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What is public health informatics and what can it do for my local health department? Date: Thursday, April 30, 2009 Time: 12:00 1:30pm EDT Speakers:Dr. Arthur Davidson, Denver Public Health, adavidson@dhha.orgadavidson@dhha.org Dr. Anna Orlova, PHDSC & Johns Hopkins University, aorlova@jhsph.eduaorlova@jhsph.edu Moderator:Alastair Matheson, NACCHO, amatheson@naccho.orgamatheson@naccho.org Slide 2 Welcome and overview Why should I care about informatics? Scenarios that are relevant to your work Questions raised by these scenarios Compelling reasons to get involved What will the benefits be for you? What are some of the issues in informatics? Why is it important for local public health to be involved? What are the next steps? What the stimulus can and cannot do for you What should you do now? What is NACCHO doing? Slide 3 Scenarios Scenario 1: Communicable Disease CDC has activated its Emergency Operations Centers to coordinate the agencys response to the swine influenza outbreak. Scenario 2: Chronic Disease The mayor/county commissioner/city council person for your jurisdiction made an inquiry about public health efforts to improve cardiovascular disease care and outcomes in your community. Scenario 3: Health Information Exchange The local medical society is organizing an effort to respond to the recent incentive packages for physicians and hospitals to adopt electronic health records. The president of the society calls you to see if you would help them determine was meaningful use should be in your community. Slide 4 Scenarios (continued) Scenario 4: - Workforce New federal preparedness funding guidance focuses on building connectivity between the personal and public healthcare environments for situational awareness. The state health department (SHD) is encouraging local health departments (LHD) to develop tools for interoperability with the state and the larger health care community regarding biosurveillance systems. Slide 5 How to find needed information? Scenario 1: - Communicable Disease CDC has activated its Emergency Operations Centers to coordinate the agencys response to the swine influenza outbreak. How do you go about answering questions in your jurisdiction regarding: potential sources of infection? comparing current and prior year rates of seasonal flu? How do you acutely improve your surveillance methods? How do you share data and analyses with neighboring jurisdictions and CDC? How are you communicating information to the public? Slide 6 How to find needed information? Scenario 1 Swine Influenza What information systems, if any, do you use to support CDC response? What has been your experience to date in getting data and how you are using these information systems? Slide 7 a field that helps users (public health professionals, clinicians, etc.) to communicate to developers user needs for information technology (IT) products, so these IT products will be useful in finding information to support public health decisions. Informatics Slide 8 Informatics is the science that studies the use and processing of data, information, and knowledge Van Bemmel JH & Musen MA. 1997. Handbook of Medical Informatics. Bohn: Springer-Verlag Slide 9 Informatics is NOT Information Technology (IT). Informatics is the field that describes the problem (application domain), e.g., Flu Surveillance, for which an IT solution (application, tool) is needed, e.g., Flu Surveillance Information System to (1) track cases of sick individuals, (2) generate public health alerts, (3) monitor vaccine distribution, etc.. Informatics through modeling helps to select best IT solution to address a Problem. So, an IT professional (developer) is an engineer who builds the tool for the solution. Informatician is a user who designs the solution. Informatics vs. Information Technology Slide 10 Informatics uses models of the problem (application domain) to: capture domain knowledge; precisely specify requirements, i.e. specifications for a solution so that all stakeholders may understand and agree on them; guide the thought process; generate potential system configuration describing a generic structure and meaning; abstract specifications of the essential structure of the system; tell what something does (functional specification) as well as how the function is accomplished (implementation) Model Development is the Main Informatics Method Rumbaugh et al. 1999. Unified Modeling Language. Manual. Informatics and Modeling Slide 11 CP Friedman. Where's the science in medical informatics? J. Am. Med. Inform. Assoc. 