Advancing Occupational Safety & Health Management SystemHigh-Performance Work Systems in Occupational Health Management

Arash Jalali, MPH, MSHI

Christopher M Bell, MSHI, CAPM, CHTS-IM

UI Health Introduction

Define Biomedical and Health Informatics & Geovisualization

UHS Current System Workflow

UHS Proposed System Workflow

UHS Predictive Analytics Demo

– 495-bed hospital

– Outpatient Care Clinic

– Numerous Specialty Clinics

– Seven Health Science

Colleges

University of Illinois Mission

• Deliver personalized health in pursuit of

the elimination of racial and ethnic

health disparities

• Train professionals in a wide range of

public service disciplines serving Illinois

as the principal educator of health-

science professionals and as a major

health-care provider to the underserved

“Develop an information technology and informatics capability to enable real-time situational awareness regarding progress toward Workforce Health Protection StrategyDevelopment. That includes improved communication and information sharing among health, safety, and medical activities, fostering a more cohesive environment for workforce health protection to support mission readiness” (IOM, 2014)

IOM (Institute of Medicine). 2014. Advancing workforce health at the Department of Homeland Security: Protecting those who protect us. Washington, DC: The National Academies Press.

Fundamental Theorem of Biomedical Informatics

Friedman, C. P. (2009). A “fundamental theorem” of biomedical informatics. Journal of the American Medical Informatics Association, 16(2), 169-170.

Friedman, C. P. (2012). What informatics is and isn't. Journal of the American Medical Informatics Association, amiajnl-2012.

Hunter, J. S. (2010). Letters: Enhancing Friedman's “Fundamental Theorem of Biomedical Informatics”. Journal of the American Medical Informatics Association: JAMIA, 17(1), 112.

Fundamental Theorem of Biomedical Informatics

1. Informatics is more about people than technology

2. In order for the theorem to hold, the resource must offer something that the person does not already know

3. Whether the theorem holds depends on an interaction between person and resource, the results of which cannot be predicted in advance

“Fundamental Theorem is accompanied by three corollaries:

Scientific method: the cycle of conjecture or hypothesis, experiment, data, analysis, and thence to new conjecture persists within fundamental theorem.”

Friedman, C. P. (2012). What informatics is and isn't. Journal of the American Medical Informatics Association, amiajnl-2012.

Informatics isn't:

“Scientists or clinicians tinkering with computers: ‘Tinkerers’ are wonderful and the world needs them. They have terrific ideas, but typically, because ‘tinkerers’ lack formal training in the basic informational sciences, what they develop is not scalable or usable by anyone other than the developer him/herself.

Analysis of large datasets per se: It has been said that all epidemiologists are informaticians because they carry out statistical analyses using information technology. Epidemiologists and others who perform large-scale analytics do vital research essential to public health, but they use information technology strictly as a tool.”

(Friedman, 2012)

Friedman, C. P. (2012). What informatics is and isn't. Journal of the American Medical Informatics Association, amiajnl-2012.

Informatics isn't:

“Circumscribed roles related to deployment and configuration of electronic health records in pursuit of meaningful use: The workforce education program developed through the Office of the National Coordinator for Health IT envisioned 12 health IT workforce roles. Most of these roles—for example, configuration or technical support specialists—operate exclusively at one level of the ‘tower of achievement’ and, as such, do not meet the criteria advanced here to allow the label informatics to be attached to them.” (Friedman, 2012)

Friedman, C. P. (2012). What informatics is and isn't. Journal of the American Medical Informatics Association, amiajnl-2012.

Informatics isn't:

“The profession of health information management: This important profession evolved from the profession of medical records management. It is a profession, in and of itself, with its own culture. Rank and file health information management professionals are informed users of technology but not scientifically-trained developers or explorers of its consequences. It follows that educational programs preparing students for careers as health information management professionals are not educational programs in informatics.

