Environmental Public Health Tracking Network


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Utah's Environmental Public Health Tracking Network.

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  • Thanks for coming and for your interest in EPHT I am presenting about this network right now because after about 6 years of planning, we are launching this network both statewide as well as nationally this summer. Hopefully this network will be a useful resource for all of you.
  • The Pew Environmental Health Commission wrote “America’s Env. Health Gap…” in September 2000. The report noted a need to shift some focus to environmental health problems and hazards. It described an environmental health gap, meaning that there is a lack of basic information on environmental Health hazards which can help find links to some diseases, detect trends in public health status, measure health issues as well as plan and evaluate public health programs.
  • Thus the Environmental Public Health Tracking Program was created Data warehouse that is expected to launch in the Fall of 2008 This program consists of the ongoing collection, integration, analysis, interpretation, and dissemination of data on three important topics: Environmental hazards Exposures to those hazards The related health effects
  • This program is primarily funded and created by the CDC Utah is one of the states that is involved in this project, along with 16 other state and city agencies. The map to the right shows the states involved in EPHT in blue There are four Universities of Public Health across the nation that are also involved. These are shown with a purple star. Also, a variety of professional and non-government groups are involved and interested in EPHT such as Utah Physicians for a Healthier Environment and the Utah Environmental Health Association
  • As stated earlier, the EPHT Network will include 3 main types of data. These are hazard data, exposure data, and health effects data. hazards data can be found in air, water, soil, food, and other parts of the environment. The general categories of hazards that may be included are: •Chemical agents, e.g pesticides;   •Physical agents, e.g., radon;   •Biomechanical stressors; and   •Biologic toxins, e.g., those from harmful algal bloom. Exposure data comes from a variety of data sources such as consumption rates, environmental modeling or biomonitoring An example of environmental modeling is measuring the amount of a certain pollutant in the air and then estimating the amount of that pollutant is inhaled or absorbed based on the concentration. This is usually done through computer or mathematical models Biomonitoring data comes from directly measuring the amount of a chemical in a person’s body. This can be done through blood or urine samples. Health effects data comes from traditional public health surveillance efforts, such as disease registries, vital statistics data, annual health surveys, and hospital discharge data. While these sources provide good results, greater data standardization and availability will increase the efficiency and effectiveness of the network. Example. The environmental hazard arsenic is thought to be related to health problems. Through biomonitoring data we have found that arsenic in drinking water is associated with bladder cancer.
  • The Utah EPHTN collects, codes and standardizes data from many different organizations that track environmental hazards, exposures, and health outcomes. Here is a list of partnerships that provide data to Utah’s EPHTN.
  • There will be four portals that will be accessible Two state portals: one secure, one for the public. The state will be using a very successful system that is already in place: IBIS-PH and Secure IBIS Two national portals: one secure, one for the public Queries: Cancer Registry>Single years>age-adjusted rate>2005>breast>choose census tracts (Draper) Birth Defect>quick selection>count>2006>all>all groups>hypoplastic left heart syndrome>all types>all counties>display by county Hospitalizations>myocardial infarction>hospital discharges>county of hospital visits>11/1/06-3/1/07>all myocardial infarction>all ages>both male and female>choose zip codes (84321, 84341, 84322)>view by time interval
  • It connects us with data partners and with potential data-users
  • These are the laws that cover the data. The first two have penalties that include up to $10,000 per violation. HIPAA’s penalties are up to $25,000 per year.
  • Putting these in place, we’ve had to incorporate them into our data sharing agreements. So, we’re currently working with each of our data partners to amend the DSA’s.
  • This is what we have available right now
  • Metadata aids data discovery! Because public health professionals can’t see all of this, we are working to put up metadata – or descriptive data notes – about each dataset.
  • The Secure IBIS-PH Access Request is very different for research projects and for public health professionals [It is purposely much easier for health professionals] For public health professionals they can select a topic and a geography. For research projects, they can select a topic, a geographic area and a geographic unit (for aggregation), a time period and a time unit (for aggregation), demographic characteristics or environmental pollutants to be studied and the unit for their stratification. The Access Request contains this information, too: They explain how they intend to keep the data secure. They also list all the members of their research project or their public health program. The Data-use Agreement Form and the Secure IBIS-PH Access Agreement Form are where they agree to all the security requirements. EACH PERSON involved in the research project or in the public health program must turn in a signed copy.
