Music
Greetings everybody, and
welcome to the Introduction
to Public Health
Informatics, 101 Series.
My name Nabil Issa.
I'm the Associate
Director for Informatics
at the CSELS Division
of Scientific Education
and Professional Development.
The objective of this
course is to provide you
with the capability to explain
the importance of informatics
in IT to public health mission.
And to describe the
function and role
the informatician in support of
these public health informatics
practice.
And last, but not least,
is to differentiate
between public health
informatics and IT.
First of all, informatics and
IT is a wide-ranging discipline.
It is applied in everything
from space technology
to delivering boxes by UPS.
However, our focus here
is really public health.
So we are going to look
at IT and informatics
in the context of public health.
So before we do this, the
first thing we're going to do
is take a look at the
public health approach.
The public health approach
is simple, logical, very
systematic.
It starts by first
identifying the problem.
And identifying the problem
requires data collection
and definition of the problem.
This is what CDC takes pride
of saying that they are
an evidence-based organization.
That means decisions,
interventions, science, and all
the CDC product is based on a
very careful data collection
and an analysis of the facts.
This is what the
role of surveillance
is in the public
health approach.
Surveillance is about
collecting information
about a specific disease
or condition in order
to learn and understand the
problem that we are facing.
Second, and after
surveillance, data collection
is to understand
the risk factors.
This comes from
evaluating the data
that we've just
collected in step one
and to define the
cause of this problem.
And this is what we
interpret, here at CDC,
as the basis for epidemiology.
And once the risk
factors are identified,
we then are going to have
to evaluate intervention
and establish the science
and the methods that
can be used in order
to stem this problem,
stem the spread of diseases,
and prevent, and hopefully
eliminate, 4444444444444444
444444444444444444 the cause
altogether.
Once we establish the
science and the methods
for eliminating this disease
or solving the problem,
we will move into
implementation.
Implementation really is
simply the application
of the science and
the methodology
that we have devised
in the real world.
And once this is done, of course
we don't stop right here--
and this is what this
chart doesn't really
show you fully-- is that we
have to assess and repeat
because we may have to re-cylce
back again and then evaluate
our problem until
it is there anymore.
This is the public
health approach.
Well, public health really
depends on core sciences.
These sciences are prevention
effectiveness, epidemiology,
laboratory, informatics,
and surveillance.
I'm going to start basically
this chart that you
see in here is not
just the picture,
but it's also directional.
And it really goes
counterclockwise.
And I'm going to start with
surveillance and informatics.
Surveillance and
informatics are very closely
tied because both of them
are about data collection,
analysis, and definition
of the problem
that we are encountering.
So that really comes
as the basic science
for the public health approach.
From there, we will
move into laboratories.
In laboratories is where we
identify risk factors-- what
kind of viruses, what kind of
bacteria, what kind of carrier
factor that we are dealing with.
So laboratory really is
important in identifying
the risk factors that
we're dealing with.
Now that we have the facts,
the data, and the factor, now
we move onto the epidemiology.
In epidemiology we identify the
preventive methods and science
to stem the problem that we have
discovered through surveillance
and informatics.
Once the science and the
methodology for intervention
and prevention has decided
by epidemiologists,
then we'll move on into the
prevention effectiveness
and the application of the
science, the guidelines
into stemming the problem.
And then we continue
the cycle as you
can see from counterclockwise.
This is basically
the core science
that goes into public health.
Now we're going to go
into topic two, which
is a definition,
and the component,
and the functions
of informatics.
The public health
mission which is, "CDC
provides crucial
scientific information
that protects our nation against
dangerous and costly health
threats."
Who do we provide it to?
We provide it to health
care providers first.
We give them guidelines.
We give them science.
We give them a response
strategy, et cetera,
to be able to deal
with outbreaks,
with response to emergencies
that affects the population
health in general.
We also provide
policymakers with guidelines
on, for example, quarantine.
So it is not only the
health care providers
that CDC services, but also
it services the policymakers
who can implement law
that ensure the protection
of the public from outbreaks.
We, also, provide data and
information and science
to the population at large.
So they are able to educate
them on how to implement
their part of the prevention.
And that could include
anything on how
to deal with how to
reduce or eliminate
the chances or the risk of
catching flu, to eliminate
the risk from drinking
water, or eating raw meat et
cetera, et cetera.
So CDC addresses
the public, as well.
