INTRO

PIPER

Hi, this is Piper Hale, and you’re listening to Inform Me, Informatics. This episode is coming out right before the Public Health Informatics Conference, or PHIC, which, if you’re not familiar with it, is—exactly what it sounds like. It draws informaticians from all over the country to talk about innovations and successes in the field. It’s co-hosted by the CDC and the National Association for County and City Health Officials (or NACCHO), and because it only happens every two years, in Atlanta, it’s essentially the Brigadoon for people interested in public health informatics.

Naturally, here at the Public Health Informatics Institute, this conference is a very exciting time. So in preparation for this big event, I spoke to Dr. Umair Shah, the Executive Director of Harris County Public Health in Texas, and the former president of NACCHO, the organization that co-hosts PHIC—he just passed the mantel on in June of this year. I asked him about PHIC and why he’s looking forward to it.

UMAIR

Really, the opportunity to really speak to folks across the country who are doing really cool things and really to learn from them and to peer network with them, but also at the end of the day, to bring back ideas to your own home jurisdiction that really allows you to move your needle forward, I think is really critical to what PHIC brings to the table and why people should attend it.

Harris County Public Health, the agency Dr. Shah leads, is exactly the kind of health department that tends to be represented at PHIC. It’s known for its innovations—it’s been a pioneer in the burgeoning technology of Video Directly Observed Therapy, which allows tuberculosis outreach workers to conduct medical regimens with patients virtually. The health department was actually featured in Politico Magazine after crucial tuberculosis efforts could continue in the midst of Hurricane Harvey thanks to this technology. They’re also the first health department in the country to partner with Microsoft Research on Project Premonition—an initiative to reduce vector-borne diseases using an infrared device that can selectively capture the species of mosquitoes that carry diseases like Zika and West Nile, identifying them by the frequency of their wings flapping.

Given its reputation for being innovative, it’s no surprise that Harris County Public Health is also pioneering on the informatics front. In my conversation with Dr. Shah, he told me all about an exciting informatics project called the data warehouse, a new health data platform that will break down walls between health data silos across the agency. Dr. Shah shared with me some of the challenges of managing data across a large health department like Harris County’s, and explained how the data warehouse will help.

UMAIR

So Harris County Public Health is the county health department for the third largest county in the US. We have a population in Harris County of 4.7 million people which again is the third most populous county in the country. And we also are spread over geographically, a size that’s larger than the state of Rhode Island with 1,778 square miles. We have 22 different sites across the Harris County Public Health System. And as you can imagine, with a holistic comprehensive health department such as ours that is in a number of different areas including infectious disease, chronic disease, we do work in animal health. We have entomology, mosquito control. We have environmental public health. We have nutrition chronic disease prevention, emergency preparedness, policy and planning.

When we put that all together, there are an incredible amount of diversity of activities that Harris County Public Health is responsible for as we promote the health and well-being of our community.

And from our standpoint, because we are so spread out, because our community is so large and diverse, we have a number of different areas in our department that require the ability to speak to each other and not be siloed and not be just in an individual part of the department, but to be able to share the wealth of information across the system. And that’s really what the data warehouse project means to us and why it’s so important for the work as we build Public Health, not of yesterday or today but Public Health of tomorrow.

I think there are two main issues that we have. One is what I just described that in our department, because we have so many different kinds of databases, data systems and really, information that our programs are working with and really interested in in ensuring that they have in essence consolidated, that a lot of that work is siloed.

And oftentimes, it’s not interoperable. It’s not standardized and so it’s really the fact that we are so diverse and so spread out there to really ensure that we are looking at that community-wide public health approach in a non-siloed manner is very critical.

The second piece that we have is that many of the reports and even the data governance that we have across these data systems are also not standardized. They’re ad hoc and, oftentimes, they may actually be very onerous when it comes to using disparate databases. And so, we want to really ensure that we have the reporting systems, the reports that are generated and even the data governance not to be ad hoc and to be more standardized and really to ensure that it provides the best optimized user experience that really allows for our public health professionals to be able to do their job effectively.

And so, I think really it’s the two issues around data systems and databases being siloed and not operable, interoperable and not standardized, but also ensuring that across the system we are very much not working in a, you know, in a more non-systemic way that we are actually working across the system in a more systematic holistic approach.

