Public Health Uses of Medical Data

1
Public Health Uses of Medical Data

• Hugh H. Tilson MD, DrPH
• Maine Center for Public Health
• Sagadahoc County Health Officer

2

• Public Health NEEDS data to do its job!
• Prevents epidemics and the spread of disease
• Protects against environmental hazards
• Prevents injuries
• Promotes and encourages healthy behaviors
• Responds to disasters and assists communities in
  recovery
• Assures the quality and accessibility of health
  services

11/14/2009
2
3
Essential Services of Public Health

• Monitor health status
• Diagnose and investigate
• Inform, educate, and empower
• Mobilize community partnerships
• Develop policies and plans

• Enforce laws and regulations
• Link people to needed services / assure care
• Assure a competent workforce
• Evaluate health services
• Research

11/14/2009
3
4
What is the Public Health System?

Health care delivery system

• More than just the public health agency
• Public health system
• All public, private, and voluntary entities that
  contribute to the delivery of public health
  services within a jurisdiction.

Community
Assuring the Conditions for Population Health
Governmental Public Health Infrastructure
Employers and Business
Academia
The Media
(IOM, 2003)
5
Todays forecast is limited by lack of vision .
6
Public Health Uses of Medical Data

• Initiates direct interventions
• Stimulates general interventions
• Supports management of outbreaks
• Monitors trends in diseases/conditions
• Identifies new public health threats
• Supports intervention evaluation
• Supports PH program evaluation

7
Communicable Diseases as Public health
Priorities

• In the mid 1960s to 1970s, many highly
  credentialed scientists offered opinions that
  most communicable disease would be eradicated by
  the early 2000s.

8
Communicable Diseases Today

• Since 1970s
• HIV/AIDS epidemic
• Resurgence of Tuberculosis/DRT
• Re-emergence of Sexually Transmitted Ds
• Emerging infectious diseases (e.g.West Nile)
• Hospital acquired infections and CA MRSA
• Outbreaks of Vaccine Preventable Ds
• Threats of bioterrorism (and Anthrax attack)
• Foodborne disease outbreaks (picnics, potlucks,
  peppers and peanuts)
• Threat of pandemic influenza

9
Communicable Disease Prevention/Intervention

• The prevention of individual cases and outbreaks
  of communicable diseases in general relies on
  labor intensive direct intervention and outbreak
  management, which in turn depends on the rapid
  transmission of clinical, laboratory and
  population (epidemiologic) information.

10
Classic Direct Intervention Model

• Receipt of report (laboratory/physician)
• Confirmation of diagnosis/ history
• Patient interview(s)
• Contact follow-up/medical evaluation and
  management
• Epidemiologic analysis
• Prophylactic/therapeutic treatment
• Interview of infected contacts

11
Outbreak Management

• Surveillance (active)
• Ongoing outbreak analysis
• Interview/investigation of new cases
• Mass clinics (RX or vaccination)?
• Isolation and quarantine?
• Other strategies
• And follow-up to be sure the job is done!

12
Meningococcal Meningitis

• Fatality rate 8-15
• Spread by direct contact
• Incubation period 2-10 (us. 3-4 days)
• Usual diagnosis by culture of sterile site
• Vaccine for some strains
• Prophylaxis available

13
Classic and Current Intervention Model

• Patient presentation/clinical impression
• Culture/sterile site (48 hours)
• Fax laboratory report to PH (2-10 days)
• Confirm diagnosis (2-3 days)
• Initiate PH intervention
• Engage local partners
• ET/ clinical dx-intervention 6-15 days

14
Improved Intervention Model (Health Infonet)

• Patient presentation/clinical impression
• PCR/DNA sequencing (2-4 hours)
• Electronic laboratory report (0-8 hours)
• Confirm diagnosis (2-3 days)
• Engage local partners (concurrent)
• ET/clinical dx-intervention 2-31/2 days

15
Health Infonet and Privacy

• The disease/condition reporting rules are
  unchanged
• Statute compliance is enhanced
• Data transmission is secure
• Data files are electronic
• User access is controlled

