Public health informatics
Encyclopedia
Public Health Informatics has been defined as the systematic application of information and computer science
and technology to public health
practice, research, and learning. It is one of the subdomains of Biomedical Informatics.
At the federal Centers for Disease Control and Prevention
in Atlanta, Georgia, the Public Health Informatics and Technology Program Office (PHITPO) focuses on advancing the state of information science and applies digital information technologies to aid in the detection and management of diseases and syndromes in individuals and populations. The three sub-units within PHITPO include Informatics Practice, Policy and Coordination; Informatics Solutions and Operations; and Informatics Research and Development.
The bulk of the work of public health informatics in the United States, as with public health generally, takes place at the state and local level, in the state departments of health and the county or parish departments of health. At a state health department the activities may include: collection and storage of vital statistics (birth and death records); collection of reports of communicable disease cases from doctors, hospitals, and laboratories, used for infectious disease surveillance; display of infectious disease statistics and trends; collection of child immunization and lead screening information; daily collection and analysis of emergency room data to detect early evidence of biological threats; collection of hospital capacity information to allow for planning of responses in case of emergencies. Each of these activities presents its own information processing challenge.
(TODO: describe CDC-provided DOS/desktop-based systems like TIMSS (TB), STDMIS (Sexually transmitted diseases); Epi-Info for epidemiology investigations; and others )
Since the beginning of the World Wide Web, public health agencies with sufficient information technology resources have been transitioning to web-based collection of public health data, and, more recently, to automated messaging of the same information. In the years roughly 2000 to 2005 the Centers for Disease Control and Prevention, under its National Electronic Disease Surveillance System (NEDSS), built and provided free to states a comprehensive web and message-based reporting system called the NEDSS Base System (NBS). Due to the funding being limited and it not being wise to have fiefdom-based systems, only a few states and larger counties have built their own versions of electronic disease surveillance systems, such as Pennsylvania's PA-NEDSS. These do not provide timely full intestate notification services causing an increase in disease rates versus the NEDSS federal product.
To promote interoperability, the CDC has encouraged the adoption in public health data exchange of several standard vocabularies and messaging formats from the health care world. The most prominent of these are: the Health Level 7
(HL7) standards for health care messaging; the LOINC
system for encoding laboratory test and result information; and the Systematized Nomenclature of Medicine
(SNOMED) vocabulary of health care concepts.
Since about 2005, the CDC has promoted the idea of the Public Health Information Network to facilitate the transmission of data from various partners in the health care industry and elsewhere (hospitals, clinical and environmental laboratories, doctors' practices, pharmacies) to local health agencies, then to state health agencies, and then to the CDC. At each stage the entity must be capable of receiving the data, storing it, aggregating it appropriately, and transmitting it to the next level. A typical example would be infectious disease data, which hospitals, labs, and doctors are legally required to report to local health agencies; local health agencies must report to their state public health department; and which the states must report in aggregate form to the CDC. Among other uses, the CDC publishes the Morbidity and Mortality Weekly Report
(MMWR) based on these data acquired systematically from across the United States.
Major issues in the collection of public health data are: awareness of the need to report data; lack of resources of either the reporter or collector; lack of interoperability of data interchange formats, which can be at the purely syntactic or at the semantic level; variation in reporting requirements across the states, territories, and localities.
issues as other industries. And like other industries, the details of how these issues play out are affected by the nature of the data being managed.
Due to the complexity and variability of public health data, like health care data generally, the issue of data modeling
presents a particular challenge. While a generation ago flat data sets for statistical analysis were the norm, today's requirements of interoperability and integrated sets of data across the public health enterprise require more sophistication. The relational database
is increasingly the norm in public health informatics. Designers and implementers of the many sets of data required for various public health purposes must find a workable balance between very complex and abstract data models such as HL7's Reference Information Model (RIM) or CDC's Public Health Logical Data Model, and simplistic, ad hoc models that untrained public health practitioners come up with and feel capable of working with.
