Please join my INTERFACE:ATL networking event THIS WEDNESDAY, April 2nd from 6:30-8:00 pm at the Marriott Courtyard lobby bar, 130 Clairemont Ave. in Decatur. Meet health informatics peers to learn who’s doing what. Several state epidemiologists will likely be on hand. Free to attend, pay own food and drink. See you Wednesday!
Join our first Washington DC area INTERFACE networking salon for those interested in improving public health through informatics. After work, just blocks from TEDMED 2013 –there’s no telling who you’ll meet! Join us Thursday, April 18 from 5:30-7:00 pm at the Notti Bianche bar inside GW University Inn, 824 New Hampshire Blvd NW. Just steps from the Foggy Bottom Metro. No charge; excellent food and drink available for purchase. RSVP at firstname.lastname@example.org. Pass it on!
A key issue is whether EHRs should be certified in Stage 3 to generate electronic public health reports using a new, standardized approach. The Public Health Reporting Initiative is finalizing both a harmonized data element profile and a Clinical Document Architecture implementation guide in the next few weeks.* These are based largely on the Cancer Registry reporting standard that appears in Stage 2 MUse rules and on implementations already in place for the National Healthcare Safety Network (NHSN) and recommended for Stage 3. Adopting the PHRI approach need not require change to existing MUse reporting activities like electronic laboratory reporting, immunization registries or syndromic surveillance. However, it provides a reusable, modular, and extensible methodology that could be leveraged by these and many other types of reporting (for example, communicable disease case reports, product safety reports, birth and death reports) into the future.
The public health (and health IT) communities should examine the PHRI documents to decide if they represent an achievable step toward more generic interoperability between EHR and public health surveillance systems. If so, they will have to make their voices heard during the comment period, because MUse Stage 3 certification is NOT recommended by the HIT Policy Committee (rather, it is recommended for some future, unspecified time).
The Centers for Disease Control and Prevention (CDC), which funds much US public health surveillance, needs to decide and announce whether it will support pilot implementations, full-scale implementation, and health department migration to the new approach going forward.
The Office of the National Coordinator and CDC need to ensure that PHRI products are harmonized with similar initiatives across the ONC Standards and Interoperability Framework, and curated and maintained over time.
Other important issues in the Stage 3 recommendations include EHR data capture of information like occupation and disability; whether NHSN hospital reporting should be included as a new objective; and whether additional public health registries should be offered as choices in the incentive program.
Unfortunately, these decisions are being made at a time of significant vacancies and uncertainty in the decision-making structure at CDC. Representatives of local and state health departments, who are critical stakeholders in this process, will need to study, act and advise CDC, rather than depend on the agency. But the CDC Meaningful Use program is sponsoring a half-day Virtual Conference on public health and Meaningful Use Tuesday, December 18 beginning at 12ET. This should provide a good orientation to Stage 2 changes, and set a foundation for discussion of Stage 3.
Meanwhile, the urgent deadlines of MUse and ONC (sometimes labelled the “Office of No Christmas” for its December demands) loom. Inaction over the holidays might lead to a lump of coal in the public health stocking for Stage 3.**
* Disclosure: Author was a lead team member of the of the Public Health Reporting Initiative from October 2011-September 2012.
** References to Christmas are for humorous purposes only and do not imply an endorsement of any particular holiday or religion. Happy holidays to all, whichever you celebrate.
I recently attended the 25th anniversary celebration for the Mectizan (ivermectin) Donation Program (http://www.mectizan.org/). Today the program is closing in on eliminating onchocerciasis, or river blindness, in several nations. President Jimmy Carter, former Merck CEO Roy Vagelos and former CDC director and Task Force for Global Health founder Bill Foege took the stage to recall how the program was born and succeeded out of a combination of luck and determination. Each admitted having no clear idea about how to realize the program at first, and each offered grains of wisdom learned since.
Dr. Vagelos recalled that the decision to give Mectizan away, as much and for as long as needed to combat onchocerciasis, was made for lack of an ethical alternative, though several were explored. Unexpectedly rapid regulatory approval and high expectations forced the executive decision even before the Merck board could be consulted. The decision had an unexpected long-term impact. Chemists, doctors, even factory workers flocked to Merck to work for the company with a clear moral compass. Merck did well by doing right.
President Carter said the program illustrates the oft-overlooked power of volunteers. The distribution of Mectizan is powered by local volunteers worldwide, including Lions Clubs who mobilize a small army of local business and community leaders in most nations touched by the disease.
Mectizan 25th Anniversary Event
Dr. Foege suggested that this program’s success, in contrast to many other public health campaigns, illustrates Sutton’s lesser known second law: “I get more done with a gentle voice and a revolver than with a gentle voice alone.”(1) An effective tool made the difference. “After people took Mectizan, some had the first itch-free day that they could ever remember,” Foege said. This rapid, obvious improvement in quality of life for some helped sell the drug’s benefits to all.
These lessons should give heart to informaticians who are rapidly prototyping, piloting and iterating real tools in the field, and those using volunteers (such as in open source development) to shape the work collectively. An application that “scratches the itch,” brings rapid uptake and success. Vaporous promises and endless planning likely have the opposite effect. We must not underestimate the power of the “revolver” in the hand over well-intentioned talk, nor the power of volunteers motivated by their communities’ needs.
Notes: (1) Paraphrased. I could not find attribution of this remark to Mr. Sutton, though he is quoted “You can’t rob a bank on charm and personality,” which carries the same message!
Pictured in the photograph L to R: Dr. William Foege, Dr. Roy Vagelos, President Jimmy Carter, moderator and Task Force for Global Health President/CEO Mark Rosenberg.
Interface ATL: join public health informatics colleagues for networking, sharing and fun. Manuel’s Tavern, 602 N. Highland, Atlanta on Wednesday, November 14 6-9pm. Free event, you pay food and drinks.
informaticians bioinformatics medical informatics Seth Foldy sethfoldy.com health.e.volution