Population health informatics DME SoPH 20151006
Published on: Mar 4, 2016
Transcripts - Population health informatics DME SoPH 20151006
Population health informatics:
key concepts and trends for health professionals
Population and Global Health in Health Professional Education Symposium
Department of Medical Education / School of Population and Global Health
University of Melbourne 6 October 2015
Health and Biomedical Informatics Centre
The University of Melbourne
• What is health informatics and where did it come from?
• Don’t health professionals already know this stuff?
• Public health meets health informatics: seriously?
• ‘There’s never been a better time to be an Australian’
…population health informatician
What is Health Informatics?
My paraprhase of
Hammond, W. E. 2012. http://www.slideshare.net/HINZ/ehr-the-killer-app
–interdisciplinary field of scientific knowledge & professional practice
–that aims to improve human health
–by optimising the use of data, information & knowledge
–in planning, problem-solving, decision-making, enquiry & learning
–across the spectrum…
Why is Health Informatics?
• New knowledge is exponential:
…citizen science, stealth research,
• Practice is information-intensive:
…records, registries, reporting…
• Data processing is complex: … imaging,
• How to describe, collect, store, assure,
secure, share, integrate, analyse,
visualise, mobilise … optimise?
A potted history
of Health Informatics
1960s: Hospital management systems
1970s: Expert systems for diagnosis /
1980s: Clinical information systems /EHR,
RIS / Unified Medical Language System
1990s: Clinical workstations / Visible
Human Project / Internet health
2000s: Bioinformatics / Human Genome
Project / ontologies / modeling and
2010s: Health social media / health
analytics / ambient assisted living /
Health Informatics & e-health?
• Ehealth is “the use of information and communication
technologies (ICT) for health.
• Examples include treating patients, conducting research,
educating the health workforce, tracking diseases and
monitoring public health.”
...according to the World Health Organization, which has
been working to advance ehealth for the past decade.
2010-2013 study of 100 entry-level degrees, all health professions, all States &
K. Gray, A. Dattakumar, A. Maeder, K. Butler-Henderson, & H. Chenery, Advancing Ehealth Education for the Clinical Health Professions
Final Report, Australia. Department of Education and Training, 2014. http://clinicalinformaticseducation.pbworks.com
Very few degree coordinators could give a clear account of
campus or placement learning, teaching, assessment, quality assurance.
QA ≠ electives, home-brewed subjects, innovations
= curriculum developed and reviewed with reference to externally recognised health
informatics curriculum guidelines
Some health-profession-specific guidelines exist (e.g. nursing) and there are generic
health informatics curriculum guidelines e.g.
Certified Health Informatician Australasia Health Informatics Competencies Framework, 1.0, 2013.
J. Mantas, E. Ammenwerth, G. Demiris, A. Hasman, R. Haux, W. Hersh, et al., Recommendations of the International Medical Informatics
Association (IMIA) on education in biomedical and health informatics–1st revision. Methods of Information in Medicine 49 (2010), 105-120.
Image credit: timeshigherducation.co.uk
How do health professionals learn
about health informatics & ehealth?
Health informatics in CAPHIA curriculum guidelines -
Competencies for MPH Graduates in Australia 2009
HI-related keyword search:
“informatics”, “ehealth / e-health” ?
“electronic”, “comput*”, “technolog*” ?
“data”, “information” “knowledge”?
Area of Practice: Monitoring and surveillance
Practice Goal: Assess, analyse and communicate population health information
Unit of Competency 1. Monitor and evaluate population health data or indicators
Area of Practice: Disease prevention and control Ø
Area of Practice: Health protection Ø
Area of Practice: Health promotion Ø
Area of Practice: Health policy, planning and management Ø
Area of Practice: Evidence-based professional population health practice
Practice Goal: Engage as a professional in population health with knowledge and skills in population health
research, ethical population health practice, stakeholder analysis, information synthesis, effective
communication and cultural safety.