CDC, also, provides
science and information
to a wide range of
communities, even travelers.
Travelers today, if you're
going somewhere on a vacation
or on business, you could
go to the CDC website
and find out what are illnesses
or conditions and so on that
are at your
destination, and what
kind of vaccines or
preparations that you need
to do to protect your health.
So that is one of the services
that CDC provides to travelers.
You could take the
range of things.
CDC also provides
crucial information to,
for example, during
flu outbreaks,
even schools could go
to the CDC to find out
do they really need to close
the schools and for how long?
Now that we defined the
public health mission,
we are going to define
what is informatics.
So we could tie
informatics and IT
to the public health mission.
The public health
informatics is really
the systematic application of
information, computer science,
and technology to the public
health practice, research,
and learning.
In fact, I want to stretch
this a little bit more.
This definition mostly fits
the IT role, rather than
exactly the public
health informatician.
And I would like to add
that an informatician really
envisions and defines the
applicability of IT information
science, computer science,
and technology to solving
public health problems.
OK let's look at the details.
What we are going to do
to explain this process
is we're going to use a metaphor
of building your dream house.
So you have an idea
of what kind of house
you really want to live in.
You don't go in there and
talk to an electrician
about building your house.
You don't talk to a bricklayer.
You don't talk to a framer.
You don't talk to a
plumber, nor a painter,
but they are all essential
to building the house.
What you do is you go in to
a developer or an architect,
and you explain to them
what you really want.
The architects know exactly
what bricklayers do, and where,
and when they are needed,
same thing with plumbers,
electricians, and so on.
But they also sit down and try
to understand what kind of life
you really want to lead.
Is your mother-in-law
going to live with you?
You may need a
mother-in-law suite.
Do you have kids?
Do you not have kids?
And so on.
So the developer
and the architect
has to understand what
your dream house is.
And then, they come
up with drawings
and envisioning all that you
may aspire for, and create
a picture of what your
house is going to look like,
but they also the
blueprints for what
makes up the technical
part of the house.
And that's when the
architect will communicate
with the other builders, whether
it's bricklayers and so on,
to start building your house.
Similarly, and to
use that metaphor,
if you're a public health
official or a professional
and you have a need for
a system to help you deal
with your information--
collect information,
analyze information, and
so on-- where do you go?
You don't go to the programmers.
You don't go to a
database administrator.
You don't go to the network
administrator, nor a security
specialist, or even
the web designer
because first you have to have
a vision of what your system's
really going to do.
What it is going to look like.
You are going to have
to talk to somebody
that understands your language.
But, at the same time, that
person also understands what
can be done and cannot be done
and what is the most suitable
expertise required
to build your system.
Very much like we explained
in building your house.
But the informatician also
needs to know more than about
building the software
and hardware for you.
What they need to also know
is all about the security,
the data standards.
There are so many other issues
besides hardware and software
that the public health is
really not even aware of,
or have expertise in that
they need an informatician--
that person that has one
foot in public health
and one foot in IT--
to be able to help
you determine the design and the
functionality of your system.
This is the components, or
the specialty, or expertise,
or skills that is needed
to build your public health
information application.
Based on what I have
explained so far
we going to take
a knowledge check.
Here is a scenario where we
have a TB outbreak in 10 states.
To increase the knowledge
of the health threat
and inform the public
and health care
providers about
this outbreak, CDC
will use information
methods that
will inform the nation's
population about the importance
of-- A, research, B,
health information, C,
security measure.
The answer to that
is B. Thank you.
Another knowledge check.
The public health informatics
uses the public health
knowledge to A, broaden the
public health knowledge base
through learning.
In, other words to
educate the public
about the epidemic or the
prevention methods and so on.
B, to improve population
health in daily practice, C,
further knowledge in public
health research, and D,
is all the above.
In other words, what is really
informatics intended to do with
the A,B, or C?
The answer is, all of the above.
Topic number three
is we're going
to take a look at
the basic steps
for creating information
systems for public health use.
So far, we have discussed
the very basic principles
of the public health
science and intervention.
We also explained,
you know, the basics
for building an information
system, or the roles
of informatics through the
use of the building a house
metaphor.
Now, we're going to
dig a little bit closer
into how do we really create
a public health information
system.
We are going to start by the
roles of the informatician.
The informatician, which
is in our metaphor was
equivalent to the
architect, is the person
that you want to talk
to, or the person
who will go to epidemiologists,
who will go to surveillance
professionals, and those
who are leading a prevention
effort in public health.
