Overview of Population Health Informatics

NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FOR SALE OR DISTRIBUTION © Jones &Bartlett Learning, LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning, LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC 9781284103960_CH01_Pass03.indd 1 NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC © Jones & Bartlett Learning, LLC. NOT FORSALEORDISTRIBUTION. © Jones&Bartlett Learning,

Competencies and Training Programs Population Health Infor Informatics Emerging Need forPopulation Health NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FOR SALE OR DISTRIBUTION © Jones &Bartlett Learning, LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC . . NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning, LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC matics Workforce, NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC . . 31 11/07/17 4:29 pm 3 1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © VLADGRIN/Shutterstock CHAPTER 1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEEmerging OR DISTRIBUTION Need forNOT FOR SALE OR DISTRIBUTION

Ashish Joshi © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION KEY TERMS

Affordable Care Act (ACA) Health information technology American Recovery and Reinvestment Act Population health © Jones & Bartlett ofLearning, 2009 (ARRA) LLC Population© health Jones informatics & Bartlett (PopHI) Learning, LLC Cognitive fit theory Public health informatics (PHI) NOT FOR SALE ORElectronic DISTRIBUTION health records (EHRs) Social determinantsNOT FOR of health SALE OR DISTRIBUTION Geographic information systems (GISs)

© Jones & Bartlett Learning, LLCLEARNING OBJECTIVES© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■■ Describe the growth of the Internet and social media in the 21st century. ■■ Define population health and its determinants. ■■ Distinguish between population and public health informatics. ■■ Assess the importance of social determinants of health data. ■■ Examine the intersection of technology and health care. © Jones■■ List & theBartlett challenges Learning, and opportunities LLC related to population health © Jones & Bartlett Learning, LLC NOT FORinformatics SALE solutions. OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■■ List the factors to consider in the adoption and implementation of population health informatics solutions.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 3 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 4 Chapter 1 Emerging Need for Population Health Informatics

QUESTIONS© Jones & Bartlett FOR THOUGHT Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■■ What is the significance of social determinants of health to enhance population health outcomes? ■■ What opportunities does the growing usage of the Internet, mobile media, and social media have on health? © Jones & Bartlett■■ How Learning, can stakeholders LLC and consumers address the challenges© Jones related to& Bartlett Learning, LLC implementation of population health informatics solutions in diverse settings? NOT FOR SALE■■ WhatOR opportunitiesDISTRIBUTION do population health informatics solutionsNOT FOR provide SALE to OR DISTRIBUTION improve population health outcomes?

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC CHAPTER OUTLINE NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION I. Population Health and Its Determinants II. The Growth of the Internet and Social Media III. The Intersection of ICTs and Health Care IV. The Emerging Role of Population Health Informatics ©V. JonesChallenges & andBartlett Opportunities Learning, Related to PopHI LLC © Jones & Bartlett Learning, LLC NOTVI. Adoption FOR ofSALE PopHI Solutions OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION VII. SMAART: An Innovative PopHI Conceptual Framework VIII. Conclusion

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE▸▸ I. PopulationOR DISTRIBUTION Health and Its DeterminantsNOT FOR SALE OR DISTRIBUTION rivers of health outside the traditional medical care include social, behavioral, and environmental determinants and need to be addressed to improve health and diminish health disparities. The section below © Jones & Bartlett Learning,Dhighligh tsLLC the significa nce of these factors© Jones in the improvement& Bartlett ofLearning, population LLC NOT FOR SALE OR DISTRIBUTIONhealth outcomes. NOT FOR SALE OR DISTRIBUTION Defining Population Health Population health describes the health needs of a defined group’s entire life span (Evans,© Jones Barer, & Marmor,& Bartlett 1994). Learning,Population health LLC is a linking thread to help under© -Jones & Bartlett Learning, LLC standNOT the determinants FOR SALE of health OR of DISTRIBUTION populations (Evans et al., 1994). Social, economic,NOT FOR SALE OR DISTRIBUTION and physical environments; personal health practices; individual capacity; and coping skills all influence health status indicators. In turn, the health status indicators measure population health (Kindig & Stoddart, 2003). Population health is also considered as a summary measure that includes mortality and health-related quality of life (Field & © Jones & Gold,Bartlett 1998) (Learning,TABLE 1.1). LLC © Jones & Bartlett Learning, LLC NOT FOR SALEPublic OR health DISTRIBUTION services are typically provided by governmentNOT FOR agencies SALE and OR DISTRIBUTION include the core public health functions of health assessment, assurance, and policy setting. Several differences exist among the various aspects of Population health and public health, as shown here. Population health

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© JonesTABLE & 1.1 Bartlett Overview Learning, of the Definitions LLC of Population Health © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Definition of Population Health Source

Exploring reasons about some Young, T. K. (2005). Population health: populations being healthier than others Concepts and methods. New York, NY: © Jones & Bartlett Learning, LLC Oxford University© Jones Press. & Bartlett Learning, LLC

NOT FOR SALE ORImprove DISTRIBUTION health and reduce health Health Canada.NOT (1998). FOR Taking SALE action OR DISTRIBUTION inequalities of diverse populations on population health. Ottawa, Ontario: Health Canada.

Paradigm for understanding why Young, T. K. (1998). Population health: © Jones & Bartlett Learning, LLCsome populations have better health© JonesConcepts & Bartlett and methods. Learning, New York, NY: LLC NOT FOR SALE OR DISTRIBUTIONoutcomes than others NOT FOROxford SALE University OR Press. DISTRIBUTION

Focuses on factors that influence the Dunn, J. R., & Hayes, M. V. (1999). Toward health of populations over the life course, a lexicon of population health. Canadian variations in their patterns of occurrence Journal of Public Health, 90, S7. resulting in actions, and policies to improve © Joneshealth and & well-beingBartlett of populationsLearning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Highlight[s the] role of social and Kreuter, M., & Lezin, N. (2001). Improving economic forces in combination with everyone’s quality of life: A primer on biological and environmental factors that population health. Atlanta, GA: Group shape the health of entire populations Health Community Foundation. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Health outcomes of a group of Kindig, D., & Stoddart, G. (2003). What is NOT FOR SALE ORindividuals, DISTRIBUTION including the distribution of populationNOT health? FOR American SALE Journal ofOR DISTRIBUTION such outcomes within the group Public Health, 93(3), 380–383.

Improve[s] the health of populations Berwick, D. M., Nolan, T. W., & Whittington, J. as one element in the Institute for (2008). The triple aim: Care, health, and © Jones & Bartlett Learning, LLCHealthcare Improvement’s (IHI) Triple© Aim Jonescost. & Health Bartlett Affairs, 27 (3),Learning, 759–769. LLC

NOT FOR SALE OR DISTRIBUTIONApproach that fosters decision makingNOT FORBostic, SALE R. W., Thornton, OR DISTRIBUTIONR. L., Rudd, E. C., & by policymakers, allowing them to assess Sternthal, M. J. (2012). Health in all the implications of non-health-related policies: The role of the US Department policies of Housing and Urban Development and present and future challenges. Health © Jones & Bartlett Learning, LLCAffairs, 31(9), 2130–2137. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

■■ Is less associated with health departments at the government level (Stoto, 2013) ■■ Includes the healthcare delivery system and is seen as separate from govern- mental public health (Stoto, 2013) © Jones & Bartlett■■ IsLearning, more than the LLC sum of its individual parts (Stoto,© 2013)Jones & Bartlett Learning, LLC ■ NOT FOR SALE OR■ Includes DISTRIBUTION a broader array of the determinants of NOThealth thanFOR is typicalSALE in publicOR DISTRIBUTION health (Stiefel & Nolan, 2012) ■■ Has outcomes that go beyond state and local public health agencies and healthcare delivery systems (Ayana, 2016)

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 5 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 6 Chapter 1 Emerging Need for Population Health Informatics

©Expand Jones primary & Bartlett Learning,Promoting community LLC Provide specific © Jones & Bartlett Learning, LLC healthcare training and population-based preventive services NOT FOR SALE OR DISTRIBUTIONactivities NOT FOR SALE OR DISTRIBUTION

Improve access to Expand insurance Population Health healthcare delivery coverage system © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Enhance prevention Incentives for Improve quality of and health promotion workplace wellness care delivered measures programs

© Jones & Bartlett Learning,FIGURE 1.1 LLC The Affordable Care Act © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONData from Affordable Care Act. (2011). Federal Sentencing Reporter, 23(3). NOT FOR SALE OR DISTRIBUTION

