Last month I sat down with Vivian Singletary, who began her tenure as PHII’s Director in May 2016. Vivian has an MBA and spent over 15 years working for large corporations before switching to public health and joining the Task Force for Global Health in 2009. Since then, she has served as the supply chain manager for the International Trachoma Initiative (ITI) and the Director of PHII’s Requirements Lab.

In this episode, Vivian talks about some of her favorite past informatics projects. We discuss the African Workforce Development Allocation Tool that matched health care professionals and locations to improve employee satisfaction and health care access in communities, and the Child Health and Mortality Prevention Surveillance (CHAMPS) initiative, whose goal is to learn more about the major causes of death in developing countries for children from 0-5 years old. Vivian explains how these international projects can inform our informatics work in the U.S.

We also discuss what Vivian means by “One Public Health,” why it’s crucial for the future of public health informatics, and why technology probably isn’t the biggest barrier to achieving this vision.

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Vivian Singletary recording the podcast.

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.

JESSICA

Hi, this is Jessica Hill. I’m joined today by our producer, Piper Hale. Hey, Piper.

PIPER

Hi, Jessica, and hello, informatics enthusiasts.

JESSICA

Now, Piper has been incredibly involved in every episode of this podcast, even if you haven’t heard her voice on the mic.

PIPER

Except for sometimes you’ll hear me giggling at the very end of the episode.

JESSICA

Yes, that’s because you’re very kind and you laugh at my bad jokes. But that’s not why you’re here today. Why are you here today?

PIPER

So I’m here today because I’m really excited to introduce our guest for this episode. So for this episode, we’re speaking with Vivian Singletary, who is the new director of the Public Health Informatics Institute.

JESSICA

That’s right. Vivian has been PHII director for about six months. Before that, she was director of PHII’s requirements lab, which is one of the larger units here at the Institute. And before working with PHII, she was at the International Trachoma Initiative, which is another program here at the Task Force for Global Health.

PIPER

And prior to working in the nonprofit sector, Vivian held leadership positions in supply chain management and information systems implementation for several large corporations here in Atlanta.

JESSICA

We started out with asking Vivian to tell us more about her professional background and how she came to work in public health informatics.

VIVIAN

My particular background is in industrial and systems engineering. I have an MBA, and I’m working on finishing up a juris master’s with the Emory School of Law. So hopefully in the next year and a half, I’ll be done with that. But a very diverse background, and I bring that systems type of thinking to these informatics issues that we have at hand here to work on. And so now I get to pull together those engineering skills, those business skills, and those legal skills to make PHII run, to solve some real informatics problems. And that’s what I’m excited about.

I think you’re going to move into asking me why did I get into public health after working for corporations? Yeah, I mean, I worked in corporate America for 15 years, and then I got to a point where I felt like I wanted to do something more meaningful, I wanted to help people, I wanted to do something more mission-driven and focused. And that’s how I found the task force. I was looking for, you know, wow, would like to still use the same skills and abilities that I have, but I want to apply them to do good. And those two things just happened to come together, and that’s how I ended up here seven years ago now.

JESSICA

When you worked for larger for-profit corporations, how did those information systems compare with health information systems?

VIVIAN

Health or public health?

JESSICA

Ah, tell me more about your question. Why is it important?

VIVIAN

Well, there’s an important distinction. Now, I would say the systems that are used in many of the corporations would align very closely to what you see in health systems. You know, so your big EHRs in healthcare provider locations, you know, hospitals, doctors, offices, etc. So you have big companies like SAP and Oracle that kind of fill the space for big corporations to do everything from, you know, purchasing, payments, logistics management, warehouse management, all of those things fully integrated. And when you look at healthcare, very similar. You know, you look at the big companies like Epic, Allscripts, Cerner, very large companies, that is their business, making integrated suites of information systems.

