Tutorial Module 9: improving Public Health practice through public health informatics training

Public health informatics is the field from which public health professionals can draw to maximize efficient and effective management of information to improve public health practice. However, public health informatics or "… the systematic application of information and computer science and technology to public health practices, research and learning," is unfamiliar to most public health professionals.(1) Very few schools of public health offer public health informatics degree programs; graduate courses in informatics are more likely to be offered in schools of medicine and nursing. In order for public health professionals to contribute more effectively to the core functions of public health and be prepared to apply technology to the delivery of essential public health services, they should be educated and trained in information technology as well as public health and be knowledgeable about computer systems to manage health information.

The purpose of this module is to profile existing public health and other health informatics education and training programs. In addition, core curricula associated with academic programs as well as possible gaps in course work are identified. The last section highlights current initiatives directed at promoting improved public health informatics education and training to improve public health practice. (See Module 8 for a detailed description of public health informatics.)

Current Public Health and Other Health Informatics Education and Training Programs

Education and training programs in the field of public health informatics can include academic degree and non-degree (e.g., certificate program) coursework, fellowships, and continuing education and training efforts.

Academic Programs

Very few schools of public health offer public health informatics degree programs. Due, in part, to the fact that public health informatics is an emerging field, only two of the 32 accredited schools of public health offer a public health informatics graduate degree program. Emory’s Rollins School of Public Health offers a Master of Science in Public Health (MSPH) in Public Health Informatics, and the University of Illinois, Chicago offers an online Master in Public Health (MPH) degree program in public health informatics.

Informatics courses offered in schools of public health are more prevalent than degree programs. According to data from the late 1990s, 11 public health graduate programs in the United States offered an informatics course with an additional 13 in the planning stages.(2)

Graduate degree and non-degree programs in informatics are more likely to be offered in schools of medicine and nursing. Some of these programs offer specific courses in public health, while others do not. Schools of public health could draw from these programs to develop their own degree programs or could partner with these departments as part of an inter-disciplinary degree program in public health informatics.

The American Medical Informatics Association (AMIA) maintains a listing of Academic and Training Programs in the field of health care informatics, which includes public health, medical, nursing and other health-related fields of informatics.(3) According to the November 2003 AMIA listing, most programs for health informatics are masters’ level programs that reside in schools of medicine and in schools of nursing. (See Exhibit 1.) Many of these programs are interdisciplinary. For example, while the University of Washington’s Biomedical and Health Informatics Graduate Program is housed in the Department of Medical Education and Biomedical Informatics within the School of Medicine, its curriculum draws from seven schools and colleges: School of Dentistry, College of Engineering, Information School, School of Medicine, School of Nursing, School of Pharmacy, and the School of Public Health and Community Medicine.

Exhibit 1: Schools Offering Medical Informatics Programs

Some informatics programs in health also can be found in divisions within schools of informatics, schools of health information sciences or schools of computer science. A few informatics programs reside in schools of health services administration or schools of allied health.

Continuing Education and Training Programs

In the mid-1990s, the Centers for Disease Control and Prevention (CDC) recognized the need to train public health managers in informatics and began offering a public health informatics course for mid-career public health program managers. More recently, the CDC developed a non-degree Public Health Informatics Fellowship Program through its Epidemiology Program Office. The two year fellowship targets individuals with a public health and/or information systems background as well as graduate or professional degree in a relevant field and trains them both in informatics and in public health. Fellows also participate in the development, evaluation, and implementation of new public health surveillance and information systems in addition to the adaptation and support of existing information systems.

Various short courses and immersion programs in informatics, weekend or week long, are available in nursing, medical and health informatics. Short courses in informatics are offered through the Stanford Medical Informatics Introductory Short Course for example, a one-week intensive introduction and overview of the key concepts in health informatics. The National Library of Medicine week-long fellowship program is directed at medical educators, medical librarians, medical administrators, and faculty who may not be currently knowledgeable but can become agents of change in their institutions.

Core Curriculum in Health Informatics Programs with Concentrations in Public Health

Upon review of a subset of universities that offer graduate courses in health informatics and also emphasize public health, core courses in health informatics fall into four categories: computer science and information technology, health care/public health, informatics, and quantitative research methods and data analysis.(4) Degree requirements also include electives as well as a practicum and/or thesis project. Though individual programs may vary in terms of their core curriculum, all health informatics programs include some of the courses listed in Exhibit 2 below.

