INTRO

JESSICA

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.

Hi, I’m Jessica Hill, and welcome to the first episode of Inform Me, Informatics for the year 2017. This episode centers on a basic question, why is public health informatics so hard to talk about? Maybe you’ve asked yourself that question. I know I have. And my struggle to answer it is actually one of the big reasons we started this podcast. Or maybe you’ve had this situation happen to you. A relative asks you a seemingly innocuous and straightforward question, “What do you do at work?” 20 minutes later, you see their eyes have glazed over and they are silently nodding their head, even though it’s clear to you that they’re really not following what you’re saying. And quite frankly, you don’t mind because you’re not really even sure what you’re saying at this point. And let’s be honest, you would both like to move on to other topics so: computers, you do computers.

Sound familiar? The folks at the Public Health Informatics Institute were also familiar with this scenario. With funding from the Centers for Disease Control and Prevention, they recruited the expertise of an organization called FrameWorks Institute to help study this challenge. The resulting project is called Reframing Public Health Informatics. You can find out more about the project and the result in toolkit on the PHII website, which is phii.org. But my guest for this episode is Dr. Marissa Fond, who is the Assistant Director of Research at FrameWorks Institute. We’re going to be talking about informatics. It’s going to be meta and it’s going to be great. I spoke with Marissa back in September at the FrameWorks offices in Washington DC. We started the conversation with her explaining why many professionals, not just public health informaticians can have a hard time explaining the ins and outs of their fields.

MARISSA

Certainly, experts in any field are going to face challenges communicating about what they do. And one of the main reasons for that is that experts have naturally a really deep knowledge base and a set of so many experiences that they’ve built up over time. And so they live and breathe the work that they do. And they implicitly understand so many aspects of what that work means and how different pieces of it fit together and what effects they expect it to have.

And so all of this knowledge is brought to bear on how they communicate about their field. And so often, even though they know that they’re communicating to people who are not experts in the field, they make a lot of assumptions or they don’t know how to anticipate what non-experts won’t be able to understand, or what they won’t know, because they have that deep expertise. And so certainly, it’s a challenge for experts to break out of that expert mindset and communicate to somebody who is interested and certainly aware and knowledgeable about many adjacent fields, but maybe not an expert in the work that they themselves do.

JESSICA

To reframe public health informatics, Marissa and her team started by doing a series of interviews. FrameWorks wanted to better understand how informaticians and experts in the field think about and communicate about their work. They also wanted to learn how a more general audience of public health practitioners thinks about informatics. Some of what they found was a little surprising.

MARISSA

There was a bit of an assumption going into this project that public health informatics was conflated with IT in the public health community. And that was made very apparent in the expert interviews where experts would say public health informatics is not IT. That was a strong theme in what they said. And you can tell when you see experts proactively negating an assumption that way that they have this strong sense that this is something, a myth they need to dispel. In fact, in communications, we always recommend not doing that as a communication strategy because certainly, when you do something like that, you have to know that that assumption is there. Because otherwise, you’re only reinforcing a false assumption. Because, for example, if I were to write on the side of a yogurt container that yogurt does not cause dementia.

JESSICA

Oh, I’ve never thought about dementia when eating a yogurt at all.

MARISSA

Right. But you as a competent language user and given how language works, you would read that and you would say…well, just like you said, you would say, “I’ve never thought about this.” But you would also think, “Was there a certain issue?”

JESSICA

And why…yeah. Why did this label need to be here?

MARISSA

Right? Because why else would you have said that? And so if people aren’t thinking that informatics is the same as IT, then saying that it’s not, serves to reinforce that misassumption. And people will tend to remember that on some level. But what we found in the interviews with public health professionals, in fact, was that there wasn’t that strong conflation of informatics with IT.

JESSICA

There wasn’t?

MARISSA

There wasn’t. So when we ask people, you know, do you know what informatics is? How would you describe what is? People would always bring in data. That was very primary. They would say, in some way that informatics was about data. It was managed in some way by technology. Technology was an important component, but it was really about the data. And one thing that we noticed was that informatics kept falling out of the conversation in some way. So we might bring up informatics. We might be talking about data. Somebody might have just defined informatics in a way that felt on target. And yet, as we were talking about public health, and what’s important, and how it works, informatics fell out again, and again, and again.

And we thought, “Okay. What is going on here?” And one pattern of thinking that came out really strongly in the interviews was that if public health professionals knew anything about informatics, they thought about it as more like a tool rather than a discipline. And so they would think of informatics as an interoperability handbook. That would be somebody who’s pretty informed about informatics surprisingly so. But even something like a database or, you know, people know that it’s important for data systems to be integrated in some way. And so they saw informatics as that thing, but they didn’t see it as a discipline, as a science, as a social science.

