Public Health in the 21st Century

1. Public Health in the 21st Century John R. Lumpkin, MD, MPH Illinois Department of Public Health

2. The Challenge that we face • “THE MANAGED-CARE-BASED HEALTH SYSTEM IS FAILING. MEDICAL INFLATION IS BACK. CONSUMER DISTRUST, PROVIDER HOSTILITY, COSTLY NEW TECHNOLOGIES AND POLITICAL OPPORTUNISM WILL NO LONGER ALLOW COSTS AND QUALITY TO BE CONTROLLED BY MOST EXISTING MANAGED CARE ARRANGEMENTS”

3. The Challenge that we face • “OVERALL, QUALITY HAS NOT BEEN DELETERIOUSLY AFFECTED BY MANAGED CARE, BUT MANAGED CARE HAS NOT SUBSTANTIALLY REDUCED UNSAFE PRACTICES, OVERUSE, UNDERUSE AND MISUSE OF HEALTH CARE” - PAUL ELLWOOD

4. The Business of Health • Helping people stay healthy • Helping people get better when they are ill • Helping people live with illness when their illness is chronic • Helping people manage a changing lifestyle when their illness impairs their functioning • based upon work by the Foundation for Accountability

5. Health Care Practice is Data, Information & Knowledge intensive • Collection of Data • Physical Exam • Lab • Data with analysis is Information • rales, abn chest x-ray • Information in context with rules • bacterial pneumonia treat with Antibiotics

6. 1974 - Kerr White Chairman NCVHS • “With the advent of new technology, data can be collected in any format, aggregated by the computer and arrayed in any desired output … collecting masses of data untouched by human thought

7. The Goal of Health Practice is to Make the Right Decisionsat the Right Time

10. Barriers to a New Vision • Privacy Protections • Standards • Quality standards for On-line information • Technology • security • data entry • Costs • Attitudes and practices (confidence) • Equity

11. AHRQ ASIRM ASPE CDC CMS Data Council FDA HRSA NCHS NIH NLM OCR OPHS HHS Agencies with NHII Responsibilities

12. We received a clear message from many parties and diverse interests! Federal Leadership is essential, wanted and HHS should be it.

13. NHII CAREGIVER PERSONAL COMMUNITY

14. Financial & Administrative Comparability Privacy & Security Interoperability PMRI Data Quality PMRI Standards . . . compatible with other HIPAA standards

15. Inflamed Objectives of PMRI Report • More easily & accurately exchange PMRI between systems • Better understand PMRI across systems Ear ? Rx

16. Benefits of PMRI Standards • Support patient care • Improve quality of care • Measure outcomes • Advance public health • Enhance efficiency • Facilitate reimbursement Health Care   

17. Premise Capture data Once at the point of care, and Derive information therefrom for Every other legitimate use This Report reflects the belief that significant quality & cost benefits can be achieved in health care if clinically specific data are captured once at point of care & all other legitimate data needs are derived from those data

18. Key criteria • Degree of market penetration • Extent that standard enables interoperability • Ability to facilitate comparability • Support of • Data quality • Accountability • Integrity

19. Issues • Time for market acceptance leads to standards based on older conceptual models • Need to accelerate development and early adoption of standards

20. Guidance vs Mandate • Guidance to Industry • Adoption by HHS and other federal organizations • Example • incentive

21. Recommendations • HL7 – recognized as core PMRI standard • Recognize standards for specific market segments • DICOM • NCPDP SCRIPT • IEEE 1073 • Retire HL7 v2.1

22. PUBLIC HEALTH AND MEDICAL PRACTICE BOTH USE THE SAME DATA, WE JUST LOOK AT IT DIFFERENTLY -CHRISTINE GEBBIE

23. SNOW AND CHOLERA • DATABASE ANALYSIS • GIS SYSTEM

24. E Coli in Hamburger • Reports to the state • HD staff evaluate to determine pattern • Samples collected • PFGE run • Additional samples collected • Process can take weeks sometimes

26. How it could work • Pt refers to home system about diarrhea • Physician Identifies Patient with bloody diarrhea • Positive for E. Coli 0157:H7 • Electronic Notification of PH system • Outbreak identified • Home and Providers systems notified • Additional cases allow rapid identification of source and recall occurs

27. How it worked in 1997-1998 Decatur IL • Nov Death due to Invasive Group A strep • Nov- Jan 9 other deaths • 2 Nursing Homes • Patients • Staff • Visitors

31. Terrorism in America September 11th Common conveyance Uncommon Use Oct - Anthrax Uncommon Organism Use???

32. Biological Terrorism:A New Trend? • 1984:Oregon -Salmonella sprayed on salad bars • 1994:Tokyo - Sarin and biological attacks • 1996:Dallas – Shigella-contaminated muffins and doughnuts • 1998:Nation-wide - anthrax hoaxes

35. Recovery - Normalization Data Generation Data Collection Outbreak Management Data Analysis Outbreak Investigation

36. Impact of Surveillance on Survivability (Linear) Victims Directly Exposed 105 Fatalities With Early Warning and an Informed Public Health Response Fatalities With Traditional Public Health Response Number Dead = 0 Time Animal or Human Indicators Phase II Acute Illness Phase I Initial Symptoms Traditional Disease Detection Surveillance Effective Treatment Period t Modified from chart developed by Hopkins Bioterrorism Center

37. OBSTACLES TO PUBLIC HEALTH SYSTEM PERFORMANCE • COST OF DATA CAPTURE • INABILITY TO LINK • SPACE • TIME • ACROSS PROGRAMS • DISCONNECT BETWEEN KNOWLEDGE AND SERVICE DELIVERY

38. Financial & Administrative Comparability Privacy & Security Interoperability PMRI Data Quality PMRI Standards . . . compatible with other HIPAA standards

39. NHII CAREGIVER PERSONAL COMMUNITY