  • The public health professionals’ process is somewhat quicker than the process for research projects.
  • 1. To show progress, security, etc. – depends on memorandum of instruction 2. Access is limited to those who have signed a Data-use Agreement 3. Publications and presentations must be reviewed by the SRB at least 30 days in advance. Review of publications and presentations won’t be for quality. It will be for correct use of data (confidentiality, interpretation) and appropriate acknowledgement of the data owner. 4. Review will also ensure the data is being used for the purposes for which it was requested. The final point ensures that only the requested research topic is being researched AND that public health officials are only using it in work-related ways (not research projects)
  • Environmental Public Health Tracking Network

    1. 1. Environmental Public Health Tracking Network Alison Cox & Julia Shumway Health Program Specialists Environmental Epidemiology
    2. 2. How it all began: Pew Report <ul><li>September, 2000 </li></ul><ul><li>“ America’s Environmental Health Gap: Why the Country Needs a Nationwide Health Tracking Network” </li></ul><ul><li>Environmental Health Gap – Lack of basic environmental health information </li></ul><ul><ul><li>link hazards and disease, detect trends </li></ul></ul><ul><ul><li>measure health problems, conduct programs </li></ul></ul>
    3. 3. Environmental Public Health Tracking <ul><li>EPHT Network </li></ul><ul><ul><li>Data warehouse: </li></ul></ul><ul><ul><li>Available September 2008 </li></ul></ul><ul><li>“ EPHT is the ongoing collection, integration, analysis, interpretation, and dissemination of data on environmental hazards, exposures to those hazards , and health effects that may be related to the exposures.” </li></ul>
    4. 4. National EPHT Partnerships and Collaborations <ul><li>EPHT is primarily funded by the CDC </li></ul><ul><li>Environmental and health agencies </li></ul><ul><ul><li>Federal </li></ul></ul><ul><ul><li>State </li></ul></ul><ul><ul><li>City </li></ul></ul><ul><li>Academic </li></ul><ul><ul><li>Four academic partners </li></ul></ul><ul><li>Professional and non-government groups </li></ul>
    5. 5. Three Main Areas of EPHT Data <ul><li>Hazard data </li></ul><ul><ul><li>Water Quality </li></ul></ul><ul><ul><ul><li>arsenic </li></ul></ul></ul><ul><ul><ul><li>nitrates </li></ul></ul></ul><ul><ul><ul><li>disinfection byproducts </li></ul></ul></ul><ul><ul><li>Air Quality </li></ul></ul><ul><ul><ul><li>PM2.5 </li></ul></ul></ul><ul><ul><ul><li>Ozone </li></ul></ul></ul><ul><li>Exposure data </li></ul><ul><ul><li>Environmental Modeling </li></ul></ul><ul><ul><ul><li>Example: estimates the amount of chemical in a person by measuring that chemical in their soil and then using computer and mathematical models to estimate exposure </li></ul></ul></ul><ul><ul><li>Biomonitoring </li></ul></ul><ul><ul><ul><li>Example: detecting arsenic levels in hair, blood or urine </li></ul></ul></ul><ul><li>Health effect data </li></ul><ul><li>Example: Lead </li></ul>
    6. 6. Utah EPHT Data Partnerships <ul><li>Hazard Data Partners: </li></ul><ul><li>United States Geological Survey  </li></ul><ul><li>Federal Environmental Protection Agency </li></ul><ul><li>Utah Department of Environmental Quality, Division of Air Quality  </li></ul><ul><li>Utah Department of Environmental Quality, Division of Drinking Water </li></ul><ul><li>Exposure Data Partners: </li></ul><ul><li>Utah Department of Health, Environmental Epidemiology Program </li></ul><ul><li>Utah Public Health Laboratory </li></ul><ul><li>Health Effects Data Partners </li></ul><ul><li>Utah Department of Health, Center for Health Data </li></ul><ul><li>Utah Department of Health, Office of Vital Records and Statistics </li></ul><ul><li>Utah Population Database </li></ul><ul><li>Utah Birth Defects Network </li></ul><ul><li>Utah Cancer Registry </li></ul><ul><li>Centers for Disease Control and Prevention </li></ul><ul><li>Utah Health Information Network </li></ul><ul><li>Utah Office of Health Care Statistics </li></ul><ul><li>Indicator Based Information Systems for Public Health (IBIS-PH) </li></ul>
