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Public Health Informatics Profile ToolkitWhat is a public healthinformatics profile?A public health informatics profile is a comprehensive summary of an agency’s current andprojected information system needs and opportunities. The profile can be used to informyour agency decisions and priorities regardingsystem modernization (as defined on page 6). Forexample, priorities may be based on needs forelectronic connections with public and privatestakeholders. Information in your public healthinformatics profile can include the collection,analysis, and representation of informationpertaining to the information systems that support your public health programs, as well asan assessment of future informatics needs andopportunities.The information can be collected at the agency orother organizational level. The profile can includevarious relevant areas such as: Current and desired technical capabilities ofinformation systems Current and future use of and need for publichealth information Current and desired information exchangepartners and capabilitiesPurpose of a Public Health Informatics ProfilePurpose of aPublic HealthInformaticsProfile2 Resource needsThe Public Health Informatics Profile Toolkit ismeant to serve as a guide that you can use tocreate a public health informatics profile. TheToolkit provides practical tips and direction fortailoring a profile that realistically reflects yoursystem needs. Ultimately the profile must meetthe specific system requirements of your agency,therefore, these tools are not meant to be acookbook, but rather a set of ingredients that youassemble in a recipe that meets your needs.Note: Sample tools are referenced throughout theToolkit and can also be found in the appendices.7

Purpose of a Public Health Informatics Profile2Public Health Informatics Profile ToolkitWhy conduct a publichealth informatics profile?The need for public health agencies to electronically exchange information with our stakeholdersis growing, and the expectations for high levelsof service requires modernization of many of ourinformation systems by making them integrated,interoperable, and standards-based.Any public health organization responsible forcollecting, managing, or using public health datacan benefit from conducting the kind of assessment we describe in the Toolkit to generate a public health informatics profile. An assessment ofpublic health information systems including thetechnical as well as human skill and knowledgeresource aspects can help your agency identifyareas of opportunity, and assist in agency-wideplanning efforts. A public health informatics profile can provide your organization with a portfolioof program and/or information system needs,human resource needs, and reveal departments ordivisions where there may be synergies for working together on a similar issue, such as electronichealth information exchange.For public health to become an important playerin health care reform, public health agencies willneed to upgrade their systems in order to be anequal partner in health information exchangeinitiatives with the private health care sector(HITECH funding may support the developmentof this type of exchange). Conducting a readinessassessment for your organization can provideuseful information for planning purposes, andcan become a motivator for change within yourorganization.Who would benefit from apublic health informaticsprofile?Depending on the needs of your agency, the public health informatics assessment as described inthis Toolkit can be conducted to evaluate key information systems on a program-specific level, or8can provide an enterprise-wide view. Therefore,a public health informatics profile can benefit individuals at all levels of an organization, whetheryou are an executive responsible for overallorganizational leadership or a program managerresponsible for a particular program area.For example, executives benefit by having anoverall assessment to support strategic andtactical planning and overall information systemportfolio management. Individual program staffcan benefit from an assessment conducted withinan organization, which can reveal those programsthat are exchanging data electronically, whichones are not, and where some of the gaps arein the process. The assessment can also exposeareas of opportunity to coordinate within anagency. For example, a program manager whoneeds to implement electronic exchange withhospitals or clinics can see which programs arealready doing this and can benefit from theirexperience by partnering with them on staff andother shared resources.An assessment can also be conducted outside ofthe organization, providing a better picture ofneeds and opportunities in the external environment. For example, the readiness of healthinformation exchange among community partners(hospitals, etc.) can be determined.A Minnesota storyAs momentum was building in Minnesota regarding the adoption of electronic health records andthe desire for bi-directional exchanges betweenthe public and private sectors, the MinnesotaDepartment of Health (MDH) decided to learnmore about its agency’s readiness and needswith respect to electronic health informationexchange. It wanted a fairly comprehensive viewthat would reflect the full range of needs withinits agency, so it created and conducted a publichealth informatics assessment. This assessmentallowed the MDH to gain insight into the information system needs of its various program areas,and to use this information to initiate a dialogueabout an overall agency-wide approach to information system modernization. Using relevant

Public Health Informatics Profile ToolkitPurpose of a Public Health Informatics Profilequalitative data generated by the assessment,the MDH was able to concretely identify some ofits challenges as well as possible action steps formoving forward to create an agency-wide tacticalplan regarding the interoperability and integration of information systems. The MDH has usedthe experience and results of this work to createthe Public Health Informatics Profile Toolkit,developed with support from the Centers forDisease Control and Prevention and the RobertWood Johnson Foundation through the InfoLinksand Common Ground grant programs, respectively(see page 5 for program descriptions).29

