INTRO
JESSICA (INTRO CREDITS)
Public health informatics is the science and the art of taking raw data and turning them into useful information for health policies and programs. It takes all those data out there and turns them into knowledge of how people can live healthier lives. But how does this process work? My name is Jessica Hill, and I work at the Public Health Informatics Institute in Atlanta, Georgia. This podcast is my quest to learn about informatics and how it’s made people’s lives better, how has it made my life better, and really why does it matter. So I’m ready. Inform me, informatics.
JESSICA
Welcome back to Inform Me, Informatics. This is our second episode and I’m very excited to be able to share the second half of our conversation with Dr. David Ross, the director of PHII, which is, of course, the Public Health Informatics Institute. As you might remember, in our first episode we spoke with Dave about his professional journey from rocket science to informatics. This time, we’ll share more of our conversation with Dave, informatics projects that have made him proud, key challenges in the field, and some of the hottest issues in informatics today. So if you’re operating heavy machinery while listening to this podcast, please be careful.
DAVE
We talk a lot these days about system interoperability, and I would argue that the precedent to system interoperability is the personal human interaction interoperability. If we know one another, trust one another as people, as institutions, I know your motives if you’re hospital A and I’m hospital B, we can strike an agreement on when and how we share data and use data. That’s just really more and more and more important these days. It’s very important that we, as citizens, know how our data are being used. It isn’t that most people don’t want their data used. In fact, probably the opposite is the case. They wanna know when and how they’re used, and they wanna know they’re not going to be abused. How do…
JESSICA
Do you think people really think about that?
DAVE
I think when confronted with it, they do, yeah. I’ve seen examples of people being given examples to explain, to say, you know, “If we could use your data and many others, we could understand if, say, the care you as a group is receiving is good care or not, or could be improved. Would you like to know that you’ve contributed to improving the care that you and your family will some day receive?” Most people will say, “Well, yeah.” Especially if you say, “And I can protect and assure that we will not post any place you had this disease or diagnosis at this point in time.”
JESSICA
But I feel like that’s the big challenge, right? Because nobody can really assure that, really.
DAVE
It is a challenge. Yeah, no question about it. We live in a digital world.
JESSICA
So it’s what you’re willing to trade off because a lot of people are willing to trade off a lot and share a lot on, you know, social media because they get the benefit of support from their friends and staying in touch with their family, and maybe finding other people with similar health issues and connecting with them. So how can we, as public health, make the benefit as such to people that the trade-off feels like, yeah, that’s something you’re willing to do.
DAVE
We have a heavy burden to build that business case and I think that’s part of again, that’s part of the toolkit of informaticist and this discipline brings to public health agencies is to help build that value case or business case for the use of data. And if we can’t argue a sufficiently good robust case, then it probably maybe shouldn’t be done. Let’s give an example. Let’s start with the easy stuff. Take something really nasty like the Ebola outbreak.
JESSICA
Got it.
DAVE
I suspect most American citizens immediately felt like, “Don’t worry about my data privacy. I don’t wanna get Ebola. Because the downside of me protecting my information is that I might spread a disease that will have awful consequences and, by the way, it might come back and kill me too and my family. So okay, I’m willing to share about that one.” Right?
JESSICA
Right.
DAVE
And that’s the whole basis of reportable diseases is they have communicable significance, transmissible significance to a population. And so frankly, the law says, “We don’t really care if you don’t want us to know this. We need to know it because we have a right to protect all of us from each of us.” Right?
JESSICA
Right. And that’s where public health gets kind of more controversial.
DAVE
Yes, at times it does get controversy, but in fact, that is a public judgment, a collective democratically derived judgment that at times, your individual rights are trumped by the needs of the collective. Not always, sometimes the reverse happens.
JESSICA
Right. So when you explain that to me, I can understand an outbreak and how we need this information in order to protect the health of other people. So how can sharing the data from my primary care doctor help protect the health of…
DAVE
Okay. So let’s take one of the most powerful examples in public health land, that’s immunizations, right?
JESSICA
Right.
DAVE
By gathering data on every shot given to every person over time, that’s when an immunization information system is. What you do is then you have a population base understanding of where our protection coverage is effective and where it’s not. You’re able to look and see if there are pockets of under-immunized or unimmunized people that could be the cause of an outbreak that’s preventable.
JESSICA
Right. But that’s preventable.
DAVE
That’s preventable. Now, that’s just one example.
JESSICA
Right. No, but it makes me think… So then this is, to me, leading to other thoughts of a lot of ways that we think about health and getting sick in a lot of our communities is around, like, you did something wrong. So I think that’s part of why people don’t want their data shared because it’s…
DAVE
Sure, sure.
JESSICA
You know, if I’m getting a shot while I’m preventing something, but if I got sick, there could be a judgment that I did something wrong.
DAVE
Well, yeah, yeah, exactly. Like, I develop type 2 diabetes, or you blame me for being, you know, overweight and, you know, blame for eating the wrong food and not doing any exercise. One can be blameful about it or one can be helpful about it. Those are judgments that we have to help educate people about, but does that mean we shouldn’t look at the data?
JESSICA
Well, what do you think it would take for there to be sort of a standard electronic health record for all of the U.S.? What would that look like?
DAVE
Well, what would it take and what it looks like are two different things. What it takes is we, the citizens, want it. I mean, do you want to have a personal health record that you keep like you have your bank records? Those are yours, right? The bank holds them, the bank, but you…
JESSICA
Yeah. The bank holds them and shares them with the credit rating agencies and the car loans folks and…
DAVE
That’s right and there’s some aspects that you’re not happy with. If you don’t like it, go to your elected officials and say, “Change the laws.” But it’s still…it’s your bank account and you can open it and you can close it, right?
