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Public Health Informatics How Infomration Age Technology Can Strengthen Public Health

Public Health Informatics How Infomration Age Technology Can Strengthen Public Health

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A n n u .
R e v .P u b lic
H e a lth .
1 9 9 5 .
1 6 :2 3 9 -5 2
P U B L IC
H E A L T H
I N F O R M A T I C S :H o w
Inform ation-A ge T echnology C an
S tr e n g th e nP u b lic H e a lth *
A n d r e w
F riede
I n f o r m a t i o n R e s o u r c e s M a n a g e m e n t
O ffice, C entersfor D iseaseC ontroland
P r e v e n t i o n , 1 6 0 0 C l i f t o n R o a dN E ,A t l a n t a , G e o r g i a 3 0 3 3 3
H enrik
L .
B lu m
U n i v e r s i t y o f C a l i f o r n i a , 5 7 0 U n i v e r s i t y H a l l , B e r k e l e y , C a l i f o r n i a 9 4 7 2 0
M ike
M c D o n a ld
2 6 0 0 T e n t h S t r e e t , S u i t e 4 0 0 , B e r k e l e y , C a l i f o r n i a 9 4 7 1 0
KEYW ORDS:
com puters,
c o m m u n ic a tio n s ,
e d u c a tio n ,
in fo rm atics,
p u b l i ch e a l t h ,
in fo rm a tio n
system s,
so ftw are
A B S T R A C T
T h e c o m b in a tio n o f th e b u rg e o n in g in te re s t
in h e a lth ,

health care reform and th e a d v e n t o f th e In fo rm a tio n A g e , re p re s e n ts a c h a lle n g e a n d a n o p p o rtu n ity fo r p u b lic h e a lth .

If p u b lic h e a lth \u2019s
e ffe c tiv e n e s s a n d p ro file
are to grow ,
p ra c titio n e rs a n d re s e a rc h e rs w ill n e e d re lia b le ,
tim ely in fo rm ati6 n w ith w h ich
t o
m akein fo r m a tio n -d r iv e n
d e c is io n s ,
b e tte r
w ays to
c o m m u n i c a t e , a n d i m -
p ro v e d to o ls
t o
analyze and present new know ledge.
"P u b lic H ealth In fo rm atics" (P H I) is
th e s c ie n c e o f a p p ly in g In fo rm a tio n -
A g e te c h n o lo g y to s e rv e th e s p e c ia liz e d n e e d s o f p u b lic h e a lth . In th is
p a p e r
w e d e fin e P u b lic H e a lth In fo rm a tic s , o u tlin e s p e c ific b e n e fits th a t m a ya c c ru e
from its
w id e s p re a d a p p lic a tio n ,
and discuss
w hyand how an academ icdis-
* T h e
U SG o v e r n m e n t
h a s th e rig h tto re ta in a n o n e x c lu s iv e ,
ro y a lty -fre el ic e n s ein a n dto a n y
c o p y rig h t
c o v e rin g
th is p a p e r.
2 3 9
www.annualreviews.org/aronline
Annual Reviews
Annu.Rev.Pu
blic.Health
.1995.16:23
9-252.Downl
oadedfromar
journals.an
nualreviews
.org
byEASTCAROL
INAUNIVERSI
TYon03/20/0
7.Forperson
aluseonly.
2 4 0
F R IE D E , B L U M & M C D O N A L D
c ip lin e
o f p u b lic h e a lth in fo rm a tic s
s h o u ld b e d e v e lo p e d . F in a lly ,
w e m ake
s p e c ific
re c o m m e n d a tio n s
fo r a c tio n s
th a t

g o v e r n m e n t a n d a c a d e m i a c a n t a k e to a s s u re th a t p u b lic h e a lth p ro fe s s io n a ls h a v e th e s y s te m s , to o ls , a n d tra in in g t o

u s e P H Ito a d v a n c e th e m is s io n o f p u b lic h e a lth .
IN T R O D U C T IO N
T h e c o m b in a tio n o f th e b u rg e o n in g in te re s t
i n
h e a lth ,
c o m b in e dw ith h e a lth
care reform and the advent of the Inform ation A ge,represent a challenge and
a n o p p o rtu n ity fo r p u b lic h e a lth .
If p u b lic h e a lth \u2019s e ffe c tiv e n e s s a n d p ro file
a re to g ro w ,p ra c titio n e rs a n d re s e a rc h e rs w ill n e e d re lia b le ,
tim ely in fo rm atio n
w ith w h ic hto
m a k ein fo r m a tio n -d r iv e n d e c is io n s , b e tte r
w a y sto
c o m m u n ic a te ,
a n d im p ro v e d to o ls
to analyze and present
n e w k n o w le d g e .
"P u b lic H ealth In fo rm atics" (P H I) is
th e s c ie n c e o f a p p ly in g In fo rm a tio n -A g e
te c h n o lo g y to s e rv e th e s p e c ia liz e d n e e d s o f p u b lic h e a lth . S y s te m sd e v e lo p e d
w ith P H Ik n o w le d g ec a n h e lp a c o u n ty h e a lth o ffic e s ta ff
u s e s u rv e illa n c e d a ta
to e s tim a te th e n u m b e ro f d o s e s o f m e a s le sv a c c in e n e e d e d fo r a n o u tb re a k ; m a k e
it e a s ie r fo r a re g io n a l p la n n in gc o m m is s io n
to in te g ra te c e n s u s , s u rv e illa n c e , a n d
h o s p ita liz ,a tio n d a ta to p ro je c t th e o c c u p a n c yo f A ID Sh o s p ic eb e d s fo r a c ity , a n d
p re p a rere l~ ite d fu n d in gre q u e s ts fo r th e s ta te le g is la tu re ; a s s is t a n e p id e m io lo g is t

