Public Health and Interoperability: A State Perspective

April 17, 2019 | ASTHO Staff

Karen Smith, MD, MPH, is state health officer for the California Department of Public Health (CDPH). Formerly a public health officer for Napa County Health and Human Services Agency, Smith brings a wide array of knowledge as a physician specializing in infectious disease and public health.

Smith completed her medical training and infectious diseases fellowship at Stanford University after obtaining a master of public health degree at Johns Hopkins School of Hygiene and Public Health. Prior to her medical training, Smith served in the Peace Corps as public health laboratory director for the Marrakesh Province in Morocco, as well as the Wichienburi Regional Hospital in Thailand.

ASTHO recently spoke with Smith about the department’s capacity to address population health outcomes through informatics, analytics, and interoperability.

How did you become engaged in informatics/analytics—and more specifically interoperability?

As a former student of epidemiology, I’ve long recognized the importance of data to understanding health issues, making decisions on prevention interventions that are likely to be effective, and ultimately, in evaluating what works. As the public health paradigm has shifted to recognize the effect of social and environmental factors on health, I have increasingly focused on the need to incorporate data from many sectors into our analyses. I believe this is the only path to understand the risks and protective factors that create healthy and resilient people, families, and communities. Without that understanding we will continue to work on important, but incomplete, prevention solutions.

As part of our new strategic direction, CDPH adopted “Public Health 2035,” an initiative with the goal of becoming the ideal health department of the future. Key to this goal is the role data plays in driving action to building healthier communities in California wherein all Californians can thrive. Collecting that data and transforming it into actionable information is a challenge in most health ecosystems due to a lack of standardization around data sharing.

There are critical success factors to interoperability, including semantic (vocabulary), technical (interface standards development), or functional (data use agreements and consensual workflows/data flows) that will enable standardized data sharing across disparate information technology systems. Once the data is shared, challenges remain in analyzing that data for action. This analytic capability is as essential as the data acquisition itself.

Within CDPH, we are exploring the utility of predictive analytics to include three essential components:

1. It is a process that can be operationalized
2. It involves high level statistical tools/formulas
3. These statistical tools can be embedded in computer software that can quickly process large amounts of structured and unstructured data

To expand our predictive analytics capabilities, we are currently building our infrastructure, also known as the Analytics Services Unit (ASU), within our Center for Health Statistics and Informatics, using the opioid epidemic as an initial use case. The purpose of the ASU is to:

• Provide department-wide analytics and perform research to optimize descriptive and predictive analytics capabilities within CDPH
• Provide overall technical direction on statewide federated interoperability system development efforts
• Identify and address policy and operational issues relevant to analytics, data sharing, and health information exchange with internal governmental and external public health stakeholders

Policy and operational recommendations are shared with the Ecosystem of Data Sharing Steering Committee to promote an enterprise-wide approach and master data management solutions across CDPH that allow for electronic registries, databases, and surveillance systems to address data quality issues and ensure alignment with objectives.

Why is interoperability important for public health and what does it mean for S/THOs? Why is electronic case reporting (eCR) important?

Interoperability is the critical foundation for the near real-time acquisition of pertinent data and its transformation into actionable information to achieve public health opportunities. Appropriate data is the basis for a rational, science-based approaches to problem solving. Our prioritization of interoperability has afforded CDPH an opportunity to participate in the Digital Bridge initiative, which aims to successfully launch an electronic approach that allows healthcare providers and public health agencies to exchange data automatically. This real-time, automated process promises to improve the timeliness, accuracy, and completeness of data, preventing dangerous disease outbreaks. The Digital Bridge initiative chose eCR as its first interoperability use case. The Digital Bridge eCR approach works with existing electronic health records to identify potential reportable disease cases that are digitally sent to the appropriate public health agencies. Digital Bridge is supporting the development of interoperability standards through eCR.

What has been your experience connecting public health information systems with health information exchanges and networks?

Slow. This is a complex, resource intensive effort that requires coalition building, financial support, technical assistance, and a governance structure for sustainability. Our mantra is that “business imperatives drive data requirements that in turn suggest technology solutions.” Part of our coalition building within the California Health and Human Services Agency includes bringing its 13 departments into a workgroup focused on developing alternative models for connecting agency departments with outside stakeholders via available, established health information exchanges (HIEs) in California. CDPH’s Chief Data Officer serves on this workgroup and keeps the CDPH Ecosystem of Data Sharing Steering Committee abreast of collaborative efforts, including opportunities to align and synchronize efforts to achieve non-duplicative, cost-savings where possible.

How can we advance interoperability across all state and territorial health agencies (e.g., recommendations, funding, gaps, and needs)?

There are four areas that need additional development to support advancing interoperability across states and territorial health agencies:

• Interoperability standards development across states, such as the standards and guidance developed for eCR, but with a wider focus
• Sustainable funding to support interoperability initiatives, to include buy-in from funders at all levels who appreciate the value of interoperable data systems
• Understanding and sharing governance models that promote sustainability
• Identification and promulgation of promising practices in health agency implementation of interoperability initiatives to learn what has worked

For more information, check out California Department of Public Health’s Informatics Branch.