Anything done using a computer: This increasingly frequent misuse of informatics almost requires no elaboration. It reflects the same fundamental confusion between a tool and a field of human endeavor.” (Friedman, 2012)

Biomedical and health informatics (BMHI)

"Biomedical and health informatics (BMHI) is the science of using data and information, often aided by technology, to improve individual health, health care, public health, and biomedical research." (Hersh, 2009)

Hersh, W. (2009). A stimulus to define informatics and health information technology. BMC Medical Informatics and Decision Making, 9(1), 24.

Hersh, W. (2009). A stimulus to define informatics and health information technology. BMC Medical Informatics and Decision Making, 9(1), 24.

Public Health Informatics

“Public health informatics differs from other informatics specialties in that it involves:

1. The focus of public health informatics is on applications of information science and technology that promote the health of populations as opposed to the health of specific individuals.

2. A focus on disease prevention, rather than treatment;

• Public health informatics is on applications of informatics science and technology that prevent disease and injury by altering the conditions or the environment that put populations of individuals at risk.”

(Magnuson & O’Carroll, 2014)

Source: Magnuson, J. A., & Fu, P. C. (2014). Public Health Informatics and Information Systems. Springer London. URL: http://link.springer.com/book/10.1007/978-1-4471-4237-9

3. “A focus on preventive intervention at all vulnerable points in the causal chains leading to disease, injury, or disability.

• Public health informatics applications explore the potential for prevention at all vulnerable points in the causal chains leading to disease, injury, or disability; applications are not restricted to particular social, behavioral, or environmental contexts.”

(Magnuson & O’Carroll, 2014)

Source: Magnuson, J. A., & Fu, P. C. (2014). Public Health Informatics and Information Systems. Springer London. URL: http://link.springer.com/book/10.1007/978-1-4471-4237-9

4. “Operation typically within a governmental, rather than a private, context.

• As a discipline, public health informatics reflects the governmental context in which public health is practiced. Much of public health operates through government agencies that require direct responsiveness to legislative, regulatory, and policy directives; careful balancing of competing priorities; and open disclosure of all activities.”

(Magnuson & O’Carroll, 2014)

Source: Magnuson, J. A., & Fu, P. C. (2014). Public Health Informatics and Information Systems. Springer London. URL: http://link.springer.com/book/10.1007/978-1-4471-4237-9

Visual Analytics & Geovisualization

Visual analytics

“Visual analytics is the science of analytical reasoning facilitated by interactive visual interfaces. People use visual analytics tools and techniques to synthesize information and derive insight from massive, dynamic, ambiguous, and often conflicting data; detect the expected and discover the unexpected; provide timely, defensible, and understandable assessments; and communicate assessment effectively for action.”

(James & Cook, 2005)

Source: Thomas, James J., and Kristin A. Cook, eds. Illuminating the path: The research and development agenda for visual analytics. IEEE Computer Society Press, 2005. http://vis.pnnl.gov/pdf/RD_Agenda_VisualAnalytics.pdf

Visual analytics

“Visual analytics is a multidisciplinary field that includes the following focus areas:• Analytical reasoning techniques that enable users to obtain deep insights that

directly support assessment, planning, and decision making

• Visual representations and interaction techniques that take advantage of the human eye’s broad bandwidth pathway into the mind to allow users to see, explore, and understand large amounts of information at once.”

(James & Cook, 2005)

Source: Thomas, James J., and Kristin A. Cook, eds. Illuminating the path: The research and development agenda for visual analytics. IEEE Computer Society Press, 2005. http://vis.pnnl.gov/pdf/RD_Agenda_VisualAnalytics.pdf

Visual analytics

• “Data representations and transformations that convert all types of conflicting and dynamic data in ways that support visualization and analysis

• Techniques to support production, presentation, and dissemination of the results of an analysis to communicate information in the appropriate context to a variety of audiences.”

