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Integrating child health information systems.

The Health Resources and Services Administration and All Kids Count (a national technical assistance center fostering development of integrated child health information systems) have been working together to foster development of integrated child health information systems. Activities have included: identification of key elements for successful integration of systems; development of principles and core functions for the systems; a survey of state and local integration efforts; and a conference to develop a common vision for child health information systems to meet medical care and public health needs. We provide 1 state (Utah) as an example that is well on the way to development of integrated child health information systems.

Child↗

Consuming research, producing policy?

The authors' 1990 article "Producing Health, Consuming Health Care" presented a conceptual framework for synthesizing a rapidly growing body of findings on the nonmedical determinants of health. The article received a very positive response, and here the authors reflect on what lessons might be learned from that response about the style or content of effective interdisciplinary communication. Much substantive knowledge has been accumulated since 1990, and a number of different frameworks have been developed before and since. The authors situate theirs within this literature and consider how they might have modified it if they "knew then what they know now." They ask what impact this article, and the much broader stream of research on the determinants of health, has had on public policy?

Canada↗

Evolution of the determinants of health, health policy, and health information systems in Canada.

The history of health determinants in Canada influenced both the direction of data gathering about population health and government policies designed to improve health. Two competing movements marked these changes. The idea of health promotion grew out of the 1974 Lalonde report, which recognized that determinants of health went beyond traditional public health and medical care, and argued for the importance of socioeconomic factors. Research on health inequalities was led by the Canadian Institute for Advanced Research in the 1980s, which produced evidence of health inequalities along socioeconomic lines and argued for policy efforts in early child development. Both movements have shaped current information gathering and the policies that have come to be labeled "population health."

Canada↗

Syndromic surveillance in public health practice, New York City.

The New York City Department of Health and Mental Hygiene has established a syndromic surveillance system that monitors emergency department visits to detect disease outbreaks early. Routinely collected chief complaint information is transmitted electronically to the health department daily and analyzed for temporal and spatial aberrations. Respiratory, fever, diarrhea, and vomiting are the key syndromes analyzed. Statistically significant aberrations or "signals" are investigated to determine their public health importance. In the first year of operation (November 15, 2001, to November 14, 2002), 2.5 million visits were reported from 39 participating emergency departments, covering an estimated 75% of annual visits. Most signals for the respiratory and fever syndromes (64% and 95%, respectively) occurred during periods of peak influenza A and B activity. Eighty-three percent of the signals for diarrhea and 88% of the signals for vomiting occurred during periods of suspected norovirus and rotavirus transmission.

Adolescent↗

[Informatics of public health management in the Udmurt Republic].

The paper outlines the structure and basic directions of activities of the Information Computer Center (ICC) of the Ministry of Health in the Republic of Udmurt. ICC develops of software for polyclinics, hospitals, counting offices, clinical units and other divisions of therapeutical and prophylactic institutions.

Computer Systems↗

A public health nursing informatics data-and-practice quality project.

Automation of nursing documentation in client records is one of today's formidable challenges in healthcare settings. Some stakeholders view standardized nursing language as a fundamental component of an automated record, with the end goal of generating valid, reliable data on nursing services and client outcomes. However, few successful applications of standardized nursing language for practice standards and data generation exist in the literature. A joint practice-and-data quality project based on standardized nursing language in an automated platform was undertaken by four local public health departments. Outcomes of this project included articulation of standards for nursing practice and creation and implementation of a sound data quality infrastructure for nursing documentation of client assessments, service delivery information, and client outcomes.

Case Management↗

Development of a GIS-based, real-time Internet mapping tool for rabies surveillance.