And he will try
to understand what
is really their needs, what is
the problem they are facing?
Whether technology has
a role in helping them
resolve the problem
and implement
prevention effectiveness.
Or maybe there is no role
for technology in there.
But this is not the developers
or the database administrators.
This is not their role.
This is really the role
of the informatician.
Again, this is the person that
has a foot in public health
and in IT.
That person, after
talking to epidemiologist,
surveillance specialists,
subject matter experts,
will try to envision
and advise and provide
a scenario in which technology
can be effectively used
to solve this problem.
So that person must really
understand the public health
functions at least from
a knowledge point of view
and explain to
those who are making
the decision the capabilities,
opportunities, and limitations
of introducing IT to
solve that problem.
That's not really all it
takes, but that person
must take into
consideration data
security, data
standards, policies
on collecting the
data-- for example,
OMB requirements for
allowing even the CDC to go
out and collect data.
So that informatician will be
able to tie all of these pieces
together and come up
with a proposed solution
to that public health problem.
One of our major
objectives, here,
is to explain the difference,
not only just the functionality
or what is needed to do to build
a public health information
system, but also the
role of public health,
the informatician, and
the IT professional
in building that system.
This is a very
congested slide in here.
But it's very important.
And this is why there is a
separate copy of this slide is
going to be provided to
you so you could follow up
and you could use it
later after this course.
On the left hand side, you
will see that first column.
It displays step one
through step five.
The very, very
simple, very basic
steps that are necessary to
take to build a public health
information system.
First, you have to have a vision
for and a planning for what
that system is going to do.
You cannot just start digging
the foundation and building
the walls before you know what
kind of dream house you really
want.
So step one, you have to have
the vision for what is it
that you're trying to solve.
Number two, most systems
are all about data.
You have to figure
out what data it
is that you need to
understand your problem
and to devise a solution to it.
So you have to determine what
health data that you need.
And once you mention data, you
are almost definitely deciding
on standard linking
and integration
because there is no data
that is an island by itself.
It often has to be combined
and integrated and linked
with other sets of data
right after it's collected.
Step number three, is
privacy and security.
That is not to underestimate
what is federally mandated.
That information
that is collected
from the public on diseases or
anything else that is collected
by public health must comply
with data privacy and security
mandates, for example, HIPPA.
Step number four, once you
know what the vision is,
you know what data you need,
you know all the standards
and privacy, and so
on that are required,
and the function that you
need to apply to that,
now you start
designing your system.
And designing your system,
of course, is two steps.
One is to determine all the
functionality on that data.
What is it you
expect to come in?
And how it's going
to be processed.
What's going to go out?
And then, once you have
that blueprint for a system,
then you hand it over
for implementation.
And that's where IT
actually takes charge.
And once you have
your system, and you
start collecting your
data, and now the data
is flowing, of course, you're
doing that for a purpose.
And that is to analyze that
data, to visualize that data,
and to use it to make
informed decisions.
Now we know step one
through five, who does that?
Who decides on the vision?
Who decides on the
data standards?
Who develops these
systems is what
we try to explain in
the right three columns.
So you have public health,
you have the informatician
in the middle, and
on the other extreme
you have the information
technology professional.
And you could see right
away, without looking
at the yellow boxes in there,
that the informatician really
has to span-- he doesn't have
to be a fully public health
official.
You don't have to understand
the public health functions
and missions and practice 100%,
but you have to be aware of it.
This is why you will see that
these yellow boxes never cross
from one extreme to another.
At the same time, an
informatician doesn't really
need to know technology 100%.
He or she needs to
be familiar and aware
of the functions,
and the capacities,
and the capabilities of
information technology
in order to connect the public
health mission with the IT
solutions.
So I'm not going to go
into the details, here,
but it's just to explain
the purpose of this chart
here because we're going
to discuss the details
in the succeeding slides.
OK, well let's start with the
vision and system planning.
So you have a public
health problem.
You say, I have a tuberculosis
outbreak in 10 states.
I need to go to the
emergency department,
or to clinics, and
so on, and I need
to collect the data on patients
that go through these clinics.
Well, do you use
paper and pencil?
You can.
This is how it was
done in the old days.
Of course, as you know, and
without going into details,
this could be very
time consuming.
You could only
collect so much data.
Once you come back
home, how are you
going to consolidate it and
make it into one big, large list
that you could analyze?