The Affordable Care Act (ACA) addresses population health in several ways (Affordable Care Act, 2011; see FIGURE 1.1). The ACA defined the affordable care organization (ACO), which includes clinicians, hospitals, and other healthcare organizations.© Jones They share& Bartlett mutual responsibility Learning, for LLC the population of patients with© the Jones & Bartlett Learning, LLC goalNOT of improving FOR SALE health outcomes OR DISTRIBUTION and reducing health costs and inefficiencies.NOT FOR SALE OR DISTRIBUTION A critical change is required by key stakeholders at the cultural, operational, and financial levels to improve population health. Collaboration among a variety of stakeholders (patients, providers, health plans, employers, government, the private sector, and the local community) is a vital component of the population health approach © Jones & toBartlett strengthen Learning, care delivery andLLC improve the well-being of individuals© Jones and families.& Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Determinants of Population Health Multiple determinants, including educational, social, behavioral, and environmental factors, influence population health outcomes (Kindig & Stoddart, 2003; see FIGURE 1.2). Improving population health requires partners across many sectors including public © Jones & Bartlett Learning,health, healthcare LLC organizations, community© Jonesorganizations, & Bartlett and businesses Learning, (Drum- LLC NOT FOR SALE OR DISTRIBUTIONmond & Stoddart, 1995). population healthNOT data help FOR organizations SALE toOR do theDISTRIBUTION following (Parrish, 2010): ■■ Identify at-risk populations ■■ Close communication gaps among individuals, public health agencies, and ©clinical Jones care & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ■■ Identify cost-effective healthcare delivery models ■■ NOTProvide FOR access SALE to available OR public DISTRIBUTION health programs and services NOT FOR SALE OR DISTRIBUTION ■■ Improve population health decision making Health and health problems result from a complex interplay of factors. Social determinants play a key role in the health of each individual. Social determinants © Jones & ofBartlett health have Learning, gained importance LLC in recent health policy discussions.© Jones Existing & Bartlett liter- Learning, LLC NOT FOR SALEature has OR specified DISTRIBUTION the importance of the social determinantsNOT of health FOR in improving SALE OR DISTRIBUTION the health of populations. Education level, employment, income, family and social support, and community safety are all components of the social and economic determinants of health (County of Los Angeles Public Health, 2013). Unhealthy behaviors

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 6 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION I. Population Health and Its Determinants 7

© JonesSocial & and Bartlett economic Learning, LLC © Jones & Bartlett Learning, LLC factors (education, NOT FORtranspo SALErtation, OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION poverty, income) Quality of life

Environmental Multiple factors (built stakeholders Cultural context © Jones & Bartlettenvironment, Learning, housing) LLC © Jones & Bartlett Learning, LLC

NOT FOR SALE OR DISTRIBUTION Multi-sectorNOT FOR SALE OR DISTRIBUTION Health behaviors Mortality and collaborations (diet, physical life expectancy activity, smoking)

Technology Continuous © Jones & Bartlett Learning, LLCHealthcare services © Jones & Bartlettmonitoring Learning, LLC (access, quality, and evaluation NOT FOR SALE OR DISTRIBUTIONand cost) NOT FOR SALE OR DISTRIBUTIONOverall well-being

Biology and genetics Programs and policies (age, gender, family Interventions history, disease status) Innovations Outcomes © Jones & Bartlett Learning, LLC assessment© Jones & Bartlett Learning, LLC NOTFIGURE FOR 1.2 Determinants SALE OR of population DISTRIBUTION health NOT FOR SALE OR DISTRIBUTION Modified Parrish, R. G. 2010. Measuring population health outcomes. Preventing Chronic Disease,7(4): A71. Retrieved from http://www.cdc.gov/pcd/issues/2010 /jul/10_0005.htm

© Jones & Bartlettare commonly Learning, associated LLC with the lower social and ©economic Jones position & Bartlett of a popu Learning,- LLC lation or community. Poor education, lack of affordable housing, and insufficient NOT FOR SALEincome OR DISTRIBUTION affect not just the individuals and families whoNOT have fewer FOR resources, SALE but OR also DISTRIBUTION all the communities in which they live. Researchers estimate that access to quality medical care may prevent less than 20% of avoidable deaths. The remaining 80% of avoidable deaths are attributable to genetics (20%), and social, behavioral, and environmental determinants of health (60%; Taylor et al., 2016). Improvements in © Jones & Bartlett Learning,healthcare LLC resources and other determinants© Jones are& likelyBartlett to have Learning, a large impact LLC on NOT FOR SALE OR DISTRIBUTIONprevention and the management ofNOT some illnessesFOR SALE (Starfield, OR 2006). DISTRIBUTION Gathering social determinants of health data would result in effective risk assessment to ultimately support population health management. It can help healthcare professionals to identify care gaps. Healthcare organizations can also get better insight into individual drivers of patient engagement and can match individuals © Jonesto specific & interventions, Bartlett Learning, preventive services, LLC or resources that are most© likelyJones to & Bartlett Learning, LLC NOTenhance FOR outcomes. SALE SocialOR DISTRIBUTIONdeterminants of health have not been sufficientlyNOT recog FOR- SALE OR DISTRIBUTION nized despite the knowledge of their impact on health outcomes and longevity. The interventions that address social, behavioral, and environmental determinants of health are also less developed. There is a need to generate integrated, evidence-b ased approaches to have a better impact on health outcome and lowering of healthcare © Jones & Bartlettcosts. Learning, This gap has slowedLLC health policymakers in promoting© Jones innovative & Bartlett models Learning,of LLC NOT FOR SALEcare, OR even DISTRIBUTION though these nonmedical determinants of NOThealth areFOR worthy SALE of attention. OR DISTRIBUTION Several challenges limit the integration of social determinants of health data. These impact evidence-based decision making, resulting in barriers to improving overall population health. Some of these challenges are (Robert Wood Johnson Foundation, 2016):

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■■ Limited knowledge of what works best: Clinicians, healthcare providers, pro- ©gram Jones operators, & Bartlett and researchers Learning, are utilizing LLC data on social determinants© of Jones & Bartlett Learning, LLC NOThealth FOR to identify SALE the best OR ways DISTRIBUTION to collate and use these data so that guidelinesNOT FOR SALE OR DISTRIBUTION can be evidence based. ■■ Lack of standardization and tools: The absence of standard measures for collect- ing data on social determinants leads to inconsistencies. This limits the analysis and decisions that can be made using such data. © Jones & ■Bartlett■ Limited knowledgeLearning, in connecting LLC patient, population, and public© Jones health data: & BartlettDevel- Learning, LLC NOT FOR SALEopment OR of DISTRIBUTION effective, targeted health interventions requiresNOT linking FOR of data SALE at mul- OR DISTRIBUTION tiple levels, from patient-level to population and social determinants of health. ■■ Health systems need to understand their communities better: Community needs and requirements to create programs, policies, and interventions need to be well understood. © Jones & Bartlett Learning,■■ Sharing LLC data across sectors: Data sharing© Jones and its& utilityBartlett in health Learning, decision LLC making presents a fundamental challenge that involves issues of trust, system NOT FOR SALE OR DISTRIBUTIONinteroperability, sector, and workflows.NOT FOR SALE OR DISTRIBUTION ■■ Identifying and developing the right technologies: Integrating social determinants of health data into electronic health records (EHRs) has also been a major challenge. The main alternative to EHRs for the collection, sharing, and use of social determinants of health data are custom technology, cloud-based ©technology, Jones &and Bartlett geo-visual Learning,analytics. LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Some of the outcomes facilitated by the analysis of social determinants of health data include the following (Falk, 2016):

■■ Increased advocacy to address health inequalities ■■ Better policymaking © Jones & ■Bartlett■ Improved Learning, health outcomes LLC © Jones & Bartlett Learning, LLC NOT FOR SALE■■ Cost-effective OR DISTRIBUTION interventions NOT FOR SALE OR DISTRIBUTION ■■ Leadership action plans that positively impact safety, cost, and clinical outcomes ■■ Improved clinical decision making and evidence-based practice ■■ Improved practice guidelines Different stakeholders have different interests, which are not often unified. Although © Jones & Bartlett Learning,policymakers LLC focus on health policy decision© making, Jones advocacy & Bartlett groups typically Learning, focus on LLC NOT FOR SALE OR DISTRIBUTIONimproving outcomes related to one disease orNOT its determinant. FOR SALE If the goal OR is overall DISTRIBUTION health improvement, individual groups working in silos are not productive (Kindig & Stoddart, 2003). Population health improvement as a goal creates an overarching need for a population health perspective that encompasses health outcomes across determinants.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ▸▸ NOTII. T FORhe Growth SALE OR of DISTRIBUTION the Internet NOT FOR SALE OR DISTRIBUTION and Social Media Information and communication technology (ICT) has continued to proliferate at © Jones & aBartlett rapid pace. Learning, The beginning LLC of the 21st century has ushered© in Jonesthe possibility & Bartlett of an Learning, LLC NOT FOR SALEunprecedented OR DISTRIBUTION era of scientific discovery and promise. New ICTsNOT are FOR being exploredSALE OR DISTRIBUTION to effectively and efficiently communicate with, engage, and educate the diverse public. Such technologies can be utilized as web-based apps, mobile phones, and alert systems. Technology continues to improve (Maynard & Harper, 2011). Computers

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are now available at much lower, affordable prices. The Internet is a massive net- © Joneswork, connecting & Bartlett millions Learning, of computers LLC(FIGURES 1.3 and 1.4). The World© Wide Jones Web & Bartlett Learning, LLC NOTallows FOR individuals SALE to OR access DISTRIBUTION information via a computer, mobile telephone,NOT tablet, FOR SALE OR DISTRIBUTION gaming device, or digital TV (Internet Live Stats, 2017).

