Public health informatics and information systems.

Preface
Acknowledgements
Contents
Part I: Context for Public Health Informatics
	1: Public Health Informatics: An Introduction
		Introduction to PH Informatics
		Public Health in the US
			Background
				Federal Level
				State Level
				Local Level
				Principles and Purpose
			Current State
		Public Health Informatics
			Background
				Underlying Principles
				Data Sources and Data Partners
					Output of PHI Efforts
			Principles and Purpose
			Current State
		Public Health Information Systems
			Background
			Principles and Purpose
			Current State
		Drivers of Change for Public Health Informatics and Information Systems
			Health Care Reform
			Precision Public Health
			mHealth and uHealth
			Public Health 3.0
		Summary
		References
	2: History of Public Health Information Systems and Informatics
		Introduction
		Data, Information, and Knowledge
		The Development of Counting and Counting Machines
			Development of Mechanical Counting Devices
			The Development of Modern Mechanical Measuring Devices
		Stages in Development of Public Health Information Management Systems
			The Age of Observation
			The Age of Analysis
			The Origin of Modern Public Health Informatics
				The Cholera Outbreaks in England
				Public Health Data Collection in the United States
		The Three Waves of Federal-State Systems Development in the US
			The First Wave: Independent Systems Development
			The Second Wave: Federal Funding of State-Level Systems
			The Third Wave: Integration of the Benefits of State-Level System Development with the Tools of Software Reuse
		Summary
		References
	3: Public Health Informatics in the Larger Context of Biomedical and Health Informatics
		Introduction
		The Sub-Disciplines of Informatics
		Major Applications of Informatics
			Electronic and Personal Health Records
			Information Retrieval (Search) Systems
			Consumer Health
			Telemedicine
			Bioinformatics
		Data Science and Analytics
			Big Data
			Machine Learning and Artificial Intelligence
		The Value of Informatics
		Summary
		References
	4: Governmental and Legislative Context for Informatics
		Overview
		Introduction
		Legal and Regulatory Framework for Public Health Informatics
			Fundamentals of the Policy Process in the United States
				Organization and Authority of the Legislative Branch
				Organization and Authority of the Executive Branch
				Role of the Private Sector in Policy Development and Implementation
			The Policy Environment for Public Health Informatics
				Health Insurance Portability and Accountability Act (HIPAA)
				Health Information Technology for Economic and Clinical Health (HITECH) Act
				Affordable Care Act (ACA)
				Food and Drug Administration Safety and Innovation Act (FDASIA)
				MACRA, MIPS, and APMs (Alternative Payment Models)
				Twenty-First Century Cures Act
		Future Policy Challenges
			Data Sharing and Health Information Exchange
			Social Determinants of Health
			Getting to Public Health 3.0
		Summary
		References
	5: Role of Informatics in Bridging Public and Population Health
		Introduction
		What is Population Health?
			Population Health Definitions and Frameworks
				Definition(s) of Population Health
				Population Health Framework(s)
				Population Health Operations
			Population Health Terminology and Components
				Outcomes
				Determinants
				Interventions
				Relationships and Analytics
				Denominators
			Population Health within the Context of US Healthcare Delivery
		Population and Public Health: Overlaps, Differences, and Alignments
			Conventional Differences Between Population and Public Health
			Growing Overlap of Aims and Goals of Population and Public Health
			Current Drivers of Aligning Population and Public Health
			Health IT Opportunities to Bridge Population and Public Health
		Role of Informatics in Population Health
			Definition of Population Health Informatics
			Different Technological Domains of Population Health Informatics
			Data Types and Sources of Population Health Operations
			Informatics Challenges in Population Health
		Using Informatics to Bridge Population and Public Health: Case Studies
			Maryland: Hospitals Becoming Mini-Health-Departments Taking Care of Neighborhoods
			Massachusetts: Medicaid Providers Paying Attention to Neighborhood Stress Scores
		Summary
		References
Part II: The Science of Public Health Informatics
	6: Information Infrastructure to Support Public Health
		Introduction
			Evolution of the Public Health Infrastructure
			Introduction to the Chapter
		A Robust Information Architecture for Public Health
			Information Architecture
			An Information Architecture Unlocks Potential for Public Health Organizations
				Surveillance of Chronic Diseases