Unit of Competency 16. Collect, organise, critically analyse and articulate secondary information
…and more detail throughout fourth-level Elements of Competence
University of Melbourne MPH students
21 MPH students have taken the
interdisciplinary elective subject ISYS90069
Ehealth & Biomedical Informatics Systems
since it began in 2011.
‘It is really nice to interact with all the
students from different backgrounds.’
‘It was a good overview on biomedical
informatics. I have definitely gained
new insights in this area.’
‘This subject is an overview of medical
science in electronic version and how to
integrate this information and get a
nice overview of the world.’
Overview, definitions & a specific PHI lecture.
Other topics of high interest to MPH students:
1. Clinical research informatics
2. Consumer health information
3. Decision support for precision medicine
4. Ehealth in low income countries
5. Electronic medications management
6. Electronic patient records
7. Geospatial data in health
8. Government ehealth strategies & policies
9. Mobile apps & social media for health
10. Patient portals in hospital & primary care
11. Self quantification for health
12. Telehealth infrastructure and trends
Public health meets health informatics, seriously
Until the mid-1990s
introducing electronic data and
communications tools and
still was seen by many in the public
health community as
obscure, complex, impractical,
expensive, overly specialized and
not obviously useful…
“Public health informatics”
was defined first in 1995,
in the United States, as
the application of information
science and technology
to practice and research
in public health.
Seminal papers in public health informatics
Friede, A., Blum, H. L. ,McDonald, M., Public
health informatics: how information-age
technology can strengthen public health, Annual
Review of Public Health, 16(1), 239-252, 1995.
“The combination of the burgeoning
interest in health, health care reform
and the advent of the Information
Age, represents a challenge and an
opportunity for public health.
If public health’s effectiveness and profile
are to grow, practitioners and
researchers will need reliable, timely
information with which to make
information-driven decisions, better
ways to communicate, and improved
tools to analyze and present new
Yasnoff, W. A., et al., Public health informatics:
improving and transforming public health in the
information age, Journal of Public Health
Management and Practice, 6(6), 67-75, 2000.
“Development of effective public health
information systems requires
understanding public health
The current need for PHI arises from
dramatic improvements in
information technology, new
pressures on the public health system,
and changes in medical care delivery.
Application of PHI principles provides
unprecedented opportunities to build
Challenges > opportunities include:
Information architecture all-sorts > Platforms to scale up data exchange & interoperability
Jurisdiction silos > Whole-of-health IM/IS/IT management & governance
Human factors issues > Support for more effective ways to do what needs to be done
Public health > Population health
Public health goes back a long way, but
by the second half of 20th century
expansion of the biomedical model
of health overshadows public health.
Emphasises and integrates social,
environmental, cultural and physical
determinants of health
Widens needs / implications for
Population health informatics
…means that public health informatics
from the informatics of core functions
such as biosurveillance, outbreak
response and electronic laboratory
to the informatics of human-health
related aspects of agriculture,
architecture, climate and ecology.
“Biomedical informatics (BMI) must provide a coherent
framework for dealing with multi-scale population data
including the phenome, the genome, the exposome,
and their interconnections.
The combination of these more continuous,
comprehensive, and personalized data sources requires
new research and development approaches to data
management, analysis, and visualization. “
Sanchez, F. M., Gray, K., Bellazzi, R., & Lopez-Campos, G. (2014). Exposome informatics: considerations for
the design of future biomedical research information systems. Journal of the American Medical
Informatics Association, 21(3), 386-390.
Images: www.cdc.gov http://www.usa.philips.com/healthcare/innovation/thought-leadership/connect-to-healthy-sxsw
Rethinking scope of PHI in view of
Edmunds, M., Thorpe, L., Sepulveda, M., Bezold, C., & Ross, D. A. (2014). The Future of Public
Health Informatics: Alternative Scenarios and Recommended Strategies. EGEMS, 2(4).
