After undergoing the accreditation process in 2014, the Whatcom County Health Department had renewed interest in and commitment to being data-driven. But what did that mean, exactly? Strategic planning activities highlighted opportunities to use data for decision-making, but how could this health department get the right information to the right people at the right time?

In this episode, I speak with Nicole Willis, an epidemiologist at the Whatcom County Health Department, who led the agency’s efforts to build its informatics capacity. Nicole explains how the agency first learned of informatics, and the steps the agency took to become more informatics-savvy. The story of their work provides concrete examples of how this local public health agency started to build its informatics capacity. Nicole discusses their efforts to connect with fellowships, build a cross-agency team, complete an informatics self-assessment, and finally, create an informatics unit at the agency. Nicole also shares lessons learned throughout the process and some possibilities for where Whatcom County’s informatics work is headed in the future.

I’m very grateful Nicole was willing to share her experiences on our podcast, and we hope they will be helpful to other health departments as well. If you’re interested in building the informatics capacity at your agency, below is a list of resources Nicole and her team used in the early stages of their process.

For additional training resources, Nicole and her team used resources available from the Informatics Academy at the Public Health Informatics Institute and the Northwest Center for Public Health Practice.

If you haven’t subscribed to Inform Me, Informatics, you can do so on iTunes or Soundcloud. We’re also now on Google Play and Player.fm. Like the podcast? Please consider rating us on iTunes! This will help other listeners find out about us.

Nicole Willis of Whatcom County presents on building informatics capacity at her agency at the poster session of the 2016 CSTE annual conference.

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

In this episode, I’ll be talking with Nicole Willis, who is an epidemiologist at the Whatcom County Health Department in Washington State. I was very excited to speak with Nicole because the work in Whatcom County is a great example of how an agency can prioritize informatics and then take concrete next steps to increase its informatics capacity. During our discussion, Nicole is going to mention a few different resources that she and her team used. In the spirit of full disclosure, some of these resources are from the Public Health Informatics Institute, which also produces this podcast. Could this be seen as self-serving? Perhaps, but we hope this episode will be really useful to other agencies that are interested in becoming more informatics savvy as well. I started the conversation by asking Nicole how the Whatcom County Department of Health got interested in informatics in the first place.

NICOLE

Maybe our starting point was back in September of 2014 and this pretty heavy sense of urgency came throughout our strategic planning process, accreditation prep, CHA/CHIP work, QI, and performance management planning, and there was this constant, you know, statement that we need data, we need data to move our decisions, we need data to evaluate our programs. And so while we identified that it was pretty urgent and we documented our commitment to it even in our strategic plan, we still weren’t quite sure how we were going to get started. We really talked about how do we create an agency-wide culture that information and data is valued, and our decisions are driven by data, and that the information needs of staff and community partners are met.

JESSICA

First, Nicole and her supervisor researched the attributes of data-driven public health departments. Nicole named a few different resources they found particularly useful. These are resources like the Washington State Department of Health’s Foundational Public Health Services report and NACCHO’s operational definition of a functional local health department. Their research also led them to resources that discuss public health informatics specifically like articles about building an informatics-savvy health department. We’ve put citations and some links to resources on this episode’s blog post on the PHII website in case you wanna go there to check them out.

NICOLE

We were pretty surprised how well the articles articulated our urgent situation and had some clear kinda new vocabulary to us on how we could address our needs and have some advice on where to start. And even today, I still use those articles to kinda help set the table of what it is and why it is that we’re interested in informatics. And the only challenge of this was we still have very little awareness of what informatics was.

JESSICA

So Nicole kept looking and eventually, she came across the ITIP fellowship. ITIP stands for Informatics Training In Place program and it’s a fellowship that’s part of Project Shine. Project Shine is a group of fellowships that are administered by CDC, CSTE, and NACCHO. Since ITIP is a training in place fellowship, Nicole kept right on working as the epidemiologist in Whatcom County while she completed informatics trainings and built a network of other people doing similar work at their agencies. By 2015, Nicole understood the basic functions and activities of an informatics-savvy health department and she had started her ITIP fellowship.

So what next? Nicole’s mentor encouraged her to look at change management literature since building informatics capacity would require agency-wide buy-in and assured willingness to try new things. Nicole designed a team approach and started recruiting colleagues. In the first year, there was an eight-person team from across the agency’s divisions.

