National Center for Chronic Disease Prevention and Health Promotion
Volume 14 • Number 2 • Spring/Summer 2001

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What Is Public Health Informatics All About?

Consider the name Informatics. With the possible exception of internal medicine, has ever a health-related discipline been lumbered with so inexpressive, so unexciting a label? We know what surgeons do, or proctologists, or biochemists, but informaticians?”

– Milton Corn, M.D., Computing

Public health systems have improved people's health and longevity in the last two centuries by creating safer water and sewage disposal systems, controlling disease-bearing insects and rodents, immunizing large populations, responding quickly to disease outbreaks, and establishing and enforcing safe food processing and handling practices. Implementing these kinds of public health improvements depends on having accurate, comparable, and timely information, so the public health system's ability to collect, analyze, use, and communicate health-related information is critically important. Enter the field of public health informatics, a broad and interdisciplinary science that promotes the sharing and use of health information. 

Informatics has been used in the medical field for about 30 years, but the public health community has embraced it only recently. Since the early 1990s, CDC has been working with other federal health agencies, state and local governments, professional associations, and the health care informatics community to advance its use. Examples of informatics activities include integration (linking together a wide variety of surveillance activities), standardization (developing and using detailed standards for data elements required to support public health surveillance), and information dissemination (using the Internet to dynamically generate and disseminate information). Each of these strategies improves the timeliness, completeness, and accessibility of public health data.

Computer technology gives us the tools to develop and implement systems— informatics addresses such issues as the impact computerization will have on data collection, analysis, information dissemination, and communication, and even on our understanding of public health issues. The use of the Internet is an example of how informatics differs from computer science. Internet technology is a powerful tool, but informatics specialists must be employed in deciding how this tool should be used to better meet the goals of public health. “The application of public health informatics is essential for developing, evaluating, and implementing new public health surveillance and information systems and for adapting and supporting existing ones,” said CDC epidemiologist Amy Zlot, MPH. She describes some examples, as well as the challenges, of public health informatics as

• Accessing and using nontraditional and diverse sources of data for public health surveillance. In addition to health-related data, these might include administrative, law enforcement, transportation, and workforce data.
• Improving the timeliness and quality of data while also reducing the burden of collecting data.
• Ensuring the privacy and confidentiality of information about individuals. 

The public health informatics community is working with national and global organizations to develop standards for diverse sources. Data standards are needed for identifiers, diagnostic codes, procedure codes, and medical vocabularies. Standard data formats and protocols must be developed for collecting and transmitting data. Opportunities exist to link a wide variety of surveillance data and to integrate information systems activities. Such informatics undertakings can improve the timeliness and quality of data and reduce the burden of collecting data by discouraging the development of isolated, stand-alone systems. 

“I like to think of public health informatics as more than the sum of its parts,” said Ms. Zlot, discussing why people often have difficulty understanding what it involves and why it is important. She explained that public health informatics combines various disciplines— public health science, computer science, information technology, cognitive science, education, management, economics, and even political science and anthropology— to ensure that public health data are easy to access, analyze, and communicate, and are used appropriately. 

Timothy J. Carney, MPH, an informatics specialist at CDC, says that even though the field is often associated with applications and programs, packages, or tools, it actually encompasses a larger process of what he calls the “data progression pathway.” This pathway represents the process of moving from data to information, information to knowledge, knowledge to decisions, and decisions to outcomes. 

“The movement along this pathway, whether by individuals or organizations, gives rise to many actions that create a juncture between the business process and information technology. It is at this juncture of the technology and the processes that we find informatics. Informatics examines ways that information technology can be used to improve business processes that will more efficiently and effectively meet the organization's missions goals, and objectives.” 

Examples of Applied Public Health Informatics
Informatics was brought to bear on a public health policy issue when the Office of Management and Budget (OMB) revised Directive 15, which defines standards for federal statistics and reporting on race and ethnicity, to reflect the growing multiracial population in the United States. The revised Directive includes new categories for race and ethnicity and allows individuals to check more than one racial category. Users will be able to more accurately indicate their racial and ethnic background(s), but researchers may find it challenging to compare new surveillance data on race and ethnicity with those collected in previous years. A public health informatics perspective includes understanding the impact that collecting and reporting racial and ethnic data will have on public health information and surveillance systems. Therefore, informatics specialists are involved in studying how surveillance systems are implementing the new OMB Directive 15 on race and ethnicity. 

Informatics is being used at the national level to streamline the health care administration process and protect confidential health care information under the Health Insurance Portability and Accountability Act (HIPAA). CDC's strategies in this area include adopting or creating standards for collecting, managing, analyzing, accessing, and disseminating information. 

Although the methods for conducting public health surveillance may differ considerably by program and disease, surveillance activities share many common practices. The National Electronic Disease Surveillance System (NEDSS) was created to electronically integrate and link public health surveillance activities. Upon its completion, NEDSS will include data standards, an Internet-based communications infrastructure built on industry standards, and policy-level agreements on data access, sharing, burden reduction, and confidentiality protection. 

Components of NEDSS include 

• CIPHER (Common Information for Public Health Electronic Reporting)— detailed standards for data elements.
• Public Health Conceptual Data Model (PHCDM)—a framework for organizing data standards and guide-lines.
• User interface guide—for Windows and Web-based applications.
• Secure Data Network (SDN)—to exchange sensitive data over the Internet.

NCCDPHP's Pregnancy and Pediatric Nutrition Surveillance Systems were pilot projects for the Secure Data Network. These systems will enhance the collection and application of pregnancy and pediatric nutrition surveillance information through electronic data transfer using the secure network. 

The field of informatics also promotes better access to information. The Internet has been a very effective tool for disseminating information, and more specifically, interactive Web sites have enabled users to customize how the data are displayed. For example, the growing use of NCCDPHP's Behavioral Risk Factor Surveillance System (BRFSS) Web site shows the need to access dynamically driven data over the Internet. Users are allowed to query the system by indicator (i.e., diabetes, exercise, nutrition), by demographic category (i.e., age race, sex), and by year. Since 1998, when the dynamic portion of BRFSS was added, the number of hits the site receives has increased from 300 per month to more than 7,000 per month. 

In addition, an informatics approach can facilitate information sharing and improve knowledge about programs within NCCDPHP. Systems are being developed that capture a wide range of information about prevention programs and research activities. For example, the Diabetes Management Information System enables project officers to share information about objectives, target populations, progress reports, and collaborations, as well as other activities. The system will provide a systematic method of collecting information from individual diabetes control programs and standardize the content of this information. Other systems are also being developed to capture information on research programs. These systems will record and organize research findings as well as any evidence showing how these findings contributed to changes in public health policy and practice. Users worldwide will be able to submit customized queries and retrieve information that is relevant for guiding their work. Informatics promotes the use of these tools and helps to develop, document, and evaluate systems that can support our public health programs. 

For more information about the NCCDPHP informatics initiatives, contact Amy Zlot at azlot@cdc.gov, or Tim Carney at tcarney@cdc.gov, or call 770/ 488-5700.

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