Due to the variability of the incoming data to public health jurisdictions, data quality assurance
is also a major issue.
tools to produce routine or ad hoc reports, to sophisticated statistical analysis tools such as DAP
/SAS
and PSPP
/SPSS
, to Geographical Information Systems (GIS) to expose the geographical dimension of public health trends.
Computer science
Computer science or computing science is the study of the theoretical foundations of information and computation and of practical techniques for their implementation and application in computer systems...
and technology to public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
practice, research, and learning. It is one of the subdomains of Biomedical Informatics.
United States
In the United States, public health informatics is practiced by individuals in public health agencies at the federal and state levels and in the larger local health jurisdictions. Additionally, research and training in public health informatics takes place at a variety of academic institutions.At the federal Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
in Atlanta, Georgia, the Public Health Informatics and Technology Program Office (PHITPO) focuses on advancing the state of information science and applies digital information technologies to aid in the detection and management of diseases and syndromes in individuals and populations. The three sub-units within PHITPO include Informatics Practice, Policy and Coordination; Informatics Solutions and Operations; and Informatics Research and Development.
The bulk of the work of public health informatics in the United States, as with public health generally, takes place at the state and local level, in the state departments of health and the county or parish departments of health. At a state health department the activities may include: collection and storage of vital statistics (birth and death records); collection of reports of communicable disease cases from doctors, hospitals, and laboratories, used for infectious disease surveillance; display of infectious disease statistics and trends; collection of child immunization and lead screening information; daily collection and analysis of emergency room data to detect early evidence of biological threats; collection of hospital capacity information to allow for planning of responses in case of emergencies. Each of these activities presents its own information processing challenge.
Collection of public health data
Before the advent of the internet, public health data in the United States, like other healthcare and business data, were collected on paper forms and stored centrally at the relevant public health agency. If the data were to be computerized they required a distinct data entry process, were stored in the various file formats of the day and analyzed by mainframe computers using standard batch processing.(TODO: describe CDC-provided DOS/desktop-based systems like TIMSS (TB), STDMIS (Sexually transmitted diseases); Epi-Info for epidemiology investigations; and others )
Since the beginning of the World Wide Web, public health agencies with sufficient information technology resources have been transitioning to web-based collection of public health data, and, more recently, to automated messaging of the same information. In the years roughly 2000 to 2005 the Centers for Disease Control and Prevention, under its National Electronic Disease Surveillance System (NEDSS), built and provided free to states a comprehensive web and message-based reporting system called the NEDSS Base System (NBS). Due to the funding being limited and it not being wise to have fiefdom-based systems, only a few states and larger counties have built their own versions of electronic disease surveillance systems, such as Pennsylvania's PA-NEDSS. These do not provide timely full intestate notification services causing an increase in disease rates versus the NEDSS federal product.
To promote interoperability, the CDC has encouraged the adoption in public health data exchange of several standard vocabularies and messaging formats from the health care world. The most prominent of these are: the Health Level 7
Health Level 7
Health Level Seven , is an all-volunteer, non-profit organization involved in development of international healthcare informatics interoperability standards...
(HL7) standards for health care messaging; the LOINC
LOINC
Logical Observation Identifiers Names and Codes is a database and universal standard for identifying medical laboratory observations. It was developed and is maintained by the Regenstrief Institute, a US non-profit medical research organization, in 1994...
system for encoding laboratory test and result information; and the Systematized Nomenclature of Medicine
Systematized Nomenclature of Medicine
The Systematized Nomenclature of Medicine is a multiaxial, hierarchical classification system . As in any such system, a disease may be located in a body organ which results in a code in a topography axis and may lead to morphological alterations represented by a morphology code.-Purpose:SNOMED...
(SNOMED) vocabulary of health care concepts.
Since about 2005, the CDC has promoted the idea of the Public Health Information Network to facilitate the transmission of data from various partners in the health care industry and elsewhere (hospitals, clinical and environmental laboratories, doctors' practices, pharmacies) to local health agencies, then to state health agencies, and then to the CDC. At each stage the entity must be capable of receiving the data, storing it, aggregating it appropriately, and transmitting it to the next level. A typical example would be infectious disease data, which hospitals, labs, and doctors are legally required to report to local health agencies; local health agencies must report to their state public health department; and which the states must report in aggregate form to the CDC. Among other uses, the CDC publishes the Morbidity and Mortality Weekly Report
Morbidity and Mortality Weekly Report
The Morbidity and Mortality Weekly Report is a weekly epidemiological digest for the United States published by the Centers for Disease Control and Prevention...