I mean, you could have
anywhere from thousands
to tens of thousands of cases.
And that's not possible to
do that manually or on paper.
So you need to figure out some
other means, such as hardware,
for example.
Do you use a tablet?
Do use a mobile device?
Do you use a server on
the internet, and so on?
Somebody has to
envision that solution.
Somebody has to know and
piece all of that together.
Software may exist.
If there is a
software that exists,
then our problem
is less complex.
But if software needs
to be developed,
we need to know what platforms.
Do I have the right
software for the handheld?
Do we get it for the
laptop, et cetera?
And not to mention
the fact that we also
have communication problems.
Do we need to communicate
that data directly?
Do we have to store
it and then send it
to the CDC or a central place
using flash drives, CDs,
electronic, over the internet?
So there's many, many
scenarios or situations
that you have to envision.
What kind of system
that you really
need to tackle your problem.
And this job really is
the informaticians job,
who needs to decide,
and who has to have
a knowledge of the capabilities
and the applicability
of hardware, the
functionality of the software,
and he has to have a
knowledge of the coverage,
the throughput, the
geographic availability
of the communication medium.
So we haven't gone
into any details.
This is very high level
vision and system planning.
From there, we go to the next
step, which is really data.
It's all about data.
What data do we need
to go and collect?
And in what format?
And once we collect
data, we don't
want to collect data
we already have.
If we already have demographic
data, we go in there
and collect data about
patients in a certain area.
And we come back, and then we
could link it and integrate it
with the demographic
data we have.
But to do this, we
have to make sure
that the data we are
collecting can inter-operate
and can link to other
data that we already have.
So if we are collecting
data on TB, for example,
we may want to integrate
and then link this with data
that we have on HIV.
And if we don't use a standard
method for collecting the data
and coding this data, then we
will not be able to link it.
So this is not something
that comes after the fact.
You have to think about this
before you build the system
and start doing data collection.
Otherwise, it's
too late and you're
going to miss a lot on what
you can get out of the data.
So health data standards
and integrations
are really important.
Next, after we decide
what data and what data
standards we are
going to use, we
have to address
issues because we
don't know if privacy
really applies
or not until we determine
what data we need.
So we found out
that we really need
to know the person's name, birth
date, address, where they live,
and so on.
Well, this is
private information.
To handle private
information at the CDC,
there are mandated
government requirements.
There are HIPAA regulations.
There are even additional
security and privacy issues
that we really need to address
before we start developing
the system because they
do affect the design
and the development of the
software that comes next.
And there is really
no compromise
on data security and privacy.
And when we talk
about data security,
we sometimes interpret it
in the context of privacy.
But part of data
security is also
integrity, the
integrity of the data.
We don't want to collect
the right information
about the wrong person, or
the wrong person associated
with the right information.
We need to make sure that
this data is accurate.
It is, when we collect it, it's
not susceptible to corruption
or loss because that does affect
privacy and security of data,
as well.
So the quality of that
data is very important
and needs to be addressed
before we start actually
designing the system
because our system design
is going to be impacted,
affected, and shaped by all
that we have discussed above.
Now that we know the vision for
what the system is going to do,
what it's going to
look like, and what
it's going to consume
in terms of input,
and provides in
terms of output, we
know the data security,
the coding, the standards
and all of that, now we are
ready to sit down and start
designing the different
components for the hardware
that we're going to collect.
We may need software
for handheld devices
to collect the data.
And we need hardware
for servers to host
the data that is collected
by these mobile devices.
So you could see why
these previous steps are
necessary to be done
before we get into the data
design and implementation.
The data design and
implementation, as it says,
there really is two steps.
One is to design the blueprint
for the components that
are going to go into
developing that software.
This is usually
an informatician,
a systems analyst.
This is where the
informatics professional
has to have a good
knowledge of the IT.
So they don't need to implement.
Just like in our
metaphor, the developer
needs to understand what
the bricklayers does,
what the electricians
do, and so on in order
to the provide them
with this blueprint
for the house and
the specifications
for them to start implementing.
So the first step, the
definition and the design
is heavily slanted in the
informaticians role, as well as
some IT.
The implementation,
on the other hand,
once you have the blueprint
for what needs to be done,
this is when the bricklayer
and the electrician
they use these to
go on their own
and start doing
the implementation.
And that's the stage, which
is really very IT heavy.
