OVERVIEW:
The landscape in health care has been changing at a fast pace in many, if not all, of its specialties and levels. Not surprisingly, health informatics has been evolving especially fast, forcing other specialties to start closing the so-called digital divide. The informatics revolution received its first push from the health care business model, and public health?despite its many important functions that demand a continuous flow of information to and from health care providers?was initially left out. However, two pieces of legislation were considered key in helping speed up the growth of public health informatics and improving its information systems. The first was the American Recovery and Reinvestment Act (ARRA) of 2009, which authorized ?reimbursement? for providers that became ?meaningful users?; and the second was the Health Information Technology for Economic and Clinical Health (HITECH) Act, which enabled coordination and communication between agencies, health care providers, and public health. This ensured that all of them became trained, meaningful users and that all had access to certified Electronic Health Records (EHRs).
Public health information systems are complex; they require a good understanding of their multilevel approach and the collective efforts of many players for their successful design and implementation.
This week you will explore the basic principles of Public Health Information Systems. You will examine public health trends in informatics and evaluate the software and surveillance methods of these systems.
Early identification of the outbreak of infectious diseases is a vital part of detecting and preventing public health problems. One essential element of early identification is monitoring events/trends at local levels, which provides public health officials with data on potential outbreaks and enhanced situational awareness. As a result, there is a significant need for reliable information-sharing processes (infrastructure) between local health care providers and public health officials.
This week, you will explore some of the key public health information systems. You will analyze their content and how they are used, and, most importantly, you will evaluate their potential applications.
TEXTS/RESOURCES:
i. Shi, L., & Johnson, J. A. (Eds.). (2014). Novick & Morrow?s public health administration: Principles for population-based management (3rd ed.). Burlington, MA: Jones & Bartlett.
Chapter 13, ?Public Health Information Systems and Management? (pp. 267?288)
ii. Centers for Disease Control and Prevention. (2014). Immunization information systems (IIS). Retrieved from http://www.cdc.gov/vaccines/programs/iis/default.htm
iii. Centers for Disease Control and Prevention, Office of Surveillance, Epidemiology, and Laboratory Services. (2013). Behavioral risk factor surveillance system 2011 codebook report: Land-line and cell-phone data. Retrieved from http://ftp.cdc.gov/pub/data/brfss/CODEBOOK11_LLCP.rtf
iv. Commissioned Corps of the U.S. Public Health Service. (2014). America?s health responders: History. Retrieved from http://www.usphs.gov/aboutus/history.aspx
v. HealthyPeople.gov. (2015). Health communication and health information technology. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=18
vi. Kukafka, R., & Yasnoff, W. A. (2007). Public health informatics. Journal of Biomedical Informatics, 40(4), 365?369.
vii. Public health informatics by Kukafka, R., & Yasnoff, W. A., in Journal of Biomedical Informatics, 40(4). Copyright 2007 by Elsevier Science & Technology Journals. Reprinted by permission of Elsevier Science & Technology Journals via the Copyright Clearance Center.
viii. National Cancer Institute. (n.d.a). About the SEER program. Retrieved from http://www.seer.cancer.gov/about/
ix. National Cancer Institute. (n.d.b). Information for cancer registrars. Retrieved from http://www.seer.cancer.gov/registrars/
x. North American Association of Central Cancer Registries. (2015). Retrieved from http://www.naaccr.org/
xi. Noble, D. J., Panesar, S. S., & Pronovost, P. J. (2011). A public health approach to patient safety reporting systems is urgently needed. Journal of Patient Safety, 7(2), 109?112.
xii. Shapiro, J. S., Mostashari, F., Hripcsak, G., Soulakis, N., & Kuperman, G. (2011). Using health information exchange to improve public health. American Journal of Public Health, 101(4), 616?623.
