Public Health in the 21st Century

John R. Lumpkin, MD, MPH

Illinois Department of Public Health

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”

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

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

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

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

The Goal of Health Practice is to Make the Right Decisionsat the Right Time

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

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

We received a clear message from many parties

and diverse interests!

Federal Leadership is essential, wanted and

HHS should be it.

NHII

COMMUNITY

CAREGIVERPERSONAL

PMRI Standards

. . . compatible with . . . compatible with other HIPAA standardsother HIPAA standards

Financial &

Administrative

Interoperability

Comparability

Dat

a Q

ualit

y

Privacy &SecurityPMRI

PMRI

n More easily & accurately exchange PMRI between systems

n Better understand PMRI across systems

Objectives of PMRI Report

Inflamed Ear

? Rx

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

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

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

Issues

n Time for market acceptance leads to standards based on older conceptual models

n Need to accelerate development and early adoption of standards

Guidance vs Mandate

n Guidance to Industry

n Adoption by HHS and other federal organizationsu Example

u incentive

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

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

-CHRISTINE GEBBIE

SNOW AND CHOLERA

n DATABASE ANALYSIS

n GIS SYSTEM

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

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

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

Terrorism in America

September 11th

Common conveyance

Uncommon Use

Oct - Anthrax

Uncommon Organism

Use???

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

Data Generation

DataCollection

Data Analysis

Outbreak Investigation

Outbreak Management

Recovery -Normalization

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

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

PMRI Standards

. . . compatible with . . . compatible with other HIPAA standardsother HIPAA standards

Financial &

Administrative

Interoperability

Comparability

Dat

a Q

ualit

y

Privacy &SecurityPMRI

PMRI

NHII

COMMUNITY

CAREGIVERPERSONAL