So that is system design
and implementation.
Of course, we
finished our system.
We developed the software.
We tested it.
We catered for all the security,
for all the data standards.
We started collecting the data.
But we do all of
this for one purpose,
for eventually
the final purpose.
And this is to start analyzing
and visualizing and tracking
that information.
And that final step
really is not so much IT.
You may use IT tools to do
this, but the visualization
and the analysis
of data, what if.
And recognizing patterns
in the data and so on.
This is when the
informatician can help.
But, also, it's a
public health function
where you have
statisticians, and then you
have epidemiologists and
public health officials
who will be using these
analytical tools to do
the data.
With all of these
five steps, we have
completed a very simple public
health information system.
Let's take an
example, for example,
of an application that
was developed by the CDC
for tracking the flu.
FluView is one of
CDC's software that
gives you a clear cut way to
share national influenza data.
And that is really needed by
the public health community--
by clinicians, by scientists,
and the general public.
And I would add on to this
list, also, communities.
Communities meaning the
school administrators.
As I gave an example before,
in case we have the flu,
do we need to close
the school or not?
And that's where CDC
provides the information
to make their decisions
and their recommendations
to make the decisions
by the school officials
easier to achieve.
How do we do that?
Of course, here is the way
that scientific data is not
easy to understand by
the general public.
So this data has to be, once
we collect it and we track it
on a daily basis, we have to
present it to decision makers
at all levels in a way
that is the digestible,
easy to understand.
One example of this and
one really prominent way
of presenting data are maps.
And you take, for example, this
is a very realistic map that
shows the influenza cases
between 2012 and 2013.
And you can see how it is
very easy to look at this data
and find out where is the
high presence of influenza.
As you can see, in Texas,
in the south here somewhere,
up in the Midwest, and so on.
So that is just
an example of how
data that is
collected by the CDC
could be published for use
by a wide range of users.
Well, we are at a
knowledge checkpoint here.
On the basis of what
you have learned so far
about creating an information
system to help solve
a public health problem,
which of the following
does an informatician
consider first
when identifying technology
to use for sharing
national malaria data?
That FluView that you've
seen, in other words,
what was the first step taken
to develop such a system?
Health data standards
and integration?
Vision and systems planning?
System design and
implementation?
Obviously, the answer is
B because first you really
have to have a vision of
what the system is going
to look like-- what
is it supposed to do,
who is going to be using it and
so on-- before you dig deeper
into the details of data
standards and development
and implementation.
Another knowledge check.
Informatics is used to create a
program-- such as CDC's FluView
as we showed you a very, very
brief snippet of that-- which
of the following
three disciplines
must work together
to visually represent
the data in an effective method?
In other words, what would
you use to visualize the data?
Is it computer
science, epidemiology,
and public health?
B, technology, computer
science, and applied information
methods.
C, technology, surveillance
system, and epidemiology.
This is a very
tricky question that
could be really interpreted
in several ways.
But what we're trying
to say, here, it's
really technology and computer
science and applied methodology
that is used to produce,
for example, the map
that you just have seen.
OK, the last topic
that we have is
at the intersection
of the informatician,
the public health official, and
the information technologists.
It's a very interesting topic,
but it's a topic that has been,
and up until today,
is very confusing
to many people in public health.
Where does public
health start and end
before informatics starts and
ends before IT starts and ends?
So people are confused.
Who is really the
informatics professional?
Who is the IT professional?
And who is the public
health professionals?
It overlaps, there Is no doubt.
And we feel that
this is long overdue
that we attempt to
explain the difference
and where do these
specialties really intersect.
That's what really is important
because it's not clear cut.
It is not a black
and white line that
says this is the public
health informatician.
This is what they know.
This is what they do.
And then the
informatics and the IT.
There is definite
overlap and you will
see that in the next slide.
In this slide, which
you already have
seen that presents the
five steps for building
a public health
information system,
now what we're
going to do is we're
going to explain the
yellow boxes, which
says of all these steps-- one
to five-- how much public health
knowledge do we really need?
How much informatics
knowledge do we need?
And how much technology do
we need or is really involved
in performing this step?
On the vision and
system planning,
we need a person that
has a broad knowledge
of the public health practice.
You don't have to be
an epidemiologist.
You don't have to be a
surveillance professional.
You don't have to be a
public health advisor.
But you need to
know what they do.