xiii. The White House. (2012). National Strategy for Biosurveillance. Retrieved from http://www.whitehouse.gov/sites/default/files/National_Strategy_for_Biosurveillance_July_2012.pdf
xiv. Walden University, Academic Skills Center. (2015). Downloading SPSS. Retrieved from http://academicanswers.waldenu.edu/faq/72984
xv. Wu, L. (2014). Issue brief: Health IT for public health reporting and information systems. Office of the National Coordinator for Health Information Technology. Retrieved from http://www.healthit.gov/sites/default/files/phissuebrief04-24-14.pdf
xvi. Gunn, J. E. (2013). Syndromic surveillance: The Boston experience. National Association of County & City Health Officials. Retrieved from http://www.nacchostories.org/syndromic-surveillance-the-boston-experience.
xvii. Fairchild, A. L. (2003). Dealing with humpty dumpty: Research, practice, and the ethics of public health surveillance. Journal of Law, Medicine & Ethics, 31(4), 615?623.
xviii. Laureate Education (Producer). (2015a). Introduction to secondary data [Video file]. Baltimore, MD: Author.
Introduction to Secondary Data
Program Transcript
FEMALE SPEAKER: In this video program, Talmadge Holmes and Tammy Root
think about the issues you should consider when using secondary data in
research. Reflect upon their perspectives presented about using secondary data.
Then consider the purpose of secondary data and when it may be appropriate for
you to use secondary data sets in your own research.
TALMADGE M. HOLMES, PHD, MPH: One of the barriers in doing research,
especially if you are doing primary data collection, is sometimes you don’t know
where the data are. In my specific case, I had to physically go to a facility and
look through paper records to find the data that I needed.
And of course with any data gathering process– and this is a form of secondary
data analysis in that I wasn’t actually interviewing people or doing anything like
that. So I had to accept what the data provided me. So therefore the same issues
exist. The data might not be complete. The data might not be recorded the same
way from time to time. So those are all common barriers when you’re doing
primary, slash, secondary data collection.
But today more than ever, there is a tendency and actually a preference to do a
secondary data analysis. So here’s a situation where we have data at our
disposal. And now we need to come to the research question, develop the
research question or questions given the data.
The process is, first, what is the data. Characterizing the data. What are the
different data elements that are there? How are they measured? We need to be
very familiar with that data to start out with, otherwise we can’t really ask a
relevant question. And more importantly, we won’t know how to do the analysis.
So we’ve got to start out being very familiar with the data if that’s possible.
A lot of data that are collected and are in the public access have things called
data dictionaries out there. And those basically represent what I’m talking about
in terms of being familiar with the data. Usually there are the variables that are
listed, how they’re measured, and any other characteristics of the data that the
sponsoring agency has collected for use. And that’s what I would say would be
the first step is familiarity with the data.
I have had many Ph.D. students now at Walden. And several of them have done
secondary data analysis using existing public data, if you will. One of my
students used the NHANES data, which is data collected by the National Center
for Health Statistics, which is a part of the Centers for Disease Control and Prevention.
And NHANES has been an ongoing study for many years now. And each year
they may add a few questions on a specific topic. But generally speaking, they’ve
asked the same questions over many years of cohorts of individuals. And there’s
a lot of data there. So this allows a lot of opportunity for doing this, taking data
and asking specific research questions based on those data.
At one point in time I was very much against Ph.D. Students using secondary
data. And that partly is based on my own experience. Because I did, essentially,
primary data collection for both my Master’s and Ph.D.
And I had an experience with a colleague who did not have that experience. She
actually was handed a data file and developed her question from the data file,
based on the data file. And then went to her first job, and was asked to do a
study not based on secondary data but to gather the data. And unfortunately, she
had no experience with that. So it can be a problem.
But a lot of our students at Walden have had some experience with perhaps not
doing a study, but they understand about differences in quality, differences in
completeness, those kinds of things.
So one of my processes or policies is that I will actually try to get a student to tell
me what experience they’ve had with that. And then I feel more comfortable
saying to them, especially if they’re proposing to use secondary data, I feel a lot
more comfortable with them doing that as long as they understand these issues
and can talk about them in chapter five and other places in the dissertation where
we need to talk about that as potential limitations to the study.
So I have not changed my mind. I would still rather there be primary data
collection. But given the world as it is today and a lot of data we have out there,
information overload, there’s a lot of data out there that we can take advantage
of. And students often have access to those data.
