A Practical Roadmap to Integrating
Public Health (Surveillance) IT
Systems
Massimo Mirabito, Kumar Batra, Priscilla Chu
Sharon R. Burks, William D. Correll, Thomas Sukalac
Presenter Disclosures
Max Mirabito, Kumar Batra, Sharon Burks
 Employed by Northrop Grumman
 Own Northrop Grumman Stocks
 Currently working on the CDC CIMS Contract supporting CDC/NCHHSTP
Thomas Sukalac, William D. Correll
 Employed by the Centers for Disease Control and Prevention
 Currently support CDC/NCHHSTP
Priscilla Chu
 Employed by the San Francisco Department of Public Health
 Currently supporting the Population Health Division
The State of Public Health IT Systems
 Public health systems are becoming increasingly integrated
 2011 MMWR report “State Electronic Disease Surveillance
Systems — United States, 2007 -2010”
• 22% increase in integrated systems
• 211% increase in interoperable systems
 NCHHSTP is encouraging data integration and harmonization
 Surveillance Systems Consultation recommendations
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Leadership is involved in standardizing public health data
Build systems that will break down silos
Increase interoperability and harmonize data submission
Facilitate collaboration between public health partners
Provide guidance and facilitate information exchange
Develop Public Health informatics workforce
The Importance of Integration
 Collecting and aggregating
 Deliver efficient and effective services
 Shifting from disease specific to integrated systems
• Unified offering across disease domains
 Benefits
• Improved data sharing and data quality
• Increase agility and ability to delivery services
• Detect, monitor, track, identify and correlate
Roadmap to Public Health IT System Integration
Roadmap: Key Factors
Factors Influencing Integration
 Leadership priorities
• Aligned with mission, integrate all diseases, one system, privacy and
confidentiality, efficiencies
 Public Health Programs and Initiatives
• Critical, guide and shape
 System Design and Architecture
• Design, resources, security, support, expandability
 Integration
• Data exchange, interoperability, Application Program Interfaces (APIs)
Four areas to Focus
Roadmap: Organization
Organizational Factors
 Look Inside
• Strengths – EPI, surveillance, research, creativity
• Weaknesses – IT fragmentation, knowledge, siloes, policies and practices
 Look externally
• Opportunities – Healthcare reform, liberating data, increase collaboration
• Threats/Challenges – Constrained budgets, categorical funding, policies
Look closely at your
organization
Roadmap: IT Environment
IT Landscape
 Current landscape
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Invested considerable resources
Duplicative systems and outdated technology
Systems collect similar data in different formats
IT is burdened; more and more to support and maintain
 Upcoming landscape
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Technology has created new expectations
New ways of socializing and discovering data
Mobility is pressuring IT
It’s harder to keep up
IT is more complex than 20
years ago
Roadmap: Integration Challenges
Integration is Difficult
 People
• Communicate vision
• Balance needs
 Complexity
• Compartmentalization, unique needs
• Rushing to integrate, lack of requirements
 Resources
• Funding, Infrastructure, Sustainability
 Harmonization
• Concept vs. operationalization
Risk is not your enemy
Roadmap: Recommendations
Recommendations
 Align integration to Executive priorities, Public Health
programs, Architecture, Integration
 Develop your unique blueprint
 Involve IT & Informatics early and often
 Identify ways to liberate data to increase collaboration
Align your solution to your
focus areas
Roadmap: The San Francisco Blueprint
Roadmap: San Francisco Department of Public Health
(SFDPH) Population Health Division
 Background
 Process
 Key factors
influencing integration
 Organization
 IT environment and
information systems
 Lessons learned from
integration
Background
 Program Collaboration
and Systems Integration
(PCSI) initiative
 Syndemic analysis
 65+ separate data
systems
 Decision made by Local
Health Officer to move to
integrated system
Winchester Mystery House
Roadmap: The SFDPH
Population Health Division
Process
 Stakeholder engagement
 Informatics assessment
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Conducted 14 focus group interviews
Synthesized information into an
informatics report
 Market solutions report
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Specific to local criteria
 Business case
 Software system
demonstrations
 Software system selection
Roadmap: The SFDPH
Population Health Division
Key Factors Influencing Integration
 Strategic Map: Build an integrated information and
knowledge management infrastructure
 Ability to share data for client-centered holistic and syndemic
approach
 Increase efficiency:
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More collaboration
Less paper
Less duplicate data entry
Roadmap: The SFDPH
Population Health Division
External Factors
Internal Factors
Organization
Strengths
S
· Leadership support for
integration
· Epidemiological/analytical/
research capacity
Opportunities
· Health care reform and
meaningful use
· Funding
· IT reorganization
Roadmap: The SFDPH
Population Health Division
Weaknesses
W
· Siloed systems
· Medical record vs. public
health data
O Threats
· Costs of clinical systems
· Decreasing funding
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IT Environment & Information Systems
 IT’s support of systems
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IT focused on clinical systems
Public health’s outdated
systems
 Lack of investment in IT
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Infrastructure, capacity and
bandwidth
Workforce development –
look at future needs
Roadmap: The SFDPH
Population Health Division
Lessons Learned from Integration
 Stakeholder engagement
is important
 Change is everywhere
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Population Health Division reorganization
New Chief Informatics Officer - IT
reorganization (4x)
Clinical side reorganization
 Change management
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Too much change at once is difficult
Speak to the elephant
Roadmap: The SFDPH
Population Health Division
Conclusion
 Develop a customized informatics blueprint
 Invest in IT (infrastructure and human capital) and
increase public health informatics capacity
 Consider working with Informatics
resources at CDC
Integration is lifestyle
Integration is a marathon
Integration is a team sport
Acknowledgments
US Centers for Disease Control and Prevention
 Gustavo Aquino – NCHHSTP Associate Director for Program
Integration
San Francisco Department of Public Health
 Israel Nieves – Director, Office of Equity and Quality
Improvement, Population Health Division, San Francisco
Department of Public Health