In previous columns in this series,1–3 we have advocated that public health agencies become more “informatics savvy.” In our view, improving the capability of the public health enterprise to rapidly adopt innovative approaches for the collection, use, and sharing of data and information is central to the future of public health in the United States. Furthermore, as the US health care system continues to accelerate the adoption of “eHealth” as a core business practice, the public health system is challenged to keep pace.
As noted in our prior columns, many barriers exist that limit the ability of public health to keep pace. Among the greatest of these challenges is the limited capacity of our nation's public health informatics workforce. As noted in a prior Management Moment column in this journal,2 important strategies exist to strength the informatics workforce: more active recruiting for full-time informatics specialists and education of existing staff. Although useful, these 2 approaches are limited. In this column, we describe a third approach, which connects academically trained experts in informatics through brokered and mentored partnerships with public health agencies. We term these partnerships as public health informatics incubators.
Large cadres of informatics specialists are trained each year in top universities. These individuals have unique technical and information systems skills, which if properly brokered and mentored can be applied to solve real-world public health problems. Unfortunately, public health agencies typically do not have access to these academically trained informatics specialists to assist in modernization of antiquated information systems.
By forging partnerships with academic institutions that train these informatics specialists, public health can access informatics talent (often at low cost), forming teams with health agency staff to develop and deploy new informatics tools. Under the Centers for Disease Control and Prevention (CDC) leadership, such a partnership has been developed that links Georgia Tech graduate students with public health mentors at state and local health agencies and at CDC to apply state-of-the-art techniques, such as the new HL7 FHIR (Fast Health Care Interoperability Resources) standard, to specific health program needs such as prevention of drug overdose, falls in the elderly, sexually transmitted disease monitoring, and pediatric obesity.
First, these partnerships have rapidly created tools that help solve an immediate problem in a public health agency using open-source standardized methods. Once developed, a tool can be rapidly deployed at other health agencies and could even populate a “Public Health Informatics App store” to be used across the nation. Furthermore, by immersing young informatics experts in real public health problems, they are experiencing the direct impact of their skills on a societal need, leading to potential future involvement in public health. These young professionals might even be organized into a “Public Health Informatics Corps” as a way of recognizing their contributions and maintaining connections over time. As a result of working side by side with these trained informatics specialists, public health agency staff themselves learn how to apply new and well-established informatics techniques to solve other public health problems.
Innovative incubator projects can be an important catalyst, leading to broader system benefits including improved interoperability, more timely and automated data transfer between public health agencies and the health care system, and provision of decision support tools that enhance prevention efforts at the point of care. Public health surveillance systems and survey methods can be enhanced through use of more innovative tools, leading to improved workflow.
Furthermore, this approach provides an opportunity for public health to form new partnerships and to discover new possibilities. Many (perhaps most) public health information systems are locked into outmoded technologies, processes, and techniques. By forging new partnerships and exploring new possibilities together, there is an opportunity to “leapfrog” into new and exciting ways of doing business, leading to improved agency capabilities and capacity.
FHIR—A Tool for Public Health Informatics Innovation
Central to the Georgia Tech partnership noted earlier is the use of Fast Health Care Interoperability Resources,4 a new open-source standard to help achieve interoperability. The FHIR effort is devoted to using modern, Internet-based approaches to accessing and exchanging health data. Importantly, for public health, communities of practice shape FHIR efforts. The community defines priorities and makes agreements on how to represent data in standardized ways that align with certain uses, such as reporting to public health. Use of the FHIR standard and greater involvement in the standards development effort hold great potential for public agencies that wish to become more “informatics savvy.”
How Might a Public Health Informatics Incubator Work?
