State and Local Perspective on Public Health Data Standards

Marty O’LaVenture, Public Health Informatics Advisor Minnesota Department of Health,

Minneapolis, Minnesota

at the Annual Meeting on Public Health Data Standards Consortium, March 16-18, 2004, Bethesda Marriott, Bethesda, MD

Opportunities for Strategic Action 

Topics for Discussion

• A State & Local Perspective: Opportunities and Challenges

• Opportunities for Strategic Action 1. Provide senior leadership informatics training2. Improve process for meaningful input3. Expedite tools for adapting, implementing and

maintaining standards 4. Increase public health Informatics capacity 5. Support state executive level Public Health

Informatician

State and Local Perspective-The community, where the work of

public health gets done -

“Although the development of comprehensive data standards and vocabularies is not trivial, it pales by comparison to the challenge of adapting, implementing, and maintaining standards in our public health agencies and daily use.”

- MDH - 2003

Local Public Health-The community, where the work of

public health gets done -

Where the standards, practices, policies, and procedures are made operational, institutionalized, and maintained, and the work of community public health get done.

Huge Increase •Information Systems •Data Standard Requirements

Facing a Storm of Needs, an Avalanche of Requirements and a Decrease in

Resources

Significant Decreases in Non-BT Funding

Example Surveillance for Infectious Diseases at MDH

Reportable Disease Surveillance

Influenza & Respiratory Surveillance

- SARS -

Public

Veterinary/Animal Health & Vectors

West Nile Virus

Unexplained Deaths

Source: Minnesota Department of Health

Opportunities for Strategic Action

For Developing Public Health Vocabulary and Data Standards

1. Support informatics training to increase understanding and commitment by senior leadership

2. Secure meaningful input from states & counties using strategic collaborative approaches

3. Expedite tools for adapting, implementing and maintaining standards

4. Increase public health informatics capacity5. Support a State executive level Public Health

Informatician

1. Support Informatics Training for Senior Leadership

Example Activity• Executive leadership training with the Public

Health Informatics InstituteApproach• Modular, iterative & strategic learning • Practical & adult learning focused • Emphasis on their decision making role in the

process

Example: Public Health Informatics Institute -

Leadership Workshop

1. Introduction

2. Informatics Context

3. Key Best Practices

4. “Just Do It”

5. Wrap-Up & Evaluation—All

Public Health Executive Leadershipfor Informatics Excellence

Executive Workshops Program

www.phii.org

Public Health Executive Leadershipfor Informatics Excellence

Executive Workshops Program

www.phii.org

Workshop Agenda

• Manage change pro-actively

• Develop informatics competencies

Implement Key Informatics Practices

OrganizationDevelopment

Accountability & Evaluation

• Use advanced accountability practices

• Effective project management• Strategic IRM planning• Enterprise architecture• Portfolio management

• Conduct comprehensive evaluations

Leadership & Governance

• Implement enhanced role for CIO

• Ensure governance connects agency and informatics strategies

Key Best Practices – Overview

Be smart.

Be wise.

Be good.

› This is a facilitated group session intended to help participants apply workshop concepts

› Please see session material under the tab marked: Just Do It

Practice Makes

Better

just do it

Materials

• Toolkit

• Resources

• Glossary

• Annotated bibliography

• Slide presentation

Introduction

INFORMATICS implies a disciplined approach to

information systems design

and implementation that will drive

improvements in public health practice

Using Informatics to Change Practice

Source: Adapted from Bellinger, G. Knowledge Management and the Minnesota Department of Health

Practice is the action taken based on our understanding of the knowledge and context for public health use.

ResultsParticipant Evaluation

Location /

Participant1st

National

State 36

Local

Other 4

Total 40

Ratings(5 point scale)

3.4

Length Full day

2nd

State

8

4

12

4.8Half

Day

3rd

National

4th

State

Total

2 20 66

8 38 50

4 8

14 58 124

4.5 4.4

Half Day

Half Day

Example Comments

• “this is the best workshop I have attended in years…” ~ and I have been to a lot…”

(county health official)

• “Very practical, I will use this tomorrow”(health department

director)

• “I don’t get it all yet, but this will be very helpful as I work with my county IT staff”

(local director)

2. Secure Meaningful Input Using Strategic Collaborative Approaches

Example Activity• Collaborative development around specific needs –

lab specificationsApproach• Make strategic use of staff input and foster

communities of practice• Use a facilitated – collaborative process• Provide national leadership not national control• Stress shared ownership not required liability• Know who you are talking to

Perspective & ChallengeDiverse Sets of Agencies & Partner Organizations

Agencies / Professionals

• 60 States & Territories health departments

• ~ 3000 local heath departments

• ~ 100,000+ professionals

• ~ 50 disciplines

• •

                                                                                         

                                                                                                                                                                                                   

                                                                                 

                                                                                 

Affiliated Organizations• ~ 115

Make Strategic Use of Staff

“I have participated in several national {standards} groups…..Unfortunately, most of what takes place is a lot of whining and spinning of wheels and eventually, the people who really do want to get something done, give up and go off and do it themselves”… - State staff – 2003

“…I feel like a token representative….and I have no effective way to get input from peers.….”