BACKGROUND: Oral rabies vaccination programs have been implemented to control the spread of wildlife rabies in the United States. However, current surveillance systems are inadequate for the efficient management and evaluation of these large scale vaccine baiting programs. With this in mind, a GIS-based rabies surveillance database and Internet mapping application was created. This surveillance system, RabID, provides a new resource for the rapid mapping and dissemination of data on animal rabies cases in relation to unaffected, enzootic, and baited areas where current interventions are underway. RESULTS: RabID is a centralized database for diagnostic and demographic information collected by local, state, and federal agencies involved in rabies surveillance. The geo-referenced database remits data to an Internet-accessible mapping application that displays rabies surveillance data in relation to environmental and geographic features. CONCLUSION: RabID provides a pioneering example of the power of geographically based Internet-accessible, infectious disease surveillance. This surveillance system was developed from existing technology and is readily adaptable to other infectious diseases and may be particularly useful for zoonoses. The development and application of public health informatics technology may enhance the effectiveness of public health interventions and allow better evaluation of public health interventions.

Animals↗

Health informatics education: an opportunity for public health in Canada.

Health information infrastructure is being developed across Canada, and health informatics education should be a component of the emerging infrastructure. However, educational opportunities do not appear to be developing in pace with infrastructure. This study characterizes the required education, and describes specific issues facing the development of health informatics education. Twenty-six key informants were interviewed, and responses were analyzed to identify major themes. Subjects agreed that the current capacity for health informatics education is inadequate. Also, limited expertise could adversely affect health infostructure implementation and health system performance. A need was identified for both advanced and basic education. Four issues facing the development of health informatics education in Canada were consistently identified: awareness, collaboration, funding, and human resources. Public health is well positioned to play a central role in health informatics education due to its historical basis in handling health information, and its developing expertise in health informatics applications.

Canada↗

Toward a veterinary informatics research agenda: an analysis of the PubMed-indexed literature.

PURPOSE: Veterinary medicine and human health are inextricably intertwined. Effective tracking of veterinary information - veterinary informatics - impacts not only veterinary medicine, but also public health, informatics research, and clinical care. However, veterinary informatics has received little attention from the general biomedical informatics community. METHODS: To identify both active and under-researched areas in veterinary informatics, we retrieved Medical Subject Heading (MeSH) descriptors for veterinary informatics-related citations and analyzed them by topic category, animal type, and journal. RESULTS: We found that the categories of veterinary informatics with the most growth were information/bibliographical retrieval, hardware/programming, and radiology/imaging. Less than two articles per year were published in the areas of computerized veterinary medical records, clinical decision support, standards, and controlled vocabularies. Veterinary informatics articles primarily address production animals such as cattle and sheep, and companion animals such as cats and dogs. Six journals account for 31% of the veterinary informatics literature, 35 journals account for 66%. CONCLUSIONS: Veterinary informatics remains an embryonic field with relatively few publications. With the exception of radiology/imaging, published articles are primarily focused on non-clinical areas such as hardware/programming and information retrieval. There are very few publications on controlled vocabularies, standards, methodologies for integrating disparate systems, computerized medical records, clinical decision support systems, and system usability. The lack of publications in these areas may hamper efforts to collect and track animal health data at a time when such data are potentially critical to human health.

Medical Informatics↗

Information system architectures for syndromic surveillance.

INTRODUCTION: Public health agencies are developing the capacity to automatically acquire, integrate, and analyze clinical information for disease surveillance. The design of such surveillance systems might benefit from the incorporation of advanced architectures developed for biomedical data integration. Data integration is not unique to public health, and both information technology and academic research should influence development of these systems. OBJECTIVES: The goal of this paper is to describe the essential architectural components of a syndromic surveillance information system and discuss existing and potential architectural approaches to data integration. METHODS: This paper examines the role of data elements, vocabulary standards, data extraction, transport and security, transformation and normalization, and analysis data sets in developing disease-surveillance systems. It then discusses automated surveillance systems in the context of biomedical and computer science research in data integration, both to characterize existing systems and to indicate potential avenues of investigation to build systems that support public health practice. RESULTS: The Public Health Information Network (PHIN) identifies best practices for essential architectural components of a syndromic surveillance system. A schema for classifying biomedical data-integration software is useful for classifying present approaches to syndromic surveillance and for describing architectural variation. CONCLUSIONS: Public health informatics and computer science research in data-integration systems can supplement approaches recommended by PHIN and provide information for future public health surveillance systems.