You need to know what the
public health practice is about,
but you don't have to be
a professional in there
to be able to envision
an IT solution that
solves public health problems.
That person also doesn't
need to be a developer,
doesn't need to be a
system administrator that
is able to service
and maintain hardware,
nor that person needs to be able
to design and develop software.
But they need to know what the
software can and cannot do.
They need to know
what is the difference
between a server and a PC,
a mobile device, a laptop.
And what are the opportunities
of using them to solve
the public health problem.
At this stage, at
the first step,
which is the
envisioning a system
and finding out what is
in technology can be used
for that particular
public health problem,
the informatician has a really--
and it's not a one person
problem, remember.
The this is a
multi-disciplinary approach,
so therefore, an
informatician has
to know a little
about public health,
but they have to consult and
get the public health officials
or professionals input
into this process,
as well as a
technologist because they
need to rely in some details
about the capabilities
and capacity of the different
hardware and software
and communication solutions.
So you could see that
for the first step,
we need a broad spectrum
of expertise that
goes into the defining the
vision and planning the system.
The next step, which is
the health data standards,
really has two aspects to it.
One is to define, obviously,
what data do we need
and what coding
standards do we need.
Do we use ICD-9?
Do we use HL7?
Do we go to health
information exchange?
And we need to understand
what electronic health records
they maintain or what
electronic lab reports
that they get and so on.
So all of this is
really not something
that the IT professionals-- in
other words, the programmers,
and the software developers,
and the system administrators
and so on-- they don't really
understand what that is.
They are not up to
knowledge as far
as ICD or HL7 is
concerned and so on.
This is really between the
public health professionals
and the informatician.
But, of course,
with some, in fact,
if I have anything
to do with this,
I will even shrink that
yellow box a little bit
and show less
technology involved
in this step-- less
information technology involved
in completing this
sub-step in number two.
The second stage of this step,
once we have defined the data
standards and so on, we
have to design and develop
the tables that are going to
go into storing this data.
We may have files.
We may have what they
call SQL Servers that
consist of tables that link
together with columns and rows
and so on that are needed to
receive and store our data.
So this is really mostly not
a public health professional skills
required skill or knowledge.
This is very much between the
public health informatician
and the IT professional.
And only a certain segment
of the IT professionals,
which is really mostly
database administrators that
are involved in determining
the design of the database that
is going to receive the data
fields or the data columns that
have been decided
by the informatician
and the public
health professionals.
So that's the range of
skills and expertise
you can see here that is
required to perform step two.
Step three, which is really
data privacy and security,
it definitely takes a knowledge
of the Health Information
Portability and
Accountability Act.
That is not something that
the information technologists
really understand at all.
And when it comes to
getting OMB compliance,
or permission to
collect the data,
or determining whether this
is privately identifiable
information or not, is really
up to the epidemiologists,
the surveillance professionals
and the informatician
to sit down and decide what
data privacy, data quality, what
kind of policies,
sharing of this data.
You cannot just collect the
data and put it on the web
for everybody to
see, for example.
There are conditions on how
this data is going to be used.
This is not an IT issue.
This really spans the
public health and, then,
the informatics domain
or skills knowledge.
However, to implement
the security--
like putting user
IDs, passwords,
sometimes encryption,
sometimes limitations
on who can access and
not access the data
and so on-- the implementations
of security is really in the IT
domain, fully in the IT domain.
They just simply have
the key to the vault.
It's simply the system
administrators, the software
developers, the
database administrators.
Those are the people that have
very low access to just about
everything, the lowest level in
both the software and the data
spectrum.
So the implementation of
data privacy and security.
Then, once it's the
decided and determined
by public health
and informatician,
goes into the IT
professionals to implement.
System design and
implementation,
all the functionality that
goes into the data-- converting
data, data flow, case
definition, case definition
is really mostly a
public health function.
The public health officials,
or the epidemiologists,
or the surveillance
professional will determine
what constitutes a flu case.
How do you identify a flu case?
That is not something the
informatician-- although it
looks like it's heavily focused
on the informatician area--
it should really stretch more
towards the public health.
Data interoperability,
and so on,
in that portion of
the system design
really belongs between
the public health
and the informatician.
Once the blueprints are drawn
for what the data should look
like and the functionality
and how the data should flow
and how the data should be
secured and accessed and so on,
then it is handed over to
the technologists-- who
have the knowledge and expertise
in managing information,
developing the system,
creating the databases
and so on-- to perform that.