Not just USA…
• Macfadyen, D., Importance of informatics for public health and the work of the World Health
Organization in Europe, in Health in the New Communications Age, M. F. Laires, M. J. Ladeira
and J. P. Christensen, Eds., Amsterdam, Netherlands: IOS Press, 27-30, 1995.
• Frisch, L. E., et al., Public health informatics in Canada, in Public Health Informatics and
Information Systems, J. A. Magnuson and P. C. Fu, Eds., London, England: Springer, pp. 603-
• Qi, Xet al.(2015). Cross-sectional survey on public health informatics workforce in China:
issues, developments and the future. Public health. DOI: http://dx.doi.org/10.1016/j.puhe.2015.03.002
• Richards, J., Douglas, G., and Fraser, H. S., Perspectives on global public health informatics, in
Public Health Informatics and Information Systems, J. A. Magnuson and P. C. Fu, Eds., London,
England: Springer, pp. 619-644, 2014.
Global PHI: the big picture gets bigger…
Health Metrics Network hosted by the World Health Organization
MOVE-IT & SWISH programs
PHI: the evidence base
American Medical Informatics Association
Annual Symposium 2013,
first ever PHI ‘Year in Review’ session
2013-2014: 65+20 PHI articles
meaningful use, syndromic surveillance, immunization registries, electronic laboratory reporting,
geospatial data, natural language processing, data quality, chronic disease prevention and
management indicators, screening systems, policy and infrastructure decision support and
bidirectional communication, consumer online behaviors, PHI workforce and training
Many good editorials, e.g.
• Cimino, J. (2014). Consumer-mediated health information exchanges. Journal of biomedical informatics, 48, 5-15.
• Mandl, K. (2014). Ebola in the United States: EHRs as a public health tool at the point of care. JAMA, 312(23), 2499-2500.
• Yasnoff, W. (2014). Proposal for Financially Sustainable Population Health Organizations. Pop health mgmt, 17(5), 255-256.
However…. original research reports in PHI are scarce.
PHI: specialised disciplinary & professional expertise
Core competencies for public health
informatics specialists were
formulated in 2009.
Relatively recent, compared to other
health informatics subspecialities
(such as imaging informatics,
nursing informatics, pathology
Karras, B., et al., Competencies for Public
Health Informaticians, Atlanta, USA:
University of Washington Center for
Public Health Informatics and Centers for
Disease Control and Prevention, 2009.
Two-year, competency-based training program - 3 examples of PHIFP assignments from http://www.cdc.gov/phifp/about.html :
1. The US Environmental Public Health Tracking program supports a national network of aggregated environmental
hazard, human exposure, and health outcomes data. A fellow developed an application ontology and co-designed
a content management database. The result streamlined the input of new data sources and visualizations.
2. The Health Workforce Information System of an African nation has been in place for several years, yet its positive
impacts on planning and practice have not been formally documented. To identify and document impacts, a fellow
led a team to review policy documents, interview senior officials at two Ministries of Health and four health
professional regulatory bodies, and analyze data from the system.
3. The US Laboratory Efficiency Initiative supports State and Local Public Health Laboratories to maintain services
during budget cuts. A fellow developed an assessment tool to help laboratories assess their informatics
capabilities. The fellow also developed guidelines to help bridge the identified gaps.
Whole conference specifically on public
2003-11 annual; 2014ff biennial
Regularly over 1000 attendees
Co-sponsors: National Association of
County and City Health Officials
(NACCHO) and the Centers for Disease
Control and Prevention (CDC)
A conference theme in 2014:
New opportunities, new
technology, new leaders
…. New technologies provide
challenges and opportunities in
public health, so how do we use
these eﬃciently and eﬀectively?
Prof Ray Wills
The current Australian context – example 1
Communicable Diseases Intelligence reporting
The National Health Security Act 2007
(National Health Security Act , No 174)
authorises the exchange of health information,
including personal information,
between jurisdictions and the Commonwealth.