JESSICA
Yes, yes.
DAVE
And you do pay attention to see if the information is right.
JESSICA
I do.
DAVE
Right. You don’t want me to sort of slipping in and taking 1,000 bucks out of your account.
JESSICA
No, no. I get very prickly about that.
DAVE
You really wanna know, that’s is my number. Yeah. I trust that number, right? The same about our health. I mean, do we want this information? What I’m suggesting with the maturity of electronic health records is we all eventually mature to the point where the public, the citizens, each of us wants our providers of care to have the right accurate information on us. There are multiple ways to skin that cat.
JESSICA
That wasn’t a very helpful metaphor to use.
DAVE
Okay. There are multiple ways to [inaudible 00:08:38.731]
JESSICA
To maybe skin that apple.
DAVE
Anyway, there are multiple ways to solve a problem and how you make that information about you useful to you is what the EHR really is about. I thought you were gonna ask me about the coolest projects we’ve worked on.
JESSICA
Well, why don’t we make that the last question?
DAVE
All right. Well, what’s the coolest project, one of the coolest project…
JESSICA
Yeah. I should ask the question. You’re right, you’re right. I said I would ask you. Okay. Dave, what’s one of the coolest projects you’ve worked on in the past five years?
DAVE
Well, I think a couple come to mind. So I’m gonna give you three, but I’ll make it quick. One…
JESSICA
Do you think that’s what informaticians always do, you ask them one question and they give you three answers?
DAVE
Well, you know, I’ve learned this is what politicians do. You give the answers you wanna give, not necessarily the question you’re asked.
JESSICA
That’s good. I can learn that. As somebody who wants to interview people, that my question is just a guideline, so thank you for that lesson.
DAVE
Yeah. Well, it’s one of the things they teach you in dealing with the press is answer what you want to answer.
JESSICA
Okay. So what do you wanna answer?
DAVE
So number one was the launch of the Informatics Academy. So we really produced the first evidence that show that these basic informatics concepts and principles we were teaching were learnable by a cross-section of public health people. This was not just techies. In fact, the majority of people were not. They were public health department people of all sorts of stripes, from environmentalists to health agency directors to epidemiologists. It was a cross-section of the people you find in a public health agency and some technology people. The project optimize is another one and it’s something we did in partnership with PATH which is a large NGO in Seattle, which was looking at how do you automate and improve, systematize the vaccine supply chain in developing countries. What we demonstrated was you can define vaccine supply chain in a uniform way that all countries, regardless of who they are, could adopt it. We had Asian and African, and Middle Eastern countries involved, and WHO. We had a lot of naysayers at the beginning, said this is not possible, everybody’s different. It was a collaboratively done thing. They developed the best process and the best procedures. Fabulous project.
JESSICA
And when everyone’s doing the same process, then you can learn, like, best practices and what makes it go initially.
DAVE
Right. And when you start building automation support, you start to create systems that other people will then want to adopt. So you create cost efficiencies also, right? And the other one was a project called the Inventory Management Tracking System that we did, IMATS for CDC is how it’s known today. But it relates to how to improve the strategic national stockpile for vaccines and medical supplies, and CDC…
JESSICA
Destinations, other countries?
DAVE
Yeah. For the U.S., for the U.S. This is a project we were brought in by CDC to do and help them with it, develop one version of a system that was not being adopted by the States. And it worked and worked on this, and it really was a lot of push back from the States. We got involved because our basic premise was you have to start where the work happens, you have to start with the people who do the work, and not try to guess at what you think they need to do, but actually find out what they do and how they do it in the context in which they do it. And by applying our collaborative requirements development method, we were able to help both the CDC developers and program people come into deep interaction with state and local people who did this kind of work, and out of it, we refine the requirements for what has now become the IMAT System and is now adopted in many, many states. And so at times like flu pandemic, like with H1N1…
JESSICA
H1N1. Yeah.
DAVE
The system we helped create and refine was actually very helpful to the nation and so that’s informatics in action to actually prevent disease.
JESSICA
That’s such a great point to end on because that’s what we’re looking for, examples of how informatics in action actually makes people’s lives healthier.
JESSICA
Thanks again to Dr. David Ross for talking with us. Dave is the director of the Public Health Informatics Institute, but he’ll be taking over as president and CEO of the Task Force for Global Health very soon. Please be sure to tune in next time when we’ll be exploring how informatics supports immunization efforts and how your local pharmacy maybe talking with the state information system. We hope it is.
MARY BETH KURILO
For pharmacists there’s also sort of the return on investment to make sure that they’re giving all the immunizations that the patient is due for. And from the public health perspective, that makes sure that the population is that much more covered.
JESSICA
Thanks to Kathleen Turaski of Resonance Marketing, who designed our logo. Our theme music is called “Carnivale Intrigue,” and was composed by Kevin MacLeod. Inform Me, Informatics is a project of the Public Health Informatics Institutes and the Informatics Academy. You can find out more at phii.org. You can also find us on Facebook and follow us on Twitter, @phinformatics. If you like this podcast, please rate us on iTunes. The ratings help other people find out about us and it can help us spread the word. Finally, many thanks to our production team, especially Piper Hale and Christopher Hall, who edited this episode. You both are awesome and we really appreciate all your help, your hard work, and your guidance. I’m Jessica Hill, and you’ve been informed.
BUTTON
JESSICA
I forgot what I was gonna say.
