USING INFORMATION SYSTEMS FOR PUBLIC …

1 353 CHAPTER 13 USING INFORMATION SYSTEMS FORPUBLIC health ADMINISTRATION James Studnicki*Donald J. BerndtJohn W. FisherWhere is the Life we have lost in living? Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in INFORMATION ? Eliot,Choruses from the RockChapter OverviewPublic health organizations require well-designed INFORMATION SYSTEMS inorder to make optimal use of the mounting supply of health -related rely on these SYSTEMS to inform managerial decision makingand improve operations in areas such as epidemiologic surveillance, healthoutcomes assessment, program and clinic administration, program evaluationand performance measurement, PUBLIC health planning.

2 And policy design considerations in developing INFORMATION SYSTEMS include service-based and population-based application objectives, units of analysis, datasources, data linkage methods, technology selection and integration strate-gies, and INFORMATION privacy protections. A growing collection of modelsand resources now exists for developing effective INFORMATION SYSTEMS forpublic health organizations. INFORMATION SYSTEMS have emerged as an essential PUBLIC health , INFORMATION SYSTEMS provide real-time data to guide PUBLIC health de-cisions.

3 The rise in importance of health INFORMATION SYSTEMS (HISs) has threefundamental sources: (l) the expanding breadth of data available from multi-ple PUBLIC and private sources, (2) advances in INFORMATION technology (IT),and (3) the growing recognition of the power of INFORMATION in PUBLIC healthdecision making. Administrative data from PUBLIC and private health serviceproviders as well as insurers contain an electronic history of healthcare cost*The authors wish to acknowledge the work of Stephen Parente, the author of the previousversion of this 4/4/07 11:59 AM Page 353 Jones and Bartlett Publishers.

4 NOT FOR SALE OR DISTRIBUTIONand use. Government surveys provide an unprecedented level of detailed in-formation on health status, functional status, medical care use and expendi-tures, nutrition, sociodemographics, and health behaviors. HISs support a wide variety of PUBLIC health system objectives, includingthe following: Epidemiologic disease and risk factor surveillance Medical and PUBLIC health outcomes assessment Facility and clinic administration (billing, inventory, clinical records,utilization review), cost-effectiveness, and productivity analysis Utilization analysis and demand estimation Program planning and evaluation Quality assurance and performance measurement PUBLIC health policy analysis Clinical research health education and health INFORMATION dissemination IT has now advanced to the point that one year of the Medicare pro-gram s entire claims history roughly 200 million observations can be ana-lyzed on a high-end personal computer (PC) workstation.

5 Advances in IT aredramatically influencing PUBLIC health organizations and their historical rolesin collecting and disseminating data. Vital statistics and disease registries critical functions of PUBLIC health departments at both the local and nationallevel are being transformed by IT and its emphasis on evidence-based deci-sion making. Yet, HIS resources remain difficult to develop and manage inaddressing current PUBLIC health challenges. Data sets are located in a balka-nized array of separate computing platforms with little interconnectivity.

6 ForHISs to be effective, PUBLIC health administrators must assess available datasources, design blueprints for extracting INFORMATION and knowledge, andevaluate the benefits derived from these SYSTEMS . This chapter examines concepts, resources, and examples of HISs forpublic health organizations. Issues and implications for PUBLIC health man-agement are explored in the following five areas: 1. Contemporary concepts and applications of HISs in PUBLIC health2. INFORMATION SYSTEMS architectures 3. Available databases 4.

7 Operational models 5. Privacy and security Contemporary Concepts and ApplicationsWhat is PUBLIC health INFORMATION ? A more telling question may be what isnotpublic health INFORMATION , because the scope of data required to examinescientifically the multiple and overlapping health , social, and environmentalfactors that affect a population can be enormous. Traditionally, PUBLIC healthor epidemiologic data consist of vital statistics, disease registries, and othersurveillance-based resources. However, these resources are often limited inscope because they only record natality, morbidity, mortality, and perhapssome measure of environmental and behavioral influences.

8 Managing health354 Chapter 13 USING INFORMATION SYSTEMS for PUBLIC health 4/4/07 11:59 AM Page 354 Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION resources effectively at the population level requires a much broader scope ofdata resources to measure the effectiveness and cost of health interventionsand policies. An examination of PUBLIC health applications of HISs is facilitated by anunderstanding of the two most common applications of these SYSTEMS inpractice. First, INFORMATION SYSTEMS are used to store and make available ser-vice data that reflect activities performed by PUBLIC health organizations andother health -related entities.

9 Second, INFORMATION SYSTEMS store and makeavailable population-based data that are important for surveillance, programevaluation, policy making, and priority setting in PUBLIC health . These twocommon applications are not separate but interact extensively. For example, routinely collected service data by local PUBLIC health agen-cies often include the results of blood lead screening of children under 5 yearsof age, immunization status, and encounter data recording the results ofclient visits for tuberculosis (TB) and sexually transmitted diseases (STDs).

10 Other routinely collected service data include records of individual client en-counters in the federal Special Supplemental Food Program for Women,Infants, and Children (WIC) and other early intervention programs. These ser-vice data are important for the effective management of individual care bypublic health and ambulatory care providers. Importantly, these data reflectindividual transactions and can be used to monitor program performance andto describe a group of users at a particular facility but they do not necessar-ily offer INFORMATION about an entire community or important practical distinction exists between the service-based ap-plication of HISs and the population-based application, which offers informa-tion about defined communities and population groups of interest.