NICOLE

I think now we would probably call the team of a bunch of thought leaders, those folks who are in a position of power, but have great ideas and really have an interest and commitment to being in local public health and that they also are the folks who can make a lot of this work happen. I created a team charter to kinda help keep us on track and the first real big task of this informatics team was to complete the informatics savvy self-assessment. We took the tool mostly as in a group setting. I think the team had a pretty hard time getting started. As we’re going through the questions, they didn’t feel like they were the right people to answer the questions, but when I was preparing to administer the assessment, I remember reading something about like, in the early stages it’s very much less about, you know, the right way to answer the questions, but the conversations that will flow from it.

And so I just tried to help them understand like, you know, let’s just get going, get the ball rolling on this, and really what we’re trying to figure out is what our agency’s data and information challenges. And while they struggled to get going I think by the end of the assessment, we were really, a lot of my notes were, you know, really good little gems of information of, you know, real honest challenges that we’ve been having around here. And we were definitely a solid one for many of the questions in every domain and I think our average score was a one.

JESSICA

And just for listeners who might not be familiar with the assessment tool, I think it goes from zero to five, right?

NICOLE

Yes.

JESSICA

So you know, one was showing some progress.

NICOLE

Yup. It definitely was. The definition for level one says something about, you know, you’ve got ad hoc and individual heroic efforts. And so I try to keep reminding them that, sure, we were a one, but we had some heroic efforts that we were starting to do and they kind of liked that.

JESSICA

Yeah. So what did the assessment tell you or sort of what next steps did you all identify after having done that?

NICOLE

So one of the things that it demonstrated, I think mostly around like, actual information systems was a lot of our systems for local public health in Washington State, the State Department runs a lot of our surveillance system. So there was a lot of things that were outside the scope of our control around improving those systems. So while we knew it was important, we didn’t prioritize that one for this first year and we really focused in on sort of the governance vision and workforce development. Really, the first priority was this workforce development concept. We really acknowledged that staff. It wasn’t just informatics skills, but just even, you know, core competencies around assessment and analytical skills was really pretty important. So that is where we really put a lot of emphasis on in the beginning and we came up with the team learning plan. The team would test it and then eventually we wouldn’t start hosting all staff trainings.

So we utilize online resources from the Northwest Center for Public Health Practice and Public Health Informatics Institute as a team and we completed seven trainings over the course of a year. And a lot of the team liked the group learning approach which fit nicely with the research we’ve been doing around team learning theories and becoming a learning organization.

JESSICA

Did you catch that Nicole said she and her team completed seven different informatics related trainings? That’s a lot. Another priority for workforce development was to make sure staff had an accurate and complete understanding of the data already available to them.

NICOLE

In Washington State, our state health department administers a lot of our surveillance systems and population health query systems. One thing we identified that there was a real general lack of awareness of the state systems and then perhaps real or perceived barriers to accessing the information that was readily available for us to use, but people just had this barrier of accessing it. So for me this was a bit of an aha moment in our project. So we kind of had to take like a time out and figure out, “Okay, this is it. This is the really important part of where our starting point is and this is why we continue to heavily focus on the training and education before we address any of the governance issues.”

So part of what I did is I hosted a Washington State Department of Health data tour workshop for team members so we could go through the different surveillance systems that you needed to log in for. It was like, you know, you sign a piece of paper and that’s how you get your login. And then also the population health query systems that the state has been working on quite a bit.

JESSICA

Given all the work that Nicole and her team had done to build informatics capacity at their agency, I was curious what she thought were the main accomplishments of the past year as well as lessons learned from the process.

NICOLE

Recently, we took the self-assessment again and so far the results show that we stepped up in each of the three domains, and we’re up to a level 2 now. Meaning we’ve got some organized efforts around becoming informatics savvy. I really wish I had taken a video of us completing the assessment in October versus when we took it in June. It’s like a different group of people.

Whether or not we’ve moved forward on like, the actual, you know, question or activity, but the staff knew what that meant like, they actually know what data standards are and we know more about information systems. So you know, in October, people were very unaware and maybe a little embarrassed of their ability to answer the questions and now just in June, they were confident, they were proud, we were laughing about things that we’ve done well. And the tool started to becoming like, “Okay, so what do we wanna do next year?” And we have such more of a clear plan on what we wanna work on. So I wish I’d taken a video because it would be kind of really neat to see the confidence amongst the group. So that’s… I think that alone is such a good accomplishment.

