Welcome to Population Health, Population Health and the Application of Health IT. This unit will introduce you to the field of population health and will explore how health information technology, or HIT for short, can be applied for these purposes. This is Lecture a. The objectives for this session are to define the terms and describe the perspectives related to population health and public health, discuss paradigms and strategies relevant to improving the health of populations. In a moment, we will spend considerable time explaining what a population is, but in brief, we mean the people who live in a community or region, and we also mean other groupings of individuals that are of particular interest to the organization that wants to improve their health. This educational program is sponsored by the US Department of Health and Human Services Office of the National Coordinator for Health Information Technology. So one of our main focuses for this component will be on how health information technology can be applied to population health. For that reason, in this lecture we will offer an overview of how HIT, also refered to as health informatics, can be used, both to improve the health of populations of individuals, either when targeted by government public health programs, or cared for by integrated delivery systems, or IDSs. A health maintenance organization, HMO, like Kaiser Permanente, and an accountable care organization, HCO, like those spreading rapidly across the US, are both types of IDSs. The field of Population Health Informatics is made up of three broad disciplines, represented by the three overlapping sectors of this Venn diagram. The first discipline, on the left, is information and data sciences, the second, at the top, is the basic clinical sciences, such as medicine and nursing, and the third, on the right, is what we would term the population health and public health sciences, which would include epidemiology, health policy, community health education, and the new field of population care management developed first in management care organizations such as HMOs. Over the next decade, the US healthcare system and, for that matter, pretty much all the systems around the globe, will be completely transformed by a whole array of new health information technologies. While there's not always full agreement as to what is or is not included in the HIT definition, most agree that the anchor of a community's HIT system is rapidly becoming the electronic health record, or EHR for short. EHRs, sometimes also called electronic medical records or EMRs, got their start as the clinical tool that one doctor or one nurse uses to chart the interaction between the clinician and patient as they used to do with the paper record. Today, a clinical EHR does that and a lot more. In addition to charting, a comprehensive EHR usually also includes clinical decision support, or CDS systems, that offer guidance on the best course of action, and also, computerized provider order entry, or CPOE systems, such as e-prescribing systems. Another very important type of HIT relevant to this lecture is public health IT systems, these are tools used by government public health agencies such as vital statistics, reporting, reportable diseases, and systems that document health outcomes of different geographic areas. Another type of HIT, perhaps the most widely used electronic data system in the US at this time, is administrative and claims data systems. These are the management information systems used by hospitals and other healthcare providers, and the data systems that health insurance companies and managed care plans use to administer and pay for healthcare services. In the early days of insurance, when the insurers paid the doctor or hospital, it was termed paying a medical insurance claim, so the label has stuck. Today in America, for virtually all people who are covered by health insurance, electronic claims or administrative data describe the interaction between the private or government insurance company and the provider of care. Another growing type of health IT is systems in the hands of the consumer or patient. These would be personal health records, or PHRs, maintained by the consumer, usually at a website, such as Microsoft's Health Vault. This category would also include information collected by health related apps on mobile phones and other devices, and accordingly this domain is termed mHealth. The last somewhat related category of health IT domain is biometric devices that can monitor people's biologic functions, such as heart or blood levels, or activities. The more complex clinical devices are sometimes termed remote patient monitoring devices, or telemedicine. The term telemedicine also includes systems that support live interactions between patient and clinician, and these systems are often used to treat patients in their homes or in a clinic distant from a specialist. HIT has a huge implication for the future of population health and for public health. Today, most of the digital tools are widely applied in clinical and administrative settings to support the care provided to individual patients, but those of us interested in the relatively new domain of population health are excited that these HIT systems can now also be used for community focused activities. In addition, some systems are also being developed specifically for interventions related to government public health programs at the community level, or for programs focused on other large groups of individuals to find in other ways, for example, those enrolled in specific insurance programs. Interest and innovation of HIT applied in these areas is increasing exponentially and we are pleased to help lay the groundwork for applying these tools and the remainder of this lecture and its related units. HIT is the application of electronic health records and other digital technologies to the delivery and management of health care. Interoperable EHRs, that is EHRs that can talk with one another, represent the backbone of what is rapidly becoming a national health care information infrastructure. As described previously, EHRs are becoming the base, but there are also many other types of health information technologies. Health informatics is a term used by academics and by clinicians and a growing number of other individuals that builds on the definition of health IT. Informatics is the systematic application of information and computer sciences, and technology to health care practice, research, and learning. Health informatics implies it's not just the technology, and not just the analytics, it's also about the learning and the knowledge, that is, taking data and creating information. It's the science that underlines both HIT and use of information. While there are distinctions between the term HIT and informatics, in practice, people often used the terms interchangeably. In this unit and in many of the other units of this component, we will talk as much about the field of population health, and the closely related field of public health, as we will about HIT and health informatics. We use the term population health as a comprehensive framework for assess and improving the health and well-being of a defined population. Population health is practiced by both private and public organizations that focus on communities, that is, a geographic area, or on persons who are enrolled by a health organization, or other groupings of individuals that comprise specific cohorts of interest. The big difference between regular clinical care provided by a doctor, or a hospital, is that the provider of population health, while interested in, and concerned about the individual, is mainly focused on the entire group of individuals, including both the people who seek care and those who don't come in. Furthermore, population health, if done right, focuses not just on the medical care model but also on other non-biologic or medical factors that impact a person's health. A definition for public health is related. Public health represents societal, that is, governmental, actions that improve the health of populations. Almost all public health programs focus on communities, jurisdictions, or other geographic areas. Public health agencies, such as local or state health departments, or federal public health agencies like the CDC, don't limit themselves to people who may be cared for by one or another provider, or only to those