They didn’t see it as a discipline that would incorporate thoughts about workflows or users. The people who generate and collect the data would later analyze the data. The people were kind of absent from their thinking about informatics. And similarly, the people that we interviewed really would never be able to name an informatician. So they didn’t know what to call that person. They couldn’t point to a colleague who did that work.

And so the implications of that might seem minor, but they’re important because if you say something like, “We need to help local health departments increase their informatics capacity.” Somebody who’s not an informatics expert, would likely interpret that as, “Yes. We should upgrade the databases that these local health departments are using to manage data.” But they wouldn’t be likely to think about developing a workforce and increasing informatics capacity at that health department because they’re not seeing the discipline and they’re not seeing the professional, the informatician who does this work. And so it was a subtle pattern, but one that was repeated throughout the interviews.

JESSICA

Yikes. So clearly, talking about informatics is hard. But take heart, after analyzing the interview findings, Marissa and her team develop strategies to help informaticians communicate about their fields. Answer the explanatory metaphors.

MARISSA

FrameWorks works a lot with metaphors. That’s something that we do across a lot of our projects because it offers a succinct way to increase understanding by linking a concept that’s unfamiliar like public health informatics with a concept that’s much more familiar to people.

JESSICA

So you’re taking advantage of the way people already think about certain things and leveraging that to be able to explain what informatics does for public health, is that right? So like taking the frameworks that are already there and mapping them on to something in public health informatics.

MARISSA

That’s a great way of putting it, yeah.

JESSICA

The FrameWorks team brainstormed many different metaphors that might help explain informatics and the ways that supports public health practice. Their original list had 22 different options. One early example was a metaphor that compared public health informatics to global banking. Think about it. Hmm, keep thinking about it. Through feedback from project partners, FrameWorks narrowed the 22 options down to three main metaphors.

MARISSA

And so the first one that we recommended was one that is not unfamiliar to the field, actually. But it’s a metaphor of translation. So public health information translation and how informatics is about translating data from different sources collected in different ways, into a common language that public health can understand and interpret across sectors. And so the informatician is the professional who understands what different audience members know or need to know, what their needs are, how they’re likely to interpret certain information, all of these social factors that go on or that are important to think about when you’re trying to translate different types of data into a usable set.

So that one is important because it focuses, again, on the informatician as a professional skilled in a particular competency and having a lot of knowledge about how this process needs to happen. And also, it’s something that people implicitly understand, that if you’re a group of people and you’re not speaking the same language, somebody has to develop a dictionary. There have to be rules for how you’re going to translate all of these languages into some usable system that people can communicate with.

JESSICA

When you were first speaking about the translator role, I was thinking about how in one agency that we know there are many, many different information systems. And so data are flowing in through many different routes, but they could all have connection to a similar topic. So for example, like childhood obesity. There are many different data streams that would give you information that’s important to know about childhood obesity, but you need someone to be able to bring all those together and synthesize them to really understand what the picture looks like for your particular context. But then, when you started talking about what data dictionary is and having the ability to exchange and convert the data from one system to another, then I think of something very different. I think of the actual information systems themselves, and how informatics helps those become interoperable. So how are they both part of the translator metaphor? Or how were you thinking about the metaphor in that way?

MARISSA

I think that you’ve just used them that way, in the sense that you’ve expanded the metaphor to capture these two aspects of informatics in a sense. And if you are in a situation where you want to be focusing perhaps more on interoperability or something like that, then you could use it in that way. Whereas, if you want to talk about all the other ways that you could translate data, you could do that as well. So I think that in your example, you’ve shown how you can use it kind of flexibly to accomplish the goal that you want to accomplish.

I think that the key with a metaphor like this one about translation, is that even more important than using the metaphor alone is to do that explanation. So to really talk and using the metaphor kind of as you just did, to explain what’s happening. So who is the informatician? Where is he or she? What is he or she doing? And who are the other parties involved? What do they need to know? When do they need to know it? What would be most helpful for them? Painting that picture and expanding the metaphor to do that explanatory work is so effective.

JESSICA

What was another metaphor?

MARISSA

So another metaphor, this one focuses more on the design and remodeling, let’s say, of data systems. And so if you compare an informatician to an architect, somebody who is building a building thinking about how that building needs to function. What it needs to do for the people who are going to use it. How it fits into the local context and the materials that are available. How the process needs to happen, all of these things, is similar to what an informatician does with data systems. One person in public health that I was talking to mentioned, it’s like, you wouldn’t build a conference center by randomly adding rooms piecemeal one by one, right? I mean you just wouldn’t.

