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Washington’s Roadmap to Advance Informatics

Posted By Kim Peifer, Travis Kushner, and Bryant Karras, Friday, March 11, 2016
Updated: Thursday, March 10, 2016

“Data” is a word that we hear or use in every aspect of our lives. In public health, we want a lot of it—it represents the puzzle pieces that we try to work into a picture. The Washington State Department of Health (WA DOH) collects data from a wide array of sources—labs, health clinics, schools, hospitals, and national surveys are a few examples.

Let’s consider the clinician at a health clinic as an example. To fulfill their responsibilities in reporting to WA DOH, a single clinician might share data (paper, fax or electronic interface) through 10 different systems (or more!). We are overwhelming our data source(s) with the burden of number of reports and method of reporting.

Figure 1. The number of connections to other practices that the “average primary care physician” coordinates with (1). Figure by Jeff Horsager (University of Washington Capstone Project, Health Informatics and Health Information Management)
Below is a list of systems at WA DOH that each require different data-sharing interfaces (paper, fax, or electronic webpage or automated system). One clinician or health system may need to connect/report to all of these systems, and each must be done separately. The data collected spans the life of the patient. At WA DOH these systems are in four different divisions of the agency.
  • Birth Record
  • Newborn Screening
  • Birth Defects Surveillance
  • Immunization
  • Early Hearing Detection Diagnosis and Intervention
  • Syndromic Surveillance
  • Reportable conditions
    • Communicable (e.g. pertussis)
    • Cancer
    • Blood Lead
  • Death Reporting (EDRS)
  • Trauma Registry
  • Prescription Drug monitoring Program
  • Meaningful Use Registration of Intent
  • Clinician License Renewal

This isn’t just a problem for the party that must establish multiple connections with WA DOH based on the needs of different programs. The maintenance of these systems occupies a huge amount of resources at WA DOH. Currently, the IT team at WA DOH supports 220 systems, 305 applications, and 48 services.

We recognize that this isn’t a sustainable arrangement for our partners or for us, and see a role for public health informatics in generating solutions. The Public Health Informatics Institute (PHII) defines public health informatics as “…the discipline that supports the effective use of information and information technology to improve public health practice and population health outcomes.” We aim to leverage this field to improve scenarios like the one outlined above, and to this end we have generated an Informatics Roadmap.

The Informatics Roadmap is a three-year operational plan to advance public health informatics in the agency, with the broader intention of advancing public health informatics in Washington State.

Development of the Informatics Roadmap began in 2014 with agency-wide qualitative interviews by the WA DOH Informatics Team. We then partnered with PHII as the first real-world user of their tool “Building an Informatics-Savvy Health Department.” The tool was developed by PHII in collaboration with the Minnesota Health Department and the Oregon Public Health Division. The assessment uses the capability maturity model (a registered trademark of Carnegie Mellon University) to assess three core domains:

Figure 2. Components contributing to Informatics capacity (2)

We used the tool to determine the current informatics capability within the agency as well as local health jurisdictions in the state. Nine program areas, representing the six DOH agency divisions and three local health jurisdictions (Whatcom County, Seattle & King County, and Spokane), completed the assessment in teams. In total, the Informatics Roadmap engaged 100 participants.

With the results of the assessment as a foundation, the WA DOH informatics team proposed goals and objectives to advance our capabilities. These were vetted at an in-person meeting with representatives from each group, as well as field leaders/subject experts (Oregon Public Health, Minnesota Health Department, and PHII).

Following the in-person meeting, we refined, vetted, and consulted specific program areas/teams to shape the high-level document into an operational plan (including action items and timelines to achieve each objective). Ultimately, we established these goals to advance the capability of public health informatics in Washington:

Figure 3. Components contributing to Informatics roadmap
Currently, we are working on a method to track the actions that we have outlined in the Informatics Roadmap, and we plan to meet on a quarterly basis with our state health officer to assess progress in the active items of the current quarter. The effort to synergize agency efforts and actively advance public health informatics in Washington will be challenging, but we look forward to reporting back on our progress!
Figure 4. The Informatics Roadmap team: Kim Peifer, Bryant Karras, and Travis Kushner
  1. Primary Care Phisicians' Links to Other Physicians Through Medicare Patients: The Scope of Care Coordination. Hoangmai H. Pham, MD, MPH, et al., et al. 4, 2009, Annals of Internal Medicine, Vol. 150, pp. 236-242.
  2. Public Health Informatics Institute. Informatics Savvy Health Department Resources. Public Health Informatics Institute. [Online]
Kim Peifer, MPH is Applied Public Health Informatics (APHIF) fellow, Travis Kushner, MPA is Public Health Data Exchange program coordinator, and Bryant Karras, MD is chief informatics officer in the Washington State Department of Health. For more information about surveillance and informatics, join the CSTE Surveillance/Informatics Steering Committee. To learn how to become a fellow in the APHIF program, visit the Project SHINE webpage.

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Joseph McLaughlin says...
Posted Wednesday, March 16, 2016
Strong work, you guys. Thanks for sharing! Joe
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