1995 2: 65-67 Problem (domain) modeling is FOUNDATIONAL for a successful IT application Informatics Information Technology Slide 12 Using Informatics Tool of Modeling Scenario 1: - Communicable Disease CDC has activated its Emergency Operations Centers to coordinate the agencys response to the swine influenza outbreak. How do you go about answering questions in your jurisdiction regarding: potential sources of infection? comparing current and prior year rates of seasonal flu? How do you acutely improve your surveillance methods? How do you share data and analyses with neighboring jurisdictions and CDC? How are you communicating information to the public? Modeling User Workflow. Slide 13 Ambulatory Care Response Team State Public Health Surveillance System Event Detection CDC 1- Report/retrieve symptoms, diagnosis & medication prescription data from EMRs 2 Data mining of EMR notes 3 Notify on increased number of cases & recommend to order pathogen test 7 Report on the positive case electronically & by phone Media Local Public Health Surveillance System Hospital Neighboring Jurisdictions PUBLICPUBLIC Laboratory 4 Order pathogen test 5 Report test results EHRS Modeling User Workflow 5 Report test results Pharmacy Slide 14 Ambulatory Care Pharmacy Local Public Health Surveillance System Event Monitoring CDC 2 - Monitor newly diagnosed cases & vaccination data from EMRs 1 Send health alert 6 Send order to activate emergency vaccination 9 Send updates on the event Media 10 Send health alert to the public 3 - Monitor ER visits & hospitalizations data from EMRs 7 Order/ Supply vaccine Hospital State PH Surveillance System Neighboring Jurisdictions 8 Monitor vaccine supplies Response Team PUBLICPUBLIC Lab 4 Order pathogen test 5 Report test results EHRS Modeling User Workflow 5 Report test results Slide 15 Ambulatory Care Local Public Health Surveillance System Event Management CDC 2 - Monitor newly diagnosed cases & vaccination data from EMRs 1 Send Outbreak updates 6 Send Rapid Flu Test Kits 9 Send outbreak updates Media 10 Send outbreak updates to the public 3 - Monitor ER visits, hospitalizations data from EMRs & utilization data Hospital State Public Health Surveillance System Response Team PUBLICPUBLIC Lab 4 Order pathogen test 5 Report test results EHRS 9 Activate coordinated response Modeling User Workflow Neighboring Jurisdictions Pharmacy 7 Order/ Supply vaccine 8 Monitor vaccine supplies 5 Report test results Slide 16 Output of Informatics Modeling Tools Modeling helps identify and define: Participants Actors involved in the information exchanges regarding the swine influenza outbreak: Hospitals, Ambulatory Clinics, Laboratories, Vaccine Supplies and Distributors, Local and State Health Departments, CDC, Schools, Media Interactions Actions between participants in the information exchange answering questions regarding: potential sources of infection, comparing current and prior year rates of seasonal flu, methods to acutely improve your surveillance methods, sharing data and analyses, communicating information to the public Slide 17 From User Needs to System Development Flu Surveillance Information System Specifications Design Trial Implementation Deployment Evaluation Informatics Concepts:Public Health Concepts Problem / Domain:Flu surveillance Goal:Help coordinate CDC response on Swine Flu outbreak Stakeholders (Actors)Participants in information exchange Functions (Actions)Interactions among participants in the exchange Data:Cases by jurisdiction, lab data, vaccine supplies data, etc. Information:Event detection, monitoring, response Knowledge:Situational awareness Tool (Modeling):Workflow and dataflow Slide 18 Adjectives are used to distinguish the field where informatics is applied such as medical environmental dental nursing public health .... Informatics Applications Slide 19 Public Health Informatics is the application of information science and technology to public health research and practice What is Public Health Informatics? Friede A, McDonald M, Blum H. 1995. Public health informatics: how information- age technology can strengthen public health. Ann Rev Public Health 16:239-52 Slide 20 Lagging National Agenda for PH Informatics Funding and Governance (11 Items) Architecture and Infrastructure (10 Items) Standards and Vocabulary (11 Items) Research, Evaluation and Best Practices (14 Items) Privacy, Confidentiality, and Security (12 Items) Training and Workforce (16 Items) Yasnoff WA, Overhage JM, Humphrey BL, LaVenture M. A national agenda for public health informatics. JAMIA 2001; 8 (6): 535-45. Slide 21 Scenario 2 Chronic Disease The mayor/county commissioner/city council person for your jurisdiction made an inquiry about public health efforts to improve cardiovascular disease (CVD) care and outcomes in your community. What are your sources of data for responding to the following questions: How bad is the problem in our community? Do we know of any ongoing interventions? Where are they being conducted? What have been the results of those efforts? Can we compare current to prior year rates? Do you have any ideas on how to improve surveillance and methods for intervention? A foundation is interested in supporting public health efforts: how would you propose next steps? How to find what information we need? Slide 22 Laboratory Ambulatory Care Pharmacy School Local CVD Surveillance System CVD Surveillance DHHS 4 Prescribe Medication and Treatment Plan 1 Conduct Routine Check-ups 7 Report Data to Public Health 2 Order