Bioterrorism↗

SARS and population health technology.

The recent global outbreak of SARS (severe acute respiratory syndrome) provides an opportunity to study the use and impact of public health informatics and population health technology to detect and fight a global epidemic. Population health technology is the umbrella term for technology applications that have a population focus and the potential to improve public health. This includes the Internet, but also other technologies such as wireless devices, mobile phones, smart appliances, or smart homes. In the context of an outbreak or bioterrorism attack, such technologies may help to gather intelligence and detect diseases early, and communicate and exchange information electronically worldwide. Some of the technologies brought forward during the SARS epidemic may have been primarily motivated by marketing efforts, or were more directed towards reassuring people that "something is being done," ie, fighting an "epidemic of fear." To understand "fear epidemiology" is important because early warning systems monitoring data from a large number of people may not be able to discriminate between a biological epidemic and an epidemic of fear. The need for critical evaluation of all of these technologies is stressed.

Communicable Diseases↗

[Role of mass media during the severe acute respiratory syndrome epidemic].

OBJECTIVE: To understand the impact of effective interaction between public and media on the prevention and control of severe acute respiratory syndrome (SARS). METHODS: Based on the theory of field epidemiology, the traditional and modern technologies were brought forward. In the late period of SARS epidemic, investigation on knowledge, attitude and practice on SARS prevention and control among general population was conducted. RESULTS: During the 3 month period of SARS epidemic in Shenzhen, techniques of the "E-health and public health informatics" as an emerging fields were used to focus on population to eventually improve the health of entire population. Methods as television, radio, newspapers, magazines, printing and distribution of specific materials on SARS were included, and hotlines of telephone and mobile phone, web-based sites, electronic screening advertisements, and consultation or forum for the public etc. were used. Among 3405 subjects interviewed, more than 95% gave right answers on the SARS related questions. Most of them held the optimistic and scientific attitude. 80% of the population had taken the measures as recommended. 82.4% of the citizens were happy about the local government's action and 93.8% thought hospitals and healthcare workers should be respected and honored. CONCLUSION: Dealing with the urgent public health problems and emerging infectious diseases outbreak, epidemiologists need to keep good relations with media, and making use of modern electronic technologies to communicate with the public.

Adolescent↗

The Latin American Social Medicine database.

BACKGROUND: Public health practitioners and researchers for many years have been attempting to understand more clearly the links between social conditions and the health of populations. Until recently, most public health professionals in English-speaking countries were unaware that their colleagues in Latin America had developed an entire field of inquiry and practice devoted to making these links more clearly understood. The Latin American Social Medicine (LASM) database finally bridges this previous gap. DESCRIPTION: This public health informatics case study describes the key features of a unique information resource intended to improve access to LASM literature and to augment understanding about the social determinants of health. This case study includes both quantitative and qualitative evaluation data. Currently the LASM database at The University of New Mexico http://hsc.unm.edu/lasm brings important information, originally known mostly within professional networks located in Latin American countries to public health professionals worldwide via the Internet. The LASM database uses Spanish, Portuguese, and English language trilingual, structured abstracts to summarize classic and contemporary works. CONCLUSION: This database provides helpful information for public health professionals on the social determinants of health and expands access to LASM.

Databases, Bibliographic↗

Using information technology to improve the public health system.

Information technology can be both a vital tool and critical link in the modern public health system. This article discusses the role of information technology in public health and the activities of the Information Technology Collaborative, one of the collaboratives that comprise the national Turning Point initiative. Data are presented from a nationwide survey investigating local health department information technology needs and information technology use. This data, and data from an investigation of state-level public health information technology, will be presented in a more complete format on the Information Technology Collaborative's online Public Health Information Systems Catalog, a free resource for individuals interested in public health informatics. Recommendations for future initiatives, policy changes, and information technology standards are discussed.

Catalogs as Topic↗