Public Health in the 21st Century

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Public Health in the 21st Century

• John R. Lumpkin, MD, MPH
• Illinois Department of Public Health

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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

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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

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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

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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

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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

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The Goal of Health Practice is to Make the Right
Decisionsat the Right Time
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Barriers to a New Vision

• Privacy Protections
• Standards
• Quality standards for On-line information
• Technology
• security
• data entry
• Costs
• Attitudes and practices (confidence)
• Equity

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HHS Agencies with NHII Responsibilities

• AHRQ
• ASIRM
• ASPE
• CDC
• CMS
• Data Council
• FDA

• HRSA
• NCHS
• NIH
• NLM
• OCR
• OPHS

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We received a clear message from many parties
and diverse interests!

Federal Leadership is essential, wanted and
HHS should be it.
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NHII
CAREGIVER
PERSONAL
COMMUNITY
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PMRI Standards
. . . compatible with other HIPAA standards
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Objectives of PMRI Report

• More easily accurately exchange PMRI between
  systems
• Better understand PMRI across systems

Ear ? Rx
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Benefits of PMRI Standards
Health Care ? ? ?

• Support patient care
• Improve quality of care
• Measure outcomes
• Advance public health
• Enhance efficiency
• Facilitate reimbursement

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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
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Key criteria

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

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Issues

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

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Guidance vs Mandate

• Guidance to Industry
• Adoption by HHS and other federal organizations
• Example
• incentive

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Recommendations

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

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PUBLIC HEALTH AND MEDICAL PRACTICE BOTH USE THE
SAME DATA, WE JUST LOOK AT IT DIFFERENTLY

• -CHRISTINE GEBBIE

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SNOW AND CHOLERA

• DATABASE ANALYSIS
• GIS SYSTEM

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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

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How it could work

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

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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

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Terrorism in America

• September 11th
• Common conveyance
• Uncommon Use
• Oct - Anthrax
• Uncommon Organism
• Use???

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Biological TerrorismA 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

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Recovery - Normalization
Data Generation
Data Collection
Outbreak Management
Data Analysis
Outbreak Investigation
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Impact of Surveillance on Survivability
Phase II Acute Illness
Phase I Initial Symptoms
Traditional Disease Detection
Surveillance
Effective Treatment Period
t
Modified from chart developed by Hopkins
Bioterrorism Center
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OBSTACLES TO PUBLIC HEALTH SYSTEM PERFORMANCE

• COST OF DATA CAPTURE
• INABILITY TO LINK
• SPACE
• TIME
• ACROSS PROGRAMS
• DISCONNECT BETWEEN KNOWLEDGE AND SERVICE DELIVERY

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PMRI Standards
. . . compatible with other HIPAA standards
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NHII
CAREGIVER
PERSONAL
COMMUNITY
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