(James & Cook, 2005)

Source: Thomas, James J., and Kristin A. Cook, eds. Illuminating the path: The research and development agenda for visual analytics. IEEE Computer Society Press, 2005. http://vis.pnnl.gov/pdf/RD_Agenda_VisualAnalytics.pdf

Geovisualization

“Geovisualization, or geographic visualization, is an approach and a process through which maps and graphics are used to gain insight from geographic information. An emerging field within geographic information science, it focuses on using dynamic and interactive graphics to generate ideas from digital data sets but is loosely bounded due to the multitude of disciplines that contribute to this aim and uses to which such activity can be put. Geovisualization embraces a whole range of exciting, impressive, novel, and sometimes bizarre graphics to try and help those involved in data analysis “see into” their data.”

(Kemp, 2008)

Source: Kemp, K. (Ed.). (2008). Encyclopedia of geographic information science. Sage.

Public Health Geovisualization

Health Data Geovisualization

Source: NorthShore University HealthSystem (2014). Syndromic Surveillance Across the NorthShore Population.URL: http://fad.northshore.org/wga/WGAPublic.aspx

Health Data Geovisualization

Source: NorthShore University HealthSystem (2014). Syndromic Surveillance Across the NorthShore Population. URL: http://fad.northshore.org/wga/WGAPublic.aspx

Health Data Geovisualization

Source: Chicago Health Atlas (2014). Browse by neighborhood. URL: http://www.chicagohealthatlas.org/

Health Data Geovisualization

Source: Chicago Health Atlas (2014). Browse by neighborhood. URL: http://www.chicagohealthatlas.org/

Epi Info™

“Epi Info™ is a data collection, management, analysis, visualization, and reporting software for public health professionals. It is used worldwide for the rapid assessment of disease outbreaks; for the development of small to mid-sized disease surveillance systems; as ad hoc components integrated with other large scale or enterprise-wide public health information systems; and in the continuous education of public health professionals learning the science of epidemiology, tools, and techniques.

Epi Info™ is a trademark of the Centers for Disease Control and Prevention (CDC). The software is in the public domain and freely available for use, copying translation and distribution.”

(CDC, 2014)

Source: CDC (2014). What is Epi Info URL: http://wwwn.cdc.gov/epiinfo/

Smarter Public Health Prevention System (SPHPS)

Source: Chen, B. (2014). Simplifying the Bull: How Picasso Helps to Teach Apple’s Style: Inside Apple’s Internal Training Program. URL: http://www.nytimes.com/2014/08/11/technology/-inside-apples-internal-training-program-.html

Create Forms

• Data CollectionEnter Data

• Data Analysis & Spatial Analytics

Analyze Data

• Geo-Visualization: Dynamic Mapping & Visualization

Create Maps

• Mobile Survey (Qualtrics)

Create Forms / Enter Data

• Data Analysis & Spatial Analytics (IBM SPSS & ESRI ArcGIS)

Analyze Data

• Geo-Visualization: Dynamic Mapping & Visualization (ESRI ArcGIS)

Create Maps

Jalali, A., Olabode, O. A., & Bell, C. M. (2012). Leveraging Cloud Computing to Address Public Health Disparities: An Analysis of the SPHPS. Online journal of public health informatics, 4(3).

The Smarter Public Health Prevention System (SPHPS) will securely incorporate population centric view and patient centric view to form a cloud-knowledge discovery environment to drive knowledge based decisions.

Jalali, A., Olabode, O. A., & Bell, C. M. (2012). Leveraging Cloud Computing to Address Public Health Disparities: An Analysis of the SPHPS. Online journal of public health informatics, 4(3).

The Smarter Public Health Prevention System (SPHPS) theory proposes that the gravitational force between two objects, Population Health and Patient-Centered Care, is Workforce Health Protection or Occupational Health.

Integrated Employee Health System:

“An infrastructure that would support all health system employee health activities; provide a way to link information about all aspects of the health of employees; and make this information available to leadership at all levels for the purposes of decision making, accountability, continuous improvement, surveillance, and other questions related to health.” (IOM, 2014)

IOM (Institute of Medicine). 2014. Advancing workforce health at the Department of Homeland Security: Protecting those who protect us. Washington, DC: The National Academies Press.

