The systematic application of computer science, information, and technology to the realms of public health, learning, and research is referred to as public health informatics. This area of study contains the principles that define, describe, guide, and serve as a creation of a framework for the types of challenges and activities within this field of study. It is important to note that public health is different from that of healthcare within a healthcare setting as it deals with the overall health of the given population or community, as opposed to the specific addressing of health issues for those who seek out treatment for specific ailments or illnesses. Understanding the difference between the two, and how information technology is applied within this realm is the first step in understanding the new world of medicine in existence today.
Patients who are being treated for a particular illness may be placed in quarantine if they have either a deadly or a highly communicable disease within a healthcare setting, while the education and prevention of the spread of that disease within the general public would fall under the domain of public health. In this manner, both actions work to prevent the further spread of a given illness. Environmental factors, including automobile safety and water and air quality would fall under the purview of public health, as an additional example (Yasnoff, O’Carroll, Koo, Linkins, & Kilbourne, 2000).
The second principle of public health looks at the prevention of disease and or injury through the modification of the conditions present within the environment of the general population that serve to put that population at risk. Public health works to prevent damages and or infections as opposed to healthcare within a healthcare setting, a practice that is designed to treat the condition following its initial occurrence. The third principle investigates the various methods of prevention that may be taken at each step in the process that may result in disease, disability and or injury. The preventative interventions designed by public health initiatives are based on their level of expediency, efficacy, cost, effectiveness, and level of social acceptability. A public health initiative that is low cost and effective, for example, would have a decreased effect when compared to one that is easily implemented and acceptable on a social level as well, for example. Examples of public health initiatives include legislative mandates regarding standards for housing and building codes, solid waste and greywater disposal systems, wastewater treatment plants, the mandate of smoke alarms and fire systems within commercial buildings, the fluoridation of a municipal water supply, and the removal of lead from gasoline due to the health issues that the breathing of the fumes caused. While some clinical and surgical encounters fall under the domain of public health measures, such as those associated with preventative care, the majority of clinical and surgical encounters would, on the other hand, fall under healthcare within a healthcare setting as they are designed to treat a preexisting condition. Vaccinations fall under the heading of public health as, while not mandatory in all areas, these actions work to ensure that the majority of children and infants in the U.S. are protected from contracting various diseases, ranging from measles, mumps, and rubella to chicken pox (Centers for Disease Control and Prevention, 2014).
The fourth, and final principle, allows for an understanding of the governmental context of public health initiatives. The majority of public health initiatives are employed through various governmental agencies and it is through these agencies that responses are provided to legislative, regulatory, and policy dictates. These mandates work to balance the priorities of society as a whole while at the same time taking into account the specific needs of a given community, enabling the agency to work to protect the community as effectively as possible within the context of a given emergency. Examples may include the shutting down of a restaurant that has been shown to cause food poisoning due to the improper storage or cooking of food; recalls on medications, like aspirin, when a particular batch has shown to cause sickness instead of aiding in health improvements; recalls on food wherein that food has been shown to cause illness; and even the closing off of a given body of water, such as a community pool, when improper treatment has allowed for the spread of bacteria.
The principles that define public health are those that likewise govern public health informatics. To assess the health risks and status of a given population, it is the responsibility of investigators to collect as much information as possible on the given issue of public health. This may include collecting information from hospitals, doctors, social service agencies, site investigations, and population surveys; all of which must be wholly accurate and analyzed in such a way as to provide a direct course of action for the members of public health, allowing for a determination as to what must be done to work to address the given threat to the community. All data must be legible, easy to understand, and appropriately analyzed, while at the same time ensuring that all patient privacy data is protected. This matter is further compounded as a result of a lack of standardization during the process and a lack of standardization between the processes present in different groups working to advocate for the public health. Coding systems and standards currently in place did not take into account the needs of an ever growing population when they were implemented, and do not take into account the need to manipulate an ever increasing amount of information. In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was enacted for the purpose of mandating standards for the transmission of patient data, administrative data, and financial data as related to healthcare.
A further obstacle present is the current difficulties and obstacles that are present in the exchange of information that occurs between clinical care and public health; a great deal of the information is provided on handwritten forms that are put into the computer at a later date, creating issues of underreporting of the current state of conditions and diseases affecting a given population, as such reporting is based off of information entered into computer databases, which may be delayed during transcription. Information must be able to flow easily between laboratories, clinical offices, and make its way to the public health system as necessary in the most expedient manner possible. The automated presentation of prevention guidelines does indicate clinical care improvements; however, public health and clinical activities are still not integrated to optimal levels at the level of electronic information sharing and data exchange.
While information exchange may be seen as an issue, it is no secret that it has improved over the years. This is largely as a result of the Health Information Technology for Economic and Clinical Health (HITECH) Act, a mandate that encourages hospitals and other organizations responsible for the provision of healthcare to utilize electronic health records (EHR), thus increasing the expediency of data collection and transfer (Livingood, Coughlin, & Remo, 2010). Through the creation of incentives designed to counteract the high up-front costs that may be present in the transition from paper records to EHRs, the utilization thereof is more likely which in turn works to facilitate the jobs of those within the field of public health (Livingood, Coughlin, & Remo, 2010; Wager, Lee, & Glaser, 2014). Applied EHR systems are typically either not available in other organizations or the records created in one are not compatible to other medical institutions, thus working to increase the overall protection afforded to patients (Menachemi & Collum, 2011).
As technologies continue to advance, the challenges of public health informatics are starting to be addressed; with the implementation of EHRs, the field has been improved dramatically, allowing for increased data exchange between those in clinical care and those in the fields of public health. As a nation, the improvement of public health informatics through the application of technology has served to increase the overall levels of health within the community, allowing for the focus in today’s society to shift from treatment to prevention as a primary form of care.
- Centers for Disease Control and Prevention. (2014, August 20). Protect Your Baby with Immunization. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/features/infantimmunization/
- Livingood, W. C., Coughlin, S., & Remo, R. (2010). Public Health & Electronic Health Information Exchange: A Guide to Local Agency Leadership. Retrieved from http://www.phii.org/
- Menachemi, N., & Collum, T. H. (2011, May 11). Benefits and drawbacks of electronis health record systems. Risk Management and Healthcare Policy, 47-55. Retrieved from http://www.ncbi.nlm.nih.gov
- Wager, K. A., Lee, F. W., & Glaser, J. P. (2014). Health Care Information Systems: A Practical Approach for Health Care Management (3rd ed.). United States of America: Wiley.
- Yasnoff, W. A., O’Carroll, P. W., Koo, D., Linkins, R. W., & Kilbourne, E. M. (2000). Public Health Informatics: Improving and Transforming Public Health in the Information Age. Journal of Public Health Management and Practice.