When you look at public health, it’s not that same way. You know, public health is quite segmented in the space in terms of profitability as compared to these other industries. It’s just not the same thing as, you know, so it’s much smaller, much, much, much more specialized, and there’s not an opportunity to make a ton of money, you know, if you’re a vendor in that space. So what we tend to see in public health are fragmented systems that are put together oftentimes by the local or state jurisdictions. You see a lot of homegrown systems that have been developed over time to support their needs. So that’s how I see the difference here. I think some of that’s beginning to change for some things, particularly around reportable diseases. But I can’t say that’s across the board for everywhere in public health. So I see that as, like, the big distinction between public health and healthcare in corporate America.

JESSICA

So, and when you were working for the International Trachoma Initiative, or ITI, was informatics part of your work then?

VIVIAN

Yes, but I really didn’t focus on it nearly as much as I do now. In public health and in global health, informatics, I think, has always been an afterthought. It’s like, hey, we’ve got to get these, you know, drug donations out. We’ve got to move them out. But then it’s an afterthought about, well, how do we figure out how much inventory is left? How do we figure out how we know how many doses were actually given to the people in a community? Who were they given to? Often, those things are an afterthought in public health, and not in a negative way, but you’re so interested in helping people that when you’re thinking about, how do I measure the impact, it’s just after you’ve done all of this, you know. And so I’m so happy now that I get to also integrate informatics at the forefront of projects, and it’s not an afterthought anymore.

JESSICA

So it doesn’t have to be the quiet part, like, underneath everything.

VIVIAN

Right.

JESSICA

And what are some advantages, do you think, about actually putting it in the forefront and talking about informatics upfront?

VIVIAN

Absolutely. So when we think about a big program that PHII is a part of which is CHAMPS, the Child Health and Mortality Prevention Surveillance program, where you are trying to understand what’s killing kids under the age of five. You know, and in order to get to that answer, you have to have an approach in a structured way that you are going to collect this data from these various sites that you’re setting up so that you can analyze the data, compare the data in such ways, and come to some conclusions on what things really need to be focused on and interventions that need to be made. So when you’re dealing with, you know, small projects or large projects, making sure informatics is at the forefront of that thinking ensures that you can answer all of those critical questions on the back end, that you were initially setting out to be able to answer.

JESSICA

This kind of helps us transition to some of your work when you were director of the requirements lab. So what are some of your favorite or most memorable projects from when you had worked in the requirements lab?

VIVIAN

Okay, so I have a couple. I would say one of the most memorable that’s kind of still ongoing is the African Workforce Development Allocation Tool. And this project was interesting to me because we didn’t initially know what type of technical assistance we were going to give to Mozambique, which was the first country that we worked with. They knew that they had a problem in terms of deploying their human resources for health out into the districts. They were seeing that where they were deploying people, people didn’t want to stay. They would apply for transfers. You know, you’d have people that didn’t want to show up to work or, you know, maybe they would work for a couple of years and leave and move on to do other things.

JESSICA

Wait, so I just wanted to clarify. So the Ministry of Health is saying, “We have this human resource challenge,” but really, it was an informatics solution to a human resources challenge?

VIVIAN

There was an informatics solution, and this is the allocation tool that we created in conjunction with Georgia Tech. So while some problems are, you know, maybe there are social behavioral issues, there can be some type of informatics approaches that may work to resolve them, and this one actually had some impact. So just to explain very quickly about the tool, the tool that was created in conjunction with some Georgia Tech students, it is a linear mathematical model that helps take into account information from the graduating human resources for health before they get deployed out to the districts.

So it takes into account what cadre that they’re working in. Are they doctors? Are they nurses? Are they, you know, dentists, etc.? You know, what is their salary? What areas in terms of preference in terms of districts do they prefer to go to? So now we’re asking, it’s like, “Where do you want to go?” And we’re not just, you know, making a wild choice. It also takes into account the demand at the district level, because each of the districts has different needs. So maybe they had a dentist or a doctor that retired and they need to backfill it. So they also express their numbers per cadre that they need to fill. So this model takes all of this into account, and the objective of the model is to try to deploy the healthcare workers to one of their first three preference based on the needs of the districts. And what we found is that, particularly for Mozambique, it drove down their requests for reallocation to other locations over 85%.

JESSICA

Oh my goodness.