UHS Current System Workflow

UHS Proposed System Workflow

UHS Predictive Analytics Demo

Current System Workflow:

“Paper Persistence”

Harrison, M. I., Koppel, R., & Bar-Lev, S. (2007). Unintended consequences of information technologies in health care—an interactive sociotechnical analysis. Journal of the American Medical Informatics Association, 14(5), 542-549.

Last updated in 2011

Report submission

is unsecure via email

Need to print,

complete, sign, scan . .

Data captured through first report of injury/illness form is via a paper-based sources.

Proposed System Workflow:

Data-Driven Decision-Making

Centers for Disease Control and Prevention. CDC’s Vision for Public Health Surveillance in the 21st Century. MMWR 2012;61(Suppl; July 27, 2012): 1-42

Public Health Surveillance in The Larger Context of Health Knowledge

Tolentino, H. (2012). Problem Solving Framework for Public Health Informatics. American Medical Informatics Association Annual Symposium, Panel Discussion, Date of Presentation: November 7, 2012.

Plan

Capture

Manage

Analyze

Use

Evaluate

• Storage/Retrieval• Transformation• Exchange• Protection• Integration

• Visualization• Classification• Aggregation, linkage• Knowledge representation

• Organizational context• Information needs• Change management issues• Resources (financing, workforce)• Information systems architecture

• Capture Methods• Data Types & Formats• Data Standards• Data Quality

• Process• Outputs• Outcomes• Impact

Information Value Cycle

DATA

INFORMATIONKNOWLEDGE

ACTION

Adapted from Taylor, R. S. (1982). Value-added processes in the information life cycle. Journal of the American Society for Information Science, 33, 341-346.

Improving our informatics capabilities "enables evidence-based decision making, surveillance, accountability, and continuous quality improvement" (IOM, 2014)

IOM (Institute of Medicine). 2014. Advancing workforce health at the Department of Homeland Security: Protecting those who protect us. Washington, DC: The National Academies Press.

Qualtrics "is high risk

data, such as HIPAA,

compliant, thus the

data is secure."

Electronic data capture

For first report of

injury/illness report

via Qualtrics

Perform predictive analytics

on UIC hosted servers

Operational Dashboard

Provide real-time health

performance metrics to

leadership via visual analytics

Electronic data capture

For first report of

injury/illness report

via Qualtrics

Performing predictive analytics

ESRI Operational Dashboard

Provide real-time health

performance metrics to

leadership via visual analytics

IBM SPSS Modeler

Cerner PowerInsight

Enterprise Data Warehouse

Enterprise Data Delivery

Information Environment (EDDIE)

Cerner - Integrated Employee Health System

Predictive Analytics (Text Analytics) Demo:

Improved Employee Health Outcomes & Optimize Decisions

Making with GIS (Geographic Information

Systems)

Mapping Total Reported InjuryWithout Data Preparation

IBM SPSS Modeler Text Analytics 16 Data Preparation (Example Stream)

IBM SPSS Modeler Text Analytics 16 (Key Concepts for Injury Into Five Categories)

2013- Measuring Geographic Distribution (Mean Center)

2013- Mapping Clusters (Optimized Hot Spot Analysis)

Mapping Total Reported Injury Counts -2013

“mere collection of data is not enough; the data must be aggregated, analyzed, and used to monitor the effects ofthe program and enable continuous improvement” (IOM, 2014)

IOM (Institute of Medicine). 2014. Advancing workforce health at the Department of Homeland Security: Protecting those who protect us. Washington, DC: The National Academies Press.

Garman, A. N., McAlearney, A. S., Harrison, M. I., Song, P. H., & McHugh, M. (2011). High-performance work systems in health care management, Part 1: Development of an evidence-informed model. Health care management review,36(3), 201-213.

Empowering The Frontline

“The effect of team outcomes has also been documented in several health care–specific studies. One study found a significant association between the level of team participation and safety outcome including whether respondents reported seeing harmful errors or near-misses or experienced work-related injuries, occupational stress.”

(Garman et al., 2011)