At that stage, we are really
done with the development
of the system.
And then, we go into the vision
and analysis and reporting
of the health data.
What this really
requires is, this
is mostly a person who is
most likely a statistician,
or a person that is able to
synthesize and report data.
So the expertise in
public health practice
is definitely needed because
we don't really know.
We may be looking for a specific
spike somewhere in that data.
For example, certain
symptoms being reported.
So this only can be determined
by the public health
professional.
But the implementation
of the logic,
and the software, and
the use of the systems--
like SAS, or R, or even
writing customized software--
that is going to really
require the informatician
and the IT
professionals to cater
for these special
analytical needs.
But when it comes
to analyzing data,
then you really need a
wide spectrum of expertise.
Definitely public health,
definitely IT, in case
there is a specific analytics
things that we need to do.
And then the informatician
straddles both the IT
and the public health on that.
That really
summarizes, basically,
all that we have
been talking about,
which is the steps to
create a public health
information, and
then the skill set,
and the competencies
that are needed.
More specifically the
overlapping skills
and expertise needed
across the public health,
informatician or informatics,
and the information technology.
So let's summarize
really the difference.
We are going to have a
text that you can walk away
with that you could refer to--
rather than going into all
the details that we have
discussed so far-- that will
explain to you what
is an informatician,
or an informatics
professional, and what
is an IT professional,
or a technologist.
Let's start with the role of the
informatician in public health.
And you're going to note there
is some repetition in here,
but this really is
a snippet of text
or a summary of all
of the functions
that are performed
by the informatician.
Of course, number one is
to plan, design, and define
functional requirements for
public health information
system.
That is what we refer to as
having the vision to what
is needed and how do we go
about defining the boundaries
in the scope for such a system.
The number one is to evaluate
the application and impact
of information systems
in support of the goals.
Just because we have
technology, doesn't
mean that we have a solution.
Understanding and
knowing the technology
and being able to communicate
with the technologists, you
have to be able to see is
there an opportunity in using
technology, what technology,
when, and where, and so on.
The informatician also
serves as a liaison
between a
multi-disciplinary team.
The informatician has to be able
to understand the public health
language and the IT language.
And there is a big
divide in here.
Many times in our systems,
we spend lots of money
and where systems go wrong
is in the misinterpretations
of requirements.
The technologists think
that you said, football.
And they developed a
soccer game for you.
We want to eliminate
that misunderstanding
by bringing somebody
who is really
aware of the language that is
spoken by both disciplines.
Use data standards to
support interoperability
of data between systems.
Who is really going to
be on top of knowing,
for example, how
do we code gender?
Do you do we use M for
male and F for female?
And what do you use for other?
Do we use O?
Or maybe somebody says,
no, we cannot do that.
We have to use zero
and one, and no.
My God what is no really?
It is a nothing,
but it's a concept
that technologists
may understand,
but public health
don't really relate to.
So there is lots of
data standards and data
coding issues that are necessary
to not only get the right data,
but also to be able
to link and make
more meaningful
use out of the data
once it's collected
and brought in.
So the informatician is
really just the right person
to be the person who really
understand all the data
codings and standards.
Ensure confidentiality,
security,
and integrity standards.
You can't really rely
on technologists--
especially today
technologists art
is mostly an
outsourced profession.
You may have a contractor
working on your system today,
once it's done, or even
halfway into the process,
this person is gone.
So there is somebody that
has to carry that torch.
And the person who
really should be
on top of the security, and
confidentiality, and integrity
issue is the informatician.
And the informatician
also should
be knowledgeable about health
data standards, sources,
and meaningful use
of health data.
For example, we know
that there is plethora
of health information exchange.
And there are what they call
health data aggregators now.
They are coming
all over the place.
I mean there is
electronic health records,
electronic lab reports,
even social media
is getting into the health
data domain and so on.
Who is going to keep
track of all if these?
Where the data flows.
How does it flow from hospital,
to local health departments,
to state health?
Understanding that whole
system is really not--
Of course, in their
own specific domain,
the public health
professionals may need
to understand some of that.
The technologist, or
the IT professionals
don't really understand
the National Health systems
and where data is.
There's a certain
specialty in there
and certain skill it
takes to understand
how the national
data is collected,
where it's a stored, how it
flows, how it's being used,
and so on.
That is really the major
role of the informatician.