Exhibit 2: Health Informatics Coursework

Noteworthy public health classes in health-related informatics degree programs and unique courses used in the study of health informatics are highlighted in Exhibit 3.

Exhibit 3: Specific Courses in Public Health Informatics

Potential Gaps in Informatics Education and Training for Current and Future Public Health Professionals

Though public health informatics classes can be found in many of the 32 accredited schools of public health, a very small number of degree programs in public health informatics are currently available. In addition, it does not appear that schools of public health have emphasized informatics as an integral part of a well-rounded public health curriculum. Health informatics programs are offered in various universities, however, courses in public health and public health informatics usually are limited to elective classes.

In addition to offering more public health informatics degree programs in, or in conjunction with, schools of public health, topics to which additional attention could be paid in health informatics courses, in general, to improve public health practice include:

• Data capture and preparation;

• Variety of data sources available to practitioners;

• National and/or uniform data standards;

• Benefits of informatics on health practice; and

• Evaluation of the impact of informatics on health practice.

Current Initiatives Promoting Improved Public Health Informatics Education and Training

The Institute of Medicine (IOM) Committee on Educating Public Health Professionals for the 21st Century released a report in November of 2002 identifying informatics as one of the eight areas of critical importance to public health education in the 21st century.(5) The IOM report recommends two tiered continuing education for public health practitioners:

1. All public health practitioners should have a basic understanding of how informatics contributes to the core functions, the steps necessary and possible roles they could play to develop information systems, and the roles practitioners can play to develop and apply public health informatics; and

2. Select public health practitioners with responsibility over health applications of information technology should have additional expertise in project management, change management, information and knowledge development, systems development, information technology research.(6)

Associations, academic institutions, government agencies and foundations are tackling the charge to improve public health informatics education and training. For example, the American Medical Informatics Association (AMIA) Spring 2001 Congress brought together the public health and informatics communities to develop a national agenda for public health informatics. Training of the public health workforce in informatics was announced as an urgent need. Several recommendations were offered to improve the informatics skills and knowledge base in public health workers, including:

• Establish new and strengthen existing academic programs in public health informatics;

• Develop a national competency-based continuing education program in public health informatics;

• Enhance the CDC Public Health Informatics Fellowship Program; and

• Establish instructional design guidelines for public health informatics curriculum for the current public health workforce.

Another suggestion from the recent AMIA meeting was to define informatics performance standards as part of the National Public Health Performance Standards Program, an effort to evaluate the public health systems performance delivering the essential services.

AMIA meeting participants also supported the CDC’s and other efforts (e.g., University of  Washington’s Public Health Informatics Group, John Hopkins University) to develop core competencies in public health informatics.(7) Some of the various competencies include:

• Understanding of the respective roles and domains of IT and public health team members;

• Managing information of the public health organization as a key strategic resource and mission tool;

• A working knowledge of information system development, networking, and database design;

• Applying data collection processes, information technology applications, and computer systems storage/retrieval strategies;

• Managing information systems for collection, retrieval, and use of data for decision-making;

• Using various kinds of information technology to improve individual professional effectiveness (e.g. state of the art software tools, communication technology, online health information, privacy and confidentiality of information, distance learning);

• Harnessing the power of modern information technology to improve the functioning of the public health enterprise (e.g. integrated databases, data standards, enterprise-level health information architecture, implementation of security systems, accountability of public health agency); and

• Skills in IT planning and procurement, IT leadership, managing change, communication, and systems evaluation research.

Current public health workforce development initiatives could serve as vehicles for increasing awareness and knowledge among public health practitioners about public health informatics:

• Public Health Leadership Institutes;

• CDC’s Public Health Training Networks and the CDC in partnership with the Association of Public Health Laboratories’ National Laboratory Training Network;

• Public Health Foundation’s TrainingFinder.org application, a Web resource for training courses related to public health;

• Agency for Healthcare Research and Quality’s User Liaison Program (ULP), which disseminates important research findings for state and local policy through interactive workshops among other media;

• The National PH Leadership Development Network offers regional institutes in 46 states to train public health leaders;

• The Management Academy for Public Health provides a model program for state-based teams of public health leaders;

• The National Library of Medicine offers individual fellowships in informatics research as well as post-doctoral fellowships in informatics at various universities through the “University Medical Informatics Research Training Programs”; and

• The Centers for Disease Control and Prevention conduct a two year fellowship program in Public Health Informatics.

