A Trip in the Time Machine

What information management capabilities will future US health departments need?  Shaun Grannis (Regenstrief Institute), Torney Smith (Spokane Regional Health Department), David Ross (Public Health Informatics Institute) and I were asked to gaze over the horizon during a 2012 Public Health Accreditation Board think tank.  Our work was recently published online-ahead-of-print by the American Journal of Public Health.

We looked first at potential changes in health department function suggested by the Patient Protection and Affordable Care Act (“ACA”).  Some argue that health departments might exit direct individual health services, as uninsured populations fall and Accountable Care Organizations rise.   Perhaps health departments will no longer need to track individual clients and services?  On the other hand, others have proposed expanded health department roles in community-based preventive services.  Billing for individual services like vaccination is becoming more important than ever for department revenues.   Millions will remain uninsured even after ACA implementation, health departments will continue to track cases of reportable illness and injury, and will remain accountable for transparent and up-to-date data on population health trends.  In balance we found arguments that most health departments could jettison the responsibility for collecting and protecting individual health information unconvincing.  It is likely that faster, better and safer information management is needed instead.

We also looked at projected technology changes.  Perhaps health departments won’t need to collect surveillance data when interconnected electronic health records might make such data searchable on demand?  The slow pace of interoperability initiatives, and the likely demand that health performance data be independent, transparent and accountable made us skeptical that simply “grazing on others’ data” will be meet all needs within several decades.  Meanwhile numerous other information sources, for example data recorded by citizens and sensors, will probably be added to the floods of data obtained from health care providers.

Inevitably, then, most health departments will be subject to a growing glut of electronic information like other health organizations.  Indeed, if they will fulfill their mandates and avoid shrinking into vestigial remnants, they must manage information and knowledge more competently than ever before.   The good news is that as connectivity, standardization and cloud capabilities improve, it will be easier for individual local and state health departments to lease shared information systems rather than manage them locally.  By collaborating on such shared systems they will be able to focus more on how they want to use information to protect and improve the public’s health, and less on managing hardware and software.   However, this vision depends on goal-oriented collaboration and planning between local, state and federal agencies.

Every public health department will need certain capabilities to navigate the course ahead, making these capabilities appropriate for consideration in the process of health department accreditation.  We hope our article and will initiate lively discussion on what such capabilities should look like.  What do you think?

Network with ATL Colleagues: INTERFACE Weds. APRIL 2, 2014

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NTERFACE:ATL networking event WEDNESDAY, April 2nd from 6:30-8:00 pm at Marriott Courtyard lobby bar

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!

Atlanta Networking Sept. 19

Please share as desired with those interested in health informatics.   I look forward to seeing you in Decatur September 19.

Who will you meet? Food, drink, informatics networking in DC near TEDMED April 18

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 sfoldy@sbcglobal.net.  Pass it on!

Who Leads Informatics at CDC?

Hard on the heels of my own departure from the US Centers for Disease Control and Prevention (CDC) on September 30 comes a clean sweep of high-level informatics leaders in the organization.   Sources now confirm that James Buehler, MD the current Director of the Public Health Surveillance and Informatics Program Office (PHSIPO) will depart before year’s end.  His supervisor, PHS Rear Admiral (ret.) Steven Thacker, a long-time advocate for cross-cutting integration, is also slated to leave his post as Director of the Office for Surveillance, Epidemiology and Laboratory Services (OSELS).  These departures follow at least three years of marked funding reductions at CDC’s informatics core.

[Update 12/11/12: We’ve learned Dr. Buehler is departing for family reasons, and Dr. Thacker for health reasons.  Friends and colleagues of Dr. Thacker can connect with him and his family here.]

Few signals indicate the future direction for informatics at the Agency.   Acting leadership for OSELS will be placed in the hands of Denise Cardo, MD, director of the Division of Healthcare Quality Promotion, and Dan Jernigan MD, MPH of the National Center for Immunization and Respiratory Diseases (NCIRD) as her deputy.  While Buehler and I were recruited from outside CDC, both of the new OSELS leads come from powerful National Centers in CDC’s Office of Infectious Disease.  This may (but also may not) indicate a plan to redistribute the OSELS portfolio across the National Centers (sometimes called “Silos of Excellence”). 

The timing for an apparent leadership vacuum and dwindling resources could not be worse.  It comes in the middle of a massive one-time Federal investment of tens of billions of dollars in healthcare information technology and exchange.  Standardization engendered by the “Meaningful Use” electronic health record incentive program could enable major progress in public health programs if two conditions are met.  First, cash-strapped local and state public health agencies must make it a priority to migrate to new, more uniform standards and must have the resources to do so.   Second, critical public health requirements for information exchange must be successfully negotiated with cost-averse healthcare providers and their information system vendors.  Neither can be accomplished without dedicated leadership and resources.  The need for a confident, skillful, flexible and funded approach to public health information exchange with healthcare providers has never been greater.  We anxiously await the announcement of both new a new informatics vision and stable leadership at CDC.

 

Informatics, Global Health and Sutton’s Second Law

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.

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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.

Additional information on the 25th anniversary event available at http://www.mectizan.org/news/mectizan-donation-program-celebrates-25-years-of-partnership-and-progress .

Keywords: public health informatics, Seth Foldy, health informatics, open source, Jimmy Carter, William Foege, Roy Vangelos

Interface ATL Public Health Informatics Event

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