. Allowing for vaccine tracking during vaccine shortages or manufacturer recalls

7. Flagging high-risk patients for timely vaccination recalls

8. Assisting with vaccine safety and adverse event reporting

8 Immunization Information System (IIS) Benefits for Healthcare Providers

Consolidating immunization records from different sources

Immunization Information System (IIS) Benefits for Healthcare Providers

• can combine vaccine records from different clinics or sources into one place

Automatically calculating the immunizations needed

Immunization Information System (IIS) Benefits for Healthcare Providers

• can automatically calculate which vaccines a patient still needs

Easily providing official copies of immunization records

Immunization Information System (IIS) Benefits for Healthcare Providers

• providers can quickly print official copies of a patient's immunization records.

Reducing chart pulls for coverage assessments

Immunization Information System (IIS) Benefits for Healthcare Providers

• reduces the need to pull paper charts or for coverage checks or ___ reviews

Healthcare Effectiveness Data and Information Set (HEDIS)

Immunization Information System (IIS) Benefits for Healthcare Providers

• reviews automating vaccine inventory and ordering procedures: can automate vaccine inventory and ordering making supply management easier

Allowing for vaccine tracking during vaccine shortages or manufacturer recalls

Immunization Information System (IIS) Benefits for Healthcare Providers

• provider can track vaccines during shortages or recalls.

Flagging high-risk patients for timely vaccination recalls

Immunization Information System (IIS) Benefits for Healthcare Providers

• system can flag high risk patients so they get timely reminder for vaccination

Assisting with vaccine safety and adverse event reporting

Immunization Information System (IIS) Benefits for Healthcare Providers

• helps with reporting vaccine safety issues or side effects

1. National TB Surveillance System

2. TB Genotyping Information Management System (TB GIMS)

3. Electronic Disease Notification System

3 Tuberculosis Electronic Information/Data Reporting Systems

National TB Surveillance System

Tuberculosis Electronic Information/Data Reporting Systems

• An electronic incident surveillance system that collects 49 data items on newly diagnosed verified cases of TB in the United States. 

• the appropriate authorities transmits the data from the state or designated health jurisdiction to CDC at 3 intervals: initially at the time of case verification or the TB or the confirmation of TB disease, at receipt of initial test results for drug susceptibility and at treatment closure.

1. Initially at the time of case verification or the TB or the confirmation of TB disease, 

2. At receipt of initial test results for drug susceptibility 

3. At treatment closure

3 Intervals of the National TB Surveillance System

TB Genotyping Information Management System (TB GIMS)

Tuberculosis Electronic Information/Data Reporting Systems

• Builds upon the established infrastructure of the CDC’s National TB Surveillance System and incorporates genotype data to create a centralized database and reporting system

• State public health laboratories submit isolates from culture-confirmed cases to one of two designated genotyping laboratories for molecular characterization, which helps with identifying recent transmission and potential outbreaks

Electronic Disease Notification System

Tuberculosis Electronic Information/Data Reporting Systems

• Alerts state at the local health department programs or of refugees and immigrant arrivals to their jurisdictions and provides overseas medical screening results and treatment follow up information to 

• Each refugee or immigrant with a TB classification is referred to the TB program for medical screening and treatment follow up

National TB-Related Performance Indicators (NTIP)

CDC uses data from the TB reporting systems to disseminate performance measurement reports for what?

immunization

In the first case study,

• the PHI ensured the retrieval of destroyed health records (____ data) for displaced Hurricane Katrina communities by linking people with their records through informatics.

• By retrieving health records, the PHI enforced the rules regarding ____ record requirements while ensuring provision of needed ____

norovirus

In the second case study,

• the PHI, while participating in assessment activities to monitor health status and health problems in displaced Hurricane Katrina communities, identified a _____ outbreak.

• the PHI developed and used a simple data checklist of symptoms and compiled daily information reports and environmental risk information to evaluate the ongoing effectiveness and quality of emergency public health services.

Clinical Nursing Information System (CNIS)

In the third case study,

• PHNI designed an assessment activity for barriers to adherence behaviors with TB treatment.

• The PHNI described a ___________ for behavioral adherence model adapted to TB program literature

• The resulting dataset can be used to manage data, monitor the performance plan, and evaluate the effectiveness and quality of personal health services