(MMWR) based on these data acquired systematically from across the United States.
Major issues in the collection of public health data are: awareness of the need to report data; lack of resources of either the reporter or collector; lack of interoperability of data interchange formats, which can be at the purely syntactic or at the semantic level; variation in reporting requirements across the states, territories, and localities.
Storage of public health data
Storage of public health data shares the same data managementData management
Data management comprises all the disciplines related to managing data as a valuable resource.- Overview :The official definition provided by DAMA International, the professional organization for those in the data management profession, is: "Data Resource Management is the development and execution...
issues as other industries. And like other industries, the details of how these issues play out are affected by the nature of the data being managed.
Due to the complexity and variability of public health data, like health care data generally, the issue of data modeling
Data modeling
Data modeling in software engineering is the process of creating a data model for an information system by applying formal data modeling techniques.- Overview :...
presents a particular challenge. While a generation ago flat data sets for statistical analysis were the norm, today's requirements of interoperability and integrated sets of data across the public health enterprise require more sophistication. The relational database
Relational database
A relational database is a database that conforms to relational model theory. The software used in a relational database is called a relational database management system . Colloquial use of the term "relational database" may refer to the RDBMS software, or the relational database itself...
is increasingly the norm in public health informatics. Designers and implementers of the many sets of data required for various public health purposes must find a workable balance between very complex and abstract data models such as HL7's Reference Information Model (RIM) or CDC's Public Health Logical Data Model, and simplistic, ad hoc models that untrained public health practitioners come up with and feel capable of working with.
Due to the variability of the incoming data to public health jurisdictions, data quality assurance
Data quality assurance
Data quality assurance is the process of profiling the data to discover inconsistencies, and other anomalies in the data and performing data cleansing activities Data quality assurance is the process of profiling the data to discover inconsistencies, and other anomalies in the data and performing...
is also a major issue.
Analysis of public health data
The need to extract usable public health information from the mass of data available requires the public health informaticist to become familiar with a range of analysis tools, ranging from business intelligenceBusiness intelligence
Business intelligence mainly refers to computer-based techniques used in identifying, extracting, and analyzing business data, such as sales revenue by products and/or departments, or by associated costs and incomes....
tools to produce routine or ad hoc reports, to sophisticated statistical analysis tools such as DAP
DAP (software)
Dap is a statistics and graphics program, that performs data management, analysis, and graphical visualization tasks which are commonly required in statistical consulting practice....
/SAS
SAS System
SAS is an integrated system of software products provided by SAS Institute Inc. that enables programmers to perform:* retrieval, management, and mining* report writing and graphics* statistical analysis...
and PSPP
PSPP
PSPP is a free software application for analysis of sampled data. It has a graphical user interface and conventional command line interface. It is written in C, uses GNU Scientific Library for its mathematical routines, and plotutils for generating graphs....
/SPSS
SPSS
SPSS is a computer program used for survey authoring and deployment , data mining , text analytics, statistical analysis, and collaboration and deployment ....
, to Geographical Information Systems (GIS) to expose the geographical dimension of public health trends.
Applications in health surveillance and epidemiology
- SAPPHIRE (Health care)SAPPHIRE (Health care)The Situational Awareness and Preparedness for Public Health Incidences and Reasoning Engines is a semantics-based health information system capable of tracking and evaluating situations and occurrences that may affect public health. It was developed in 2004 by Dr...
or Situational Awareness and Preparedness for Public Health Incidences and Reasoning Engines is a semanticsSemanticsSemantics is the study of meaning. It focuses on the relation between signifiers, such as words, phrases, signs and symbols, and what they stand for, their denotata....
-based health information system capable of tracking and evaluating situations and occurrences that may affect public healthPublic healthPublic health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
.