4 billion © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 3 billion

2 billion © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC

NOT FOR SALE OR DISTRIBUTIONInternet users NOT FOR SALE OR DISTRIBUTION

1 billion

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 0 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 Year (as of July 1)

FIGURE 1.3 Internet users in the world © Jones & BartlettData from InternetLearning, Live Stats. (2017). Internet LLC users by region. Retrieved from http://www.internetlivestats.com/internet-users/© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

10.3% 9.3% 8.6%

17.1% 3.8% 0.7% © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

50.2% © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR AsiaDISTRIBUTION 50.2% NOT FOR SALE OR DISTRIBUTION Europe 17.1% Lat Am / Carib. 10.3% Africa 9.3% North America 8.6% © Jones & Bartlett Learning, LLCMiddle East 3.8% © Jones & Bartlett Learning, LLC Oceania / Australia 0.7% NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION FIGURE 1.4 Internet users by region Reproduced from Internet World Stats – www.internetworldstats.com/stats.htm. Basis: 3,731,973,423 Internet users on March 31, 2017. Copyright ©2017, Miniwatts Marketing Group.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 9 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 10 Chapter 1 Emerging Need for Population Health Informatics

North America 88.1% © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOREurope SALE OR DISTRIBUTION 77.4% NOT FOR SALE OR DISTRIBUTION Australia / Oceania 68.1% Latin America / 59.6% Caribbean Middle East 56.7% © Jones & BartlettWorld, Learning, Avg. LLC 49.6% © Jones & Bartlett Learning, LLC NOT FOR SALE OR AsiaDISTRIBUTION 45.2% NOT FOR SALE OR DISTRIBUTION Africa 27.7%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Penetration rate

© Jones & Bartlett Learning,FIGURE 1.5 LLC Internet penetration rates by regions© of Jones the world & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONReproduced from Internet World Stats. (2017). Internet usage statistics: The Internet bigNOT picture. Retrieved FOR from http://www.internetworldstats.com/stats.htm SALE OR DISTRIBUTION

Currently, around 40% of the world’s population has an Internet connection (Pew Research Center, 2016). As FIGURE 1.5 shows, North America has the highest Internet© Jones penetration & Bartlett rate (88%), Learning, and Africa has LLC the lowest Internet penetration ©rate Jones & Bartlett Learning, LLC (27.7%) (Poushter, 2016; Internet World Stats, 2017). Nearly half of Internet users are NOTfrom Asia FOR (50.2%), SALE as compared OR DISTRIBUTION to 8.6% in North America. NOT FOR SALE OR DISTRIBUTION Mobile and Internet technology use has become a daily, routine activity in most parts of the world. Internet use is proliferating, especially for obtaining health information (Atkinson, Saperstein, & Pleis, 2009). In addition to making and receiving calls, cell phones are widely used for multiple purposes including sending messages © Jones & andBartlett capturing Learning, pictures and videos.LLC Mobile health technologies© constituteJones one& Bartlett of the Learning, LLC NOT FOR SALEmost rapidly OR growing DISTRIBUTION markets globally. Growth is primarily attributedNOT FOR to an SALEincreas- OR DISTRIBUTION ing penetration of smartphones, tablets, and other mobile platforms, and the mHealth Solutions Market is predicted to be worth 59.15 billion USD by 2020 (Mark ets and Markets, 2017). The use of mobile devices has transformed many aspects of health care. More than © Jones & Bartlett Learning,half of the LLC Internet users in the United States© (65%)Jones reported & Bartlett using social Learning, networking LLC NOT FOR SALE OR DISTRIBUTIONsites in 2011 (Pew Research Center, 2016) NOT(FIGURE FOR 1.6). Facebook SALE is OR the most DISTRIBUTION popular social networking site globally (Capurro et al., 2014), with an estimated 1 billio n active users in total, including 580 million daily users. Twitter, with 500 million users world- wide, detects and predicts events and sentiments by observing users’ posts (tweets) in real time (Capurro et al., 2014). Social networking sites offer a range of possibilities for ©establishing Jones multidirectional& Bartlett Learning, communication LLC and interaction, as well as quickly© Jones & Bartlett Learning, LLC monitoring public sentiment and activity (Capurro et al., 2014). NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ▸▸ III. The Intersection of ICTs and Health Care The advent of ICT has transformed healthcare delivery into patient-centered care. © Jones & ICTsBartlett allow theLearning, delivery of LLChealthcare services, particularly© to Jones isolated communi& Bartlett- Learning, LLC NOT FOR SALEties. Integration OR DISTRIBUTION of clinical and nonclinical data sources by NOTusing ICTsFOR to enhanceSALE OR DISTRIBUTION population health outcomes across diverse geographic settings is a growing need.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 10 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION III. The Intersection of ICTs and Health Care 11

80 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 65% 61% 60

40 43% 38% 29% © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 27% NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 20 16%

8% 13% 9% © Jones2% & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT0 FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2005 2006 2007 2008 2009 20010 2011

Ever Yesterday © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEFIGURE OR 1.6DISTRIBUTION Social media use by adults NOT FOR SALE OR DISTRIBUTION Modified from Madden, M., & Zickuhr, K. (2011). 65% of online adults use social networking sites. Retrieved from http://www.pewinternet.org/2011/08/26/65-of -online-adults-use-social-networking-sites/

© Jones & Bartlett Learning,Policymakers LLC on a global scale are© encouragingJones & Bartlettthe use of suchLearning, technologies LLC to improve health and healthcare systems. Mobile health technologies, remote wear- NOT FOR SALE OR DISTRIBUTIONable devices, and sensors have demonstratedNOT FOR immenseSALE ORpotential DISTRIBUTION in preventing diseases and improving well-being in numerous settings (Capurro et al., 2014). Future technological innovation is going to keep transforming health care. Previ- ously, technology played a minimal role in health, and healthcare professionals were the only way to take care of people (Friede & O’Carroll, 1996). Technology is now © Jonesplaying a significant& Bartlett role Learning,in health management LLC information systems (HMISs),© Jones pub- & Bartlett Learning, LLC NOTlic healthFOR surveillance, SALE OR geographic DISTRIBUTION information systems (GISs), and NOTEHRs andFOR SALE OR DISTRIBUTION facilitates access to both public health programs and services. Technology is used to monitor patterns of illness and to detect emerging or imminent threats to public health (Araujo et al., 2009). Public health professionals have been among the first users of information © Jones & Bartletttechnology. Learning, Technology LLC can help providers identify© and Jones address &nonmedical Bartlett fac Learning,- LLC NOT FOR SALEtors OR that DISTRIBUTION affect population health (Institute of Medicine,NOT 1997).FOR More SALE and ORmore DISTRIBUTION organizations are beginning to record population-level data using cloud-based

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 11 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 12 Chapter 1 Emerging Need for Population Health Informatics

tools and technologies. Mobile devices including smartphones, tablet computers, and© remote Jones monitoring & Bartlett devices Learning, have ample potential LLC for use in disease prevention,© Jones & Bartlett Learning, LLC earlyNOT risk identification,FOR SALE healthcare OR DISTRIBUTION delivery, and timely support to populationsNOT liv- FOR SALE OR DISTRIBUTION ing in diverse settings (Centers for Disease Control and Prevention, 2006). These emerging technologies present an opportunity to address global health challenges in both developed and developing countries. Healthcare organizations around the globe are forming technological infrastructures that enable several stakeholders © Jones & toBartlett make better Learning, informed, faster LLC decisions and individuals to© betterJones manage & Bartlett their Learning, LLC NOT FOR SALEhealth outside OR DISTRIBUTIONof the hospital setting (Deloitte, 2016). InnovativeNOT technologies FOR SALE cover OR DISTRIBUTION multiple areas including surveillance for disease, environmental monitoring, pol- lution mitigation and prevention, behavior modification, screening, and chronic disease management (Eng, 2004). The wide-scale adoption of health information technology has enabled diverse stakeholders, such as providers, payers, and © Jones & Bartlett Learning,government LLC agencies, to collaborate using© newJones digital & tools Bartlett to improve Learning, the health LLC of defined populations. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

▸▸ IV. The Emerging Role of Population ©Health Informatics Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC InformaticsNOT FOR is the scienceSALE of OR information, DISTRIBUTION where information is defined as data withNOT FOR SALE OR DISTRIBUTION meaning (Bernstam, Smith, & Johnson, 2010). Informatics serves as a bridge across practitioners and professions to support collaboration and electronic communication. Informatics tools provide benefits to both administrative and clinical aspects of healthcare delivery and assist in collaborative practice by enhancing communica- © Jones & tionBartlett across teamLearning, members. LLCTABLE 1.2 lists some of the key global© Jones accomplishments & Bartlett Learning, LLC NOT FOR SALEin the field OR of healthDISTRIBUTION informatics. NOT FOR SALE OR DISTRIBUTION

TABLE 1.2 Key Global Health Informatics Accomplishments © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONYear Country Key AccomplishmentsNOT FOR SALE OR DISTRIBUTION

1949 Germany First professional organization for Informatics was founded

1950© Jones United & Bartlett Kingdom Learning, Medical Informatics LLC initiated in the UK © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1952 United States First computer was used in clinical practice at the American Society for Clinical Pathology (Rappoport Arthur M-Bee)

© Jones & Bartlett1959 Learning, United States LLC First CT scanner was developed© Jones by Robert &Ledley, Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONone of the founding fathersNOT of Informatics FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 12 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION IV. The Emerging Role of Population Health Informatics 13

