Policy and Position Statements

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Informatics Workforce Position Statement

I. ASTHO supports comprehensive policies that define, create, and sustain public health informatics career series in state and territorial health agencies.

The Association of State and Territorial Health Officials (ASTHO) recognizes the need for state and territorial health officials to classify, develop, and train the public health informatics workforce to support evolving public health information management activities.

II. Within this context, ASTHO recommends that state and territorial health agencies:

Distinguish the differences between informatics and other public health specializations, such as information technology (IT) and epidemiology, to ensure that staff are given suitable responsibilities, held to appropriate expectations, and paid fitting salaries.

  • Ensure consistent definitions are used for informatics, particularly for health agency activities and staffing.
  • Understand the value of an informatician, as this can facilitate interdisciplinary, efficient, and effective public health work.
  • Recognize that informaticians receive specialized and advanced degrees and certifications in informatics.
  • Educate health agency staff about informatics and the informatician’s role.

Actively create a new public health informatics career series or career path within public health agencies, culminating in informatics leadership roles.

  • Structure career series with a progression of increasing technical and managerial responsibility and commensurate salary levels.

Contribute to informatics workforce development.

  • Communicate to public health schools and organizations that are involved in informatics, such as ASTHO, the need for training the public health workforce about public health informatics and encourage each to incorporate these needs in future training programs.
  • Participate in informatics fellowship programs.
  • Identify internal informatics mentors that can help health department staff with career development.

III. Background

Informatics is an interdisciplinary field that requires training in a practice domain as well as information, computer, cognitive, and organizational sciences. Therefore, an informatician with a public health background (e.g., a Masters of Public Health or other degree with extensive public health experience) is classified as a public health informatician. CDC defines public health informatics as “the systematic application of information, computer science, and technology to public health practice, research, and learning.”1 Using this combined technical and public health skillset, public health informaticians distill data from IT applications within and outside of the health agency into actionable information to improve population health. 

The need for public health informatics awareness and a dedicated career series is motivated by myriad factors. Over the past few decades, new technologies and increased health IT adoption have transformed public health surveillance and silo information systems. Public health traditionally received information such as state-mandated disease reporting and vital statistics through paper, phone, and fax collection. Evolving health information technologies such as EHR systems allow for faster and more accurate reporting to public health. In 2013, 59 percent of hospitals and 48 percent of physicians had an EHR system, which was a 47 percent and 26 percent increase respectively since 2009.2

User expectations have kept pace with emerging technologies as clinicians, public health workers, and the general public increasingly expect to have simple and timely access to public health information, such as immunization records and vital statistics.

Coupled with this expanding technological capacity, there is growing interest in integrating public health and primary care for improved health outcomes. This interest in part stems from federal initiatives such as health reform driven accountable care organizations and patient-centered medical homes that necessitate information exchange amongst clinicians and care partners.

Another major federal driver of public health informatics’ growth is the Office of the National Coordinator for Health IT (ONC), which was formed in 2004 to provide national oversight and support of informatics activities, including those pertaining to public health. The federal government has released numerous informatics reports and frameworks that highlight the important role of public health agencies in disease surveillance, situational awareness, and overall population health. The federal government has placed increasing emphasis on interoperability to facilitate information exchange between organizations, and has encouraged health agencies to develop the appropriate technical and administrative infrastructure for this exchange.3 Achieving interoperability requires a workforce that has substantive knowledge of data standards, storage and processing procedures, and transmission mechanisms.

The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted under The American Recovery and Reinvestment Act (ARRA) created the Medicare and Medicaid EHR Incentive Programs (Meaningful Use) to incentivize EHR adoption and use among healthcare organizations and professionals. Meaningful Use has significantly increased electronic provider reporting from hospitals and providers to public health through optional and required public health reporting. According to a 2014 ONC report, 87 percent of attesting hospitals selected a public health reporting measure, with immunization reporting as the most popular.4

CDC operates several national surveillance initiatives, including the National Electronic Disease Surveillance System and BioSense 2.0. These voluntary programs use standardized, structured data reporting that requires significant efforts from specialized health agency staff.