As a result of the successful collaboration with Georgia Tech, CDC and partners have developed a model that works and could be replicated across the nation. The essential organizational elements include (1) a resource of informatics talent, (2) public health agency leadership and commitment to collaborate on a specific project, and (3) a brokering function linking these 2 elements and providing consultation and assistance. Furthermore, the process could be supported by a scalable educational component, such as the Massive Online Open Course (MOOC), developed by one of our coauthors (M.L.B.), which offers highly skilled informatics students (many of whom are working professionals) the ability to learn about health interoperability and to build FHIR-based solutions in close collaboration with project mentors using an FHIR app development platform.5
Under this model, informatics talent could consist of current graduate students in university-based informatics programs and also recent graduates of such programs. Therefore, a “node” of a national network could reside at an academic institution with an academically based leader who enables and encourages collaborative project development. Public health agency involvement could be fostered by CDC, by a professional association, and/or by a nongovernmental organization. Brokering and coordination would be essential to network functioning.
In practice, this structured approach involves several steps:
- First, a need is identified and a public health agency partner, involving program and informatics leadership, creates a project proposal.
- Then, a broker examines the proposal, consults with the public health agency partner, and transmits the refined proposal to an academic institution.
- Next, a selection process occurs such that a team is formed to include technical expertise, a project manager, and a health agency mentor to craft a work plan and to review purpose, deliverables, scope, scale, and timeline.
- Next, the project works to create a working prototype app or a design.
- Once the team completes its task, the output is “handed off” to the state health department or other partner to explore further implementation.
- Finally, the health agency or other partner may explore a range of options such as further prototyping, contractor involvement, partial deployment, or a demonstration project, leading to ultimate implementation.
In some cases, the process may not lead to implementation but will benefit the partners as a learning opportunity, leading to future exploration and to partnership development. In any event, public health agency program staff will see future possibilities and prioritize informatics innovation as central to program operations.
In contrast to many expensive and somewhat inflexible contractual arrangements, the incubator model provides low-cost access to informatics expertise with great flexibility of approach. Furthermore, this approach leads to the use of innovative informatics tools, techniques, and thinking that are on the “cutting edge” of the rapidly changing health information landscape. Under the current Georgia Tech collaboration, students participate in public health projects as part of a course in health informatics; therefore, their time is donated. Mentors at CDC or in public health agencies are currently contributing their time as part of normal job duties since involvement leads to information system improvement. CDC, under the Entrepreneur in Residence's salary, now covers brokering costs. In addition to personnel resources, technical infrastructure is needed to support project development and operations; at present, these resources have also been contributed, but funding would be required to scale them beyond the current Georgia Tech course. Additional funding may be needed to take a student-led project, once completed, and move it fully into production through involvement of a contractor or agency staff. All of these costs are real and must be understood in depth. If this promising approach is to be sustained, a business model and financing strategy must be created to ensure sustainable financing.
An urgent need exists for public health to improve the collection, use, and sharing of data and information by accessing expertise in “cutting-edge” informatics techniques and thinking. Augmentation of the current public health informatics workforce is crucial to addressing this urgent need. Creation of public health informatics incubators linking trained informatics specialists to public health agencies holds great promise as a low-cost way to rapidly innovate public health information systems, leading to enhanced public health decision making and improved population health. Testing (or expanding) this approach in other state and academic settings could be an important next step to validate and refine the use of this approach.
1. LaVenture M, Brand B, Baker EL. Developing an informatics-savvy health department: from discrete projects to a coordinating program, part I: assessment and governance. J Public Health Manag Pract. 2017;23(3):325–327.
2. LaVenture M, Brand B, Baker EL. Developing an informatics-savvy health department: from discrete projects to a coordinating program, part II: creating a skilled workforce. J Public Health Manag Pract. 2017;23(6):638–640.
3. Brand B, LaVenture M, Baker EL. Developing an informatics-savvy health department: from discrete projects to a coordinating program, part III: ensuring well-designed and effectively used information systems. J Public Health Manag Pract. 2018;24(2):181–184.
5. Braunstein ML. Practitioner's Guide to Health Informatics. New York, NY: Springer. 2015.