				Responding to Community Needs
			A Model Information Architecture for Public Health
			Technical Approaches to Supporting the Infrastructure
			Illustrations of Robust Public Health Information Architectures
				Immunization Records
				Electronic Laboratory Reporting
				Electronic Case Reporting
				Bidirectional Communication
		Role of Organizations: Managing the Public Health Infrastructure
			Business Process Analysis and Redesign
			User-Centered Approach
		The Role of the Public Health Workforce
			Public Health Informaticians
			Public Health End Users
		The Indiana Network for Patient Care: A Real-World Instantiation of a Robust Information Infrastructure Supporting Public Health Processes
			The INPC Supports Public Health Use Cases
			The Indiana Network for Population Health
			The Indiana Addictions Data Commons
		Summary
		Future Directions
			Intelligent Public Health Systems
			Interoperability
			Infrastructure Investment
		References
	7: Data Sources and Data Tools: Preparing for the Open Data Ecosystem
		Introduction
		History and Context of Data
		Definition of Data and Information
		Definition of an Information System
		Value of Data
			Timeliness
			Accuracy
			Sufficiency
			Relevance
			Cost-Effectiveness
		Strategies and Tactics to Finding the Right Data
		Regulatory, Ethical, and Legal Responsibilities and Authority
		Open Data Movement
			Federal Data Sources
			International Data Sources
			State Data Sources
			Local Data Sources
			Health Information Exchanges
		Data Tools
			Introduction to Data Tools
			Public Health Informatics Competencies
			Creating Cost-Effective Environments for Analysis
			Commonly Used Software Tools
			Telling the Story with Data
		Summary
		References
	8: Public Health Information Standards
		Introduction
		Context for Public Health Standards
		The Value of Standards
		Obstacles to Adoption of Standards
		Standards Categories
			Process Standards
				Security Policies
				Data Use Agreements (DUA)
				Metadata
			Data or Content Standards
				Data Format Standards
				Vocabulary Standards
				Laboratory Test and Result Code Standards
				Other Data Content Coding Standards
		A Closer Look: Format Standards Paradigm—HL7®
			HL7® Version 2.x Artifacts: Reporting Observations (ORU)
			HL7® Version 3 Artifacts: Clinical Document Architecture (CDA)
			HL7® FHIR
		A Closer Look: Vocabulary Standards—SNOMED CT®
			Concepts
			Concept Identifiers
			SNOMED CT® Descriptions
			SNOMED CT® Relationships
			SNOMED CT® Browsers
		Summary
		Future Directions
		References
	9: Privacy and Confidentiality of Public Health Information
		Introduction
		Basics of Privacy and Confidentiality
		Health Data Life Cycle Framework
		Data Protection Laws
			Federal Laws
				HIPAA
				The Privacy Act of 1974 and Related Regulations
				Substance Abuse Patient Records
				The Health Information Technology for Economic and Clinical Health Act
				The 21st Century Cures Act
				Laws Protecting Veteran and Military Health Information
				Other Federal Data Protection Laws
			State Laws
				Broad Protections for Individuals’ Information
				General Health Information Privacy Laws
				Public Health-Specific Laws
			International Laws
				General Data Protection Regulation (GDPR)
				The International Health Regulations (2005)
		Data Use and Public Health Ethics
			The Federal Policy for the Protection of Human Subjects (“Common Rule”)
			WHO Guidelines on Ethical Issues in Public Health Surveillance
			Law and Ethics
		Summary
		Future Directions
		References
	10: Health Systems Security
		Introduction
		The Context of Health Data Security
			Overview of Data Security
			Core Concepts
				Data, Information, Knowledge, Wisdom
				Privacy and Confidentiality
				Protected Health Information
			Regulation: The HIPAA Rules
		Security Paradigms
			CIA Triad
				Confidentiality
				Integrity
				Availability
			Parkerian Hexad
				Confidentiality and Possession
				Integrity and Authenticity
				Availability and Utility
		Health Data Security Breaches
			The Value of Health Data
			The Value of Public Health Data
			Health Data Security Breaches
			Technical Details of Security and Data Breaches
		Strategic Security
			Risk Assessments
			Adopting a Security Framework
				Identify
				Protect
				Detect
				Respond
				Recover
			Resources
				Security Team
				Funding and Support
				Time
			Countermeasures
				Physical Security Measures
				Administrative Security Measures
				Technical Security Measures
		Case Study: KHIE
			Context of KHIE
			Security Concerns and Preventive Measures
			KHIE: The Future
		Summary
		References
	11: Electronic Health Records: Origination, Adoption, and Progression
		Introduction
		The Uses of an Electronic Health Record System