And so similarly, you don’t want to be doing that with data systems. You have to design with the big picture in mind. And an informatician is an expert of doing just that. And so this one is important because it speaks to the design and planning of systems, which is certainly something that public health professionals believe is important. But the remodeling piece of this is also important. Because we found that public health professionals were very wary of adding systems on top of systems, on top of systems. They would say we have so much data. I know that sounds certainly familiar.

JESSICA

Yeah, so much data.

MARISSA

And we don’t need more systems. I have 25 Excel sheets open right now. I don’t need another thing. But if an informatician is skilled in taking the system that already exists and adapting it, or expanding it slightly, or changing something to make it more functional, then that’s something that our research at least shows public health professionals know to be so valuable to their work. So that’s another way of talking about informatics and public health informaticians.

JESSICA

We were actually at the Informatics Academy. We had a webinar with the Washington State. And they were talking about moving to an enterprise strategy and thinking about their data. But they had a visual that showed all the different ways data flowed in and out of their agency, and it was…it couldn’t even fit on one, you know, piece of paper. And so thinking about how you design those systems that you can bring things together versus continuing the silos, I think really resonates with people.

MARISSA

The idea that informatics is a discipline that can cut across silos, and potentially even help them to work together is something that is valuable.

JESSICA

Absolutely. So that’s kind of under the architect metaphor. And then what was the third one?

MARISSA

So the third one focuses mostly on the timely delivery of information. And so we have a metaphor for talking about data logistics or thinking about shipping packages. How can a package get from one place to another place securely, on time, undamaged, all of these things. People understand how a complex system is needed for Amazon to do its shipping. That was an example that came out in our research. We didn’t write that one in but Amazon or FedEx, it’s amazing that the system is in place to get all of these pieces of mail to the right place and so fast.

And so even though people might not know the ins and outs of FedEx, they know something about the complexity of the system. And so we use that as an analogy to talk about how public health informaticians can build the types of systems that move data around that way, in a way that is not only fast, but also secure, which is so important when you have so much data, such a high volume. Getting it to the people who need it at the right time. Especially for projects that involve things like getting ready for seasonal flu, and things like that, where time is of the essence. The data can’t be two years old. It needs to be happening quickly. And public health informatics is so important for implementing that kind of system and making it run and making sure that it works for the people who need it.

JESSICA

So there you go. The next time a friend or relative asks you what you do, you can say, “I’m a data translator. I design and improve information systems so they can exchange data and provide them in a format that’s useful for programming and reporting.” Or you can say, “I’m a data architect. I design and build information systems so they can synthesize lots of different data from lots of different sources.” Or maybe you’ll say, “I’m like the FedEx for public health. I make sure packages of data arrived to the right people at the right time.” After all of this detailed discussion about what public health informatics is, what it does, and how to talk about it, I asked Marissa how she defines informatics.

MARISSA

I think of public health informatics as the discipline or a science that figures out how to take data from a lot of different sources collected in a lot of different ways by a lot of different people in a lot of different circumstances, and translate them all into a language that public health professionals can interpret and use and action across all of their work. And without that, you’re not able to do the work that you need to do collaboratively because you’re not all speaking that same language of data that’s so important for public health success.

JESSICA

And that’s public health informatics. Thanks again to Dr. Marissa Fond and the team at FrameWorks Institute. I learned a lot from our discussion, and I’ve really enjoyed trying out the metaphors on my friends and family. Special shout out to Clara if you’re still listening. Both FrameWorks and PHII would like to thank all of the informaticians, and other public health professionals who participated in each phase of this research. Your thinking helped refine the communications tools, and this project would not have been possible without your valuable input.

If you’d like to learn more about the communication strategies we discussed, FrameWorks developed a whole toolkit about the metaphors and ideas for how to use them. Check them out at phii.org or at frameworksinstitute.org. This podcast is a project of the Public Health Informatics Institute and the Informatics Academy. You can find us on Facebook and follow us on Twitter @PHInformatics. If you like the podcast, please rate us on iTunes or whatever platform you use to listen. Our theme music is called Carnivale Intrigue. That song and all the other songs in this episode were composed by Kevin MacLeod. This episode was produced by Piper Hale, our very own podcast architect. I’m Jessica Hill, and you’ve been informed.

BUTTON

MARISSA

My colleague asked me, “How is that epic informatics project?” and I said, “That’s a really funny informatics joke.”