who have an insurance card from one health plan. The American Public Health Association, the National Academy of Science, and others have identified an array of areas of expertise of public health. Which is noted here, include health assessment, health assurance, and setting of health policy. While health departments do also get involved in the direct provision of care for special populations, or care related to communicable diseases in the US, the majority of care provision is actually done by non public health agencies. Even if it is reimbursed by public insurance programs, like Medicaid, Medicare, and now the Affordable Care Act, or ACA. Public health encompasses the entire population, usually defined on a geographic basis. While population health focuses only on a subset of the broader population, such as those with a specific disease, or employed by a certain provider, or cared for by a certain organization. Many of the approaches and interventions used within population health are borrowed from the public health field. Some people use the two terms synonymously, but that is not always correct. This has led to a controversy, in part because public health officers have been providing population health, albeit with limited resources, for many years. And increasingly the term population has been adopted by healthcare organizations and providers, such as large hospital systems, health maintenance organizations, accountable care organizations, and insurance companies. While these organizations apply approaches borrowed from their public health colleagues, they apply them, along with medical care delivery, to only a subset of the population. Shown here is the growth rate of electronic health record adoption by office-based medical doctors, in terms of what is defined as both basic and comprehensive. In this case, comprehensive includes not just the charting function of the electronic health record, but also clinical decision support, computerized provider order entry, such as e-prescribing, and some inter-operability across providers in the community. The basic would include mainly medical charting. A similar growth rate for acute care hospitals is shown here. These figures represent the latest available statistics that go up to 2014. But when you're listening to this, you can assume that pretty much 100% of US hospitals, and probably 90% of US office-based medical doctors have electronic health records. So, we are on the dawn of a new era, as you can see. As recently as five or ten years ago, the rates were really quite low. We've had huge growth in a short period, in large part do to the health information technology for economic and clinical health HITECH Act, EHR funding program, under President Obama. Coordinated through the office of the National Coordinator for Health IT, and sponsored by the Centers for Medicare and Medicaid Services. This funding program was known as the Meaningful Use Program, because doctors and hospitals did not receive their substantial incentive payment, as much as $40,000 per doctor, unless they meaningfully used the EHR systems. The HITECH Meaningful Use Program is covered in far more detail elsewhere in the ONCHIT curriculum. Of relevance to this lecture, and to the rest of this unit, is the meteoric increase in electronic data. Which encompasses almost all clinician-patient interaction for everyone in a community and also very large growth in other public health and consumer based HIT. The possibilities for the new field of population health informatics represent a huge opportunity to improve the nation's health. The definition of population health informatics is the systematic application of Health IT, and other digital technologies and information sciences, to the improvement of health and well-being of a defined community or other target population. You're probably not surprised by this definition, given the previous slides. But again, trying to understand how one uses the raw data, the technology, and devices to improve the health of populations is what this entire component is all about. And it goes beyond the HIT and the informatics. To do this right, we must also take into consideration public health and clinical and healthcare management methods and principles. And that is what we aim to do in this component. This graphic is an important, if a bit complex, one. It represents a paradigm about the distinction between population health informatics, public health informatics, and clinical informatics. The graphic provides a framework of the key participants in the system. The ovals on the right represent the consumer side. And the ovals on the left represent the provider side. The central two ovals represent the consumer, or patient on the right. And the clinician, say doctor or nurse, on the left. This is the essence of the clinical relationship. As noted by the top box, this interaction is the main domain of clinical informatics. The consumer is part of a population of interest, signified by the second oval on the right. This could be all those consumers cared for by a large group practice of doctors, or an HMO, or those with a certain disease. This cohort, and all other persons are part of some total population, such as those residing in a city, or state, as represented by the third oval on the right. The field of public health informatics, as represented by the box on the right, has traditionally focused on this entire cohort of persons, usually defined geographically. In the US, no provider or insurance company serves this entire cohort. Thus, the need for the second, inner targeted population oval. Continuing on the left hand side, the next oval represents the provider organization, within which the doctor, or other clinician, fits. This could be a single hospital, a doctor's office, a patient centered medical home, PCMH, or an ACO, or other integrated delivery system involving multiple physician groups and hospitals. In the US, no one provider organization provides all care in a region. So to capture electronic information for a typical patient, sub-population or entire population, means working across more than one provider organization. The last oval on the left acknowledges that to capture the entire picture a wider field of vision involving many provider organizations is needed. The box on the slide's bottom center shows the focus of the field of population health informatics. That is to say, the population health informatics field deals more with sub-populations and populations than individual patients. And it deals more with provider organizations and health systems than individual clinicians. But we don't want to take this conceptual model too far. Of course, the consumer and clinician are key. The other right and left side ovals, and the fields of clinical and population health informatics do overlap in many ways. As do the fields of population health informatics and public health informatics. But more on this overlap in the rest of this unit, and other lectures in this population health educational component. This concludes Lecture A of population health, population health and the application of health IT. In summary, you have been introduced to the definitions and various perspectives, both related to population health and public health in this growing field of health IT. The field of population health informatics is made up of three broad disciplines. Information and data sciences. Basic clinical sciences, such as medicine and nursing. Population health and public health sciences, which would include epidemiology, health policy, community health education, and the new field of population care management. Health IT is the application of electronic health records and other digital technologies to the delivery and management of healthcare. Public health represents societal, that is governmental, actions that improve the health of populations and encompasses the entire population, usually defined on a geographic basis. Population health is a comprehensive framework for assessing and improving the health and well being of a defined subset of the broader population, such as those with a specific disease, or employed by a certain provider, or cared for by a certain organization. Population health informatics is the systematic application of health IT and other digital technologies and information sciences to the improvement of health and well being of a defined community or other target population.