cholesterol test Media 10 Conduct Health Education 6 Fill Prescription 9 - Monitor ER visits, hospitalizations data from EMRs & utilization data Hospital State Public Health Surveillance System Payor 11 Send reports 3 Report test results 8 Coordinate Care PUBLICPUBLIC 5 Monitor Treatment EHRS 12 Conduct Surveys (BRFSS) Modeling User Workflow Slide 23 Electronic Health Record (EHR) Electronic Health Record (EHR) is information, assembled and maintained in an electronic format which pertains to the health status of an individual and the health services delivered to an individual. EHR is also defined as: standardization in the field of health information and communications technology to achieve compatibility and interoperability between independent systems to ensure compatibility of data for comparative statistical purposes (e.g., classifications), and to reduce duplication of effort and redundancies. International Organization for Standardization (ISO). URL: http://www.iso.ch/ Slide 24 Electronic Health Record System (EHR-S) Electronic Health Record System (EHR-S) includes 1.longitudinal collection of electronic health information for and about persons, where health information is defined as information pertaining to the health of an individual or health care provided to an individual; 2.authorized users; 3.provision of knowledge and decision-support that enhance the quality, safety, and efficiency of patient care; and 4.support of efficient processes for health care delivery. Critical building blocks of an EHR system are: the electronic health records (EHR) maintained by providers (e.g., hospitals, nursing homes, ambulatory settings) and the personal health records (PHR) maintained by individuals Key capabilities of an EHR System. Institute of Medicine. Report. July 31, 2003. URL: http://www.iom.edu/report.asp?id=14391http://www.iom.edu/report.asp?id=14391 Slide 25 Electronic Health Record (EHR) Infrastructure EHR Infrastructure is comprised of: databases, programs, software, hardware, servers, firewalls, access rules, Virtual Private Network (VPN) linkages, and web browser capabilities of the electronic health record system. Slide 26 Why Now? Public Health Informatics Slide 27 Scenario 3: Health Information Exchange The local medical society is organizing an effort to respond to the recent incentive packages for physicians and hospitals to adopt electronic health records. The president of the society calls you to see if you would help them determine was meaningful use should be in your community. What are issues that you should consider as a member of the planning team? Who on your staff would best serve as a liaison to the group? What would you want to be an outcome from your LHD involvement? How to find what information we need? Slide 28 Health IT Strategic Framework President Bush 2004 Launch Strategic Framework Goal 1: Inform Clinical Practice Incentivize EMR adoption Reduce risk of EMR investment Promote EMR distribution to rural and underserved areas Goal 3: Personalize Care Use of personal health record Enhancement of informed consumer choice Promote telehealth systems Goal 2: Interconnect Clinicians Foster regional collaboration Develop Nationwide Health Information Network (NHIN) Coordinate federal health information systems Goal 4: Improve Population Health Unify PH surveillance architectures, Streamline quality and health status monitoring Accelerate research and dissemination of evidence into practice Slide 29 Build a Nationwide Health Information Network (NHIN) regional health information organizations (RHIOs) and exchanges (RHIEs) RHIOs and RHIEs would in turn be formed by: health care providers (HCPs) integrated electronic health record systems (EHRS) to improve patient safety and deliver quality care personal health records payers ancillary services (labs, pharmacies, radiology) Thompson TG and Brailer DJ. The Decade of Heath Information Technology to Deliver Consumer-centric and Information-rich Health Care. Framework for Strategic Action. US DHHS, July 21, 2004. URL: URL: http://www.hhs.gov/healthit/strategicfrmwk.htmlhttp://www.hhs.gov/healthit/strategicfrmwk.html Federal Vision Slide 30 URL: http://www.hhs.gov/healthit/resources/HITStrategicPlanSummary.pdfhttp://www.hhs.gov/healthit/resources/HITStrategicPlanSummary.pdf ONC HIT Strategic Plan, 2008-2012 Slide 31 American Health Information Community Business needs and priorities Use Cases Standards Interoperability Specifications NHIN Network service providers Architecture specifications Policies State laws and regulations Federal leadership Certification Criteria development Testing Business Deployment Sustainable business models State / regional partnerships Software and Evaluation Cycles National Health IT Landscape Executive Branch HIT Initiatives Source: ONC, Second Nationwide Health Information Network Forum, Oct 2006 HIE HIO RHIO Slide 32 AHIC Use Cases Slide 33 7.3.2 Request immunization information Section 9.0 Information Exchange Section 7.2 Public Health Section 7.1 Clinician Section 7.3 Consumer 