TAMMY ROOT: Well, my research first started with my dissertation. And my
dissertation was focused on expanding the latent class model for small samples.
And when I was developing this methodology, I thought about, well, I need a
small sample. And something that had come to mind was eating disorders and
substance use. So my dissertation was heavily mathologically focused.
Throughout the research process I’ve experienced lots of barriers, as I’m sure
most colleagues and students will also attest to. One of the barriers I
experienced was data acquisition, finding the data that I needed. I’ve run into
several issues, because I’ve used secondary data analysis throughout my entire
publishing career, with having the data in a format that is friendly enough to use
in a particular data analysis package.
When using secondary data analysis, there are several things to keep in mind.
The first one is data veracity. You want to make sure that the data that you’re
using are valid, and reliable, and were collected in a way that is appropriate.
And one thing to also keep in mind with regard to this is who sponsored the data
collection. For example, if you are interested in looking at smoking behavior, and
Phillip Morris was a sponsor for a particular data set, then you have to have
some caution in terms of what those findings were. So it’s important to know who
collected the data, how they were collected, and who sponsored the data
collection.
You also have to keep in mind that when you’re using secondary data, you’re
limited to the data that was collected. And you’re also limited to the scales of
measurement in which that data were collected. So if you did not want to do
some type of discrete analysis, but yet your primary outcome is discrete, that
could cause a problem. You can also lose information if you have a discreet
outcome versus a continuous outcome. So that’s something to keep in mind.
Also you often, unless it’s a publicly available data set, have to have a data
sharing agreement in place with the owner of the data. So if you’re not using a
publicly available data set, you have to consider this and be sure that you
understand what the data sharing agreement entails.
And this can also be related to publishing. If you are using a data set from
someone else where a data sharing agreement is in place, you will sometimes
have to have publishing guidelines set forth initially.
There’s also cost, potentially. If you don’t have access to a publicly available data
set, data can cost quite a bit of money to use. And sometimes the data that you
need for your particular research isn’t available publicly.
For my dissertation I was interested in eating disorders and substance use. I
could not find a publicly available data set. So what I did was I was part of a listserve in the eating disorder community. And I sent out an email to everyone on
the list-serve explaining what my dissertation was going to be examining, and did
anyone have archival secondary data that they would be interested in sharing
with me. And that is how I found my data.
With that though, it was not a publicly available data set. So I had to make sure
that the data sharing agreement met with both my and my advisers approval.
xix. Laureate Education (Producer). (2015b). Secondary data in doctoral research [Video file]. Baltimore, MD: Author.
Secondary Data in Doctoral Research
Program Transcript
DR. PETER ANDERSON: In general, I think using secondary data is an
outstanding way to conduct dissertation research.
DR. DANIEL SALTER: We highly, highly, highly encourage folks to publish their
research, so that it goes out into the research stream, so that other people can
see what you found.
NARRATOR: Dr. Daniel Salter is the director for strategic research initiatives in
the Center for Research Quality at Walden University.
Dr. Peter Anderson serves as a full-time faculty member in Walden’s College of
Health Sciences. Dr. Salter and Dr. Anderson discuss the use of secondary data
in doctoral research.
DR. DANIEL SALTER: Research really needs to follow the question, and the
type of question you’re wanting to answer. Often the type of question you ask will
demand that you collect data that doesn’t exist already. But for many research
questions we do in Applied Sciences and Health Sciences, and Education, and in
Management, there are tons of information already being collected that can
answer good research questions.
The issue’s going to be the quality of how it’s collected, knowing what they did to
get that information. That’s where collaborating with a agency or something as a
researcher is advantageous, in the sense that you can be a part of that process.
We do work with students who use data that have already been collected. But
some students work with an agency from before that data is even collected in the
first place. So they may be collecting operational data in a health services
agency, and you as a researcher may have a chance to collaborate with them
before they even start the process. So you know on the other side that they’ve
collected some good information that is amenable to being studied later.
There’s no reason for everybody to be doing the same thing. It saves time and
money. And those companies have a vested interest in it as well. But those are
arrangements to make right up front, and be clear on who uses what and how.