VIVIAN

And so they’ve been using it over the last couple of years, over the last couple of graduating classes, and have found great, great success with that. We are in the process of partnering with Tanzania for them to implement it, and we’ll be beginning works with Zimbabwe to do the same. And so now this tool has evolved from an Excel-based spreadsheet to its nice and sleek-looking web-based, browser-based tool.

JESSICA

I also asked Vivian about some of PHII’s current projects. One of them focuses on electronic case reporting, or ECR, which is a hot topic right now in public health informatics. Such a hot topic that you might remember our latest episode was about Chicago’s ECR demonstration project. Right now, PHII is working on an initiative called Digital Bridge that has similar goals to that demonstration project, and it hopes to reach across health departments, healthcare, and vendors.

VIVIAN

A big gap for us, at least here in the U.S. healthcare, is communication of information between healthcare and public health. So we still are a little behind the curve in moving that forward, but I think that we have a good plan with this project that we’re working on. It’s called the Digital Bridge, and it’s helping to bridge that gap between U.S. healthcare and public health, and it’s trying to find a standardized way to move information about reportable conditions and diseases from healthcare directly into public health.

Today, many of the practices that we still have require manual interventions, with people having to call or fax, you know, information to public health to make them aware of some notifiable, nationally notifiable condition. And we want to move away from that, because now that healthcare has automated itself with, you know, EHRs over the last decade or so, we now have the opportunity for healthcare to be able to report that information, you know, through a pipeline directly to their local or state jurisdictions that make it much less of a burden on the healthcare practitioner, and also less burden on the public health side.

I think this is an incredibly important project for us, and we’re working on this with funding from Robert Wood Johnson Foundation and in collaboration with Deloitte Consulting on this. So we are excited, and we think that we’re going in the right direction here.

JESSICA

So just to kind of clarify what would be new or different through this kind of reporting. So right now, I can imagine going into a doctor’s office, and when the person is treating me, they often type directly into an electronic health record, so it’s already kind of being digitized right there. But if there were something that needed to be reported to public health directly, somebody would have to look at that digital information and make a call or send a fax?

VIVIAN

Yes, in many cases, that’s what happens now. They’ll either make a call, send a fax with a, you know, filling out a form that may have been provided to them by public health. There may also be an electronic laboratory that goes over to public health, but what happens oftentimes on the electronic laboratories is there’s very little information. And so things get sent to public health, and they’re not sure, particularly if they have to take an action, who this person is, where they live, and there’s just not enough information on that electronic laboratory. Although it alerts them, you know, if someone has some type of disease where they need to do contact tracing, they just don’t know where to start. They don’t have a number, you know, to contact this person. They don’t have an address. And so they have to then go back to healthcare to ask them for that information. And so instead of having all of this disparate information coming in, this will bring fully integrated information into public health to allow them to take action where necessary.

JESSICA

So I feel like I want you to know that I know that that’s not easy. I think some people may be like, okay, super easy, like, just make the electronic health record, send the information to public health. You know, we send information all the time digitally. Why is this different?

VIVIAN

Yeah, I think the difference in this is just really trying to get public health to be the one public health. We need to be able to talk as one to, particularly to the healthcare vendors, because as they have to make modifications to their systems, they don’t want to have to do it for 2800, you know, local and state jurisdictions. They want to really talk to public health as one. And we as public health have to come together and provide that so that we can have better systems overall at the end of the day. And I can’t say that it means that it’s perfect, but it means that we’re moving in the right direction if we can make some compromises and be okay with that.

You know, we talked about the big healthcare systems, the big systems that are in place in corporate America, like the supply chain systems that I named. One of the key things is that many industries, many people got together and figured out, you know what? We’re pretty much all doing the same thing. And that’s how these vendors kind of grew out of that. We don’t need to figure it out on our own. Because if you go back, you know, 50 or more years ago, every company was figuring it out for themselves, and now they have people that have figured it out. They’ve invested a ton of money in there and can go forward.