Getting Started3Public Health Informatics Profile ToolkitGetting StartedThere are many things to consider before starting an initiative like this, such as developing aproject management plan, developing a businesscase to garner support for the project, identifyingproject stakeholders, and identifying the scope ofthe project. This section describes how to developa broad conceptual overview of the project, howto define the project scope, followed by definingthe project goals.How do we develop aconceptual view of theproject?Developing a conceptual view of the project inthe form of a diagram or other graphic elementcan help clarify project goals, and can providea visual tool for communicating those goals andproject scope to a broad audience. A frameworkassists the project by “getting everyone on thesame page” about what the project entails orexcludes. This view is often conveyed using apicture or figure.Tips for developing a framework Use pictures whenever possible to provide avisual interpretation for the project. Show how various components/elements arerelated to one another to ensure a commonunderstanding among the project team andwith project stakeholders. Keep it simple, and include the key elementsthat should be conveyed.Developing a framework can be an iterativeprocess, and may take multiple versions beforegetting it right.A Minnesota exampleFigure 1 provides an example framework thatcould be used for a public health informaticsprofile. This framework depicts how Minnesota’spublic health informatics profile assessmentfocused on collecting data and sending data withan emphasis on data partners, datasets, and applications as well as an emphasis on data input,10

Public Health Informatics Profile ToolkitData Partners(Data Recipients from MDH)Individual Level Data Summary DataReports PublicationsData SetsCollectingData ho do we collect data from?W What data do we collect? How do we collect the data? What data is exchangedelectronically now? Readiness / opportunities forelectronic exchange.ApplicationsSendingData W hat data gets stored, analyzed, utilized &managed? How is that data represented? Are nationalstandards used? What are the future needs related to standardsand electronic exchange capabilities? Getting StartedData Partners(Data Collection by MDH)3 ho do we send data to?W What data do we send? How do we send the data? What data is exchanged now? Readiness / opportunities forelectronic exchangeFigure 1: MDH Informatics Profile Conceptual Model (Includes Infrastructure, data sets and applications)For purposes of this survey, the questionnaire will focus on applications, data input, data output and exchangecapabilities of an information system.data output, exchange capabilities, and utilization of standards in an information system. Foradditional ideas, see Appendix C.   Will the assessment be limited to systemsthat have electronic applications or willprograms that have paper-based systemsbe included as well?How do we defineproject scope?   Do the systems need to have a certain sizeor functionality to be of interest?Before starting the project, it is essential toclarify the scope of the project. Defining the scopeup front is critical for developing a project planthat is realistic and attainable, and defining thescope early in the project assists when “scopecreep” attempts to broaden the project beyondthe original project objectives. Given that thereare many stakeholders to consider, making thescope manageable can be challenging. Therefore, it is essential at this point of the project tokeep project parameters narrow by determiningwhat should be included or excluded from yourassessment. The following are some key points toconsider when defining project scope. Explore the answers to questions such as:   Will your assessment be conducted agency-wide or will it focus in an area or two(e.g., a public health area such as chronicdisease or maternal and child health)?   Will the scope include external partners orwill the focus be internal only? Identify and engage key stakeholders (seetips below and the Stakeholder Analysis toolin Appendix I). Include sponsors, project team, and stakeholders in defining the project scope. Brainstorming sessions/methods can be useful forgetting input into the scope. If resources are a constraint, consider whatresources are available before broadeningproject scope. Consider relevant factors such as agencypriorities or relevant policy directions as aplace to prioritize. Consider a scope that would look at the public health expectations that are in the HealthOutcomes Policy Priorities, Meaningful UseMatrix (released by the Department of Healthand Human Services in 2008 and updatedin 2009) which provides guidance to states11

Getting Started3Public Health Informatics Profile Toolkiton priorities. For more information on thematrix, see the following document: TARGS 0 10741 876940 0 0 18/Meaningful%20Use%20Matrix%2007162009.pdf C onsider multiple phases to your approach(e.g., phase one to collect the most criticalinformation and phase two to collect information that is less urgent).For an example scope statement, please see theMinnesota Department of Health Scope Statementin Appendix B.Tips for identifying key stakeholdersA Minnesota storyAs with any project, it is important to identify keystakeholders and consider their desires and needsfor the project. Stakeholders can serve as important champions for the project if they are engagedearly on, particularly if they are able to shape theproject in the project definition phase.Recognizing that its many stakeholder groupswanted to benefit from the project, the MDH helda special one-day meeting prior to conductingits assessment to refine the project scope andidentify goals for the assessment. The range ofstakeholders included:Sometimes it is helpful to think of stakeholdersin two groups. The first is a broad list of peopleand organizations affected. In public health thistypically can be a wide range of persons from legislators to clients. This is an important list to thebusiness case. The second group is often a smallsubset of this group, and will include persons andprograms that have the most knowledge about thepublic health system. The IT department, who wanted to createand populate a detailed database of alldepartment databases;Things to consider when identifying project stakeholders include: Consider the planned scope of the projectand identify individuals across the organization that may have an interest in the project. Using the appropriate communicationtechniques is important throughout theentire project (see Stakeholder Analysis inAppendix I). Tailor messages to individuals if needed. Ask for their help or support of the project.Tips for involving stakeholders:Minnesota exampleOnce the public health informatics profile reportwas issued, the project team asked key stakeholders to be “supporters” for a new project todevelop an agency-wide plan for data integration12and interoperability. By requesting support of keyproject stakeholders, the project team was ableto demonstrate broad support for their proposedproject. The security staff, who wanted an inventoryof security practices across the agency; The privacy staff, who wanted to documentthe legal status of reporting on certaininformation; The program staff, who did not want to participate in a long survey; The e-health program staff, who wanted toassess the readiness of systems for electronic exchange of health information; The Common Ground program staff, whowanted to learn about the chronic diseaseprogram areas and complete their project ina defined timeframe.Note: The MDH is one of 31 Common Ground grantees (see program description on page 5).Bringing the various stakeholders together allowed the project manager to identify the variousneeds and to carve out a realistic scope for theproject. Ultimately the scope was defined to meetmainly two of these needs due to limitations onresources to carry out the project.