© Jones1960 & Bartlett France Learning,Training LLC programs for Informatics in France© began Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1968 Brazil Computers were first used in Medical care

1987 Hong Kong Hong Kong Society for Medical Informatics (HKSMI) was established © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 1988 United States American Medical Informatics Association (AMIA) NOT FOR SALE OR DISTRIBUTION established NOT FOR SALE OR DISTRIBUTION

1989 Switzerland International Medical Informatics Association formed

© Jones & Bartlett Learning, LLC1993 Nigeria ©First Jones International & Bartlett Working Conference Learning, on Health LLC NOT FOR SALE OR DISTRIBUTION NOTInformatics FOR in Africa SALE OR DISTRIBUTION

1996 United States A 2-year fellowship program was established by the Centers for Disease Control and Prevention © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT1997 FOR SALE Argentina OR DISTRIBUTION Biomedical Informatics group was establishedNOT FOR SALE OR DISTRIBUTION

2000 New Zealand Health Informatics program established in New Zealand

© Jones & Bartlett2001 Learning, Canada LLC Canada Health Infoway© Joneswas established & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2002 Australia Australasian college of health informatics established

2004 United States Office of the National Coordinator for Health Information Technology was created © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION2005 United StatesNOT National FOR Center SALEfor Public HealthOR DISTRIBUTION Informatics was created by CDC

2006 Saudi Arabia Saudi Association for Health Informatics was established © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT2009 FOR SALE United OR States DISTRIBUTION The Health Information Technology for NOT FOR SALE OR DISTRIBUTION Economic and Clinical Health (HITECH) Act established

2017 India Digital Health Technology Ecosystem incorporated © Jones & Bartlett Learning, LLC into National Health© Policy Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Modified from Ng, S. K., & Wong, L. (2004). Accomplishments and challenges in bioinformatics. IT Professional, 6(1), 44–50.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 13 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 14 Chapter 1 Emerging Need for Population Health Informatics

Public© Jones Health & BartlettInformatics Learning, LLC © Jones & Bartlett Learning, LLC PublicNOT health FOR informatics SALE OR (PHI) DISTRIBUTION is the science of applying information-ageNOT FOR SALE OR DISTRIBUTION technology to serve the specialized needs of public health (Friede, Blum, & McDonald, 1995). PHI is a systematic application of information, computer science, and technology in the practice of public health (Yasnoff et al., 2000). It addresses three core functions of public health: (1) assessment of population health, (2) policy © Jones & deBartlettvelopment, Learning, and (3) assurance LLC of the availability of high-quality© Jones public & Bartletthealth Learning, LLC services. The scope of PHI expands beyond conceptualization and design and NOT FOR SALEdevelopment OR (Yasnoff DISTRIBUTION et al., 2000). NOT FOR SALE OR DISTRIBUTION Members of the public health and informatics community discussed key PHI issues during the American Medical Informatics Association Meeting that was held in Atlanta during May 15–17, 2001 (Yasnoff et al., 2001). The issues were related to funding and governance; architecture and infrastructure; standards and vocabu- © Jones & Bartlett Learning,lary; research, LLC evaluation, and best practices;© Jones privacy, confidentiality,& Bartlett Learning,and security; LLC NOT FOR SALE OR DISTRIBUTIONand training and workforce (Yasnoff et al.,NOT 2001). FOR All stakeholdersSALE OR perceived DISTRIBUTION the role of information systems to be beneficial in improving the health of individuals (Yasnoff et al., 2000). Some of the PHI-related challenges included developing integrated national public health information systems, enhancing integration efforts between public health and clinical care systems, and addressing the concerns of information© Jones technology & Bartlett on confidentiality Learning, and LLC privacy (Yasnoff et al., 2001). © Jones & Bartlett Learning, LLC NOTA follow-up FOR PHI SALE conference OR DISTRIBUTIONwas held in 2011 to revisit the PHI agenda develNOT- FOR SALE OR DISTRIBUTION oped in 2001 (Massoudi et al., 2012). Three key themes were identified: the need to (1) increase communication and information sharing within the PHI community; (2) improve evaluation methods, competency training, and the use of public health; and (3) enhance leadership and coordination to move the field forward. Further © Jones & recommBartlettendations Learning, included LLC finding ways to strengthen prevention© Jones in the& Bartlettpublic Learning, LLC NOT FOR SALEhealth and OR clinical DISTRIBUTION continuum and to build health at the communityNOT FORlevel (Massoudi SALE OR DISTRIBUTION et al., 2012).

Population Health Informatics © Jones & Bartlett Learning,The U.S. LLCHITECH Act of 2009 was designed© Jones to boost &health Bartlett information Learning, technol- LLC NOT FOR SALE OR DISTRIBUTIONogy adoption nationwide. President ObamaNOT signed FOR the SALE act into ORlaw onDISTRIBUTION February 17, 2009, as part of the American Recovery and Reinvestment Act of 2009 (ARRA) economic stimulus bill. Some of the key processes included care coordination, cohort management, clinician engagement, and reporting and knowledge management. Managing public health practice effectively and enhancing societal well-being© Jones require & multiple Bartlett resources Learning, that provide LLC accurate, high-quality, and timely© Jones & Bartlett Learning, LLC information. PHI focuses on population-level, preventive-based information. It also servesNOT as an FOR applied SALE science OR in relevant DISTRIBUTION government settings with a central goalNOT of FOR SALE OR DISTRIBUTION public health promotion (Yasnoff et al., 2000). PHI is a combination of medicine, public health, computer science, and information processing (Kukafka, 2005). It has also been defined as the application of ICTs in public health practice while integrating health research with information technology (Reeder, Hills, Demiris, Revere, & © Jones & Pina,Bartlett 2011). Learning,Application of PHILLC principles provides unprecedented© Jones opportunities & Bartlett to Learning, LLC NOT FOR SALEbuild healthier OR DISTRIBUTION communities (Savel & Foldy, 2012). NOT FOR SALE OR DISTRIBUTION A paradigm shift toward the area of population health informatics (PopHI) has begun. This shift is because of the increasing focus on social health determinants

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 14 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION IV. The Emerging Role of Population Health Informatics 15

and use of technology in health care, combined with stakeholder initiatives including © Jonesthe ACA, & HITECH Bartlett Act, Learning,and other relevant LLC reforms (Vest & Gamm, 2010).© Jones PopHI & Bartlett Learning, LLC NOTis the FOR systematic SALE application OR DISTRIBUTION of information technologies and electronicNOT informa FOR- SALE OR DISTRIBUTION tion to the improvement of the health and well-being of a defined community or other target population (Kharrazi et al., 2017). For a health risk assessment to be conducted effectively at the population level, aggregate data are needed from a variety of sources including health facilities, social services, law enforcement agencies, © Jones & Bartlettdepartments Learning, of labor LLC and industry, population-level© surveys, Jones and & on-site Bartlett inspec Learning,- LLC NOT FOR SALEtions OR (O DISTRIBUTION’Carroll, Yasnoff, Ward, Ripp, & Martin, 2003).NOT PopHI FOR can also SALE be described OR DISTRIBUTION as an integration of social determinants of health data sources (both clinical and nonclinical) by combining principles of ICT to enhance population health outcomes across diverse geographic settings (Joshi, Arora, & Malhotra, 2017; FIGURE 1.7). The current need for PopHI arises from dramatic improvements in informa- © Jones & Bartlett Learning,tion LLC technology, new pressures on© the Jones public health & Bartlett system, and Learning, changes in health LLC- care delivery. PopHI systems involve creation, storage, and processing of data to NOT FOR SALE OR DISTRIBUTIONgenerate information and knowledge.NOT PopHI FOR facilitates SALE data-driven, OR DISTRIBUTION well-informed, evidence-based decision making for populations living in diverse settings. In addition to the informatics developments, elements of the PopHI system are a means to generate and process data to achieve meaningful information and knowledge about geographic areas that have concentrations of unfavorable health indicators © Jonesor are composed & Bartlett of populations Learning, of underserved LLC groups (Kharrazi et al., ©201 Jones7). The & Bartlett Learning, LLC NOTdevelopment FOR SALE of such OR systems DISTRIBUTION aims to help stakeholders gather timely andNOT accurate FOR SALE OR DISTRIBUTION information about entire population groups and permit assessment of disparities of health status among different populations (FIGURE 1.8). PopHI also refers to the application of emerging technologies to improve the health of populations (Eng, 2004). Some of the challenges that exist in relation to the © Jones & BartlettPopHI Learning, tools and technologies LLC include privacy and security© Jones of patient & data, Bartlett confidenti Learning,- LLC NOT FOR SALEality, OR quality, DISTRIBUTION sustainability, and the existing technologyNOT divide (Eng,FOR 2004; SALE FIGURE OR 1.9). DISTRIBUTION

Information © Jones & Bartlett Learning, LLC ©sy Jonesstems & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Social determinants of health data Population health © Jones & Bartlett Learning,data LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Clinical care data

Computer Geographic science © Jones & Bartlett Learning,setting LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION FIGURE 1.7 Intersections of population health, information systems, and computer science among populations in diverse geographic settings

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 15 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 16 Chapter 1 Emerging Need for Population Health Informatics

PopHI

FIGURE 1.8 Diverse stakeholder involvement in PopHI © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Big data (increasing velocity, volume, veracity, and variety)