7.1.3 Administer vaccine or drug 7.2.1 Identify individuals needing prioritized intervention 7.1.2 Identify individuals to receive vaccine or drug 7.3.1 Provide available immunization information 7.1.4 Report administration information to registries 3 5 2 7.1.5 Monitor for adverse events Section 7.4 Registries Public Health Agencies Schools Emergency Response Entities 7.4.4 Receive vaccine or drug administration information 1 5 7.4.2 Provide vaccine or drug administration information 7.1.1 Incorporate immunization schedules into clinician systems 7 1 3 Immunization Knowledge Providers 2 7.4.1 Incorporate immunization schedules into registries 1 2 Supply Chain Perspectives/Roles Information Sources & Recipients May be one or more of those listed below: 7.4.3 Retrieve vaccine or drug administration information Individuals Requiring Intervention - Public Health Case Reporting Use Case VAERS / Public Health Case Reporting Use Case 6 6 3 Other Immunization Information Systems Health Registries Payors Health Care Organizations 72 Health Information Exchange OR Point-to-point exchange OR Specialty Network Capabilities as needed in context: 9.3 Subject-data matching 9.2 Data retrieval 9.1 Data delivery 9.4 Data provisioning 9.5 Support for personally controlled health records 9.6 Emergency access Emergency Priorities Contextual Focus Legend 7.3.3 Receive Vaccine Recall Information 8 7.4.5 Provide vaccine recall information 8 8 7.1.6 Receive vaccine recall information Scenario 1: Vaccine and Drug Administration and Reporting 4 4 5 Slide 34 HITECH Act - 2009 Policies, new technologies, and approaches for protecting privacy and security of health information Strategies to enhance use of HIT to: improve quality of care reduce medical errors, reduce health disparities, improve public health, increase prevention and coordination with community resources improve continuity of care among health care settings Specific plans to ensure that technology is designed to be appropriate for populations with unique needs Slide 35 HITECH 2009: Implementation Framework Federal Health IT Strategic Plan 2 Goals: Patient-focused health care Population health 4 themes Collaborative governance Adoption of electronic health records Interoperability Privacy and security 2004 Goals Inform clinical practice Interconnect clinicians Personalize care Improve population health Slide 36 ARRA Funding Many Sources, Many Purposes Appropriations for Health ITNew Incentives for Adoption $2 billion for loans, grants & technical assistance for: National Resource Center and Regional Extension Centers EHR State Loan Fund Workforce Training Research and Demonstrations New Medicare and Medicaid payment incentives for HIT adoption $20 billion in expected payments through Medicare to hospitals & physicians $14 billion in expected payments through Medicaid ~$34 billion expected outlays, 2011-2016 At least $300 million of the total at HHS Secretarys discretion for HIE development Funneled largely through States or qualified State-designated entities For planning and/or implementation Appropriations for HIE $4.3 billion for broadband & $2.5 billion for distance learning/ telehealth grants Broadband and Telehealth $1.5 billion in grants through HRSA for construction, renovation and equipment, including acquisition of HIT systems Community Health Centers Slide 37 HITECH Components: Implications State planning/implementation grant(s) (2009) Matching funds may be required 09-10, will be required 2011 State EHR adoption loan fund (2010) Competitive grant to states Matching required Providers must agree to submit quality reporting, use EHR for exchange, submit plan for sustainability Extension Program (2009-2011) All providers in region Prioritize public/nonprofit, Federally Qualified Health Centers, rural, primary care Research and consulting, assist with implementation, adoption/ maintenance, facilitate HIE, develop curricula for HIT education 50% of annual capital and operating budget for 2 years, optional after Slide 38 HITECH: Meaningful Use (as we speak) To receive incentives, providers must meaningfully use a certified EHR: Use electronic prescribing Be connected in a manner that provides for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination Submit information on clinical quality measures Others: public health reporting (biosurveillance, disease surveillance), outbreak management, immunizations, electronic lab reporting, bidirectional communication Slide 39 Alert: patient with symptoms in outbreak region Slide 40 What should be the relationship between NHIN and US public health agencies? and How will public health be integrated into NHIN? Public Health in a NHIN Slide 41 Slide 42 Source: Eileen Koski. Quest Diagnostics. PHIN-2004, May, Atlanta GA Percent of Children Tested for Lead with BLL>10 g/dL in the USA Vision: PH Surveillance under NHIN Slide 43 Scenario 3: Health Information Exchange The local medical society is organizing an effort to respond to the recent incentive packages for physicians and hospitals to adopt electronic