			Enable Primary and Secondary Uses
			Provide Secure Access and Control of the Flow of Information
			Reduce Data Errors in Patient Care
			Increase Patient Access and Awareness
			Align with Regulation and Policies
			Provide Interactive and Pervasive Information Systems
			Gather Accurate Data for Research, Education, and Public Health
		Achieving Portability
			The Ideal Scenario
			Barriers to Success
			Integration, the Evolution of the EHR
		Origins of the EHR
			Origins of EHR Interoperability
			Origins of EHR Privacy and Security
		Legislation, Regulation, Policies, and the Importance of Standards
			Standardization
			Provider Access and Identification
			Office of the National Coordinator for Health Information Technology (ONC)
			Health Information Technology for Economic and Clinical Health (HITECH) Act
		EHRs in Public Health and Healthcare
			Meaningful Use
			Incentives for Adoption of EHRs
			Maintenance of EHRs
			Extensibility of EHRs
			Security of EHR Information Systems
		EHRs and Health Outcomes
			Population and Public Health Outcomes Improvement
			EHRs and Public Health 3.0
		Lessons Learned from EHR Developments and Implementations
			The Good News
			The Anticipated Progress
		Limitations, Disparities, and Unintended Consequences of EHR Adoption and Progression Globally
			Adoption Imbalance Within the US
			EHR Progress in Developed Countries
			Developing countries lagging behind
			Economics of EHRs
			Other Effects of EHR Adoption
		Conclusion
		References
	12: Public Health Analytics and Big Data
		Introduction
		From Data to Wisdom
			Data, Information, Knowledge, and Wisdom
			Key Terms in Analytics
			Categorization of Analytical Approaches
		Data Sources for Public Health
			Introduction to Secondary Data Sources
			The Concept of Big Data
		Data Processing
			Vectorization of Datasets
			Limitations and Challenges Impeding Effective Vectorization
		Natural Language Processing (NLP)
		Machine Learning Approaches
			Supervised Learning Algorithms
			Unsupervised Learning Algorithms
			Neural Networks
			Applications of Analytics in Public Health
			Common Pitfalls and Challenges
		Model Training, Evaluation and Validation
			Model Training Approaches
			Performance Metrics
			Feature Selection Techniques
			Model Validation
			Model Life Cycle
		Summary
		References
	13: Project Management and Public Health Informatics
		Introduction
		Project Management Competencies in Public Health Informatics
		Project Management and the Prevention of Information Systems Project Failure
		Project Management Methodologies
		The Project Management Context: Definition of a Project
		Project Management vs. Operations Management
		The Project Management Knowledge Areas
		The PMI Project Management Process Groups
			Initiating the Public Health Informatics Project
			The Project Charter
			Planning the Public Health Informatics Project
			Developing the Project Schedule
			Executing the Public Health Informatics Project
				Human Resource Management and Informatics Project Execution
				Communication and Informatics Project Execution
				Monitoring and Controlling the Informatics Project
				Managing the Triple Constraint
			Closing the Informatics Project
		Summary
		Recommended Resources for the Study of Informatics Project Management
		References
Part III: Key Public Health Information Systems
	14: Informatics in Disease Prevention and Epidemiology
		Introduction
		Disease Prevention Programs
			Components of Public Health Prevention Programs
			Information Integration
		Disease Control and Prevention Information Systems
			Public Health Surveillance
				Reportable and Notifiable Diseases
				Passive and Active Surveillance
				Laboratory Information
				Case Reports
				Chronic Disease Surveillance
				Design of Public Health Surveillance Systems
				Registries
				Cycle of Public Health Surveillance
			Disease Outbreaks and Clusters
				Outbreak Detection and Recognition
				Outbreak Tracking
			Laboratory Information
				Public Health and Clinical Laboratories
				Electronic Laboratory Reporting (ELR)
			Field Investigation Information Systems
				Contact Tracing, Notification, and Treatment
				Purposes of Field Investigation Information Systems
		Interoperability and Integration in Disease Control Information Systems
		Summary
		Future Directions
		References
	15: Public Health Laboratories
		Introduction
		The Public Health Laboratory
		Differences Between PHLs and Other Laboratory Types
		Informatics in the Public Health Lab
		Issues with Interoperability
		Public Health Laboratories and Informatics Standards
		Summary
		References
	16: Syndromic Surveillance: A Practical Application of Informatics
		Overview
		Introduction
		What Is Syndromic Surveillance?
