Informatics as a Strategic Priority and Collaborative Processes to Build a Smarter, Forward-Looking Health Department

This article was published in the Journal of Public Health Management and Practice

Control of the Public Health IT Physical Infrastructure: Findings From the 2015 Informatics Capacity and Needs Assessment Survey

Background: Despite improvements in information technology (IT) infrastructure in public health, there is still much that can be done to improve the adoption of IT in state and local health departments, by better understanding the impact of governance and control structures of physical infrastructure. Objective: To report out the current status of the physical infrastructure control of local health departments (LHDs) and to determine whether there is a significant association between an LHD\u27s governance status and control of the physical infrastructure components. Design: Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County and City Health Officials. Participants: A total of 324 LHDs from all 50 states completed the survey (response rate: 50%). Main Outcome Measure(s): Outcome measures included control of LHD physical infrastructure components. Predictors of interest included LHD governance category. Results: The majority of the control of the physical infrastructure components in LHDs resides in external entities. The type of governance structure of the LHD is significantly associated with the control of infrastructure. Conclusions: Additional research is needed to determine best practices in IT governance and control of physical infrastructure for public health

An Iterative, Low-Cost Strategy to Building Information Systems Allows a Small Jurisdiction Local Health Department to Increase Efficiencies and Expand Services

Objective and Methods: The objective of this case study was to describe the process and outcomes of a small local health department\u27s (LHD\u27s) strategy to build and use information systems. The case study is based on a review of documents and semi-structured interviews with key informants in the Pomperaug District Health Department. Interviews were recorded, transcribed, coded, and analyzed. Results and Conclusions: The case study here suggests that small LHDs can use a low-resource, incremental strategy to build information systems for improving departmental effectiveness and efficiency. Specifically, we suggest that the elements for this department\u27s success were simple information systems, clear vision, consistent leadership, and the involvement, training, and support of staff

Performance evaluation of image segmentation

In spite of significant advances in image segmentation techniques, evaluation of these methods thus far has been largely subjective. Typically, the effectiveness of a new algorithm is demonstrated only by the presentation of a few segmented images that are evaluated by some method, or it is otherwise left to subjective evaluation by the reader. We propose a new approach for evaluation of segmentation that takes into account not only the accuracy of the boundary localization of the created segments but also the under-segmentation and over-segmentation effects, regardless to the number of regions in each partition. In addition, it takes into account the way humans perceive visual information. This new metric can be applied both to automatically provide a ranking among different segmentation algorithms and to find an optimal set of input parameters of a given algorithm

Using Information Systems to Improve a Mid-Sized Local Health Department’s Effectiveness in a Time of Rapid Change

Background: Informatics capacity building is resource and personnel intensive. Many local health departments (LHDs) face tradeoffs between using their resources to carry out existing mandates and using resources to build their capacity, for example, through informatics, to deliver essential services in a more effective and efficient manner. Objective: The purpose of this case study is to describe how a mid-sized LHD built and used information systems to support its strategic objectives, clinical services, and surveillance. Methods: The mid-sized LHD described here was chosen for its “best practices” in informatics capacity building and use by NACCHO\u27s study advisory committee. To conduct the case study, authors reviewed departmental documents and conducted semistructured interviews with key informants in the agency. Interviews were recorded, transcribed, thematically coded, and analyzed. Results and Conclusions: Findings from the case study suggest that including capacity building in informatics as a strategic priority is one of the most effective ways to ensure that informatics are assessed, updated, and included in resource decisions. Leadership at all levels is critical to the successful implementation of informatics as is proactive partnership with community partners who have overlapping goals. The efficiency and effectiveness of LHDs rely on informatics capacity, especially when resources are challenged

A draft framework for measuring progress towards the development of a national health information infrastructure