PIPER

So regarding this new data warehouse, is this warehouse slated to solve these problems and support Harris County’s health goals? And if you could talk a little bit about how the warehouse is going to be structured, what kinds of data it will store, in what formats and how different stakeholders are going to be able to access it, all that kind of thing.

UMAIR

Sure. So, I think the first thing is to say, you know, from a visual standpoint, it’s not that you have a data warehouse in a physical brick-and-mortar, you know, from that standpoint, but the visualization is that you have a data warehouse that actually is a virtual system that allows for communication across those 20-plus different sites.

And so, you have standardization. You have integration. You’re using common language in terms of the data sets themselves. You have better documentation of where the data is, how to report on that data. You have a better understanding of data literacy, a better understanding of how you work across the system with similar language sets and common understanding of vocabulary and language.

So you’re actually working through that in a more structured way but also, in a way that really allows for different stakeholders to be able to use this information more effectively.

And I think there’s this other piece of this which I think is really critical which is some centralization of the governance structure and really at the end of the day that you have to have a data warehouse team that really is not just as a top-down approach, but that data warehouse team that really lives and breathes throughout all of those different program areas.

So they’re working with a common understanding of what the problems are, a common understanding of what the potential solutions are, and a common understanding of at the end of the day, how do they work together?

So the governance structure that has to have commonality, I think is absolutely critical to the piece. But at the end of the day, you also have to have governance in the standpoint of overall departmental leadership that really allows for all of the directors and all of those that are working with the data sets but also the ones overseeing the data sets that they all recognize the importance of it. They also support it and that we as a department then invest in it.

So for us, that data warehouse, again, not the brick and mortar data warehouse but this virtual system that we’re creating really allows for all of those things to be part of the system that is really going to be, again, public health of tomorrow.

PIPER

The data warehouse is built on a SQL database that will house data sets from all over the agency. From there, an extraction, transformation and load process powered by Informatica will export the source data into the warehouse, and will allow seamless exchange using a standardized, interoperable platform. By standardizing the county’s data in this way, the warehouse will allow swift exchange between siloed divisions within Harris County Public Health. I asked Dr. Shah to give me an example of how local public health practitioners might use the data warehouse to improve health outcomes.

UMAIR

I think that the most specific example comes to really ways to collect different kinds of data that we otherwise were not necessarily doing, right.

So oftentimes, we’re really very much interested in capturing public health data from the very traditional way of, you know, how many animals did you pick up with your animal control officer? How many mosquitoes did you collect in your mosquito control traps? How many patients with tuberculosis did you provide directly observed therapy to? How many individuals did you serve in the clinic? But this really allows us to really look across the system at what are those social factors, as you know, called social determinants of health that really allow us to go into socio-economic factors

So if you look at immunization rates, we would then layer the immunization rates with socio-economic data and look at what are the education levels, high school graduation rates, what are the housing types in that area, what are the GDP, you know, of that community if you will in a very macro way or really looking at the buying power of an individual in a very micro way when it comes to the homes or the households in that particular community. How does that impact the overall immunization rate of that community? I think that’s really one of the big challenges that we have.

The other challenge that I would say from a health equity standpoint is that we really recognize that place matters. I think the real way for us to approach health equity in our community is that we believe place matters and that health happens not just in the health care system in the hospital or the emergency department of the clinic, that health happens where we really all are, right, in the community where you live, learn, work, worship and play.

And so, I think it’s really important that at the end of the day we recognize that, regardless of what data systems you’re using, what platforms that you’re really applying to the problem, that we are at the end of the day very much a part of the solution of applying the social determinants and the social factors lens to you know, to what we’re really trying to do within the health department.

So one of the things that over time that we have really done is that, if somebody wanted to report…a community member wanted to report a foodborne illness, they would have to pick up the phone and make a verbal or an oral report that would then be put in through a data system, somebody typing away, and an inspector then be you know, going out to investigate.

What we’ve done over time is actually in fact created a mobile app and had some integration back through our website and some electronic reporting systems, so an actual community member could potentially now do all that verbally or orally by picking up the phone and calling.