			Definition of Syndromic Surveillance
			Purpose/Goals/Role Within Larger Public Health Surveillance Context
			Brief History of US-based Modern Syndromic Surveillance
		Syntactic Standards
			Data Format and Transmission
			Data Standards
			Unstructured/Free Text Data and Processing Approaches
			Data Quality
			Data Analysis
		Policy Considerations
			Communication of Syndromic Surveillance Data
		Use Cases
			Local System (NC DETECT)
			National Syndromic Surveillance Program (NSSP)
		Summary
		Future Directions
		References
Part IV: Challenges and Solutions
	17: New Means of Data Collection and Accessibility
		Introduction
		Public Health Data and Data Sources
			Type of Public Health Data
			Public Health Data Sources
				Social Media Data
				Electronic Health Records
				Social Determinants of Health Data
		Data to Action: A Guiding Framework for Data Collection and Accessibility
			The 3As of Data to Action
				Availability: Data Needs to Be Available Before It Can Be Accessible
				Accessibility: Data Needs to Be Accessible to Be Analyzable
				Analyzability: Data Needs to be Analyzable Before It Can Be Used for Action
			The 3Ps of Data to Action
				Data Preparation
					Organizational Data Preparation
					Technical Data Preparation
					Issues in Technical Data Preparation
				Data Processing
					Data Storage and Repositories
				Data Provisioning
		New Means of Data Collection
			Geographic Information Systems Data: Satellite and Drone Imagery
			Internet of Things: Smart Sensors and Devices
		New Means of Data Accessibility
			Democratization of Health Data
			Data and Metadata Standards
			Data Integration
		Future of Data Collection and Accessibility
			Blockchain and Data Access
			Big Data
			Data Quality
		Summary
		References
	18: Interoperability and Health Information Exchange for Public Health
		Introduction
			What Is Health Information Exchange?
			What Is Interoperability?
			Why Does Public Health Need HIE and Interoperability?
		History of HIE and Interoperability
		HIE Uses in Medicine
		Case Studies in HIE for Public Health
			Reporting Notifiable Conditions to Public Health Agencies
				Electronic Laboratory Reporting
				Electronic Case Reporting
					The Electronic Initial Case Report Standard
					Setting Case Reporting on FHIR
			Syndromic Surveillance
			Health Indicators
			Specialized Registries
		Drivers of HIE and Interoperability
			Policies That Drive HIE Adoption and Usage
			Role of Government-Facilitated HIE
			Current Adoption and Use of HIE by Public Health Organizations
		Challenges to HIE and Interoperability in Public Health
		Summary
		Future Directions for HIE and Interoperability in Public Health
			The Trusted Exchange Framework and Common Agreement (TEFCA)
			Fast Healthcare Interoperability Resource (FHIR) Specification
			Tethered Patient Portal
			Learning Health System
		References
	19: Geographic Information Systems
		Introduction
		The Importance of GIS and Its Contribution to Public Health
		Theoretical Foundations and the Development of GIS
		How Do Geographic Information Systems Work?