BACKGROUND: American public policy makers recently established the goal of providing the majority of Americans with electronic health records by 2014. This will require a National Health Information Infrastructure (NHII) that is far more complete than the one that is currently in its formative stage of development. We describe a conceptual framework to help measure progress toward that goal. DISCUSSION: The NHII comprises a set of clusters, such as Regional Health Information Organizations (RHIOs), which, in turn, are composed of smaller clusters and nodes such as private physician practices, individual hospitals, and large academic medical centers. We assess progress in terms of the availability and use of information and communications technology and the resulting effectiveness of these implementations. These three attributes can be studied in a phased approach because the system must be available before it can be used, and it must be used to have an effect. As the NHII expands, it can become a tool for evaluating itself. SUMMARY: The NHII has the potential to transform health care in America – improving health care quality, reducing health care costs, preventing medical errors, improving administrative efficiencies, reducing paperwork, and increasing access to affordable health care. While the President has set an ambitious goal of assuring that most Americans have electronic health records within the next 10 years, a significant question remains "How will we know if we are making progress toward that goal?" Using the definitions for "nodes" and "clusters" developed in this article along with the resulting measurement framework, we believe that we can begin a discussion that will enable us to define and then begin making the kinds of measurements necessary to answer this important question

Indivo: a personally controlled health record for health information exchange and communication

<p>Abstract</p> <p>Background</p> <p>Personally controlled health records (PCHRs), a subset of personal health records (PHRs), enable a patient to assemble, maintain and manage a secure copy of his or her medical data. Indivo (formerly PING) is an open source, open standards PCHR with an open application programming interface (API).</p> <p>Results</p> <p>We describe how the PCHR platform can provide standard building blocks for networked PHR applications. Indivo allows the ready integration of diverse sources of medical data under a patient's control through the use of standards-based communication protocols and APIs for connecting PCHRs to existing and future health information systems.</p> <p>Conclusion</p> <p>The strict and transparent personal control model is designed to encourage widespread participation by patients, healthcare providers and institutions, thus creating the ecosystem for development of innovative, consumer-focused healthcare applications.</p

Infrastructural requirements for local implementation of safety policies: the discordance between top-down and bottom-up systems of action

<p>Abstract</p> <p>Background</p> <p>Safety promotion is planned and practised not only by public health organizations, but also by other welfare state agencies, private companies and non-governmental organizations. The term 'infrastructure' originally denoted the underlying resources needed for warfare, e.g. roads, industries, and an industrial workforce. Today, 'infrastructure' refers to the physical elements, organizations and people needed to run projects in different societal arenas.</p> <p>The aim of this study was to examine associations between infrastructure and local implementation of safety policies in injury prevention and safety promotion programs.</p> <p>Methods</p> <p>Qualitative data on municipalities in Sweden designated as Safe Communities were collected from focus group interviews with municipal politicians and administrators, as well as from policy documents, and materials published on the Internet. Actor network theory was used to identify weaknesses in the present infrastructure and determine strategies that can be used to resolve these.</p> <p>Results</p> <p>The weakness identification analysis revealed that the factual infrastructure available for effectuating national strategies varied between safety areas and approaches, basically reflecting differences between bureaucratic and network-based organizational models. At the local level, a contradiction between safety promotion and the existence of quasi-markets for local public service providers was found to predispose for a poor local infrastructure diminishing the interest in integrated inter-agency activities. The weakness resolution analysis showed that development of an adequate infrastructure for safety promotion would require adjustment of the legal framework regulating injury data exchange, and would also require rational financial models for multi-party investments in local infrastructures.</p> <p>Conclusion</p> <p>We found that the "silo" structure of government organization and assignment of resources was a barrier to collaborative action for safety at a community level. It may therefore be overly optimistic to take for granted that different approaches to injury control, such as injury prevention and safety promotion, can share infrastructure. Similarly, it may be unrealistic to presuppose that safety promotion can reach its potential in terms of injury rate reductions unless the critical infrastructure for this is in place. Such an alignment of the infrastructure to organizational processes requires more than financial investments.</p