Decision Support for Public Health Practice: Research Findings in the Development of Knowledge...
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Decision Support for Public Health Practice: Research Findings in the Development of Knowledge Management and Disease Surveillance Tools University of Ljubljana July 10, 2007 Sherrilynne Fuller, PhD Co-Director, Center for Public Health Informatics Professor Biomedical and Health Informatics, School of Medicine University of Washington, Seattle, USA Center for Public Health Informatics University of Washington
Decision Support for Public Health Practice: Research Findings in the Development of Knowledge Management and Disease Surveillance Tools University of
Decision Support for Public Health Practice: Research Findings
in the Development of Knowledge Management and Disease Surveillance
Tools University of Ljubljana July 10, 2007 Sherrilynne Fuller, PhD
Co-Director, Center for Public Health Informatics Professor
Biomedical and Health Informatics, School of Medicine University of
Washington, Seattle, USA Center for Public Health Informatics
University of Washington
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USA Center for Public Health Informatics University of
Washington NOTE: Map NOT to Scale for Alaska Seattle, Washington
Alaska Vancouver, British Columbia, Canada
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Center for Public Health Informatics University of Washington
University of Washington Center of Excellence in Public Health
Informatics UW Center of Excellence in Public Health Informatics
Administrative Core A Epidemiology & Biostatistics Core
Informatics Technology Core C Informatics Technology Core C
Knowledge Management myPublicHealth Knowledge Management
myPublicHealth Surveillance Integration Project WA State Dept of
Health Regional Health Information Organizations WA State local
health agencies Technology & Design Core Improving the publics
health through information integration
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Center for Public Health Informatics University of
Washington
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Role of Medical Care in 20 th Century Public Health
Achievements PH AchievementDue to Medical Care? VaccinationIndirect
Motor-vehicle safetyNo Safer workplacesNo Control of infectious
diseases+/- Coronary heart disease/stroke deaths +/- Safer and
healthier foodsNo Healthier mothers and babies+/- Family planningNo
Fluoridation of drinking waterNo Recognition of tobacco as health
hazardNo RA Patrick OCarroll, MD Region X Health Administrator
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RA Patrick OCarroll, MD Region 10 Health Administrator
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Clinical PH Information Interchange Research Questions Clinical
(patient) information to support chronic disease interventions in
communities: what is the minimum data set? Situational awareness
data exchange how to do in a focused, timely, comprehensive way? PH
clinical data (e.g. immunization, disease status, relevant
community information) to electronic health record? Timely
approaches to people and directory type information interchange?
Research findings how to extract from the literature and present to
practitioners? Utilization of community health information for
decision support for individual patients? Center for Public Health
Informatics University of Washington
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8 CPHI Key Research Areas Knowledge in Practice 1.Managing
information resources and data for PH practice 2.Business process
analysis and workflow characterization Surveillance Data for PH
practice 1.Collection and Analysis 2.Geospatial Presentation
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Center for Public Health Informatics University of Washington
Knowledge in Practice: The Challenge Neither the creation nor the
distribution of information resources* upon which public health
practitioners depend is managed or presented in any systematic or
comprehensive way at the present time *data of all types,
guidelines, research findings, maps, policies, laws, evaluation
metrics, teaching materials, etc.
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10 Center for Public Health Informatics University of
Washington Approach Research workflow and information needs of
public health practitioners to support evidence-based practice
Develop and optimize a knowledge management system to support
iterative refinement of a set of retrieval and information
management tools for public health practitioners
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Center for Public Health Informatics University of Washington
Information Needs of Public Health Practitioners: Observations nFew
formal studies of information needs, information- seeking behavior
or workflow of PH professionals nRapidly expanding volume of data
and information nMajor barriers: time, resource reliability;
discerning credibility of information nPeople are a critical source
of information in public health nSilos of surveillance information
lack currency and context nLack of linkages between individual
patient information and public health information systems Revere D,
Turner A, Madhavan A, Rambo N, Bugni PF, Kimball AM, Fuller SS.
Understanding the information needs of public health practitioners:
A literature review to inform design of an interactive digital
knowledge management system. J Biomed. Informatics 2007. Special
Issue on Public Health Informatics.
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Center for Public Health Informatics University of Washington
Information Needs of Public Health Practitioners Resources used
influenced by job function, disciplines & training Want
resources that are easy to access & use, up- to-date, free,
pre-digested & stable, focused One size/approach does not fit
all; personal customization is highly desired Revere D, Turner A,
Madhavan A, Rambo N, Bugni PF, Kimball AM, Fuller SS. Understanding
the information needs of public health practitioners: A literature
review to inform design of an interactive digital knowledge
management system. J Biomed. Informatics 2007. Special Issue on
Public Health Informatics.
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Center for Public Health Informatics University of Washington
1.Information from areas beyond biomedical domains: e.g. social,
legal, policy 2.Systematic reviews & summary information
3.Government reports (grey literature) & conference proceedings
4.Evidence-based resources e.g. full-text research articles;
synthesized reviews of clinical topics 5.Data from community-based
and clinical systems with geographic mapping and analysis
capability Information Needs of Public Health Practitioners:
Resource Types
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Center for Public Health Informatics University of Washington
Why a Content Management System? CMSs streamline the process of
creating, managing & delivering content, & put processes in
place to manage & control information as it is moved &
changed Archive / RetireCreate / Capture ManageDeliver Content
Management Solution Review / Approve Content intelligence
Collaboration services Transformation Renditions Process automation
Library services Repository services Authoring Importing
Aggregation Imaging Publishing Web delivery Portal delivery Content
distribution & syndication Streaming Real-time content Records
management Final form storage
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Center for Public Health Informatics University of Washington
Rapid Prototyping: Iterative Refinement Process
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Center for Public Health Informatics University of Washington
Prototyping the Interface Beta Version 3.0 http://myph.org/
Toolkits Locally customizable, role-based resources views Advanced
retrieval tools
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Center for Public Health Informatics University of
Washington
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http://myph.org/webalizer Usage of myPH Prototype: Data
summary, 03/05/2007 Promotion began ramp-up - Feb 2007
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19 Core Workflow Problem The information processes and workflow
of public health practice are not well characterized, making it
difficult to build public health information systems that
efficiently support practice.
