HH/NURS 3240 Chapter 34: Public Health Practice Applications

Presentation prepared by: Melissa Mcfarlane, Amid Alapour, Stella Nambuusi, & Alexandra Verba

Overview of Public HealthWith the emergence of diseases such as

SARS, H1N1 and patients presenting with multiple comorbidities, public health has been combined with technology to combat this surge of information

Public health information is collected from a myriad of sources to assist in combating acute or chronic illnesses

Public health can now seamlessly exchange and use information from clinical and other sources

Public HealthEstablished in the USA in 1798 by the

Marine Hospital Service ActAn amendment called the Public Health

Service Act was established in 1944 to include not only physical health but also mental health

Three core functions of public health are: assessment, policy development and assurance

Intertwined with the core functions are the 10 essentials of public health which was developed by the Public Health Functions Steering Committee (1994)

Essential Services of Public Health• Monitor health

status• Diagnose and

investigate • Inform, educate,

and empower• Mobilize

community partnerships

• Develop policies and plans

• Enforce laws and regulations

• Link people to needed services / assure care

• Assure a competent workforce

• Evaluate health services

• Research

Government Role In Public HealthGuided by regulations and laws

developed at the local, state/territorial and federal levels

And input received from local, state/territorial and federal public health agencies

Public Health InformaticsFocuses on preventing diseases from

occurring in a populationDefinition: “the systematic application of

information and computer science and technology to public health practice, research and learning.” (p.501)

Provides a way to standardize the collection, and dispersion of a wide variety of health data about a given population

DisclosureThe Privacy Rule in Health Insurance

Portability and Accountability Act (HIPPA), 2004 explicitly prohibits the release of patient information without consent

A clause was added to the Act which allows for the disclosure of health information of individuals when it is deemed necessary to protect the public

Patient Protection and Affordable Care (PPACA), 2010 provides provisions to register individuals in public health programs

Public Health NurseProtects the public through the

use of nursing and public health sciences

Goals: promotes health, prevents disease and disability in a population

Governed by 8 principles

Eight Principles of Public Health Nursing1. The client or “unit of care” is the population.2. The primary obligation is to achieve the greatest good for

the greatest number of people or the population as a whole

3. The processes used by public health nurses including working with the client(s) as an equal partner

4. Primary prevention is the priority in selecting appropriate activities

5. The focus is on selecting strategies that create healthy environmental, social and economic conditions in which populations may thrive

6. There is an obligation to actively identify and reach out to all who might benefit from a specific activity or service

7. Optimal use of available resources to assure the best overall improvement in the health of the populations is a key element of the practice

8. Collaboration with a variety of other professions, populations, organizations and other stakeholder groups is the most effective way to promote and protect the health of the people

Public Health Informatician Uses informatics to improve

population healthPossess expertise in information

science, computer science, and epidemiology

Public Health Nurse Informatician (PHNI)Combines the principles of nursing and

public health informaticsA meeting of clinical care and technology Implements information science,

computer science and technology to public health nursing practice, research and education

Uses technology to improve public health surveillance

Public Health Electronic Surveillance

practitioners gather data on issues such as determinants of health, environmental health risks and hazards

investigate the occurrences of health events and health care system activities and their impact on health

This helps in the planning of the appropriate intervention

In order for health care systems to communicate effectively, there is a need for an easier and faster way to access this data

Initiatives such as the Health Information Exchanges (HIEs) and the National Electronic Disease Surveillance System (NEDSS) help decrease barriers related to the sharing and collection of public health data across the organizational levels

Three levels of data collecting and sharing: Local:

◦ Collaborate with clinicians and agencies, assemble reports of communicable diseases, track and monitor cases, investigate cases and provide essential services such as vaccinations and testing

State/Territorial: ◦ establishes regulations and legislations in order

to collect reports from the local health departments and then forwards them to the CDC

◦ Implement programs, assign priorities to cases and serve as a liaison between the CDC and the local health department

Federal: ◦ CDC presents surveillance summaries and

publishes public health recommendations

National Electronic Disease Surveillance System (NEDSS)Standards for NEDSS was created in 1999

by CDC, CSTE, state and local health departments

Incorporates and exchange and use information between various state and local surveillance systems

Electronic transfer of quality and timely health information from clinical systems to public health systems without the involvement of the provider

Criteria were developed to make NEDSS compatible with State systems

Criteria to Make NEDSS Compatible1. Browser based for data entry2. Electronic Laboratory Result

(ELR)3. Single repository for integration

databasesAnd…

System wide electronic messaging

NEDSS-Base System (NBS), a secure system

Health Care Providers role, Clinical laboratories and NBS

HCPs are responsible for providing care and reporting state designated communicable disease to public health departments

As a registered NBS user, HCPs can directly enter case data & laboratory reports into state’s surveillance system at point of care.

HCPs can also securely query the database, verify completeness of reporting using analysis tools and ensure compliance with state public health laws.