Lack of data Privacy © Jones & Bartlett Learning, LLC standards © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION FIGURE 1.9 Challenges in the use of healthcare technologies Modified from Harbinger Systems. (2016). Healthcare IT: Role of EDI in Affordable Care Act reforms. Retrieved from http://www.slideshare.net/hsplmkting/healthcare-it -role-of-edi-in-affordable-care-act-reforms

© Jones & Bartlett Learning,Despite LLC these challenges, health information© Jones technology, & Bartlett including Learning, mobile LLC NOT FOR SALE OR DISTRIBUTIONhealth technology, holds significant potentialNOT for FOR engaging SALE individuals OR DISTRIBUTION in disease prevention and health promotion. It provides individuals with the necessary tools to record their data and make data meaningful. More research is needed to assess when, where, and for whom the population health technologies are efficacious. TABLE 1.3 lists the key comparisons between PopHI and PHI. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ▸▸ NOTV. C hallengesFOR SALE ORand DISTRIBUTION Opportunities NOT FOR SALE OR DISTRIBUTION Related to PopHI Experts at a symposium sponsored by the National Library of Medicine identi- © Jones & fiedBartlett six key Learning,domains of PopHI LLC as significant (Kharrazi et ©al., Jones 2017). Symposium & Bartlett Learning, LLC NOT FOR SALEattendees OR included DISTRIBUTION national experts and leading researchers NOTin academia, FOR the SALE public OR DISTRIBUTION sector, provider organizations, and the information technology industry. These six domains were as follows:

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 16 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION V. Challenges and Opportunities Related to PopHI 17

© JonesTABLE & 1.3 Bartlett Distinguishing Learning, Between PopulationLLC Informatics and Public ©Health Jones & Bartlett Learning, LLC NOTInformatics FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Population Health Informatics Public Health Informatics (PopHI) (PHI)

Common Total population Total population intervention Target population Health departments targets Healthcare organizations © Jones & Bartlett Learning, LLC Healthcare systems© Jones & Bartlett Learning, LLC Nongovernmental organizations NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Main Outreach and prevention Assessment operational Care integration Prevention goals Disease management Assurance

© JonesAction arm& Bartlett Population Learning, health organizations LLC Public health agencies© Jones & Bartlett Learning, LLC NOT FOR SALECare OR management DISTRIBUTION organizations Not-for-profit and NOT FOR SALE OR DISTRIBUTION nongovernmental organizations

Key Provider and payer systems Federal, state, and local © Jones & Bartlettstakeholders Learning,Government LLC and community ©governments Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Key Capturing nonmedical information Expanding public health IT information Interoperability across sectors systems challenges Medical and public health interoperability

© Jones & Bartlett Learning, LLCModified from Kharrazi, H., Lasser, E. C., Yasnoff, W. A.,© Loonsk, Jones J., Advani, A.,& Lehmann, Bartlett H. P., . . . Weiner, Learning, J. P. (2017). A proposed LLC NOT FOR SALE OR DISTRIBUTIONnational research and development agenda for populationNOT health FOR informatics: SALE Summary recommendations OR DISTRIBUTION from a national expert workshop. Journal of the American Medical Informatics Association, 24(1), 2–12.

■■ Interoperability and information infrastructure: Having an interoperable plat- © Jonesform & that Bartlett can facilitate Learning, data sharing LLC can potentially help advance the© Jonesagenda & Bartlett Learning, LLC NOT FORof PopHI. SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■■ Cross-organization collaboration: Well-established programs or policies for population health data sharing across diverse stakeholders do not exist. ■■ PopHI-based indicators and metrics: There is a need to have an understanding of how advanced population health metrics can be derived from the health © Jones & Bartlett informationLearning, technology LLC systems. © Jones & Bartlett Learning, LLC NOT FOR SALE■ OR■ Applying DISTRIBUTION PopHI within integrated provider systems:NOT Current FOR SALEstate-of-the-art OR DISTRIBUTION tools represent an imbalance between focusing on the population vs. individual providers.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 17 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 18 Chapter 1 Emerging Need for Population Health Informatics

■■ Computer science and informatics methods for population health: There is a great ©potential Jones to &utilize Bartlett some of Learning, the computational LLC methods from the field of com© Jones- & Bartlett Learning, LLC NOTputer FORscience SALEto address OR the DISTRIBUTION challenges of population health data integrationNOT FOR SALE OR DISTRIBUTION and analysis. ■■ Integration of social and nonmedical factors into PopHI systems: Linking social and other nonmedical information with clinical data can enhance population health methods and models. © Jones & ForBartlett each of Learning,the domains identified,LLC existing challenges ©and Jones potential & opporBartlett- Learning, LLC NOT FOR SALEtunities ORwere DISTRIBUTIONassessed, alongside future research directionsNOT to FORaddress SALE them OR DISTRIBUTION (TABLE 1.4).

Challenges and Research and Development Domains Opportunities Issues © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Interoperability Need for a clear, shared Methods for securely and andNOT information FOR SALEvision for OR a common, DISTRIBUTION privately linking patient medicalNOT FOR SALE OR DISTRIBUTION infrastructure interoperable, and robust records across stakeholders information infrastructure Promote a shared knowledge Need for effective patient base for community health trends identification methods to and population decision support © Jones & Bartlett Learning,share data LLC across systems Design end-user© Jones tools that & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONInconsistent adoption of incorporateNOT usability FOR methods SALE OR DISTRIBUTION interoperability standards and heuristics Challenges associated with Foster the integration of social silo functions and service science data into PopHI’s provisions overarching architecture

© Jones & Bartlett Learning,Cross- LLC Collaboration challenges© JonesConsensus & Bartlett on what dataLearning, to LLC NOT FOR SALE OR DISTRIBUTIONorganization among stakeholders NOT FORcollect, SALE integrate, OR and shareDISTRIBUTION as collaboration Limited PopHI data use and part of PopHI exchange agreements Discover and share new PopHI Lack of aligned incentives analytic solutions and models Instability of many among stakeholders © Jones & Bartlettpartnerships Learning, between LLCDefine population health © Jones & Bartlett Learning, LLC NOT FOR SALEprivate andOR public DISTRIBUTION data-sharing methods using NOT FOR SALE OR DISTRIBUTION organizations established standards Difficulty of blending Develop a set of metrics and medical, public health, decision support guidelines and consumer-targeted Create methods to assess the © Jones & Bartlett Learning,interventions. LLC quality of ©shared Jones data and & Bartlett Learning, LLC techniques for linking disparate NOT FOR SALE OR DISTRIBUTION data sourcesNOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 18 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION V. Challenges and Opportunities Related to PopHI 19

© JonesPopHI-based & Bartlett Understanding Learning, how newLLC Develop actionable predictive© Jones & Bartlett Learning, LLC indicators and data sources, such as models for population health NOTmetrics FOR SALE ORpatient-generated DISTRIBUTION data and metrics NOT FOR SALE OR DISTRIBUTION unstructured EHR data, can Build a health information be utilized technology framework to capture Need appropriate and integrate patient-reported informatics methods for outcomes on the population © Jones & Bartlett Learning, LLCimproving the reliability, scale© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONaccessibility, and CreateNOT a methodology FOR SALE to align OR DISTRIBUTION comparability of such existing population health measures metrics across programs Develop a prioritized Establish a framework to support population/community the roll-out of new population- © Jones & Bartlett Learning, LLC report card © Jones & Bartletthealth–focused Learning, metrics by LLC expanding collection of critical NOT FOR SALE OR DISTRIBUTION NOT FOR SALEdata elements OR DISTRIBUTION

Applying Lack of appropriate Integration of practice needs PopHI within population health for population health data integrated electronic quality measures management and governance © Jonesprovider & BartlettAbsence Learning, of proof-of- LLC Improvement of human© factors Jones & Bartlett Learning, LLC NOTsystems FOR SALE ORconcept DISTRIBUTION and return- and workflow issues for NOTall FOR SALE OR DISTRIBUTION on-investment of stakeholders enterprise-level tool Identification of a unifying implementation framework for PopHI Up-to-date meaningful infrastructure and stakeholder © Jones & Bartlett Learning, LLCuse policy, and a lack of incentives© Jones for adoption & Bartlett Learning, LLC governance structures for NOT FOR SALE OR DISTRIBUTIONeffective and efficient data NOT FOR SALE OR DISTRIBUTION sharing

Computer Heterogeneity and Develop and disseminate a “grand science and complexity of population computing challenge” for PopHI © Jones & Bartlett Learning, LLCinformatics health data sources© Jones & BartlettEncourage collaboration Learning, LLC NOT FOR SALE OR DISTRIBUTIONmethods for Privacy issues associatedNOT FOR SALEbetween OR computer DISTRIBUTION scientists population with population-level and trigger the development of health analytics advanced, innovative methods Limited collaboration Develop synthetic population-level between health information datasets that can be shared freely © Jones & Bartletttechnology Learning, and population LLC Develop guidelines for large-© Jones & Bartlett Learning, LLC health experts scale data sharing as well as NOT FOR SALE ORLack of DISTRIBUTION standardized data analytic frameworks for NOTnon- FOR SALE OR DISTRIBUTION architectures for population health researchers health Advance interdisciplinary research in applied PopHI focus areas, such as change © Jones & Bartlett Learning, LLC management© Jones and & workflow Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION reasoningNOT FOR SALE OR DISTRIBUTION