health records. The president of the society calls you to see if you would help them determine was meaningful use should be in your community. What are issues that you should consider as a member of the planning team? Who on your staff would best serve as a liaison to the group? What would you want to be an outcome from your LHD involvement? How to find what information we need? Slide 44 Public health nowadays is: Agency Healthcare provider Laboratory Purchaser Payer Pharmacy Research Public Health in HIE: Issues to Consider Slide 45 Public health nowadays is: Agency Healthcare provider Laboratory Purchaser Payer Pharmacy Research Publicly-delivered direct care, so EHR adoption issues are the same as for clinical care Public Health in HIE: Issues to Consider Slide 46 Public Health Agency: Core Functions Assessment, Policy Development and Assurance There are local, state, and federal public health agencies. Their activities are organized by disease-specific programs. Public Health in HIE: Issues to Consider Slide 47 Responsibilities of State PH Agencies: 2001 Responsibilities% % State public health authority 97 Medical examiner 21 Public health laboratory 79 State mental health authority 19 Rural health 79 State public health licensing agency 17 Children with special healthcare needs 77 State mental institution or hospital 17 Minority health 72 Partial/split responsibility for Medicaid 17 Institutional licensing agency 60 Medicaid state agency 15 State health planning & development agency 53 Lead environmental agency 15 Partial/split leadership of environmental agency 51 State tuberculosis hospital 15 Public health pharmacy 34 Health insurance regulation 15 State nursing home 28 Source: Beitsch LM et al. Structure and functions of state public health agencies. APHA. 2006:96(1):167-72 Slide 48 Responsibilities of Local PH Agencies: 2003 Personal Health Services (%)Population Level Services (%) Adult Immunizations91Communicable Disease Control94 Childhood Immunizations89Health Education87 Tuberculosis Testing88Epidemiology and Surveillance84 STD Testing and Counseling65High Blood Pressure Screening81 HIV Testing and Counseling64Tobacco Use Reduction68 EPSDT59Cancer Screening58 Family Planning58Diabetes Screening53 WIC55Cardiovascular Disease Screening50 Prenatal Care41Injury Control37 Dental Care30Violence Prevention22 HIV Treatment25Occupational Safety and Health13 Primary Care 18 Source: Scutchfield, F.D., & Keck, C.W. Principles of public health practice, 2nd ed. 2003, Thomson/Delmar Learning: Clifton Park, NY. Slide 49 State Health Department: Organizational Chart Slide 50 All public health activities are supported by customized information systems (databases, registries) developed to address the programmatic needs. Public Health in HIE: Issues to Consider Slide 51 Number of Public Health Information Systems Total number of programs: 23 programs in the Local Health Departments (HDs) 19 programs in the State Health Departments There are 3000 local HDs and 50 State HDs in the US 23 x 3000 (Local HD) = 69000 local programs/systems 19 x 50 (State HD) = 950 state programs/systems There may be as many as 70 thousand public health information systems -- all of them are customized, siloed systems. Public Health in HIE: Issues to Consider Slide 52 Electronic Health Record Public Health Systems Interoperability Public Health in HIE: Issues to Consider Slide 53 Public Health Reporting Slide 54 Currently most data are sent as paper reports (forms) from a provider office to a public health program via mail, fax, or phone. This requires data entry at every clinical setting as well as every public health setting. Duplicative data entry activities cause errors and inefficient use of resources. Customized legacy systems that utilize their own data formats, vocabularies, and often software products cannot be interoperable to transmit data across these systems. Public Health Reporting Slide 55 Provider 1 Provider 2 Provider 3 Provider 4 Provider X Public Health Reporting: Local Health Agencies Communicable Diseases Immunization EPSDT Injury Control School Health Chronic Care Biosurveilance, BT, Preparedness WIC Health Education/Risk Reduction Occupational Safety and Health Slide 56 Provider 1 Provider 2 Provider 3 Provider 4 Provider X Cancer HEDIS Public Health Laboratory Public Health Reporting: State Health Agencies Vital Statistics Communicable Diseases Immunization Lead and Environmental Epidemiology Injury Control School Health Chronic Care Biosurveilance, BT, Preparedness Genetic Disorder WIC Source: Beitsch et.al Structure and Function of State Public Health Care Agencies / AJPH, January, 2006. Slide 57 Provider 1 Provider 2 Provider 3 Provider 4 Provider X Cancer HEDIS Public Health Laboratory PH Reporting: Local/State/Federal Agencies Vital Statistics Communicable Diseases Immunization Injury Control School Health Chronic Care Biosurveilance, BT, Preparedness Genetic Disorder WIC Communicable Diseases Immunization EPSDT Injury Control School Health Chronic Care Biosurveilance, BT, Preparedness