HCPs send electronic health reports using Health level seven clinical document architecture (HL7 CDA)

public/ private laboratory staff are required by law to notify public health departments of reportable diseases

Timely reports are important to public health surveillance to prompt case/ outbreak investigation

Public Health Practitioner (PHP) role and NBS

Local/ state PHP responds to incoming data on reportable conditions and implements appropriate strategies like tracking and monitoring.

Registered NBS user public health practitioners review laboratory and HCP reports for patients residing within their jurisdiction boundaries.

Upon receipt of new report, PHP may order a public health field investigation.

PHP classifies cases basing on stored data & standard case definitions, then forwards the notifications to CDC using NEDSS, HL7 or NETSS (if no messaging guide exists).

NBS data transfer function allows users to notify another jurisdiction when Pt moves and transfer records for follow- up.

Privacy Protection and NBS To protect personal information, the NBS requires:

◦ User authentication ◦ Aauthorization ◦ auditing protocols

NBS supports user authentication to verify user identify. Once authenticated, NBS authorises access to data based on geographical area, public health events, diseases and user role.

An audit file that contains fingerprint trail with a timestamp of the user’s activities is then created by the NBS

Public Health Applications Using Informatics in an

immunization information system◦Immunization Records

1-Paper forms completed by hand and reported periodically to local health

agencies The procedure was time consuming and vulnerable to

wrong data entry II- Electronic Immunization Information

System (IIS) Confidential and computerized systems where

immunization histories are collected and can be accessed by authorized personnel

Funding and human capacity to build and manage the system are the challenges of IIS

Public Health Applications Benefits for public:

1. Having a private and secure place to safeguard immunization information from multiple providers

2. Receiving timely reminders

3. Eliminating duplicate immunization

Benefits for HCP: 1. Consolidating immunization

record from different sources2. Automatically calculating

immunization needs3. Easily providing official copies4. Automatic inventory and

ordering procedures5. Flagging high risk patients6. Tracking vaccines during

shortage or recall7. Assisting with vaccine safety

reporting8. Reducing chart pulls for

coverage assessment and HEDIS revises

Public Health Applications Using Informatics in a tuberculosis electronic

information system◦ Health care providers in the US are required to report

confirmed cases of TB◦ The following systems are involved in electronic TB

reporting: National TB Surveillance System TB Genotyping Information Management System Electronic Disease Notification System

◦ The collected data is used by CDC to report national TB-related performance indicators

◦ Health departments receive these reports electronically. They use the national reports to set performance targets, measure performance, and evaluate the program’s capacity to control and prevent TB.

Case Study 1 Immunization registries and emergency

response after hurricane Katrina◦ Most of the 200,000 residents of New Orleans who were

evacuated to shelters in Houston did not have their medical and immunization records.

◦ Proof of immunization was necessary if the displaced children wanted to remain in schools in Texas.

◦ Houston-Harris County Immunization Registry (HHCIR), Louisiana Immunization Network for Kids State-wide (LINKS) and their common vendor developed a technological bridge based on HL7 standard to connect their systems and exchange their data

◦ During the next year almost 19,000 records of immunization of displaced children were matched.

◦ That electronic innovation not only saved more than $1.6 million by preventing the unnecessary re-immunization, but also empowered displaced children, their parents and health care providers.

Case Study 2Norovirus outbreak in persons displaced by

hurricane Katrina◦ In September 2005, after hurricane Katrina

symptoms of acute gastroenteritis were observed among hurricane evacuees and relief workers.

◦ Data was collected based on a checklist of symptoms and entered into a database on a daily basis.

◦ Analysis of collected data based on reported epidemiologic and lab findings indicated an outbreak of norovirus gastroenteritis in many facilities.

◦ The spread of norovirus is person-to-person and is not the result of contaminated food or water.

◦ The information was used to provide a health alert and to promote treatments and preventive measures.

Case Study 3Using informatics for public health

program evaluation ◦Because TB disease or latent TB in a child is an

indicator of recent transmission of the bacteria, it is an important measure in assessment of effective TB prevention and control.

◦Public health nurses use a Clinical Nursing Information System (CNIS) dataset to account for nursing activities.

◦Because monitoring standardized nursing activities can help identifying missed opportunities for prevention (Such as TB prevention in children), CNIS dataset could be modified to cover the prevention efforts.

Future Directions in Public Health Information Systems

Local Agencies and public health practitioners◦ provide support and leadership in emerging concept of

multiagency responsibility for health◦ Provide health information developers with information

about the data needs that are specific to a communityFederal Agencies

◦ Help develop consensus on data and health information technology standards for an efficient national public health information system

Public health nurse informatician role◦ improve surveillance by accessing client information,

indicating data that is essential for the evaluation for community surveillance and assessing the effectiveness for health services in support of surveillance programs

ReferenceSaba, V. K., & McCormick, A.

(2011). Essentials of nursing informatics (5th ed). McGraw-Hill.