public health in the 21st century - global health …public health in the 21st century john r....
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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
n “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 facen “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
n Helping people stay healthy
n Helping people get better when they are ill
n Helping people live with illness when their illness is chronic
n 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
n Collection of Datau Physical Exam
u Lab
n Data with analysis is Informationu rales, abn chest x-ray
n Information in context with rulesu bacterial pneumonia treat with
Antibiotics
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1974 - Kerr WhiteChairman NCVHS
n “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
n Privacy Protections
n Standards
n Quality standards for On-line information
n Technology
u security
u data entryn Costs
n Attitudes and practices (confidence)
n Equity
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HHS Agencies with NHII Responsibilities
n AHRQ
n ASIRM
n ASPE
n CDC
n CMS
n Data Council
n FDA
n HRSA
n NCHS
n NIH
n NLM
n OCR
n 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
COMMUNITY
CAREGIVERPERSONAL
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PMRI Standards
. . . compatible with . . . compatible with other HIPAA standardsother HIPAA standards
Financial &
Administrative
Interoperability
Comparability
Dat
a Q
ualit
y
Privacy &SecurityPMRI
PMRI
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n More easily & accurately exchange PMRI between systems
n Better understand PMRI across systems
Objectives of PMRI Report
Inflamed Ear
? Rx
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Benefits of PMRI Standards
n Support patient care
n Improve quality of care
n Measure outcomes
n Advance public health
n Enhance efficiency
n Facilitate reimbursement
Health Care
444
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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
n Degree of market penetration
n Extent that standard enables interoperability
n Ability to facilitate comparability
n Support of uData quality
u Accountability
u Integrity
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Issues
n Time for market acceptance leads to standards based on older conceptual models
n Need to accelerate development and early adoption of standards
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Guidance vs Mandate
n Guidance to Industry
n Adoption by HHS and other federal organizationsu Example
u incentive
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Recommendations
n HL7 – recognized as core PMRI standard
n Recognize standards for specific market segmentsuDICOM
uNCPDP SCRIPT
u IEEE 1073
n 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
n DATABASE ANALYSIS
n GIS SYSTEM
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E Coli in Hamburger
n Reports to the state
n HD staff evaluate to determine pattern
n Samples collected
n PFGE run
n Additional samples collected
n Process can take weeks sometimes
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How it could workn Pt refers to home system about diarrhean Physician Identifies Patient with bloody diarrhean Positive for E. Coli 0157:H7n Electronic Notification of PH systemn Outbreak identifiedn Home and Providers systems notifiedn Additional cases allow rapid identification of source
and recall occurs
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How it worked in 1997-1998 Decatur ILn Nov Death due to Invasive Group
A strep
n Nov- Jan 9 other deaths
n 2 Nursing Homesu Patients
u Staff
u Visitors
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Terrorism in America
September 11th
Common conveyance
Uncommon Use
Oct - Anthrax
Uncommon Organism
Use???
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Biological Terrorism:Biological Terrorism:A New Trend?A New Trend?
nn 1984:1984: Oregon Oregon --SalmonellaSalmonella sprayed on sprayed on salad barssalad bars
nn 1994:1994: Tokyo Tokyo -- Sarin and biological Sarin and biological attacksattacks
nn 1996:1996: Dallas Dallas –– ShigellaShigella--contaminated contaminated muffins and doughnutsmuffins and doughnuts
nn 1998:1998: NationNation--wide wide -- anthrax hoaxesanthrax hoaxes
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Data Generation
DataCollection
Data Analysis
Outbreak Investigation
Outbreak Management
Recovery -Normalization
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0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Incubation Period)
Dis
ease
Det
ectio
n
Impact of Surveillance on Survivability
Time
Nu
mb
er D
ead
Animal or Human Indicators
105
(Linear)
Victims Directly Exposed
= 0
Fatalities WithEarly Warning
and an InformedPublic Health
Response
Fatalities With TraditionalPublic Health Response
Effective Treatment Period
Surveillance Traditional DiseaseDetection
Phase IIAcute Illness
Phase IInitial Symptoms
t
Modified from chart developed by Hopkins Bioterrorism Center
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OBSTACLES TO PUBLIC HEALTH SYSTEM PERFORMANCE
n COST OF DATA CAPTURE
n INABILITY TO LINKu SPACE
u TIME
u ACROSS PROGRAMS
n DISCONNECT BETWEEN KNOWLEDGE AND SERVICE DELIVERY
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PMRI Standards
. . . compatible with . . . compatible with other HIPAA standardsother HIPAA standards
Financial &
Administrative
Interoperability
Comparability
Dat
a Q
ualit
y
Privacy &SecurityPMRI
PMRI
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NHII
COMMUNITY
CAREGIVERPERSONAL
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