Informatics and population health. The reference for this presentation, unless otherwise noted, is chapter 23 of the optional Hoyt text. In this presentation we will consider informatics and population health, consistent with the promise of informatics for our other topics. The anticipated benefits of informatics for community and population health is better outcomes, for communities and populations. Consider everything we've discussed on an individual level, the ways that data transformed into knowledge are transforming health care. Imagine for a moment how those same principles applied to public health informatics could impact our world. The key points we will consider are community and population health, data and the public's health, novel data sources, global initiatives, and future trends. Key point one, community and population health. In communities, health is a product of many factors, and many segments of the community influence, protect and improve health. Informaticists want to be able to name and measure community health, so we need a model. In 1997, the Institute of Medicine promo, proposed this model. Encompassing concepts of social environment, physical environment, genetic endowment, individual response, behavior and biology. Healthcare, disease, health and function, well being, and prosperity. More recently, a population health outcomes model has been proposed, including interventions focusing on upstream factors. Two famous informaticists provided important contributions to population outcomes by focusing on upstream factors in the mid 19th century. Key point 2, Data and the Public's Health. When Florence Nightingale arrived at a British hospital in Turkey during the Crimean War, she found a nightmare of misery and chaos. Men lay crowded next to each other in endless corridors and the air reeked from the cesspool that lay just beneath the hospital floor. There was little food and fewer basic supplies. Nightengale documented these conditions and used statistical analysis of her documentation to lead a sanitary revolution in the military health system. By the time the war ended, the hospital were well run and efficient with mortality rates no greater than civilian hospitals. This was all going on about the same time as John Snow was investigating a Cholera outbreak in the Soho district of London close to Snow's house. Snow mapped 13 public wells and all the known Cholera deaths around Soho. And noted the spatial clustering of cases around one particular water pump on the southwest corner of the intersection of Broad and Cambridge Streets. He examined water samples from the 13 wells under a microscope and confirmed the presence of an unknown bacterium in the Broad Street samples. Snow had the pump handle removed from the Broad Street pump and the outbreak quickly subsided. Nightengale and Snow ushered in a new era by using standardized data to improve population health. Fast forward to 1988. The Future of Public Health report from the Institute of Medicine, predated wide spread adoption of health IT. However, the report called for the development of a uniform, national data set. To permit, valid comparison of local and state health data. In 2002, the Institute of Medicine released an updated report on the future of public health in the 21st century. And exclaimed about an explosion of information systems in public health. The report suggested that harnessing the potential of communication and information technologies. Will enable public health officials to collect and disseminate information more efficiently, and improve the effectiveness of public health interventions. Today we are awash, in public health informatics and meaningful use conversations. Especially with regard to governmental public health as a mandated message receiver. Standards for public health transactions in sage 2 meaningful use include SNOMED CT, LOINC, and HL7. Our national strategic goal is to strengthen the ability of public health departments. To benefit from and manage advances in electronic health information. Use of EHR data in public health is a radical departure from standard public health data sets, such as national notifiable diseases surveillance system. And the behavioral risk factor surveillance system and the 140 other surveillance systems that are operated by programs in the Centers for Disease Control. Key point 3, Novel data sources. EHR data have been used for population health purposes. The data generated by public health nurses has been used to describe populations and compare population health outcomes. Here are some examples. Mobile data have also become important in public health initiatives globally. Here are some examples. Big Data, such as the massive, new social media and internet search engine data sets, is another population health data source, here are some examples. Key point 4, Global initiatives, population health data initiatives are expanding internationally as well. Here are some examples of Global eHealth efforts from the World Health Organization, and the Centers for Disease Control. Key point 5, Future Trends. According to Hoyt, a robust public health network of the future will require data standards, electronic health records and health information exchange. Taking this notion to the population level, Friedman and Parrish proposed a PopHR or Population Health Record. Defined as a repository of statistics, measures, and indicators regarding the state of. And influences on the health of a defined population, in computer processable form, stored and transmitted securely. And accessible by multiple authorized users. The value of the PopHR as a public good would derive most fully from it's flexible inclusion of a wide range of population health information. Held by federal government agencies state and local agencies and ultimately by organizations responsible for this stewardship of EHRs. A PopHR could be very handy right now with the advent of accountable care organizations in the United States. We've returned with renewed interest to the notion of measuring improvement in community health, as we've discussed at the beginning of this presentation. To be successful, accountable care organizations will need data to measure population health, because fostering a healthy patient population is essential. To improving care quality in the new value-based care delivery system. To improve population health, communities must establish and nurture partnerships that include. But go beyond, state and local public health agencies and health care delivery systems. And this broad system of partners must have ways to describe and measure population health factors and outcomes. Population health and community health outcomes are the new informatics frontier. The key points we considered in this presentation were community and population health, data and the public's health. Novel data sources, global initiatives and future trends. These key points highlight the exciting developments in challenges of informatics in the population health context. As Dr James Bueller director of the Public Health Surveillance and Informatics Program Office says. It is important to remain flexible in this rapidly changing world, where information needs, sources, and technologies continue to evolve.