CDI reporting covers
• Arbovirus and Malaria surveillance
• Childhood Immunisation Register
• Gonococcal surveillance
• Meningococcal surveillance
• Paediatric surveillance
• Creutzfeldt-Jakob Disease Registry
• the Sentinel General Practices Research Network (influenza-like
illness, gastroenteritis, chickenpox, shingles)
• HIV/AIDS surveillance
• Invasive Pneumococcal Disease surveillance
• lInfluenza surveillance
• Notifiable Diseases surveillance (60+ different diseases)
as well as including
• Tuberculosis notifications
• Mycobacterium Reference Laboratory Network
• Rotavirus surveillance
Each scheme has evolved its own paper-
based / electronic / internet-based
system of data collection and analysis.
2014 discussion paper:
… the system needs a “re-boot” for the 21st century…
• Over the longer term, virtual data networks or health
information grids allowing real-time exchange of health
data by multiple parties could transform the surveillance
landscape – highlighting the need for a system prepared
• Partnering with health informatics
specialists to improve current
systems and support design of new
systems is essential.
• Information technology specialists who understand
public health processes and requirements could identify
ways to, for example: share data across different
platforms; link new datasets to existing systems;
generate algorithms to detect unusual patterns in health
events; and display analysed data in an accessible and
• Communicable disease surveillance must keep pace with
changes to the way the world captures, stores, transfers,
uses and disseminates information.
The current Australian context – example 2
The Australian Institute of Health and Welfare is the repository for national
metadata standards for health. www.aihw.gov.au/publication-detail/?id=10737422826
METeOR is an example of a nationwide information infrastructure initiative –
data set development.
A National Health Information Standards and Statistics Committee is
• overseeing the development of data standards for inclusion in the National
Health Data Dictionary (NHDD);
• mandatory national minimum data sets for national implementation; and
• best practice data set specifications for inclusion in the NHDD.
AIHW Corporate Plan 2015–16 to 2018–19
Aims re significant activities that support
whole-of-government initiatives include:
• cloud computing
• open data initiatives
• connections with other key agencies
• cyber security
“Our key challenge in this context is to
provide an information and
communication technology (ICT)
capability that supports high quality,
effective and timely data collection,
analysis and reporting.”
1. Geospatial data
2. Data linkage
3. Value-added feedback to data providers
4. Filling primary health care information gaps
5. Diverse product formats
6. Predictive modelling and analysis
7. Data quality
8. Supporting information needs in federated system
More examples of scope for Australian population health informatics:
Commonwealth public health regulatory policies
The policy The data / information / knowledge
Develop food standards and food regulatory policy Management and evaluation of a new food labeling
Establish the Australia New Zealand Therapeutic
Joint Adverse Event Notifications Systems
Assess the risks of industrial chemicals and provide
information to promote their safe use
Registration of identified introducers of industrial
chemicals and provision of regular information
updates, including optimal use of international
Protect the health and safety of people and the
environment by regulating dealings with genetically
modified organisms (GMOs)
Records of GMOs and maps of field trial sites and
public availability online
There’s never been a better time to strengthen
Australian population health informatics –
identity, community, evidence
• The research literature in public health informatics in Australia is diffuse.
• Since the 1980s the Australian and New Zealand Journal of Public Health has published fewer than
20 papers which make any reference to informatics and only a handful in which this is a major focus
• Of the 2,350 publications indexed in PubMed between 1990 and 2005 that were written by authors
with Australian affiliations, only 17 clearly related to public health informatics .
• However a Google Scholar search shows that among nearly 3,000 papers published worldwide
2005-2014 that mention public health informatics, mention of Australia co-occurs in nearly 20% of
• Much research activity occurring in this field is unidentifiable as such – so far.
What happens next is up to you
 Australian and New Zealand Journal of Public Health. 2014. Home page. http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291753-6405. Accessed on March 1,
 Mendis, K., Health informatics research in Australia: retrospective analysis using PubMed, Informatics in Primary Care, 15(1), 17-23, 2007.
Comments, questions, follow-up?