-State staff-2003

Example of Collaborative Development Process -LIMS

• Development of the Requirements Document for Public Health Laboratory Information (LIM) Systems

• 16 public health labs• Structured time limited

process• October 2002• “…a great jump start”

3. Expedite Tools For Adapting, Implementing

and Maintaining Standards

Example Activity• Immunization Registry and HL7 implementation

guideApproach• Provide a variety of tools & techniques to support

implementation• Encourage incremental steps (paths) to a solution

not only the “home run”• Understand & address issues of organization

change

Figure 2: Model for Identifying and Using Best Practices for Immunization Registries

Revised 9/23/ 03 - LaVenture

Best Practices**Knowledge

Successful Practices

Identifying Best Practices**

(Acquire, Develop, Disseminate)

B. Develop

C. Disseminate

A. Acquire

External* Organization Process

Using Best Practices

( Adapt, Implement & Evaluate)

1. Adapt

2. Implement

3. Evaluate

Internal Organization Process

Information System Architecture

OrganizationalContext

Example Tool for Adapting & Implementing Standards - CIRSET

(Committee on Immunization Registry Standards for Electronic Transmission)

• Created the Implementation Guide for HL7

• Peer organization, 40 immunization registry projects, state, local, CDC, and vendors.

• Action oriented; works on vocabularies & data structures

• Ex.: CVX, LOINC, XML,HL7

4. Increase Informatics Capacity

Example Activity• Informatics Competencies for Public Health

Approach• Leverage new and existing resources• Imbed expectations & authorization in grants• Manage standards and vocabulary as a type

of data and knowledge

Informatics CompetenciesInformatics Competencies for Public Health Professionals describes:

• Three classes of informatics competencies The use of information The use of information technology The development, deployment, and

maintenance of information systems

• Required levels of proficiency vary by job Front-line staff Senior-level technical staff Supervisory and management staff

Organizational DevelopmentPrinciples in Practice – Managing Change Key Best Practices – Organization Development

Organizational Capacity

Organizational Development

• The sum of individual competencies does not necessarily equal organizational capacity

• Changes may be needed in your organization to ensure that information is managed strategically and information systems development is done coherently and professionally

Principles in Practice – Managing Change Key Best Practices – Organization Development

Goal: to achieve an informatics – savvy organization

5. Support an Executive Level Public Health Informatician

Example Activity• Director of Public Health InformaticsApproach• Provide funding for senior level person with

advanced informatics skills and knowledge for every state health department.

• Ensure support through grants and requirements

Who do you Call? Who has Agency Wide Responsibility for

Public Health Informatics?

• Agency director (e.g commissioner) • State health officer• State epidemiologist (Infectious disease, Chronic

disease, Injury etc.• State laboratory director(s)• Web master• State CIO?/CTO/CSO• Project director (e.g. MCH,STD,Imm,Injury control)

The perspective on informatics standards and interoperability will vary by responsibility

State Public Health Informatician Responsibilities

• Agency wide accountability & responsibility • Ensure adherence to standards and a

commitment to interoperability• Monitor and support activities inside and

outside the agency • Monitor and participate in PHIN and NHII

strategic directions • Develop and support a state wide health

information infrastructure

Bottom Line Implications…

If we want to accelerate the development and use of public health data standards, it is time to….

Implement better approaches and practices that will more effectively utilize the capacities of local public health and pay greater attention to supporting informatics actions at state and local public health departments

Summary Action Needed

1. Expedite informatics training to increase understanding and commitment by senior leadership

2. Secure meaningful input from states & counties using strategic approaches

3. Assure the process includes tools for adapting, implementing and maintaining standards

4. Increase public health informatics capacity 5. Support an executive level state Public Health

Informatician

State and Local Perspective-The community, where the work of

public health gets done -

“Extraordinary people

doing amazing things

with little money,

facing great

challenges, and getting the work of Public Health done every day”

Questions?

Marty LaVentureMinnesota Department of Healthwww.health.state.mn.usmartin.laventure@health.state.mn.us612-590-0898

Thank You

Acknowledgements

• Dave Ross, Public Health Informatics Institute• Dennis J. Michaud, Massachusetts Department of

Public Health & CIRSET Chairperson 2003

• Warren Williams, Informatics/registryTeam, CDC • Aggie Leitheiser, Minnesota Department of Health

• Bill Brand, Minnesota Department of Health