(continues)

TABLE© Jones 1.4 Challenges & Bartlett and Opportunities Learning, Across LLC Population © Jones & Bartlett Learning, LLC HealthNOT Domains FOR (SALEcontinued OR ) DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Domains Challenges and Research and Development Opportunities Issues

© Jones & BartlettIntegration Learning,Poor understanding LLC of the Solutions need© Jones to integrate & Bartlett Learning, LLC NOT FOR SALEof social OR and DISTRIBUTIONinformation that needs nonpersonalNOT data toFOR person- SALE OR DISTRIBUTION nonmedical to remain protected or specific data factors into confidential when using Develop population-based PopHI systems nonclinical data decision-support tools for both public health/community officials © Jones & Bartlett Learning, LLC © Jonesand & clinicians Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORDevelop SALE analytic OR tools thatDISTRIBUTION work across disparate population health data types

Modified Table 1.3 Modified from Kharrazi, H., Lasser, E. C., Yasnoff, W. A., Loonsk, J., Advani, A., Lehmann, H. P., . . . Weiner, J. P. (2017). A proposed national research and development agenda for population health informatics: Summary recommendations from© a Jonesnational expert workshop.& Bartlett Journal of the AmericanLearning, Medical Informatics LLC Association, 24(1), 2–12. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ▸▸ VI. Adoption of PopHI Solutions Apart from the challenges, opportunities, and research and development issues © Jones & relatedBartlett to PopHI, Learning, the following LLC 13 overarching themes of ©PopHI Jones were &identified Bartlett Learning, LLC NOT FOR SALE(Kharrazi OR et al., DISTRIBUTION 2017): NOT FOR SALE OR DISTRIBUTION ■■ Policy alignment: There is a need to align the PopHI strategies with desired outcomes that will facilitate adoption and implementation of appropriate PopHI solutions. ■■ Data governance: Data governance and data privacy policies need to be in place © Jones & Bartlett Learning,to ensure LLC data sharing agreements so© that Jones it can further & Bartlett facilitate Learning,adoption and LLC NOT FOR SALE OR DISTRIBUTIONimplementation of PopHI solutions. NOT FOR SALE OR DISTRIBUTION ■■ Data quality: A suboptimal rate of completeness, accuracy, timeliness, reliability, or validity of a data source can produce uncertainty when the data are incorporated into PopHI solutions. ■■ Data management: Differences in granularity and heterogeneity across various ©data Jones sources & create Bartlett many data Learning, management LLC challenges. © Jones & Bartlett Learning, LLC ■ ■ NOTSustainability FOR SALEand incentives: OR DISTRIBUTION Lack of funding and difficulty attracting newNOT FOR SALE OR DISTRIBUTION funding streams may affect the scalability of a project and limit the flexibility of its core business model. ■■ Population metrics: The lack of accurate and reproducible e-metrics may reduce the effectiveness of PopHI solutions. ■ © Jones & Bartlett■ Interoperability Learning, standards: LLC Limited PopHI standards© andJones interoperability & Bartlett Learning, LLC frameworks affect the development of new PopHI solutions. NOT FOR SALE■■ Stakeholder OR DISTRIBUTION collaboration: If stakeholders do not collaborateNOT effectively, FOR SALEthis will OR DISTRIBUTION produce suboptimal results.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 20 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION VII. SMAART: An Innovative PopHI Conceptual Framework 21

■■ Tools and infrastructure: Limited PopHI data infrastructure and tools hinder © Jonesthe development& Bartlett of Learning,a robust health LLCtechnology platform for population© Jones health. & Bartlett Learning, LLC NOT■■ FOREthics andSALE security: OR Concerns DISTRIBUTION about the privacy, confidentiality, and securityNOT of dataFOR SALE OR DISTRIBUTION restrict the expansion of population-wide health information technology solutions. ■■ Best practices and dissemination: Insufficient best practices for PopHI and limited dissemination mechanisms to introduce them among stakeholders have restricted the adoption of new PopHI solutions. © Jones & Bartlett■■ EducationLearning, and training: LLC Properly training PopHI ©experts Jones in both & payer Bartlett and pro Learning,- LLC NOT FOR SALE ORvider DISTRIBUTION settings can help empower cross-organizationalNOT PopHI FOR programs. SALE OR DISTRIBUTION ■■ Evaluation methods: The development and evaluation of new PopHI methods are essential to advancing the science of population health. The emerging field of PopHI addresses a broader-level population dimen- sion as compared to PHI owing to increased adoption of value-based, technolo- © Jones & Bartlett Learning,gy-supported LLC healthcare delivery paradigms© Jones (Moreno, & Bartlett Peikes, Learning,& Krilla, 2010). LLC The NOT FOR SALE OR DISTRIBUTIONHITECH Act has produced severalNOT desirable FOR outcomes SALE including OR DISTRIBUTION increased use of information technology by healthcare providers (HITECH Act, 2009; Hsiao, Hing, & Ashman, 2014), data interoperability, integration, consolidation, and standards adoption (Centers for Medicare and Medicaid Services, 2012; Clinical Data Inter- change Standards Consortium, 2016; Dolin et al., 2001; S&I Framework, n.d.), © Jonesthe creation & Bartlettof mega health Learning, data repositories LLC (National Patient-Centered© JonesClinical & Bartlett Learning, LLC NOTResearch FOR Network, SALE 2015),OR DISTRIBUTION and advances in the utilization of big data fromNOT multi FOR- SALE OR DISTRIBUTION ple sources (Barrett, Humblet, Hiatt, & Adler, 2013). All of these factors have sig- nificantly improved the extent of the application of informatics to the population health domain. Three structural barriers exist to the greater adoption of technology in health © Jones & Bartlettcare. Learning,First, the necessary LLC technology is not available;© second, Jones the technology& Bartlett exists Learning, LLC but is not accessible; and third, technology is not always used, even when accessi- NOT FOR SALEble. OR More DISTRIBUTION effective collaboration is a crucial need to addressNOT theFOR mechanism SALE of OR data DISTRIBUTION collection, its dissemination to various stakeholders, and their use of the data in healthcare decision making. An innovative sustainable business model for multisec- tor collaboration is needed. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION▸▸ VII. SMAART: An InnovativeNOT FOR SALE PopHI OR DISTRIBUTION Conceptual Framework Health status and outcomes do not exist in isolation but are ingrained in a wider © Jonesarray of living& Bartlett conditions Learning, (Williams, LLCCosta, Odunlami, & Mohammed,© Jones 2008). & Bartlett Learning, LLC NOTIncluding FOR socialSALE context OR inDISTRIBUTION the delivery of healthcare services can haveNOT a signifi FOR- SALE OR DISTRIBUTION cant impact in the improvement of individual health. The larger social and economic policies and the economic resources available to the household can also importantly affect health. Improvement in population health involves the integration of complex, multidimensional data that enables diverse stakeholders (such © Jones & Bartlettas individuals, Learning, healthcare LLC professionals, and policymakers)© Jones to identify& Bartlett patterns Learning, LLC resulting in meaningful information (Jamison, 2006). There is a need to use the NOT FOR SALEcurrently OR DISTRIBUTION available knowledge to improve living conditionsNOT FOR and SALE the health OR of DISTRIBUTION populations.

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Defining© Jones SMAART & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC An NOTinnovative FOR Pop SALEHI framework, OR DISTRIBUTION Sustainable, Multi-sector, Accessible, Affordable,NOT FOR SALE OR DISTRIBUTION Reimbursable, Tailored (SMAART) (Joshi et al., 2017) has been proposed that aims to facilitate the integration of determinants of population health (social determinants and clinical data) to guide data-driven, evidence-based, PopHI-related programs, policies, and interventions to enhance population health outcomes across © Jones & diverseBartlett geographic Learning, settings (LLCFIGURE 1.10). © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The SMAART Approach The SMAART framework combines principles of data, information, and knowledge (DIK) (Chapter 2); human-centered design (HCD) (Chapter 6); cognitive fit theory (Dennis & Carte, 1998); information processing (Miller, 1956); and learning, © Jones & Bartlett Learning,behavioral, LLC and humanistic theories (Boeree,© Jones 1998; Duffy & Bartlett & Jonassen, Learning, 1992; Spiro, LLC NOT FOR SALE OR DISTRIBUTIONFeltovich, Jacobson, & Coulson, 1988). NOT FOR SALE OR DISTRIBUTION The principles of HCD involve (1) active involvement and understanding of users, (2) understanding task requirements, (3) appropriate allocation of function between user and system, (4) iteration of design solutions, and (5) multidisciplinary design teams. Understanding users is an important aspect of the HCD approach. An ©individual’s Jones ability& Bartlett to work withLearning, an HCD applicationLLC is influenced by multiple© Jones & Bartlett Learning, LLC demographicNOT FOR factors SALE including OR age, DISTRIBUTION literacy, spatial skills, and computer familiarityNOT FOR SALE OR DISTRIBUTION (Slocum et al., 2001). The user model gathers individuals’ understanding regarding data, functions, domain, and mapping (Lauesen, 2005). HCD involves users’ perspective to create a system that is useful and usable. Tasks classification helps to create useful applications. Common visual tasks performed by users include locating, © Jones & identifying,Bartlett distinguishing,Learning, LLCcategorizing, distributing, comparing,© Jones and correlating & Bartlett Learning, LLC NOT FOR SALEvariables OR (Wehrend DISTRIBUTION & Lewis, 1990). Interactions enable usersNOT to derive FOR meaning SALE and OR DISTRIBUTION accomplish various analysis goals. Better results are produced when the task requirement corresponds with the information presented (Joshi et al., 2012). This also improves system and task per- formance factors. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Sustainable