in c o lle c tin g a n d a n a ly z in g d a ta to s tu d y m a ln u tritio n a m o n gh o m e le s sc h ild re n a n d t h e i m p a c to f n u t r i t i o n p r o g r a m si n d i f f e r e n t r e g i o n s o f t h e U S ; a n d f a c i l i t a t e a h e a lth e d u c a to r\u2019s u s e o f m u ltim e d iato c o m m u n ic a te ,

in a c o m p e llin gfa s h io n ,
newknowledgeto professional and lay
a u d ie n c e s .
In 1 9 9 0 , G re e n e s & S h o rtliffe ,
i n
th e
Journal of
th e
A m e r ic a n M e d ic a l
A s s o c ia tio n ,p re s e n te d a n o v e rv ie w o f M e d ic a lIn fo rm a tic s (1 0 ). In th is
p a p e r
w e d e fin e P u b lic H e a lth In fo rm a tic s , o u tlin e
s p e c ific b e n e fits th a t m a ya c c ru e
from its
w id e s p re a d a p p lic a tio n ,
and discuss
w hyand how an academ ic dis-
c ip lin e
o f p u b lic h e a lth
in fo rm atics
s h o u ld b e d e v e lo p e d . F in a lly ,
w em ake
s p e c ific
re c o m m e n d a tio n sf o r a c tio n s
th a t

g o v e r n m e n t a n d a c a d e m i a c a n t a k e to a s s u re th a t p u b lic h e a lth p ro fe s s io n a ls h a v e th e s y s te m s , to o ls , a n d tra in in g to u s e P H I to a d v a n c e th e m is s io n o f p u b lic h e a lth .

W H A TIS
P U B L IC
H E A L T H IN F O R M A T IC S ?
P u b lic H e a lth In fo r m a tic s is th e a p p lic a tio n o f in fo r m a tio n s c ie n c e a n d te c h n o l-
o g y to p u b lic h e a lth p r a c tic e a n d r e s e a r c h .S p e c ific a lly , th is
m e a n sd e v e l o p i n g

in n o v a tiv e w a y sto u s e in e x p e n s iv e a n d p o w e rfu lc o m p u te rs , o n -lin e d a ta b a s e s , th e c a p a c ity fo r u n iv e rs a l c o n n e c tio n o f p e o p le a n d c o m p u te rs , a n d m u ltim e d ia c o m m u n ic a tio n s

to s u p p o rt th e m is s io n o f d is e a s e p re v e n tio n a n d h e a lth p ro m o - t i o n . P r a c t i c a l P H Iw o r k , i d e a l l y g u i d e d b y P H I p r o f e s s i o n a l s w h oa r e t r a i n e d a n d e x p e rie n c e din b o th in fo rm a tio n te c h n o lo g ya n d p u b lic h e a lth , in v o lv e s b rin g in g

www.annualreviews.org/aronline
Annual Reviews
Annu.Rev.Pu
blic.Health
.1995.16:23
9-252.Downl
oadedfromar
journals.an
nualreviews
.org
byEASTCAROL
INAUNIVERSI
TYon03/20/0
7.Forperson
aluseonly.
P U B L IC H E A L T H IN F O R M A T IC S 2 4 1
to g e th e r
s p e c ia lis ts
i n
b o th fie ld s
t o

c o n c e p tu a liz e n e w w a y s o f a p p ly in g in fo rm a tio n te c h n o lo g y to s o lv e p u b lic h e a lth p ro b le m s .T h e p ra c tic e o f p u b lic h e a lth in fo rm a tic s g o e s b e y o n d a p p ly in g k n o w n" c o m p u te r s c ie n c e ." R a th e r, it in v o lv e s s y n th e s iz in g k n o w le d g ef ro m b o th d is c ip lin e s ,