			Spatial and Attribute Data
			Map Projections and Coordinate Systems
			Scale
			Representations of Spatial Data
			Functionality: Mapping and Spatial Analysis for Health Applications
			Visual Display of Spatial Data
				Grouping Data into Classes for Mapping
				Appropriate Use of Symbols for Choropleth Mapping
			GIS Implementation: Software and Hardware
			Spatial Data Access and Development
			Web-Based GIS
			GIS Training
			Social and Institutional Issues
				Protected Health Information and HIPAA
				Security and Data Access
				Coordination with Other Agencies
				Organizational Politics
		GIS Limitations
			Accuracy and Completeness of Spatial Data
			Accuracy and Completeness of Attribute Data
			Currency and Time Period of Data Content
			Address Matching Issues
			Use of ZIP Codes
			Scale and Precision of Location
			Proximity vs. Exposure
		Summary
		References
	20: Public Health Decision Support Systems
		Introduction
		Clinical and Public Health Decision Support
			Clinical Decision Support
			Evolution of CDS in Medicine
			Public Health Decision Support
			Breadth of Decision Support in Public Health
		Public Health Decision Support Systems
			Typical Decision Support System Components
			Example of a Multi-Level PDS System
				A Hypothetical Example
				A Practical Example
		Summary
		Future Directions
		References
Part V: Case Studies: Information Systems and the Strata of Public Health
	21: Local and Regional Public Health Informatics
		Introduction
		Local Public Health Agency Characteristics
			Operational Context
			Accreditation, Strategic Planning and Critical Success Factors
			Informatics Needs
			Technological Capacity
			Knowledge and Competencies
			Resources Workforce and Funding
		Addressing Local Public Health Needs Through Informatics
			Strategic Planning and Business Process Analysis
			Community Engagement
			Investment
			Enterprise Architecture
			Performance Management of Information Technology
			Governance
		Case Study: CHORDS
			Strategic Planning
			Community Engagement
			Investment
			Enterprise Architecture
			Performance Management
			Governance
		Conclusions and Future Directions
		References
	22: Public Health Informatics and the American Indian/Alaska Native Populations: Improving Community Health Despite Challenges
		Public and Population Health and the Indian Health Service
		Epidemiology
			History of Disease and Epidemics in AI/AN Communities
			AI/AN Health and Social Status
			Determinants of Health
			Community-Initiated and Public Health Programs to Improve AI/AN Well-Being
		The Indian Health Service: A Unique Relationship
		Public Health and Informatics Within Indian Health Service
			The Development and Composition of the IHS HIT System, the Resource and Patient Management System (RPMS)
				Technical Summary of RPMS
				The iCare Component of RPMS: A Population Health Suite
			Public Health, Population Health, and Health Care Quality: A Significant Interdependency
				Public Health Reporting in Indian Country
				Data Sovereignty
			Public Health and Informatics in AI/AN Communities
				Public Health and Informatics at the National Level
				Public Health and Informatics at the Area Level
				The IHS Urban Indian Health Program and Informatics
				Public Health and Informatics at the Local Level
		IHS Partners in Public Health: The CDC, States, and Local Health Departments
			The Successful IHS/CDC Partnership to Improve AI/AN Immunization Rates
				Historic Challenges
			Achieving Vaccination Equity
		Other Programs to Improve AI/AN Health Using Informatics
			Tribal Epidemiology Centers (TECs) and Informatics
			IHS Special Diabetes Program for Indians
		Summary: The IHS HIT System Key Elements and Shortcomings
		IHS Informatics and the Future: Striving for Health Equity
			Barriers to Health Equity
			The Call for Modernization
			Opportunities and Priorities
		References
	23: Advancing Informatics Policy and Practice: A State Perspective
		Overview
		Introduction
		Informatics-Savvy Policy and Practice at a State Health Department
			Informatics Vision and Strategy
			Skilled Workforce
			Well-Designed and Effectively-Used Information Systems
		Foundational Program Activities for Building Informatics Capacity
			The Role of a Central Informatics Program or Office
			Assessment of Informatics Status and Needs
			Establish a Vision, Strategy, and High Level Roadmap
			Workforce Development in Public Health Informatics
			Well-designed Information Systems and Health Department Roles
