Question

Informatics and the Development of Standards No unread replies.11 reply. Discuss the roles of federal, state, and local public health agencies in the development of standards for informatics in healthcare.

Answer 1

Broadly speaking, the health-related activities of state and local government are: traditional public health, including health monitoring, sanitation, and disease control; the financing and delivery of personal health services including Medicaid, mental health, and direct delivery through public hospitals and health .

Areas of Public Health Responsibility

• Assure an Adequate Local Public Health Infrastructure.
• Promote Healthy Communities and Healthy Behavior.
• Prevent the Spread of Communicable Disease.
• Protect Against Environmental Health Hazards.
• Prepare and Respond To Emergencies.
• Assure Health Services.
• Federal Influences.

Specifically, public health informatics supports the mission of disease prevention and health promotion by leveraging information technology solutions, therefore enabling environmental health programs to achieve public health goals more effectively, efficiently, and inexpensively.

What Are the Implications of Each of the Four Components of Public Health?

• Health. For most of the history of public health, the term “health” focused solely on physical health.
• Population. The definition of “population,” likewise, is undergoing fundamental change.
• Society-Wide Concerns.
• Vulnerable Populations.

Examples of proposed federal actions to reduce medical errors and enhance patient safety are provided to illustrate the 10 roles:

(1) purchase health care,

(2) provide health care,

(3) ensure access to quality care for vulnerable populations,

(4) regulate health care markets,

(5) support acquisition of new knowledge

The 10 Essential Services of Public Health describe the ideal public health activities that all communities should undertake. The framework was developed by the Core Public Health Functions Steering Committee in 1994. The committee included representatives from US Public Health Service agencies and other major public health organizations.

1. Monitor health status to identify and solve community health problems
2. Diagnose and investigate health problems and health hazards in the community
3. Inform, educate, and empower people about health issues
4. Mobilize community partnerships and action to identify and solve health problems
5. Develop policies and plans that support individual and community health efforts
6. Enforce laws and regulations that protect health and ensure safety
7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable
8. Assure competent public and personal health care workforce
9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services
10. Research for new insights and innovative solutions to health problems

LOCAL PUBLIC HEALTH AGENCIES

Activities and Responsibilities

Local health departments (LHDs) have a fundamental and complex role as the front line for delivery of basic public health services to most of the communities in this country. There are nearly 3,000 local health departments in the United States, varying dramatically in geographic size, size and nature of population, urban and rural mix, economic circumstances, governmental structure within which they work, and governing organization to which they are accountable. The majority of local health departments provide a wide variety of services to very diverse communities with limited resources and too few staff s 14 full-time equivalents). Although local public health services are often discussed within the framework of the 10 Essential Public Health Services, the services actually provided vary widely from state to state, from urban to rural areas, and are especially adapted to address local priorities and concerns. Despite considerable variation, however, more than two-thirds of local health departments provide the following core services: adult and childhood immunizations; communicable disease control; community outreach and education; epidemiology and surveillance; environmental health regulation such as food safety services and restaurant inspections; and tuberculosis testing .

STATE PUBLIC HEALTH AGENCIES

The 1988 Institute of Medicine report The Future of Public Health described the need for well-trained public health professionals who can address the needs of the public health system associated with technological advances, leadership and political will, and social justice. That report briefly described major barriers to meeting those needs: lack of public health training among the leadership of public health systems, lack of financial resources, and the general limitations of the governmental environment. Those observations were significant for the times, but that landmark report did not offer additional analysis regarding the issue of workforce development. Much has changed during the past decade and a half. Since 1989, new challenges for public health have emerged, with new emphases on surveillance of complex disease patterns and syndromes, emergency preparedness with regard to chemical and biological terrorism, and the increasing diversity of the population as a whole. These challenges have escalated at a time when most states are dealing with budget cuts, personnel hiring freezes, and difficulty in recruiting and hiring public health professionals. Since two-thirds to three-fourths of the state health departments' budgets are personnel related, the cost of weak workforce development is magnified.

The Organizational Climate

All states and territories and the District of Columbia have a designated entity known formally as the state public health department. There are a total of 56 such designated units in the United States and its territories. The mission, authority, governance, and accountability of these agencies vary according to the state statutes that establish the public health departments. Some are located within a comprehensive health and human services umbrella agency; some are divisions within the governor's organizational structure; and some are stand-alone state agencies.