And now to explain the
role of the technologist
or the IT professional, which
is the programmers, the database
administrators, the web
developers or designers
as we call them, the
communication specialist,
the system administrators, all
of these buzz words in there
that make up the technologists
or the information technology
professionals.
Their role really is to
plan technology projects
and milestones, develop
software, and maintain
and operate systems.
They don't necessarily
define requirements.
They don't necessarily define
the flow or the components
or the blueprint for a
public health application.
But they certainly do
take that blueprint
and they implement it.
They develop all
the nuts and bolts
that it takes to make that
blueprint work in real life.
Once the system is developed,
you don't throw away the key.
You have to operate.
And the information technology
specialist, they evaluate.
They are constantly
monitoring the performance,
the availability, the uptime
of the servers, the throughput
of the communication
links, and so on,
lots of things that
must happen to make sure
that this system that has been
developed is up and running
and accessible by those
people that need it.
The third is really the designs,
implements, and administer
database architecture,
privacy security,
and backup procedures.
These are all examples of
what the IT professionals do
following the instructions
and the specifications
of the informatician and the
public health professional.
I could understand where there
may be some gray areas still
between a technologist and
a public health informatics
specialist, but at
least if you are
able to see where the
focus in their role
we would have achieved or
purpose from this course.
OK, now a knowledge check.
One of the United Nations'
Millennium Development Goals
is to substantially reduce
infant mortality worldwide.
A system has been developed
that will display the data
and track the progress
of attaining this goal.
Which of the following
professionals
work with health data
standards and sources
and ensures the integrity
and security of standards?
Who is the person who really is
the custodian, in other words,
of the privacy and
integrity of the data?
It is the informatician.
The information
technologist will implement
and puts the bolts--
in other words,
GM will build the car for
you, you've got to drive it.
You've got to keep it safe.
You are going to
clean it and so on.
If there's something
broken with it,
you could take it back to
the factory to be fixed,
but you're in the driver's seat.
So the informatician will build
all the capabilities for you,
but there is somebody that
has to have the oversight
and the control over that.
Another knowledge check.
Which of the following
is NOT-- it's
in capital letters-- is NOT
a function of a public health
informatician?
Use data standards to
support interoperability
of data between systems.
Ensure confidentiality,
security,
and integrity standards.
Designs, implement,
and administer
the database architecture,
privacy, security
and backup procedures.
Is knowledgeable about health
data standards, sources
and meaningful use
of health data.
Tricky question.
Note the NOT in here.
Which one of the A,B,C, D the
informatician does not do?
Number C. The informatician
doesn't really implement.
They don't program.
It is just like the
architect doesn't
sit down and build walls and
put wires through the walls
and do plumbing and so on.
The architect simply
draws the blueprints
and manages that
everything is being
implemented properly before they
hand the house to the customer.
The actual implementation and
ditch digging and wall building
and wire installations
and so on this
is not the informatician, as
indicated here in number C.
OK, so this really
concludes the course.
And to summarize of
what I have attempted
to explain to you, hopefully.
One is to explain the
importance of informatics
to the public health mission.
I think my question
on this is, do you
think you could really
do public health today
without information or
information technology?
Is it really possible to
track, collect data, assess,
evaluate, intervene, and
so on, and disseminate
the right information to health
practitioners, the public
and so on without
information technology?
I think we probably somewhat
touched base with the fact
that informatics and
information technology
really do solve problems
in public health.
And we also explained
and described
the role of the informatician
in public health practice.
This is really a
fairly new profession
because we always
knew public health
and we always knew that
there were IT professionals.
And somehow somewhat
systems were very basic.
You brought a
programmers and they
developed some specific
procedure for you.
Well, information systems
are getting very complex.
You need a multi-disciplinary
IT specialty.
The database administrators do
not program, believe it or not.
And programmers are not
really that proficient
in designing data
models and databases.
Same thing with communication.
There are communication
specialists.
Now we have information
system security officers.
Those are very specialized
professions in IT and so on.
So I hope that I was able
to explain and hopefully
the role of the
informatician-- and that
is the person who has a foot in
IT and a foot in public health.
And then finally, and this is
what we did in the last section
in this yellow
boxes, we have been
able to not draw black and
white lines between what
is an informatician and
what is an IT professional,
but at least you are
able to differentiate
the roles between public
health informatics
and information technology
roles or skill set.
And with this, we conclude
our Informatics 101.
Thank you for taking the
time to listen to that.