    7. 7. EPHT Portals <ul><li>National public portal </li></ul><ul><li>National secure portal </li></ul><ul><li>State secure portal (Secure IBIS) </li></ul><ul><li>State public portal (IBIS-PH) </li></ul>
    8. 8. Connecting Public Health Professionals with Relevant Environmental and Health data Accessing Secure IBIS-PH
    9. 9. Tracking Network Advisory Committee <ul><li>An advisory body to give an influence to </li></ul><ul><ul><li>data sharing partners, </li></ul></ul><ul><ul><li>indicator owners, and </li></ul></ul><ul><ul><li>other interested parties </li></ul></ul><ul><li>To encourage awareness and participation </li></ul>
    10. 10. TNAC Charter <ul><li>The TNAC will fill and advisory role concerning </li></ul><ul><ul><li>data content; </li></ul></ul><ul><ul><li>security and accessibility; </li></ul></ul><ul><ul><li>risk communication; </li></ul></ul><ul><ul><li>marketing and outreach. </li></ul></ul><ul><li>The TNAC will act as an intermediary. </li></ul><ul><li>TNAC will supply representatives for the Scientific Review Board. </li></ul>
    11. 11. Scientific Review Board <ul><li>Utah Department of Health </li></ul><ul><ul><li>Bureau of Emergency Medical Services </li></ul></ul><ul><ul><li>Office of Health Care Statistics </li></ul></ul><ul><ul><li>Office of Public Health Assessment </li></ul></ul><ul><ul><li>Office of Vital Records and Statistics </li></ul></ul><ul><ul><li>Utah Birth Defects Network </li></ul></ul><ul><ul><li>Utah Blood Lead Registry </li></ul></ul><ul><ul><li>Utah Public Health Laboratories </li></ul></ul><ul><li>Utah Department of Environmental Quality </li></ul><ul><ul><li>Division of Environmental Response and Remediation </li></ul></ul><ul><ul><li>Division of Drinking Water </li></ul></ul><ul><ul><li>Division of Air Quality </li></ul></ul><ul><li>University of Utah </li></ul><ul><ul><li>Utah Cancer Registry </li></ul></ul><ul><ul><li>Utah Poison Control Center </li></ul></ul>
    12. 12. Standards-based Data Security <ul><li>Utah Code 26-3-7: Limitations on disclosing identifiable health data </li></ul><ul><li>Utah Code 26-3-10: Department measures to protect health data </li></ul><ul><li>Utah Rule 380-25: Confidentiality of data received through electronic exchange </li></ul><ul><li>Utah Rule 380-250: HIPAA Privacy Rule Implementation </li></ul>
    13. 13. Granting Access <ul><li>Third Party Application for Access to Secure IBIS-PH for Public Health Professionals </li></ul><ul><li>Third Party Application for Access to Secure IBIS-PH for Research Projects </li></ul>
    14. 14. IBIS-PH Secure Query Modules
    15. 15. Finding Secure Data
    16. 16. Metadata aids data discovery. <ul><li>Metadata: “data about data” </li></ul>Type of EPHT Indicator Health outcome Measures <ul><li>Count of elevated blood lead level cases by zip code </li></ul>Derivation of measure Numerator: The number elevated of blood lead level tests reported by laboratories to the Utah Department of Health. Denominator: Denominators used to calculate rates among children represent the number of children tested and adults represent the number of persons in the Utah labor force population provided by the Utah Department of Workforce Services. Variables contained Year Age group Blood lead level Sex Zip code Variable definitions Year: Year of diagnosis Age group: The age group of the individual at time of blood lead level measurement Blood lead level: Level of lead in blood by microgram per deciliter (µg/dL) Sex: Sex of individual with elevated blood lead level Zip Code: The zip code where the individual with elevated blood lead resides at the time of measurement. Variables to group by Year Age group Blood lead level Sex Zip code Chart graphic types Vertical bar Horizontal bar Stacked vertical bar Area Stacked area Pie Line