The federal government has recognized the need for informatics workforce development, most notably with the ONC Workforce Programs that provided $118 million for informatics training to 21,437 students. The Health Resources and Services Administration also dedicated $4.4 million for the Rural Health IT Workforce program in 2013.5 CDC also operates several informatics-related fellowship programs (Strengthening Health systems through INterprofessional Education,6 and Public Health Informatics Fellowship Program7) that place fellows in state and local health departments, as well as within CDC. In 2010, CDC Director Thomas Frieden sent an open letter to all state health officers urging them to designate an executive level staff person to coordinate internal activities and participate in national discussions related to Meaningful Use.8 These activities have increased awareness of the importance of dedicated and skilled informatics staff in health agencies.

Due to these federal initiatives and local priorities, health agencies have markedly increased their informatics activities. In 2012, 52 percent of health agencies reported using health information exchange for surveillance, which was an increase from 42 percent just two years prior in 2010. All but one state reported having an immunization registry system, and 62 percent of the states have bidirectional immunization data reporting and exchange capabilities.9 In addition to clinical surveillance data, health agencies leverage data on the environment from social services and other public health programs for complex data analysis and mining to create more complete representations of population health. Health agencies need specially trained informatics staff to design, implement, and maintain increasingly sophisticated systems and perform advanced database analytics for managing population health.

Without dedicated informatics career series, health agencies have been using others (i.e., those for epidemiology or IT) for informatics work. This is inappropriately classified and means that staff may be asked to perform functions that are not specified in the career series. Additionally, salary levels from these other career series may not reflect the qualifications of and expectations for informaticians. Therefore, health agencies may have difficulty attracting and retaining high quality staff to perform informatics work.

State health agencies are beginning to recognize the need for designated informatics staff, and some states, such as Utah, have made informatics career series. The federal government has also created informatics positions such as chief informatics officer, informatics nurse, and health informatics specialist. Additionally, CDC has issued two guidance documents, the most recent of which is Competencies for Public Health Informaticians from 2009.10 and the Public Health Informatics Institute released a State & Local Public Health Informatics Position Description Framework that outlines the responsibilities and potential titles of a four classification informatics career series: executive, management, professional, clinical.11 ASTHO’s Informatics Director’s Peer Network has an entire workgroup that curates these resources and garners national attention to the need for state and local health agencies to create informatics career series.


Approval History

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and approved by the ASTHO Board of Directors. Position statements are not voted on by the full ASTHO membership.

  • Access Policy Committee review and approval: May 2015
  • Board of Directors review and approval: Sept. 2015  
  • Policy Expires: Sept. 2018  

For further information about this Position Statement, please contact ASTHO Informatics Policy staff at informatics@astho.org. For ASTHO policies and additional publications related to the Position Statement, www.astho.org/Policy-and-Position-Statements.

Related ASTHO Publications


Notes

  1. CDC and University of Washington’s Center for Public Health Informatics. Competencies for Public Health Informaticians. Atlanta, GA: HHS, CDC, 2009.
  2. ONC. “Report to Congress: Update on the Adoption of Health Information Technology and Related Efforts to Facilitate the Electronic Use and Exchange of Health Information.” Available at http://www.healthit.gov/sites/default/files/rtc_adoption_and_exchange9302014.pdf. Accessed 2-4-2015.
  3. ONC. “Federal Health IT Strategic Plan: 2015-2020.” Available at http://www.healthit.gov/sites/default/files/federal-healthIT-strategic-plan-2014.pdf. Accessed 2-4-2015.
  4. ONC. “Report to Congress” (See note 2)
  5. ibid
  6. SHINE Fellowship Program. Available at http://shinefellows.org/. Accessed 2-4-2015.
  7. CDC. Public Health Informatics Fellowship Program. Available at http://www.cdc.gov/PHIFP/. Accessed 2-4-2015.
  8. CDC. Letter from Thomas Frieden from Nov. 22, 2010. Available at http://www.cdc.gov/ehrmeaningfuluse/docs/mu-ph-coordinator-letter---20101122.pdf. Accessed 5-18-2015.
  9. ASTHO. ASTHO Profile of State Public Health, Volume 23. 2014. Available at http://www.astho.org/Profile/Volume-Three/. Accessed 2-4-2015.
  10. CDC and University of Washington’s Center for Public Health Informatics. Competencies for Public Health Informaticians. (See note 1)
  11. Public Health Informatics Institute. “Classification Categories State & Local Public Health Informatics Position Description Framework.” Available at http://www.phii.org/sites/default/files/resource/pdfs/Classification%20Categories.pdf. Accessed 2-4-2015.