DR. PETER ANDERSON: In public health and health sciences in particular, there
are lots of great data sets available through the Centers for Disease Control and
other big national organizations that have exceptional, clean, wonderful data sets
that have been gathered in the most ethical way possible, that are available to
our students to use. And I would encourage them to use them.
DR. DANIEL SALTER: A challenge that comes with secondary data is that
sometimes initially students think there’s this perfect SPSS file sitting out there on
somebody’s computer that I can just download. And off I go to run my data. It
does not work like that at all.
I would say that a problem– a red flag, if you will– for a data set is if there’s no
documentation around it, that you have to figure this out. Because you need to
know in working with secondary data, how those data were originally collected in
some way. And if the researcher, or the people who were collecting that data,
didn’t document that process, then that right there is a big red flag.
DR. PETER ANDERSON: In order to access the actual data in a secondary data
set, they have to have IRB approval. So in the process of getting IRB approval,
they can look at the data list variables. And they can look at the coding schema.
And at that point in time, when all we know is the list of variables and the coding
schema, then we might pick and choose. And data sets will come and go. But
once we’ve made our decision based upon the variables available and the coding
schema that we see, and then we open the data set, that’s it. We’re using this
data set.
The best way to present your results to the public depend upon your particular
aspect of public health or health sciences that you’re working in, and what public
you’re intending to provide your information to. So it could be that it will be a
publication in a peer-reviewed professional journal. It could be that it would be a
series of written white papers. It could be it will be oral presentations to the
military, or to the local public health branch.
DR. DANIEL SALTER: Lots of different venues for presenting research. From
very local kinds of things, to the very people that may be affected by the type of
research you’ve been doing. The practitioners, the policy makers, whoever are
local. But there’s also the need for you to take it to your professional group, many
times, and say, here’s what I found. And you share with other like-minded
researchers and people who are interested in your topic.
A challenge that comes with doing research, and especially happens at the end
of the dissertation process, is that a student is so immersed in it, and they
understand it at such a level that it’s hard to step back a little bit and realize that
people have not addressed it in the same up close and personal way that you
have. So there is that challenge there. I would say that it’s about knowing your
audience, and for many doctoral students, getting back in touch with your
practitioner role.
Say, OK now. You know, I was a practitioner at this before I became a doctoral
student. What would I want to hear? And what would I want to know? And why
do people keep slamming the door?
I had a very humbling moment as a doctoral student. Right after I was done, I
took my research to a conference. I presented. And one of the biggest senior
scholars in my whole field was sitting in the room. Which was a little intimidating.
And I gave my presentation. And afterwards she pulled me aside, and she said,
Daniel, you need to talk to us like we were second graders. And it was just sort of
this nice little way of saying, it’s easy to get into the language. It’s easy to get so
immersed in it that you forget that you’re doing it for somebody else in the first
place.
So making it palatable, making it– we often joke– how would you explain it to
your grandmother? Those kinds of strategies really do work. When you have to
go back and present it in an oral kind of way, you have know it on a different kind
of level.
To prepare for this assignment:
Review this week’s Learning Resources, including the SEER (Surveillance Epidemiology and End Results) and other cancer registry websites.
Search local news sources or other online resources for a local public health event/trend (CORONAVIRUS OUTBREAK) of interest to you.
Analyze the surveillance methods used to monitor the event/trend you selected and formulate suggestions for their improvement.
ASSIGNMENT (CORONAVIRUS OUTBREAK):
Post a 4-paragraph evaluation of the event/trend you selected (CORONAVIRUS). Include the following:
a. Introduction of public health events/trends/outbreaks.
b. A brief description of the local public health event/trend you have selected (CORONAVIRUS)
c. An explanation of the software applications/systems and surveillance methods (i.e., systems and procedures) used to monitor the event or trend of CORONAVIRUS IN CALIFORNIA AND USA at large.
d. An evaluation that explains your position on whether the surveillance methods used to monitor the event/trend of CORONAVIRUS were/are adequate and effective.
e. Recommendations on how to improve the use of informatics to monitor this event/trend (CORONAVIRUS).
f. Support your post with additional scholarly resources.
g. Use APA formatting for your Discussion and to cite your resources.