    17. 17. Unit Patient with elevated blood lead Geographic Scope Utah Geographic Coordinates West: -114.042925 East: -109.041501 North: 42.001718 South: 36.997693 Geographic scale Zip codes Time Period 2002-2006 Updated Annually Time Scale Single years Rationale The Utah Blood Registry (UBLR) within the Utah Department of Health functions to identify residents of Utah with elevated blood lead levels. The UBLR provides risk assessment to help the individual limit and remove their risk of lead exposure. The UBLR serves as a resource for physicians, hospitals, local health departments, and researchers. The UBLR provides blood lead data to national agencies for generating national statistics and to state and local agencies for identifying high risk areas. The UBLR provides an educational and data resource for physicians, nurses, and other institutions to help protect Utah’s population. Use of the Measure Limitations of the Measure Data Sources Blood lead data is provided to the Utah Department of Health, Utah Blood Lead Registry, from laboratories, hospitals, health clinics and physicians. Utah Population Estimates Committee (UPEC) and the Governor’s Office of Planning and Budget (GOPB), 2008 Baseline Economic and Demographic Projections (Revised on 7-23-2008).
    18. 18. Reporting Protocols Under the Injury Reporting Rule R386-703, specific to the injury of an Elevated Blood Lead (≥ 10µg/dL), a reportable injury evaluated or treated at a hospital shall be reported by that hospital. Reportable injuries not evaluated at a hospital shall be reported by the involved physician, nurse, other health care practitioner, medical examiner, or laboratory administrator. Each case of injury shall be reported to the Utah Department of Health or to the local health department responsible for the geographic area where the injury occurred. The local health officer shall forward all original reports to the Utah Department of Health. Because the Utah Blood Lead Registry falls under the definition of a public health entity, the Injury Reporting Rule takes precedence over the recent legislation called HIPAA, the Health Insurance Portability and Accountability Act. For more information regarding public health, including blood lead reporting and HIPAA, please go to the Centers for Disease Control and Prevention website at: http://www.cdc.gov/od/science/regs/privacy/index.htm Additional Details to consider All population estimates and projections apply to July 1 of the selected year. Citation Blood lead data provided by the Utah Department of Health is funded in part by a contract with the National Institute for Occupational Safety and Health and the Centers for Disease Control and Prevention, Preventive Block Grant Award. Contact Metadata created by: Health Program Specialist Environmental Epidemiology Program Utah Department of Health PO Box 142104 Salt Lake City, UT 84114-2104 801-538-6191 [email_address] http://health.utah.gov/epi/enviroepi/ Creation Date August 13, 2009
    19. 19. <ul><li>Research Projects </li></ul><ul><li>Public Health Professionals </li></ul><ul><li>Cover sheet </li></ul><ul><li>Secure IBIS-PH Access Request </li></ul><ul><li>Data-use Agreement Form </li></ul><ul><li>Research Proposal </li></ul><ul><li>IRB Approval </li></ul><ul><li>Letters of Support </li></ul><ul><li>Secure IBIS-PH Access Request </li></ul><ul><li>Secure IBIS-PH Access Agreement Form </li></ul><ul><li>Annually renewable upon verification that access is still necessary for work. </li></ul>Secure IBIS-PH Application
    20. 20. Public Health Professionals <ul><li>EPHT Program receives the application (electronic and paper) </li></ul><ul><li>EPHT Program forwards the electronic to the SRB </li></ul><ul><li>The SRB may require additional information, explanations, etc. </li></ul><ul><li>EPHT Program will create a login for the researcher and provide a memorandum of instruction. </li></ul>
    21. 21. Monitoring Data Access and Use <ul><li>Periodic status reports </li></ul><ul><li>Individual access review </li></ul><ul><li>Publications and presentations </li></ul><ul><li>Review of data use </li></ul>