Internet References

The following are links to other sources of information regarding public health informatics training.

• CDC Public Health Informatics Fellowship

• Healthy People 2010 Public Health Infrastructure

• Informatics Training for CDC Public Health Advisors (July 1997)

• Institute of Medicine 2002 Report “Who Will Keep the Public Health? Educating Public Health Professionals for the 21st Century”

• Management Academy for Public Health

• National Laboratory Training Network (NLTN)

• National Library of Medicine

• National Public Health Leadership Development Network

• National Public Health Leadership Institute

• Public Health Foundation’s TrainingFinder.org

• Public Health Informatics Institute

• Public Health Infrastructure Resource Center (PHF)

• Public Health Training Network (PHTN)

• Resource Center Academic & Training Programs - American Medical Informatics Association

• Rollins School of Public Health of Emory University

• University of Illinois at Chicago School of Public Health - Online MPH in Public Health Informatics

• University of Washington Matrix and Core Curriculum

Endnotes

(1) Yasnoff, William A. O'Carroll, Patrick W. Koo, Denise. Linkins, Robert W. Kilbourne, Edwin M. (November 2000). Public Health Informatics: Improving and Transforming Public Health in the Information Age. Journal of Public Health Management and Practice. Vol. 6 No. 6, pp. 67-75.
(2) Ibid.
(3) Academic and training programs can add information to this listing on their degree programs, certificate programs, fellowships and short courses. The Public Health Informatics Group at the University of Washington posts a similar, but not as current, listing.
(4) University of Washington School of Public Health and Community Medicine, Northwest Center for Public Health Practice. (August 16, 2002). Northwest Center for Public Health Practice Public Health Informatics Competencies [On-line], Available: http://healthlinks.washington.edu/nwcphp/phi/comps/competencies.html; American Medical Informatics Association. (November 11, 2002). AMIA Resources Academic and Training Programs Resource Center Degree Programs, Certificate Programs, Fellowships, and Short Courses [On-line], Available: http://www.amia.org/informatics/acad&training/; Centers for Disease Control and Prevention. (October 10, 2002). CDC Public Health Informatics Fellowship Program [On-line], Available: http://www.cdc.gov/epo/dphsi/phifp/; University of Washington School of Public Health and Community Medicine. (October 10, 2002). Public Health Informatics [On-line], Available: http://www.informatics.washington.edu/; Emory University, Rollins School of Public Health, Department of Biostatistics. (October 10, 2002). MSPH in Public Health Informatics [On-line], Available: http://www.sph.emory.edu/bios/phi.html; University of Alabama at Birmingham. (October 10, 2002). Health Informatics Program Overview [On-line], Available: http://www.hsa.uab.edu/HI/Intro.htm; Columbia University. (October 10, 2002). Medical Informatics Curriculum [On-line], Available: http://www.dbmi.columbia.edu/publichealth/docs/et.html; University of Illinois at Chicago. (October 10, 2002). Master of Science in Health Informatics [On-line], Available: http://www.uic.edu/sph/phi/; University of Washington. (October 10, 2002). The Biomedical and Health Informatics Graduate Program at the University of Washington [On-line], Available: http://www.informatics.washington.edu/index.html; University of California Santa Barbara. (October 10, 2002). Designing and Delivering a Public Health Informatics Course [On-line], Available: http://www.library.ucsb.edu/istl/00-fall/article4.html; Columbia University. Public Health Informatics [On-line], Available: http://www.dbmi.columbia.edu/publichealth/; Harold Lehmann of Johns Hopkins University. (October 22, 2002). Email correspondence regarding the Health Sciences Informatics Program of the Johns Hopkins School of Medicine.
(5) Gebbie, Kristine, Linda Rosenstock, Lyla M. Hernandez, eds. The Institute of Medicine Committee on Educating Public Health Professionals for the 21st Century. Board on Health Promotion and Disease Prevention. (2002). Who Will Keep the Public Health?: Educating Public Health Professionals for the 21st Century. National Academies Press. Washington, DC.
(6) Ibid.
(7) Yasnoff, William A., et. al. (November/December 2001). A National Agenda for Public Health Informatics: Summarized Recommendations from the 2001 AMIA Spring Congress. Journal of American Medical Informatics Association. Vol. 8, No. 6.