Tailored Multi-sector © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONSMAARTTM NOT FOR SALE OR DISTRIBUTION framework

Reimbursable Accessible

FIGURE 1.10 SMAART framework

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 22 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION VII. SMAART: An Innovative PopHI Conceptual Framework 23

Cognitive fit theory reflects how the graphical output affects the decision © Jonesprocesses & (Dennis Bartlett & Carte, Learning, 1998) and dependsLLC upon fit between information© Jones pre- & Bartlett Learning, LLC NOTsentation FOR and SALE tasks usedOR by DISTRIBUTION the decision maker. Cognitive fit examines theNOT best wayFOR SALE OR DISTRIBUTION in which a user’s task output can be presented (Dennis & Carte, 1998). The principles of information processing theory (Miller, 1956) recommend that information be presented in a meaningful manner in small chunks (like 5–7 pieces of information). It also presents information in a structured format that is © Jones & Bartlettsimple Learning, to understand. LLC According to learning behavioral© Jones and humanistic & Bartlett theories, Learning, LLC NOT FOR SALEthe OR information DISTRIBUTION presented should be highly interconnectedNOT FOR and relevantSALE toOR the DISTRIBUTION learner, and available in multiple content formats. Feedback should be provided based on responses (Boeree, 1998; Duffy & Jonassen, 1992; Spiro et al., 1988). The evaluation component assesses the process outcomes and the impact of PopHI tools and technologies on the cost of, quality of, and access to healthcare services © Jones & Bartlett Learning,( FIGURELLC 1.11). © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Attribute (context) What

Spatial data Temporal data © Jones(Where) & Bartlett Learning, LLC (When) © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONPopulation NOT FOR SALE OR DISTRIBUTION health data

Human-centered Grounded Theory approach © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION User- Use Requirement centered analysis analysis tasks

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Cognitive fit Social cognitive theory Best fit theory Information Information processing Usefulness and © Jonespresentation & Bartlett Learning, LLC theory cost-effectiveness© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Human-centered Improve process technology outcomes interventions

Clinical and non- © Jones & Bartlett Learning, LLC © Jonesclinical & Bartlett population Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORhealth SALE outcomes OR DISTRIBUTION

FIGURE 1.11 Theoretical approaches utilized in the SMAART framework

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 23 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 24 Chapter 1 Emerging Need for Population Health Informatics

©Da Jonesta & BartlettOperator Learning, LLC Programs System© Jones & Bartlett Learning, LLC Raw data Reporting NOTsource FOR SALE OR ruDISTRIBUTIONles & policies evaluationNOT FOR SALE OR DISTRIBUTION

Process outcomes Data Data If then source validation rules © Jones & Bartlett Learning, LLC © Jones Clinical& Bartlett Learning, LLC outcomes NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Data Transform Decision source data logic Non- clinical outcomes

Data Data Data Visualization Intervention Evaluation sources management analysis component component component component component component © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC FIGURENOT 1.12 FORElements SALE of the SMAART OR DISTRIBUTIONframework NOT FOR SALE OR DISTRIBUTION

Components of the SMAART Framework © Jones & SomeBartlett of the Learning, elements of theLLC SMAART framework include© Jonesthe following & Bartlett (see Learning, LLC NOT FOR SALEFIGURE 1.12 OR): DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■■ Multidimensional data: Social determinants of health data are typically organized into a geospatial unit that often has three dimensions: (1) attribute (i.e., context), (2) spatial (i.e., geographic), and (3) temporal (i.e., time). The attribute (context) component relates to issues of interest such as social © Jones & Bartlett Learning,data, LLC environmental data, and health© data.Jones The spatial& Bartlett (geographic) Learning, compo- LLC NOT FOR SALE OR DISTRIBUTIONnent includes data with location attributesNOT FOR(e.g., address, SALE region, OR DISTRIBUTIONor country) and can provide insight into how and where to obtain essential services. The temporal (time) component records the time of the observation and enables users to learn from the past to predict, plan, and build the future. The SMAART framework facilitates the integration of social determinants of health data ©such Jones as socioeconomic & Bartlett factors, Learning, the physical LLC environment, health behaviors,© Jones & Bartlett Learning, LLC NOTclinical FOR assessment, SALE and OR knowledge, DISTRIBUTION attitude, and practice ( FIGURE 1.13). TheNOT FOR SALE OR DISTRIBUTION data are generated into meaningful information to derive an individual/community risk profile, based on existing guidelines and evidence. ■■ Data management component: This component includes several modules such as data recording and storage, data, data validation techniques, and data trans- © Jones & Bartlettformation Learning, by making data LLC available in a format that is ready© Jones to be analyzed. & Bartlett Learning, LLC ■■ Data analysis component: This component includes statistical analysis capabil- NOT FOR SALEities OR to help DISTRIBUTION analyze multisectoral data at both the individualNOT FOR and aggregate SALE OR DISTRIBUTION levels.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284103960_CH01_Pass03.indd 24 11/07/17 4:29 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION VII. SMAART: An Innovative PopHI Conceptual Framework 25

Population Data Sources © Jones & Bartlett(Attribute Learning, + Location LLC + Time dimensions) © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Knowledge, Socioeconomic Physical Health Clinical attitude, and factors environment behaviors assessment practice

Subjective and Objective data © Jones & Bartlett Learning, LLC © JonesData, & information, Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORknowledge SALE approach OR DISTRIBUTION Generate risk profile Individual/Community Human-centered approch © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Prevention Monitoring Referral Management

Humanistic, behavioral, © JonesInformation & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC and learning and processing theory NOT FOR SALE OR DISTRIBUTIONPrograms, policies, and self-efficacyNOT theories FOR SALE OR DISTRIBUTION interventions

Processes Clinical Quality of life Cost-effective Longevity © Jones & Bartlettoutcomes Learning, outcomesLLC outcomes ©outcomes Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION FIGURE 1.13 Applying the SMAART framework toward social determinants of health data to enhance population health outcomes

© Jones & Bartlett Learning,■ ■LLCVisualization component: The© visualization Jones & component Bartlett contributes Learning, to display LLC- ing meaningful information in various formats including tables, charts, graphs, NOT FOR SALE OR DISTRIBUTIONand maps. This component allowsNOT individuals FOR SALE to actively OR interact DISTRIBUTION with the data to conduct specific analyses and visualize the information based on the needs of the individual or organization. ■■ Intervention component: This component involves several programs, policies, and interventions that can enhance population health outcomes across diverse © Jonesgeographic & Bartlett settings. Learning, LLC © Jones & Bartlett Learning, LLC NOT■■ FOREvaluation SALE component: OR DISTRIBUTION The evaluation component includes system NOTevaluation, FOR SALE OR DISTRIBUTION process outcomes, and both clinical and nonclinical outcomes. The SMAART framework can be operationalized as an interactive, a stand- alone, an Internet, or a mobile-enabled platform that (1) facilitates transmission © Jones & Bartlettof data Learning, and information LLC regarding the health status ©of Jonesthe individual/community, & Bartlett Learning, LLC (2) interprets data and information using previously established knowledge and/ NOT FOR SALEor OR wisdom DISTRIBUTION and use of evidence-based standards, (3) NOTaddresses FOR the specific SALE needs OR of DISTRIBUTION the individual/community, (4) provides timely feedback to the consumer addressing

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specific requirements, and (5) uses regular repetition of the feedback loop. Prior research© Jones has shown & Bartlettthe need to haveLearning, customized LLC technology solutions to address© the Jones & Bartlett Learning, LLC gapsNOT that exist FOR in theSALE integration OR DISTRIBUTIONof social determinants of health data and clinicalNOT FOR SALE OR DISTRIBUTION data to enhance population health outcomes. Several recommendations have been proposed for PopHI interventions to be successful (Kharrazi et al., 2017). Barriers such as cost, poor infrastructure, lack of or limited Internet access, and inadequately trained human resources often prevent © Jones & orBartlett delay the adoptionLearning, of technology LLC in health care (Buitenhuis,© JonesZelenika, & Pearce,Bartlett Learning, LLC NOT FOR SALE2010). Overcoming OR DISTRIBUTION these barriers is crucial if the potential ofNOT technology FOR for SALE global OR DISTRIBUTION health is to be realized. Decisions about implementation of a health technology solution should combine a range of considerations, from cost per unit to how to encourage uptake, to whether a technology can work in a particular setting and the best way to achieve implementation. This presents an urgent need to imple- © Jones & Bartlett Learning,ment sustainable, LLC low-cost, accessible, and© Jonesaffordable & technology-enabled Bartlett Learning, health LLC solutions to meet the needs of local communities, especially those living in low-re- NOT FOR SALE OR DISTRIBUTIONsource settings. NOT FOR SALE OR DISTRIBUTION