Public Health Informatics Profile ToolkitBecause there will be different levels of understanding among your various stakeholders aboutthe need for a project like this, it is important toconsider the following: Define parameters of project management; Describe the context and key drivers; Adequately and concretely describe thebusiness case to justify the project (in otherwords, what problems will the profile helpsolve?); Develop a project charter; Secure executive leadership sponsorship forthe project.Tips for managing the projectBecause a project like this may have significantscope and implications agency-wide, it is criticalto follow solid project management principles.For example, it is important to: Designate a lead project manager to overseethe project schedule, manage scope changes,identify and resolve issues, and be a centralpoint-of-contact for the project. Responsibilities of a project managerinclude:–  Building an effective project team–  Developing a schedule and budget–  Directing the overall project–  Managing project risk–  Involving stakeholders– Ensuring quality deliverables Develop a project charter outlining the goalsof the project in order to garner support forthe project. Clarify the scope of the project early on byconsidering the needs of the project sponsoras well as key stakeholders. Develop a project management plan to usefor overseeing the project once it is initiated. Develop a communications plan to ensure allstakeholders are kept informed and engaged.For large projects, conduct a stakeholderanalysis to identify your communicationsstrategies for different groups based on theirlevel of interest and their level of influence.Getting StartedHow do we define ourgoals for a public healthinformatics profileassessment?3 Be realistic about all the resources you willneed, especially staff and time.Tips for exploring context and driversfor interoperability and modernizationof public health information systemsIt is important to be able to articulate the contextand drivers for the public health informaticsprofile assessment to various stakeholders withdifferent perspectives. Some stakeholders will understand the need for the project early on, whileothers will need a little more convincing. Forexample, the context or rationale for planning andconducting your assessment may be the availability of ARRA funds and the need to prepare forhealth care reform.Example driversOn a state and local level: The desire and need for integrated and interoperable information at the state or localhealth department level in order to providehigher quality services and more timelyinformation. The need for better electronic exchange withdata partners and expectations of bi-directional exchanges with the clinical sector,allowing for improvements in overall clinicalservices to patients and population health. Meeting compliance with the “meaningfuluse criteria” as part of the American Recovery and Reinvestment Act (see ‘On a nationallevel’ below).13

Getting Started3Public Health Informatics Profile Toolkit Organizational needs around project portfolio management and identifying agencypriorities based on needs and prioritizationof resources. The need to improve services to clients,such as children, by having greater access totimelier and fully integrated information.On a national level: The American Recovery and ReinvestmentAct (ARRA), which includes the HealthInformation Technology for Economic andClinical Health (HITECH) Act, has set a goalof 2014 to increase the number of healthcare providers who have and effectively useelectronic health records (EHRs) and engagein health information exchange (HIE) in aneffort to improve our health care system.Public health agencies are a critical electronic health information exchange stakeholder,and should therefore be prepared to assesstheir information systems (particularly disease registries and immunizations registries)to be able to exchange health informationwith the private sector when needed. State Alliance for e-Health has prepared areport for states regarding electronic healthinformation exchange, which provides interim guidance to state leaders as they beginto implement HITECH. The report specifically calls on states to assess their currentsystems for readiness for electronic healthinformation exchange (www.nga.org/Files/pdf/0908ehealthhitech.pdf). The eHealth Initiative drives improvementin the quality, safety, and efficiency of healthand healthcare through information andinformation technology, including a focuson population health with the desire thatconsumers, health care providers, and thoseresponsible for population health will haveready access to timely, relevant, reliable andsecure information and services through aninterconnected, electronic health information infra

Developing a Public Health Informatics Profile: a Toolkit for State and Local Health Departments to Assess their Informatics Capacity The project was supported by the Robert Wood Johnson Foundation through an InformationLinks Grant to the Public Health Informatics Institute. The initial project (the Public Health Informatics Profile Assessment .