Responsibility of the State Health Department

One of the 10 Essential Public Health Services specifically focuses on assuring a competent public health and personal care workforce, and state health departments have specific responsibilities in this area. Continuous improvement in the quality of services delivered to the citizens of a state includes an ongoing and systematic assessment of the professional workforce available to deliver those services. The following sections describe specific components of a state-based public health system quality review process related to workforce development.

National Public Health Performance Standards Program

The role of state health departments in assuring a competent public and personal health care workforce has been described in the National Public Health Performance Standards Program, Essential Service 8 (ensuring a competent public health and personal health care work force) which identifies the responsibilities of state public health departments as including the education, training, development, and assessment of health professionals—including partners, volunteers, and other lay community health workers—to meet statewide needs for public and personal health services. Responsibilities also include the development of processes for credentialing technical and professional health personnel, the adoption of continuous quality improvement and life-long learning programs, and the development of partnerships with professional workforce development programs to assure relevant learning experiences for all participants. Continuing education in management, cultural competence, and leadership development programs are also responsibilities of the state public health agency.

The National Public Health Performance Standards identify indicators of success for a state public health agency to utilize in evaluating whether it is meeting the workforce development needs of its jurisdiction. Indicators of success include the following:

• Identification of the workforce providing population-based and personal health services in public and private settings across the state and implementation of recruitment and retention policies. This indicator includes an assessment of the number, qualifications, and geographic distribution of the public health workforce statewide.

• Provision of training and continuing education to assure that the workforce will effectively deliver the Essential Public Health Services. These plans involve resource development programs that include training in leadership and management, multiple determinants of health, information technology growth and development, and support of competencies in the specific health professions. The state public health agency should be instrumental in assuring that these functions are conducted, regardless of whether the agency provides the functions directly or facilitates their provision.

• Provision of specific assistance, capacity building, and resources to local public health systems in their efforts to assure a competent public and personal care workforce. This indicator includes the collaborative development of retention and performance-improvement strategies to fill workforce gaps and decrease performance deficiencies; and assurance of educational course work to enhance the skills of the workforce of local public health systems. State public health agencies, working in collaboration with local public health systems, can develop incentives that support workforce development activities.

• Evaluation and quality improvement of the statewide system for workforce development. To be successful in this area, the state public health agency would periodically and consistently review the state's activities to assure that a competent public and personal care workforce uses the results from reviews to improve the quality and outcome of its efforts. These reviews would include current and future workforce distribution and continuing education needs as well as public health system assessment for its success in meeting those needs.

FEDERAL PUBLIC HEALTH AGENCIES

Federal agencies are important to the development of the public health workforce generally, and specifically to the education of public health professionals. The roles of these agencies have included developing the research base that provides education; testing educational approaches; helping schools develop infrastructure; supporting faculty development; and providing funding for students. Key agencies include the National Institutes of Health (NIH), the Health Resources and Services Administration (HRSA), CDC, the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Agency for Healthcare Research and Quality (AHRQ), and their predecessors. They are located within the Department of Health and Human Services (DHHS), but the size of the department and the diversity of missions of the component units makes it critical that the discussion be specific to the individual agency.

From the broadest public health education perspective, HRSA and CDC have been central and will be the focus of this discussion. HRSA includes the Bureau of Health Professions (BHPr), which has the mission to help to assure access to quality health care professionals in all geographic areas and to all segments of society. BHPr puts new research findings into practice, encourages health professionals to serve individuals and communities where the need is greatest, and promotes cultural and ethnic diversity within the health professions workforce. The bureau identifies several specific programs for the public health workforce:

• Public Health Training Centers assess workforce learning needs and provide tailored distance learning and related educational programs.

• Public Health Special Projects community and academic partnerships improve skills and competencies of the public health workforce, provide distance learning, curriculum revision, and course content in areas of emerging importance.

• Public Health Traineeships train eligible individuals in public health professions experiencing critical shortages.

• Preventive Medicine Residencies support existing and develop new residency training programs, and provide financial assistance to enrollees.

• Health Administration Traineeships and Special Projects increase the number of underrepresented minority health administrators and the number of health administrators in underserved areas, support academic and practice linkages, and develop outcomes-based curricula.

the committee recommends that federal agencies provide increased funding to

• develop competencies and curriculum in emerging areas of practice;

• fund degree-oriented public health fellowship programs;

• provide incentives for developing academic and practice partnerships;

• support increased participation of public health professionals in the education and training activities of schools and programs of public health; especially, but not solely, practitioners from local and state public health agencies; and

• improve practice experiences for public health students through support for increased numbers and types of agencies and organizations that would serve as sites for practice rotations.