▸▸ VIII. Conclusion Effective© Jones use of data& Bartlett determines Learning, the extent to whichLLC population health stakehold© -Jones & Bartlett Learning, LLC ers NOTcan sufficiently FOR SALE address OR societal DISTRIBUTION health concerns. There is an increasing needNOT FOR SALE OR DISTRIBUTION for tools and technologies that facilitate knowledge construction (Bhowmick, Griffin, MacEachren, Kluhsman, & Lengerich, 2008). Technical constraints, including connectivity, bandwidth provision, and reliability, also need to be taken into account during PopHI implementations (Panth & Acharya, 2015). Expand- © Jones & ingBartlett the development Learning, and dissemination LLC of health data standards© Jones and vocabulary & Bartlett Learning, LLC NOT FOR SALEtools is criticalOR DISTRIBUTION to improving access. New and upcoming healthNOT technologies FOR SALE have OR DISTRIBUTION shown tremendous value in reducing healthcare costs while improving well-being. Although such technologies are being developed and utilized in several domains of care, intensive research is required to fully explore their potentials, challenges, and opportunities (Eng, 2004). There is an urgent need for PopHI training with an © Jones & Bartlett Learning,emphasis LLC on competence in population ©health, Jones data &analytics, Bartlett systems Learning, thinking, LLC evaluation, and transdisciplinary approaches to problem solving, communication, NOT FOR SALE OR DISTRIBUTIONleadership, advocacy, and technology. EconomicNOT FOR evaluations SALE also OR need DISTRIBUTION to be taken into consideration when designing, developing, implementing, and evaluating PopHI interventions. The present century has unraveled a plethora of scientific innovations and discoveries with the potential for better outcomes. Emerging technologies provide enormous© Jones opportunities & Bartlett for population Learning, health LLC improvement (Eng, 2004). These© Jones & Bartlett Learning, LLC alsoNOT present FOR an opportunity SALE OR for addressing DISTRIBUTION global health challenges in both develNOT- FOR SALE OR DISTRIBUTION oped and developing countries. The adoption of population health technologies will require optimal research in the field of PopHI.

© Jones & ReferencesBartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEAffordable OR Care Act.DISTRIBUTION (2011). Federal Sentencing Reporter, 23(3). NOT FOR SALE OR DISTRIBUTION Araujo, J., Pepper, C., Richards, J., Choi, M., Xing, J., & Li, W. (2009). The profession of public health informatics: Still emerging? International Journal of Medical Informatics, 78(6), 375–385.

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Atkinson, N., Saperstein, S., & Pleis, J. (2009). Using the internet for health-related © Jonesactivities: & findingsBartlett from Learning,a national probability LLC sample. Journal of Medical Internet© JonesResearch, & Bartlett Learning, LLC 11(1), e5. NOTAyana, FOR C. (2016). SALE DSRIP OR statewide DISTRIBUTION learning collaborative, population health. RetrievedNOT fromFOR SALE OR DISTRIBUTION https://hhs.texas.gov/sites/hhs/files/documents/laws-regulations/policies-rules/1115-docs /082916/Triple-Aim-State-Data-Clark.pdf Barrett, M. A., Humblet, O., Hiatt, R. A., & Adler, N. E. (2013). Big data and disease prevention: From quantified self to quantified communities. Big Data, 1(3), 168–175. © Jones & BartlettBernstam, Learning, E. V., Smith, J.LLC W., & Johnson, T. R. (2010). What is© biomedical Jones informatics? & Bartlett Journal Learning,of LLC Biomedical Informatics, 43(1), 104. NOT FOR SALEBerwick, OR DISTRIBUTION D. M., Nolan, T. W., & Whittington, J. (2008). The tripleNOT aim: Care, FOR health, SALE and cost. ORHealth DISTRIBUTION Affairs, 27(3), 759–769. Bhowmick, T., Griffin, A. L., MacEachren, A. M., Kluhsman, B. C., & Lengerich, E. J. (2008). Informing geospatial toolset design: Understanding the process of cancer data exploration and analysis. Health and Place, 14(3), 576–607. Boeree, G. (1998). Personality theories: B. F. Skinner. Retrieved from http://webspace.ship.edu © Jones & Bartlett Learning, LLC/cgboer/skinner.html © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONBostic, R. W., Thornton, R. L., Rudd, E. C.,NOT & Sternthal, FOR M. SALE J. (2012). HealthOR inDISTRIBUTION all policies: The role of the US Department of Housing and Urban Development and present and future challenges. Health Affairs, 31(9), 2130–2137. Buitenhuis, A. J., Zelenika, I., & Pearce, J. M. (2010). Open design-based strategies to enhance appropriate technology development. Proceedings of the 14th Annual National Collegiate Inventors and Innovators Alliance Conference: Open, March 25–27, 2010, pp. 1–12. © JonesCapurro, D., & Cole, Bartlett K., Echavarría, Learning, M. I., Joe, J., LLCNeogi, T., & Turner, A. M. (2014). The© use Jones of social & Bartlett Learning, LLC NOT networkingFOR SALE sites for ORpublic DISTRIBUTIONhealth practice and research: A systematic review. JournalNOT of Medical FOR SALE OR DISTRIBUTION Internet Research, 16(3), e79. Centers for Disease Control and Prevention. (2006). Advancing the nation’s health: A guide to public health research needs (2006–2015). Retrieved from http://www.ipacohio.org/Websites /ipac/images/LinksResources/AdvancingTheNationsHealth.pdf Centers for Medicare and Medicaid Services (CMS). (2012). 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R., & Carte, T. A. (1998). Using geographical information systems for decision making: Extending cognitive fit theory to map-based presentations. Information Systems Research, 9(2), 194–203. Dolin, R. H., Alschuler, L., Beebe, C., Biron, P. V., Boyer, S. L., Essin, D., . . . Mattison, J. E. (2001). The © JonesHL7 clinical & Bartlett document architecture.Learning, Journal LLC of the American Medical Informatics© Association Jones, & Bartlett Learning, LLC 8(6), 552–569. NOTDrummond, FOR M.,SALE & Stoddart, OR G. DISTRIBUTION (1995). Assessment of health producing measures acrossNOT different FOR SALE OR DISTRIBUTION sectors. Health Policy, 33(3), 219–231. Duffy, T., & Jonassen, D. H. (1992). Constructivism and the technology of instruction: A conversation. Hillsdale, NJ: Lawrence Erlbaum Associates. Dunn, J. R., & Hayes, M. V. (1999). Toward a lexicon of population health. Canadian Journal of Public Health, 90, S7. © Jones & BartlettEng, T. Learning, R. (2004). 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Falk, L. H. (2016). What is population health and how does it compare to public health? Retrieved ©from Jones https://www.healthcatalyst.com/what-is-population-health/ & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Field, M. J., & Gold, M. R. (Eds.). (1998). Summarizing population health: Directions for the NOTdevelopment FOR and SALEapplication OR of population DISTRIBUTION metrics. Washington, DC: National AcademiesNOT FOR SALE OR DISTRIBUTION Press. Friede, A., Blum, H. L., & McDonald, M. (1995). Public health informatics: How information- age technology can strengthen public health. Annual Review of Public Health, 16(1), 239–252. © Jones & Friede,Bartlett A., & O Learning,’Carroll, P. W. (1996). LLC CDC and ATSDR electronic information© Jones resources & for Bartlett health Learning, LLC officers. American Journal of Infection Control, 24(6), 440–454. NOT FOR SALEHarbinger ORSystems. DISTRIBUTION (2016). 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The future of public health (12th ed.). Washington, DC: National Academy Press. Internet© Jones Live Stats. &(2017). Bartlett Internet usersLearning, by region. Retrieved LLC from http://www.internetlivestats.© Jones & Bartlett Learning, LLC NOTcom/internet-users/ FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Internet World Stats. (2017). Internet usage statistics: The Internet big picture. Retrieved from http://www.internetworldstats.com/stats.htm Jamison, D. T. (2006). Disease control priorities in developing countries. Washington, DC: Oxford University Press. Joshi, A., Arora, M., & Malhotra, B. (2017). Design, development and implementation of an © Jones & Bartlettinformatics Learning, enabled SMAART LLC intervention framework. Manuscript© accepted Jones by Global & Bartlett Journal Learning, LLC NOT FOR SALEof Health OR Sciences DISTRIBUTION. NOT FOR SALE OR DISTRIBUTION Joshi, A., de Araujo Novaes, M., Machiavelli, J., Iyengar, S., Vogler, R., Johnson, C., . . . Hsu, C. 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Public health informatics: The nature of the field and its relevance to health ©promotion Jones practice. & Bartlett Health Promotion Learning, Practice, 6(1), LLC 23–28. © Jones & Bartlett Learning, LLC Lauesen, S. (2005). User interface design: A software engineering perspective. Reading, MA: NOTAddison-Wesley. FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Madden, M., & Zickuhr, K. (2011). 65% of online adults use social networking sites. Retrieved from http://www.pewinternet.org/2011/08/26/65-of-online-adults-use-social-networking-sites/ Markets and Markets. (2017). Telehealth market by component (hardware (blood glucose monitors), software (integrated), services (remote monitoring, real-time interactions), end user (providers, payers, patients), & mode of delivery (web, cloud)) - Global Forecast © Jones & Bartlettto 2021. 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