And that’s the piece that I think that we still need to do in some areas of public health. We have to figure out that we’re pretty much doing the same thing and have to come together, and we don’t need, you know, 100 different ways or 100 different systems. We just need one system that we can, you know, all use. Maybe it’s a cloud-based system. We can have our own lockbox of information. But for the most part, we’re doing the same thing. And I think that’s where we need to see, again, the coalescing of public health together.

JESSICA

I know we talk a lot about the relationships as part of informatics, and that’s what I was thinking about while you were explaining that, that it’s not just data fields and talking about information systems. There’s a lot of discussions and, like, consensus-building that has to happen as part of being able to make the data flow.

VIVIAN

Absolutely. And that gets back to the process. You know, the technology, honestly, moving information, like you said, what’s the big deal? People can exchange information every day. I mean, you wake up in the morning, I’m quite sure you’re exchanging some information on your Fitbit, how well you slept, back with the cloud, you know. And so it’s like, what’s the big deal? The technology is not the hard part. You’re absolutely right. It’s about the relationships, it’s about the process, and it’s about bringing people together to come together and to be able to collaborate and agree and build consensus. So that’s much, much more difficult, and it has nothing to do with the technology.

JESSICA

We did a call-in show earlier in the summer, and so we asked people who have listened to the podcasts to submit some questions. And one question that was submitted is, “What are new or developing technologies you see as potentially having significant impact on public health and public health informatics in the next 5 to 10 years?”

VIVIAN

Just 5  to 10 years from now? You know, I mean, there’s so much technology that exists now that can help public health, honestly. But I think the real issue is not the technology, like we were just talking about. I think it’s really getting past the barriers of people being against new ways of doing things. And I think if we can overcome, you know, that barrier, that we can use much of the existing technology to push us forward in the next five to 10 years.

JESSICA

So can we talk through maybe, like, a specific example of that? I know one thing that’s very hard to change is around ways people are used to sharing their data, specifically, I guess, through healthcare and sharing with public health, but just in general. So what are some of the approaches that you’ve seen have been really successful in kind of getting people to look at it in a new way?

VIVIAN

I mean, if we think about what’s going on in the global context, you know, I think in some ways, when you think about the global context in developing nations, sometimes I look at things that they’re doing that we’re not doing here. Like, a lot of the even simple things like using tablets to collect data, mobile data collection, we don’t really do a lot of that here, you know. So I think there’s some of those simple lessons that things that they’re doing there because they’re more open to it. They don’t have all of the constrictions and laws, and people don’t have the barriers up to, against sharing information, that we can bring back some of those things here in the U.S. and implement them.

JESSICA

How do you define informatics, public health informatics? I’m going to ask that again.

VIVIAN

Public health informatics.

JESSICA

How do you define public health informatics?

VIVIAN

Well, just public health informatics, but just informatics in general, it’s kind of back to what I said at the beginning. It’s really where business processes meet people meet technology. And that is what I say is informatics, and the public health part of it is really the domain that we focus on, and that can include anything from immunizations to, you know, reporting diseases, to making some type of public health intervention with the information that we collect. So anytime that we’re doing surveillance, immunizations, those are some of the core pieces of public health informatics that, you know, readily come to mind and that I think about.

JESSICA

Many thanks to Vivian Singletary for joining us for this episode.

PIPER

Yes, thank you, Vivian. I learned a lot from this conversation, and it made me excited for the future of PHII and for public health informatics in general.

JESSICA

Well, I’m excited about this podcast, which is a project of the Public Health Informatics Institute and the Informatics Academy. Want to learn more? Go to phii.org. You can also find us on Facebook or follow us on Twitter @PHInformatics.

PIPER

Our theme music is called “Carnival Intrigue” and was composed by Kevin MacLeod. The music used throughout this episode was also composed by Kevin MacLeod.

JESSICA

If you liked this podcast, please consider rating us on iTunes. Ratings really help other people find us and find out more about public health informatics. Finally, thanks to our production team, especially to Piper Hale for joining me on the mic this time around. I’m Jessica Hill and you’ve been informed.

BUTTON

JESSICA

I mean, I’m like, I want to optimize what I should do with my life, but…

VIVIAN

I wonder if we can program that.

JESSICA

Yeah, I know.

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