WIC Health Education/Risk Reduction Occupational Safety and Health Source: Beitsch et.al AJPH, January, 2006. HRSA AHRQ CDC DHS Lead and Environmental Epidemiology Slide 58 Provider 1 Provider 2 Provider 3 Provider 4 Provider X Communicable Diseases Immunization Vital Records Injury Control School Health Chronic Care Biosurveilance, BT, Preparedness Genetic Disorders HEDIS Public Health Data Reporting On average 49% of cases got reported (CDC, 2006). Slide 59 HIE CDA2 IHE X12 NCPDP Quality Improvement Public Health Laboratory Vital Statistics Communicable Diseases Immunization Environmental Health Injury Control School Health Chronic Care Biosurveilance, Preparedness Genetic Disorders Women & Children HL7 Provider 1 Provider 2 Provider 3 Provider 4 Provider X EHR-based Public Health Data Reporting Health Information Exchanges (HIEs) Slide 60 EHR-PH systems will enable electronic data transmission from a provider office to a public health programs via a Web-based interface. Data entry will be done once at the point of data generation, i.e., clinical setting, where EHR system will be installed. Public health programmatic resources will be used not on data management activities but programmatic activities, e.g., case management, care coordination, health education for prevention. System will be interoperable because they will utilize standardized data formats and vocabularies, messaging standards and software products that will support interoperability of EHR systems. EHR-based Public Health Reporting Slide 61 Scenario 4: - Workforce New federal preparedness funding guidance focuses on building connectivity between the personal and public healthcare environments for situational awareness. The state health department (SHD) is encouraging local health departments (LHD) to develop tools for interoperability with the state and the larger health care community regarding biosurveillance systems. What internal resources have your LHD to begin to address some of these interoperability questions? Does anyone on your staff have the skills to participate in the planning process with the SHD? How can you be sure these individuals are sufficiently trained and qualified to address the planning needs? Public Health Informatics National Context Slide 62 Building interoperable information systems for public health will require working with: Public Health Community Clinicians Vendors Role of PH Professionals as Informaticians Slide 63 Working with Public Health Community to Understand interactions between public health data systems within a health department and across health departments Understand commonalities of data and data system architectures across public health data systems Define common public health needs in EHR-based health information exchanges Role of PH Professionals as Informaticians Slide 64 Working with Clinicians to Define public health needs in EHR-based health information exchanges Understand interactions between clinical care and public health data systems Understand commonalities of data and data system architectures across clinical and public health data system Role of PH Professionals as Informaticians Slide 65 Working with Vendors to Know computer-based tools available to public health professionals Communicate public health needs for interoperable EHR-based health IT applications and non-EHR IT applications Be able to participate in the design of information systems in public health under a NHIN Role of PH Professionals as Informaticians Slide 66 Vendors involved in Health IT Slide 67 Public health professionals as informaticians have to be able to develop / critique IT technical documents including: Business Process Documents Functional Requirements Specifications Interoperability Specifications Integration Profiles Content Profiles Implementations Guides, etc. Role of PH Professionals as Informaticians Slide 68 Integrating the Healthcare Enterprise (IHE) www.ihe.net Providers, PUBLIC HEALTH and Software Developers Work Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings Slide 69 Enterprise Architecture Information Technology Investment Management Enterprise Architecture Local PH Strategic Planning Business processes System requirements Portfolio Performance Management IT Investment Management Drives Supported by Improved by Influences IT Governance & Management Processes Public Health Informatics Institute Slide 70 What is NACCHO doing? Running webinars such as these. Developing tools and templates Funding demonstration sites to show that it can be done. Advocating for local public health informatics at a national level. Slide 71 QUESTIONS? Slide 72 Questions for our listeners What do you believe might/should be your next step? Do you feel you have adequate information to take any step regarding public health informatics at your local level? Is this format of information sharing helpful to you or your LHD? What might the NACCHO Informatics Workgroup do to support further information sharing or helping your department get more involved in the near future?