w h ic h is
le a d in g to n e w
w a y so f t h i n k i n g a b o u t a n d p r a c t i c i n g p u b l i c h e a l t h .
Softwareand hardwaredevelopedfor laboratory
science or business often
l a c k f e a t u r e s r e q u i r e d f o r p u b l i c h e a l t h . F o r e x a m p l e , s t a n d a r d s t a t i s t i c a l
p a c k -
ages cannoteasily be used to perform standardization, fit
m a th e m a tic a lm o d e ls
to d is e a s e p a tte rn s , o r c a lc u la te
sam plesizes for case-control studies;
com -
m o n ly a v a ila b le
d a ta -e n try
p ro g ra m s c a n n o t h a n d le th e v e ry lo n g o r c o m p le x
q u e s tio n n a ire s
com m oni n
p u b lic h e a lth ;
general-purpose graphing program s
m a k eb a r a n d p ie c h a rts b u t n o t h is to g ra m s o r c o u n ty m a p s .P u b lic h e a lth d a ta
f i l e s
o f t e n c o n t a i n m a n ym i l l i o n s o f r e c o r d s , a n d q u i c k l y a c c e s s i n g t h e s e v e r y
large files
re q u ire s s p e c ia l d a ta b a s e d e s ig n s . F in a lly , th e re is
an increasing
need to search the full
c o n te n ts o f m a s s iv e te x t d a ta b a s e s s u c h a s p u b lic a tio n s ,
re p o rts
and recom m endations,
ta b le s
of sum m aryd ata,
in fo rm a tio n a b o u t th e
H e a l t h y P e o p l e 2 0 0 0 O b j e c t i v e s , e t c . T y p i c a l l y , t h e s e d o c u m e n t s a r e n o t k e y -
w o rd e d ,a n d th e ir
d iv e rs ity ,
d y n a m i c n a t u r e , a n d t h e u n a v a i l a b i l i t y
of appro-
p ria te
k e y w o rd s in
th e
M e S H( M e d i c a l S u b j e c t
H eadings) system
w o u ld
p re c lu d e d o in g s o ; o n e o f th e c h a lle n g e s fo r p u b lic h e a lth in fo rm a tic s is
t o
d e v e lo p s tre a m lin e d w a y sto
a c c e s s c o m p le xte x tu a l d a ta .
C D C a n d o t h e r g o v e r n m e n t a g e n c i e s i n c r e a s i n g l y
c o n s id e r in fo rm a tio n d is -
s e m in a tio n to
b e c e n tra l to th e ir
m is s io n . T h e s e a c tiv itie s
c o u ld b e e n h a n c e d
b y b u ild in g in fo rm a tio n s y s te m s s p e c ific a lly
d e s ig n e d fo r p u b lic h e a lth d a ta
and various users:
S y n th e s iz e d k n o w le d g ec a n b e e a s ily
c o m m u n ic a te dt o
th e
p u b lic th ro u g h s p e c ia liz e d
v o ic e a n d v id e o s y s te m s (in
a d d itio n to s ta n d a rd
ra d io a n d te le v is io n );
s u m m a r yd a t a c a n b e p r o v i d e d t o t h e m a n a g e ro r p u b l i c
in q u irie s s p e c ia lis t
via on-line inform ation system s; researchers m ayw ish to
use m oresophisticated
sy stem s to
m a n ip u la te c o m p le x d a ta b a s e s . D e v e lo p in g
diverse system sthat m eetthe full
ra n g e o f p u b lic h e a lth n e e d s re q u ire s d e v e l-
oping a cadre of professionals
w ith training
a n d e x p e rie n c e in b o th p u b lic
h e a lth a n d in fo rm a tio n te c h n o lo g y .
M e d ic a lin fo rm a tic s h a s fo rg e d a n a n a lo g o u s lin k b e tw e e n c lin ic a l
m e d ic in e
a n d in fo rm a tio n te c h n o lo g y , fo c u s in g o n h o s p ita l a n d c lin ic a l

research infor- m a tio n s y s te m s (a u to m a tin g m e d ic a lc h a rts , lin k in g la b o ra to ry d a ta to c lin ic a l d a ta , e tc ),

c o m p u te riz e d d ia g n o s tic s y s te m s , b io m e d ic a l e n g in e e rin g , p a tie n t
a n d s tu d e n t e d u c a tio n , a n d m e d ic a llib ra ry
a u to m a tio n (1 0 ). C le a rly th e re
o v e r l a p b e t w e e n m e d i c a l i n f o r m a t i c s a n d P H I . H o w e v e r ,b e c a u s e p u b l i c h e a l t h
h as its
fo u n d a tio n s in e p id e m io lo g ya n d p re v e n tio n , p u b lic h e a lth in fo rm a tic s
m u s t fo c u s o n s p e e d in g a n d s im p lify in g
the conversion of hypotheses about
th e d is trib u tio n
a n d d e te rm in a n tso f d is e a s e s inp o p u la tio n s in to u s a b le in fo r-
m a tio n , a n d h e lp
t o
d is s e m in a te
n e w k n o w le d g e in
w a y s th a t
w ill
s u p p o rt
www.annualreviews.org/aronline
Annual Reviews
Annu.Rev.Pu
blic.Health
.1995.16:23
9-252.Downl
oadedfromar
journals.an
nualreviews
.org
byEASTCAROL
INAUNIVERSI
TYon03/20/0
7.Forperson
aluseonly.

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