		State-Local and State-Federal Information Exchange Related Policy and Strategy
			State-Local Public Health Agency Partnership
			State–Federal Partnerships
			State–Community Partners (Private, Not for Profit, Academic and Others)
		Summary
		Future Directions
		References
	24: National Public Health Informatics, United States
		Introduction: Historical Foundation for Public Health Information Management
			Interstate Agreements
			Federal Authorities
			Public Health Information Standards
			International Influence
		Public Health Department Variability
		The Public Health Information Supply Chain
			Data Sources
			Data and Information Exchange
			Nationally Supported Information Supply Chain Activities
		Public Health Access and Use of Healthcare Data
			Distributed Queries
			Claims Databases
		Federal Role in Establishing and Promoting Information Management Standards
			Federal Regulations for Health Data Exchange
			Meaningful Use
		Future Directions in National Public Health Informatics
			Laws and Authorities That Enable Sharing of Health Data
			Interoperability and Data Standards
			Office of the National Coordinator for Health Information Technology
			US Food and Drug Administration
			Centers for Disease Control and Prevention
			Resources and Workforce Development and Capacity
		Summary
		References
	25: Perspectives on Global Public Health Informatics
		Overview
		Introduction
		Global Health
			Global Health Informatics
			The Influence of Global Health Policy
			Health Information Systems in PEPFAR
			Sustainable Systems
		Case Study of Health Information System Design and Implementation in a PEPFAR Focus Country: A Decade of Public Health Informatics in Malawi
			Malawi: Background and Overview
			Issues and Solutions
			System Description
			Supporting HIV Care and Treatment
			Beyond HIV
			A Model for Sustainability
			Lessons Learned
				False Starts and Experience Gained
				Exemplars for Sustainability
				Keys to Success
			The Past Is Prologue
		Case Study of Health Information System Design and Implementation in a PEPFAR Focus Country: Rwanda
			History of Partners in Health Informatics Projects in Rwanda, 2005 Onward
			Technical, Organizational and Functional Description of the System
			Current Status and Uses of OpenMRS at IMB
			Current Status and Uses of the System at the MOH
			Informatics-Related Issues Faced and Challenges Overcome during Implementation
			Improving Reporting Tools
			Capacity Building and the EHSDI Training Program
		The Future for the System
			Supporting a Broader Range of Diseases
			The Rwanda Health Information Exchange Project and Open Health Information Exchange
			Hospital Information Systems Based on OpenMRS
			Broader International Rollouts Based on Rwanda Experience
			Evaluation Studies of OpenMRS
			Future Plans
		Other Key Health Information Systems in LMICs
			The District Health Information System (DHIS2)
			CommCare
			Open Data Kit
			The Range of mHealth Applications
		Summary
		Future Directions
		References
	26: Improving Immunization Through Informatics: Perspectives from the BID Initiative Partnership with Tanzania and Zambia
		Introduction
		Background of the BID Initiative
		Engaging Stakeholders and Laying the Groundwork
			Critical Data-Related Challenges to Vaccine Service Delivery
			Identifying Digital Health Solutions to Close Gaps
		Software Development
		Implementation of Intervention Package
			Implementation in Tanzania
			Implementation in Zambia
		Challenges and Lessons from Intervention Development to Implementation
			Challenges to Software Development
				Lessons Learned from Software Development
			Challenges to Implementation
		Achievements, Driving Scale-Up and Ensuring Sustainability
		Summary
		References
	27: Public Health Informatics: The Path Forward
		Introduction: Influencing Factors for Public Health Informatics
		Policy
			Health Reform
			Data Sharing and Ownership
				Informatics Policies and Regulations in the United States
				Policies Succeeding Meaningful Use and MACRA
			National Initiatives
				Culture of Health
				Public Health 3.0
				Africa CDC Workforce Development Framework
				Europe’s General Data Protection Regulation
		Data
			Standards
			Big Data
			Data Quality
			Interoperability
			Socioeconomic Factors of Health
		ICT Advances
			Quantum Computing
			Artificial Intelligence
			Technical Improvements on Traditional Efforts
			Security
		The Rise of New Challenges
			Climate Change
			Social Media
		Summary
		References
Index