But we also have the high tech standpoint of it, which is that you can actually use a mobile app or a website where folks in the community can then report that foodborne illness in a more automated fashion. And so, what it does is it takes the oral reporting, the receiving of the information by phone, the data entry and all of the assignment of the work to the inspector, that’s all now done automated.

So as the individual reports from an automated system, it comes into our…again, tangentially into the data warehouse aspect of foodborne illness and it turns around and allows us to assign the work in a more electronic fashion and get the investigator to go out and by the way electronically get that information back into the data system, and be able to then use that to enact some activity, whether it’s a an investigation or even truly potentially going back to a food establishment and saying that there is some, you know, deleterious activity that might be damaging potentially to the public’s health, allows us to do that all in a more systematic electronic format.

So we really believe strongly that that is an example of where it used to be done in a more labor-intensive physical way and now it’s the data systems allow it to be done in a more streamlined effective way.

PIPER

Some of the features of the data warehouse have already experienced a soft release, but the full warehouse will be going live in Harris County over the next few months. After Dr. Shah finished telling me about this ambitious new project, I asked him the question we ask all our guests on the show.

UMAIR

How do I personally define informatics? You know, I would say that, at the end of the day, informatics is very much about systems. It’s about data systems. It’s about creating value for the evidence of the work that we do. We in public health are nowhere without our data. We are nowhere without the information and the statistics and all those measures and metrics and variables that allow us to do our work and to do it effectively, and when somebody challenges us to be able to go back to that evidence and say, this is why it’s important. But as I said earlier, we really believe strongly at our department that it’s not just information technology, it’s innovation technology.

That for us, informatics is about the innovative use of technology to be able to enact the exchange of information in a way that allows for people to understand it better and to be able to utilize it better.

And again, the final piece of that is really the sharing of the story, telling the narrative why local public health matters and why we have the challenge, what I call the hashtag invisibility crisis that we really have to be thinking about the three Vs of public health, of raising the visibility, showing the value and really, at the end of the day, the validation of our work with others who potentially can then invest in it and/or have policies in support of it. So I really believe that, in my mind, informatics is about the real…where the rubber meets the road.

If you give me a set of data points that our epidemiologists have on a spreadsheet, I may have no idea what that means. But if you take that and you make it as part of a meaningful narrative that allows me, the public health practitioner, to be able to articulate information to the community and to partners and to policymakers, that’s meaningful, that’s effective, and that’s understandable, then really that data system has now been the most incredibly useful data system that allows me to do my job better.

And I think, at the end of the day, that’s what this is all about, is how do we use that data in a way that’s gonna allow us to articulate the importance of the public health story at the local level and why what happens at the community level at the local level is absolutely critical to the health and well-being of our country.

PIPER

Many thanks to Dr. Umair Shah for taking the time to speak with me about the Public Health Informatics Conference and the data warehouse project! I’m also so grateful to his team for all their support on this episode, especially Court Wellington, who walked me through some of the technical aspects of the data warehouse, Eric Bakota, who made this episode happen, and Liz Perez and Charlie Propst, who very generously handled audio recording on Dr. Shah’s end of the conversation. Thanks also go to NACCHO’s communications team, especially Kim Rodgers.

This podcast is a project of the Public Health Informatics Institute and the Informatics Academy. Visit phii.org to learn more about all of our informatics work! You can also find us on Facebook and follow us on Twitter @PHInformatics.

The music used throughout our show was composed by Kevin MacLeod. Thanks also go to Jessica Hill, my co-producer on the show.

One more thing: we’re doing another call-in show! Vivian Singletary, the Director of the Public Health Informatics Institute and one of Health Data Management’s Most Powerful Women in Health IT for 2017, will be taking your questions about public health, informatics and all related topics on the podcast! You can email us your questions as text or, even better, voice memo files at podcast@phii.org, or you can call into our brand-new podcast call-in line to leave your question as a voicemail. The number for that is 678-974-0344. I hope to see you at PHIC!

I’m Piper Hale, and you’ve been informed.

BUTTON

PIPER

Why do you think our listeners of this podcast should be excited to attend PHIC?

UMAIR
Oh, I think they should attend PHIC because we’re telling them to. No, I’m just kidding. Right, as a local Health Authority of Harris County, everybody should go to PHIC.