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20 Workflow Analysis Research Faculty from the UW-CPHI are
participating in requirements definition projects: Kitsap County
Health District - chronic disease prevention and control (J.
Baseman, A. Turner) Spokane County Health District - public health
preparedness (B. Karras) Significance to PH Practice: improved
efficiency, cost savings, improved disease surveillance, and
improvements to the health of communities
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21 Biosurveillance Research Value of data Decision support for
biosurveillance: Utility functions for identifying and evaluating a
minimum data set (J. Doctor, J. Baseman, B. Lober) Notifiable
condition reporting Electronic forms to support notifiable
condition reporting in a health information exchange infrastructure
(B. Lober, J. Baseman, B. Karras) Future: Bayesian networks for
case identification Algorithms for probabilistic reporting criteria
Geospatial mapping of disease incidence
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22 Uncertainties about Biosurveillance Data Timeliness
Organizational processes Data entry, system architectures Network
traffic delays Integrity Accuracy, Completeness Depends on quality
control Relevance Depend on purpose of data analysis Outbreak
detection, situational awareness, program monitoring &
evaluation, community assessment Multi-attribute Utility Theory -
Utilizing to determine trade-offs
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23 Relevance Time tradeoff Children exposed to a child w/.
suspected measles. Low prior probability confirmation needed. Time
tradeoff w/ efficacy of vaccination. Utility of a lab result in N
hours? Subjects/Sampling/Instrument PH professionals practicing at
County PH offices Email request sent to County PH Officers in WA
Interactive Web Survey - Tradeoff questions, rating scales and
demographic questions
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Notifiable Conditions Survey
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25 Utility as a function of lab delay on time to act - measles
outbreak Data elements have tractable utility representations, and
utility tradeoffs. PH professionals place nonlinear value on
time-to-act, preferences
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Center for Public Health Informatics University of Washington
26 Electronic Notifiable Condition Reporting Electronic forms using
Xforms technology (XML) Form instance and data instance
Demonstration showcased: Provider engagement Efficiency through
form pre-population Efficiency through electronic transmission
Inherent auditing, recording workflow
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Lung Cancer in Washington State Age Adjusted rates Incidence:
ICD-0: C34.0-C34.9, excluding histology codes 9140, 9590-9989
Mortality: ICD-9 (1990-1998): 162.2-162.9, ICD-10 (1999- ): C34
Tables Center for Public Health Informatics University of
Washington
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Conclusion Integrated PH decision support systems are in their
infancy in the U.S. We can learn from lessons of clinical decision
support system design and deployment It is critical that we figure
out how to optimize timely data exchange of critical information
between clinical and public health information systems Much more
work is needed to understand information needs and practice in
order to optimize the decision support environment for public
health practitioners Centerfor Publ ic Health Informatics
University of Washington
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Bibliography Cont. Revere D, Madhavan A, Turner AM, Rambo N,
Kimball AM, Bugni P, Fuller S. Understanding the information needs
of public health practitioners: a literature review to inform
design of an interactive digital knowledge management system. J
Biomedical Informatics 2007 (Special Issue on Public Health
Informatics). Revere D, Bugni P, Fuller S. A Public Health
Knowledge Management Repository that Includes Grey Literature.
Publishing Research Quarterly 2007 (Special Issue on Grey
Literature 2007). Revere D, Bugni PF, Fuller S. An interactive
digital knowledge management system to improve public health
practitioners' access to public health resources. In Proceedings of
the American Medical Informatics Association (AMIA) Annual Fall
Symposium, Nov 2006. Washington DC. Revere D, Madhavan A, Kimball
AM, Turner A, Bugni P, Fuller S. myPublicHealth: Research in Public
Health Knowledge Management to Support Evidence-Based Practice. In
Proceedings of the CDC's Public Health Information Network (PHIN)
Conference, Sept 2006. Atlanta GA. Center for Public Health
Informatics University of Washington
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Bibliography Cont. Revere D, Madhavan A, Kimball AM, Turner A,
Bugni P, Fuller S. myPublicHealth: Research in Public Health
Knowledge Management to Support Evidence-Based Practice. In
Proceedings of the CDC's Public Health Information Network (PHIN)
Conference, Sept 2006. Atlanta, GA Doctor, J. Baseman, JG, Lober,
BD, Davies, J., Kobayashi, J., Karras. B., Fuller, S. Time tradeoff
utilities for identifying and evaluating a minimum data set for
event detection in time-critical biosurveillance. Submitted:
Medical Decision Making. Hoskins RE, OConnor C, Johnson C, OCarroll
P, Fuller S. EpiQMS: An Internet Application for Access to Public
Health Data for Citizens, Providers, and Public Health
Investigators. Journal of Public Health Management and Practice,
8(3):30-36, 2002. Center for Public Health Informatics University
of Washington