Opinions on Public Health

Keith discusses his views on Public Health in his (somewhat long) blog post. First things first - what is the role of public health (also referred to as population health)?

My thoughts - to analyze, record and improve the health of the population as a whole by collecting data about individuals, researching trends across populations and appropriating and distributing best practices and care for individuals.

A few observations:
I didn't use the word patient, but instead "individuals". This is because the population consists of both patients as well as non-patients.
Data is collected per individual but the analysis and research should be across a defined population.
Finally, to complete the circle to improve the health of the population, feeding best practices back into individual cases (patients and non-patients). Care can be delivered and best practices adopted only if this happens at the level of the individual.

So, in some sense, I see public health starting off by dealing with the patient level, moving to the population level and then coming back down to the patient level. Here is a little illustration to help:

 

 

I've already discussed some of the challenges of the political and jurisdictional nature here.

There are some technical challenges that we need to overcome in order to architect a sensible solution for automating data collection in public health. Some of these have to do with standards that are currently being worked on in HL7 as well as profiles being written in IHE. Are we there yet from a technical perspective? Absolutely not. However, we are a LOT further along compared to the challenges faced operationally and politically. Power and Money drive too much in this country. Right now, nobody wants to cooperate unless there is some form of profit associated - or at the minimum, no loss of one's powers and jurisdiction.

I was fortunate to have an interesting discussion with a couple of other people at IHE - MW, LF and NK at lunch today about the challenges in applying automating solutions to the public health areas.

This, like a lot of things, is a situation of "Catch 22" or a cycle where it is difficult to get the first step going. Since the states own public health data, and the center needs to purchase it from them, the states want incentives to conform to any standards developed by the center. Vendors obviously want one set of standards across the country while the different states have no incentives to agree upon one standard set of data or workflows. In fact, I will go on to say that I don't think that in public health, there is even an agreed upon workflow to collect the necessary individual data and what to do with it.

So, there are several challenges, and how do we move forward? First, we need to establish common workflows and data requirements. Next, we need to create standards while engaging both vendors and experts from areas of patient care, non-patient information collection as well as public health. Then, maybe create a new standard? Okay, let's rephrase that to agree upon a single standard for each of the different domains withing public health. It is important to try to standardize the workflow too. Finally, getting the buy-in from the states to require the use of these standards.

At the lunch table, we discussed how it would help to have a pilot first. The pilot should be one or two states with a handful of hospitals / provider organizations. It is important to restrict the participation to a handful of hospitals and provider organizations to allow for standards and profiles to mature before expanding the pilot for general consumption. This would also give the opportunity to demonstrate the possible savings from the pilot sites.