Public Health Informatics Fellowship:

1st Year Experiences in Review

AJ Rosario, MD, MPH

CDC/NCHSTP/OD/PIOYear-End Presentations

June 13, 2003

Quezon City, Metro Manila, Republic of the Philippines – “Pinoy”

Degrees: BS Biology, MD, MPH

Residency training in Infectious Dermatology / Lecturer for Medical Transcriptionist at Cybercity

Family moved in 1991; Came to the U.S. in 2001 after MPH

My Background

NCHSTP Mission Statement The National Center for HIV, STD, and TB Prevention (NCHSTP) is responsible for public health surveillance, prevention research, and programs to prevent and control human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), other sexually transmitted diseases (STDs), and tuberculosis (TB). Center staff work in collaboration with governmental and nongovernmental partners at community, State, national, and international levels, applying well-integrated multidisciplinary programs of research, surveillance, technical assistance, and evaluation.

NCHSTP/OD/PIO Graduates

Alan Sim – 1998-2000

Nabeel Khan – 2000-2002

Current PHI Fellow

A J Rosario – 2002-2004

MOTTO: Be Flexible !!!

CDC CIO Assignment

Public Health Informatics

“The systematic application of information and computer science and technology to public health practice, research, and learning”

Yasnoff WA, O’Carroll PW, Koo D, Linkins RW, Kilbourne EM: Public Health Informatics: Improving and Transforming Public Health in the Information Age. J Public Health Management and Practice 6(6):67-75, 2000

Critical Competencies Project management skills and Knowledge

Change management

Information management

Basic information systems and theory

Plan, design, and develop information systems

Implement information systems

Evaluate information systems

Apply information technology hardware

Apply information technology softwareRichards J: Core Competencies in Public Health Informatics. Public Health Informatics and Information Systems 6:98-113, 2002

Projects

− Agency of the US Public Health Service, Department of Health and Human Services

− Operates a comprehensive health service delivery system for approximately 1.5 million of the nation's 2 million American Indians and Alaska Natives

− 12 Administrative Areas

− 560 Federally recognized tribes

Indian Health Service

Predominantly rural primary care system with some urban locations

Hospital

Ambulatory Center

60% of IHS hospitals and clinics are in remote areas

Background

• HIV: AI/AN rate was 1.5 times the average rate for Whites, 1996-2000

• STD: AI/AN have the 2nd highest rates of chlamydia, gonorrhea, & syphilis of any racial/ ethnic group in US

• TB: AI/AN rate showed smallest decline of any racial/ethnic group since 1992 and was more than twice as high as the U.S. rate in 2002

− IHS Electronic Medical Record System

− Integrated solution for clinical, financial, and administrative information

Resource Patient Management System(RPMS)

2 IHS Projects

- Map to LOINC

- ID-Web

IHS lab

Quest lab IHS lab

5 Laboratory systems 3 Pharmacy systems 5 Dictation systems2 Order Entry systems

Problems encountered by the RPMS with multiple information systems

Logical Observations, Identifier, Names and Codes

March 21, 2003 : HHS, DoD and VA - 1st set of uniform standards for the electronic exchange of clinical health information -all federal agencies that deal with health care data will adopt laboratory LOINC

http://www.hhs.gov/news/press/2003pres/20030321a.html

Map to LOINC Project(Objective)

- To develop a semi-automated process to map local laboratory tests files to LOINC

CDC-IHS collaboration December 2000 Funding: April/ May 2001

Map laboratory test names to LOINC Accommodate future changes in test names /codes Meet all data security and confidentiality standards Expand to other sites

Map to LOINC Project(Specific Aims)

Map to LOINC Project(Overall Process)

Automated download of lab test names Automated identification /elimination of duplicates Automated / Manual mapping of unique test names to LOINC Export in HL7 format

Mapped laboratory test names to LOINC Completed our 5 pilot sites (Sept 2002) Generated HL7 messages successfully Expanded to other additional sites (+19) Continue expansion of the project to other IHS sites(100+ sites)

Map to LOINC Project(Current Status and Future Tasks)

Improving Quality of Care

ID-Web Project(Objective)

Feedback on HIV, STDs, and hepatitis BCaseloadCare (13 Clinical Indicators)

Links to Training (for CME credit) on National Guidelines

ID-Web Project(Methods)

ID-Web

Facility A

Facility B

Facility A

ID-Web Project(Current Status and Future Tasks)

Data validation - FY2003 Expand the project beyond pilot sites - FY2004 Demonstrates a potentially powerful tool to assist providers in

delivering high quality care for HIV, STDs, and Hepatitis B Could be expanded to include other infectious diseases Larger scale implementation will be dependent on:

Perceived value Support of data entry

Demo of the system

http://www. webepi.com/index.jsp

Presentations

JOURNAL CLUB:

Geographic Information Systems (GIS) in Public Health Practice in the New Millennium - (Authored by William A. Yasnoff and Edward J. Sodnik.

Training

AMIA 2002

HIMSS

52nd Annual EIS Conference

15th Annual IHS National Research Conference

Conferences

Travel

MENTORS

Tonya Martin

Jeanne Bertolli NCHSTP/OD/PIO

Nabeel Khan 2nd Year Fellows 1st Year Fellows

Acknowledgements PHIFP

Janise Richards

Tim Green

Rosaline Dhara

Barbara McDonnell

Leticia Dy

Phillip Lamb

My Blessings #13 Engaged Aug 13Wedding Dec 13

Thanks! Enjoy the rest of Friday the 13th!

Literature Review L.M. Lau et al. A Method for the Automated Mapping of Laboratory Results to LOINC. Proceedings of AMIA Annual Conference 2000.

K.A. Zollo and S.M.Huff. Automated Mapping of Observation Codes Using Extensional Definitions. JAMIA. 2000

Literature Review

Effect of a clinical practice improvement intervention on Chlamydial screening among adolescent girls.Shafer MA, Tebb KP, Pantell RH, Wibbelsman CJ, Neuhaus JM, Tipton AC, et al.JAMA. 2002 Dec 11;288(22):2846-52.