Population Health, Public Healthand Big Data

Jeffrey Engel, M.D.Council of State and Territorial

Epidemiologists

Objective

• How are communities using data to improve health?– Dave Ross and Ivor Horn, co-chairs of the new

RWJF initiative, Data for Health– “The Data for Health initiative will be a starting

point for identifying what infrastructure is needed to turn this information into an effective tool for improving health nationwide.” Risa Lavizzo-Mourey, RWJF President and CEO

My objective is to ask: How can Public Health improve

population health using big data?

Definitions• Public Health: The federal, state and local enterprise of

publicly funded governmental agencies whose authority rests in law and rule (mandates)– Environment: water, air, food, vector– Control of communicable diseases: immunizations,

isolation and quarantine, certain treatments (TB, STD)– Vital records– Assurance of health services: MCH, nutrition, clinical services

(local)• Population health: Morbidity, mortality, health and well-

being of a defined group of people– public health is synonymous with population health when the

denominator is the people who reside in a jurisdiction

Prep

ared

ness

Health M

onitoring(Surveillance)

National Health Care Reform• The Health Information Technology for Economic

and Clinical Health Act (HITECH) Act (2009)– Universal EHR by 2015– Meaningful Use of the EHR: Population Health

• The Patient Protection and Affordable Care Act (2010)– Access to Care– Prevention

• Health Care Payment Reform (CMMS)– From Fee for Service– To Pay for Performance

Prevention and ACA

“ensure that all Americans have access to free preventive services under their health

insurance plans and invests in prevention and public health to encourage innovations in

health care that prevent illness and disease before they require more

costly treatment”

Some More Definitions…Prevention

• Primary Prevention addresses upstream determinants of disease (e.g. nutrition, physical activity, environment)

• Secondary Prevention addresses clinical interventions (e.g. immunizations, screenings)

• Tertiary Prevention addresses disease management (e.g. asthma, diabetes, cardiovascular disease)

Public Health and Health Care Integration

IOM (Institute of Medicine). 2012. Primary Care and Public Health: Exploring Integration to Improve Population Health. Washington, DC: The National Academies Press.

Public Health 2014• Surveillance (population health monitoring)

from the EHR• Bi-directional flow of information between the

clinic/hospital and the PH agency• Community works together for prevention

– Public Health notifies clinicians of ongoing outbreaks

– Patient referred to smoking cessation services from EHR prompt

Two Models of Health Information Exchange

Federated Model Direct Model

Statewide Health Information Network of New York (SHIN-NY)

Data Sources and Infrastructure

Today there are 10 independent

RHIOs

Pilot Objectives1. To develop population level hypertension measures with specifications and to program them using HIE data through Hixny for Albany County

2. To evaluate the quality and completeness of the HIE data through Hixny and to report challenges in calculating each hypertension measure

3. To explore the feasibility of conducting stratified analyses to identify high risk population or communities in urgent need of services

Using Health Information Exchange Data to Evaluate Hypertension in

Albany County

• 415,913 Patients• 53.8M Lab Results• 11M Encounters• 1.8M Observations

Health Information Exchange = Big Data

Pilot ResultsCalculate 3 Hypertension Measures

Findings and Implications for Action

NY Pilot demonstrated population level hypertension measures could be calculated with adaptations using the HIE data through Hixny for Albany County, New York.

Compared with the national or state performance on these hypertension measures, estimates for Albany County were overall much lower. Data from 3 FQHCs resulted in the hypertension control

rates closer to the national and statewide rates.

The NY pilot identified improvement and expansion opportunities included in a successful grant application to CDC.

Pilot Objectives1. To develop population level hypertension measures with specifications and to program them using HIE data through Hixny for Albany County

2. To evaluate the quality and completeness of the HIE data through Hixny and to report challenges in calculating each hypertension measure

3. To explore the feasibility of conducting stratified analyses to identify high risk population or communities in urgent need of services

Using Health Information Exchange Data to Evaluate Hypertension in

Albany County

Health Information Exchange Challenges

• Governance– Trust– Confidentiality and security

• Resources– Technology– Workforce

• Sustainability– Private funds– Public funds

Public Health-Health Care IntegrationAn Epidemiologist’s View 2014

Public Health: Making Accountable Care Organizations Accountable

AcknowledgementsStatewide Health Information Network of New York

Steven R. SmithNYS Health IT CoordinatorOffice of Quality and Patient Safety

Using HIE to Evaluate Hypertension in Albany County, New York

Scott Momrow, MPHVice President of Marketing & OutreachHixny

Ian Brissette, PhDDirector, Bureau of Chronic Disease Evaluation and ResearchOffice of Public Health

Feng (Johnson) Qian, MD, PhDAssistant ProfessorSchool of Pubic Health, University at Albany