16
Syndromic Surveillance/Aberration Detection

• Does NOT require patient identifiers
• Uses common definitions for syndromes
• Counts are routed from hospital databases (8-12
  hours)
• Aberrations are identified through statistical
  algorithms
• Value for BT, flu outbreaks, asthma, chemical
  exposures,
• Variable thresholds

17
Use of Longitudinal Data

• Future Applications
• Consistent with Infonet partners
• Again, de-identified data
• Accumulate or query database
• Applied research
• Identify emerging issues
• Monitor trends
• Translate the evidence into efficient/effective
  state/local (national) interventions/programs

18
The best way to keep pace with progress in Public
Health Informatics is to be ahead of it!!
SO .. LETS TALK
11/14/2009
18
19
(No Transcript)
20
Maine Public Health Privacy Law

• Barbara G. Shaw, J.D.
• Senior Policy Analyst
• Institute for Health Policy
• Muskie School of Public Service

21
HIPAA Public Health Exemption

• HIPAA Privacy Rule provides that protected health
  information (PHI) shall not be disclosed without
  written authorization of the individual who is
  the subject of the information
• Public Health Exemption to the Privacy Rule
  allows covered entities to disclose PHI without
  authorization for public health purposes
• Must be public health authority
• for purpose of preventing or controlling
  disease, injury or disability for surveillance,
  investigation and interventions
• Also to a person at risk of contracting or
  spreading a diease or condition if other law
  authorizes the covered entity to notify such
  individuals.
• Authorized mandated (required) as well as
  permitted

22
Maine Public Health Exemption

• Maine privacy law 22 M.R.S.A. 1711-C
  confidentiality of health care information
• 1711-C(6)(E) provides exception for disclosure
  without authorization to federal, state or local
  government entities in order to protect the
  public health and welfare when reporting is
  required or authorized by law or to report a
  suspected crime against the health care
  practitioner or facility
• Required by law example notifiable diseases,
  cancer
• Authorized by law asthma surveillance

23
Public Health Privacy Standards for different
kinds of data

• Confidentiality provisions for infectious disease
  reporting
• 22 M.R.S.A. 824
• Information must be kept confidential
• Various exceptions (adult or child protection,
  public health officials, schools)
• Exceptions during public health threat or
  emergency
• Specific disease/health condition reporting -
  mandated
• - disease registries (cancer, birth defects)
• - occupational diseases
• - clinical occurrence/environmental exposures
  abortion/miscarriage
• metabolic abnormalities, newborn hearing
• childhood lead
• Health databases vital statistics
• Maine Health Data Organization

24
Results

• Different confidentiality standards for each
  health database
• Separate regulations to interpret and implement
  the confidentiality statutes
• Barriers for internal data sharing within MCDC
  and communication with
• external requests for info (research)

25
Challenges Maine Law

• Multiple confidentiality statutes and regulations
  in Maine public health law some more
  restrictive than 1711- C require
• One size fits all approach will not workdata
  has variable sensitivity
• But need consistency and uniform policy so that
  data of equivalent sensitivity is treated in a
  like manner

26
Challenges -HIPAA

• Provider confusion about public health exemption
  and HIPAA requirement
• HIPAA Privacy Rule does not require reporting
  (still governed by state laws) but Privacy Rule
  is not an obstacle to reporting
• PH exemption is broader than mandated reporting
  laws
• Address gaps in HIPAA Privacy Rule by clarifying
  uses of protected health information used for
  secondary or tertiary purposes.
• Logging public health disclosures

27
Challenges For Electronic Record Environment

• Consider additional security measures for
  categories of protected health information
  requiring heightened confidentiality standards
• Need for PHI privacy rules regarding public
  health information, including fair information
  practices (individual access to public health
  information). MCDC Privacy Policy is a start for
  this process
• Maintaining the public trust appropriate
  penalties
• for privacy, confidentiality breaches and
  discrimination protection based on misuse of
  protected health information