I think some of the other ones I mentioned, you know, we’ve strengthened our partnership with the Washington State Department of Health in this work. We tested those team development and change management theories on some pretty process-fatigued staff and I think we’ve had some success around that. Another accomplishment would even just be sharing our informatics-savvy journey at CSTE and NACCHO annual conferences. So I’ve been able to connect with a number of local and state health departments about their efforts and that just continues to expand our, I call it like, our network of support in this work. Another exciting news is we’ve been, Whatcom County has been selected to be a Project Shine host site again.

I think we’re starting to operationalize what it means to be data-driven and then also we’ve created a home for informatics effort. We have a new division here at the agency called Health Information and Assessment. So again, showing our commitment to becoming data-driven and then having a place for it to continue to grow, and hopefully, you know, have interns, and continue to support fellowships. And so those are some of our big accomplishments.

So I think by trial and error, I kind of collected some lessons. One of the big things is that a project cannot move faster than the knowledge of the staff participating. I think we learned quite a bit with this workforce development focus over the last year and I think it’s going to take this next year to figure out if it’s really paying off, and we stacked the deck with workforce development. And so far I think what we’re planning this next year is really gonna help with that. The importance of strengthening the relationship between state and local public health, especially around informatics and information systems work, I think a lot of times this relationship can just help foster the sort of system developers, meeting, and talking to end users, and ultimately really improving the systems that the state is creating that local public health will be tapping into that that is really important.

JESSICA

I think change organization and knowledge management tools can add value to any new project that you’re planning. It kind of is the people side of it. So it takes people to do this work and those tools and theories really help manage the people side.

NICOLE

I think talking to staff, you know, frequently about what it means to become data-driven, practice using the tools together, we really like looking at the context diagrams and business process analysis. We haven’t quite done anything thing yet. We’re planning to, but just sort of practicing and talking about the tools to figure out if they’re going to meet the needs. And sort of learning together about, you know, how do we use them in the way that they’re intended to use.

The last thing is that there’s just such great value in talking with other local and state health department staff about how they’re approaching their informatics work within their agency. A lot of times you can feel really isolated. When you’re working, you know, you’ve got a lot of tasks to do in local public health and you start feeling a little isolated without realizing that somebody else is probably going through the exact same project right now. And so I have just found that there’s so many similarities in our struggles and then some of our early wins and successes. So that one to me just continues to be really helpful.

JESSICA

After learning about all the different ways Nicole and her colleagues said about building the informatics capacity at Whatcom County Health Department, I was really curious to hear how she defines informatics.

NICOLE

I think this last year, I really realized that how important vocabulary is, especially when you’re proposing a new line of thinking or innovative solutions. So throughout my fellowship, we’ve been presented a lot of different definitions and I found many of the practical definitions to be the easiest for staff to understand. So I sort of blend a combo of all my favorite ones together. I would define public health informatics as a systems and problem solving way of thinking about how we capture, manage, analyze usable information in order to improve decision-making and ultimately population health. Somewhere I read something that I really like and it says, “Get the right information to the right person at the right time.” And I just, I think that that really sums it up quite perfectly, you know, this is… The point of this is to better use information and if you can keep with, you know, that as like, the big goal, I think you won’t lose sight of all these kind of small tasks that’ll help you get there.

JESSICA

Many thanks to Nicole Willis at the Whatcom County Health Department in Washington State. Your team story highlights ways the health department can build its informatics capacity and I appreciated your honesty and humor while telling us about your journey so far. Best of luck on those future efforts.

This podcast is a project of the Public Health Informatics Institute and the Informatics Academy. Visit phii.org to learn more about the institute and all of its great informatics work. You can also find PHII on Facebook or follow them on Twitter, @phinformatics. If you like the podcast, hey, rate us on iTunes or whatever podcast platform you use to listen. It helps more people find out about the podcast and more importantly, more people find out about Public Health Informatics.

Our theme music is called “Carnivale Intrigue,” that song along with all the other music you heard on this episode were composed by Kevin MacLeod. Thanks also to our production team especially, Piper Hale, the most podcast savvy of podcast producers. Finally, this episode is gonna be the last one of 2016, but don’t worry, we’re already hard at work for new episodes in the new year. Piper and I wanted to take this opportunity to thank you so much for listening to our stories of informatics in action. We’ve had a blast making this podcast and we can’t wait to do more episodes in the upcoming year. In the meantime, we wish you all a very safe and happy New Year. I’m Jessica Hill, and you’ve been informed.

BUTTON

PIPER

Yay. That’s a wrap, 2016.

JESSICA

That’s a wrap, 2016.

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