ORIGINAL ARTICLE
An informatics framework for public health
information systems: a case study
on how an informatics structure for integrated
information systems provides benefit in supporting
a statewide response to a public health emergency
Ivan J. Gotham • Linh H. Le • Debra L. Sottolano •
Kathryn J. Schmit
Received: 17 April 2013 / Revised: 8 October 2013 / Accepted: 23 January 2014 /
Published online: 8 February 2014
� Springer-Verlag Berlin Heidelberg 2014
Abstract This chapter illustrates how a well-established public health informatics
framework provides an integrated information system infrastructure that assures and
enhances the efficacy of public health emergency preparedness (PHEP) actions
throughout the phases of the health emergency event life cycle. Key PHEP activities
involved in supporting this cycle include planning; surveillance; alerting; resource
assessment and management; data-driven decision support; and intervention for
prevention and control of disease or injury in populations. Information systems
supporting these activities are most effective in assuring optimal response to an
emergent health event when they are integrated within an informatics framework
that supports routine (day to day) information exchange within the health infor-
mation exchange community. In late April 2009, New York State (NYS) initiated a
statewide PHEP response to the emergence of Novel Influenza A (H1N1), culmi-
nating in a statewide vaccination campaign during the last quarter of 2009. The
I. J. Gotham (&)
School of Public Health, Department of Health Policy Management University at Albany,
State University of New York , 1 University Place, Rensselaer, NY 12144, USA
e-mail: [email protected]
L. H. Le � K. J. Schmit
New York State Department of Health, Office of Information Technology Service,
Empire State Plaza, Room 148, Albany, NY 12237, USA
e-mail: [email protected]
K. J. Schmit
e-mail: [email protected]
L. H. Le
Department of Nursing, Sage College, Albany, NY 12180, USA
D. L. Sottolano
Center for Health Care Quality & Surveillance, New York State Department of Health,
875 Central Avenue, Albany, NY 12206, USA
e-mail: [email protected]
123
Inf Syst E-Bus Manage (2015) 13:713–749
DOI 10.1007/s10257-014-0240-9
http://crossmark.crossref.org/dialog/?doi=10.1007/s10257-014-0240-9&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s10257-014-0240-9&domain=pdf
established informatics framework of integrated information systems within NYS
conveyed significant advantages and flexibility in supporting the range of PHEP
activities required for an effective response to this health event. This chapter
describes, and provides, performance metrics to illustrate how a public health
informatics framework can enhance the efficacy of all phases of a public health
emergency response. It also provides informatics lessons learned from the event.
Keywords Public health informatics � Information systems �
.
Chapter 4 Information Systems to Support Population Health Managem.docxketurahhazelhurst
Chapter 4 Information Systems to Support Population Health Management Learning Objectives To be able to understand the data and information needs of health systems in managing population health effectively under value-based payment models. To be able to discuss key health IT tools and strategies for population health management including EHRs, registries, risk stratification, patient engagement, and outreach, care coordination and management, analytics, health information exchange, and telemedicine and telehealth. To be able to discuss the application and use of data analytics to monitor, predict, and improve performance. The enactment of the Affordable Care Act (ACA) brought about sweeping legislation intended to reduce the numbers of uninsured and make health care accessible to all Americans. It also ushered in an era in which changing reimbursement and care delivery models are driving providers from the current fragmented system focused on volume-based services to an outcomes orientation. As a result, the health care system now taking shape is one in which value-based payment models financially reward patient-centered, coordinated, accountable care. Against this backdrop, providers' increasing use of evidence-based medicine and growing capabilities in managing volumes of clinical evidence through sophisticated health IT systems will mean that treatments can be tailored for the individual and interventions can be made earlier to keep patients well. Furthermore, patient engagement is fast becoming a critical component in the care process, particularly in the area of population health management (PHM). Health care providers' interest in improving population health appears to be increasing because of the sudden ubiquity of the phrase, because many are participating in accountable care organizations (ACOs), and because even hospitals not participating in an ACO increasingly have incentives to reduce their number of potentially unavoidable admissions, readmissions, and emergency department visits (Casalino, Erb, Joshi, & Shortell, 2015). In this chapter we'll not only seek a common understanding of PHM but also explore how the advent of shared accountability financial arrangements between providers and purchasers of care has created significant focus on PHM. We'll also review the core processes associated with accountable care and examine the strategic IT investments and data management capabilities required to support population health management and enable a successful transition from volume-based to value-based care. PHM: Key to Success Although the ACO model is still new and evolving, approximately 750 ACOs are in operation today, covering some 23.5 million lives under Medicare, Medicaid, and private insurers. Although not all ACOs have demonstrated success in delivering better health outcomes at a lower cost, many have achieved promising results (Houston & McGinnis, 2016). As such, significant ACO growth is expected. In fact, it is predicte ...
Running Head THE HEALTH INFORMATION EXCHANGE (HIE) IN U.S 1.docxtodd521
Running Head: THE HEALTH INFORMATION EXCHANGE (HIE) IN U.S 1
THE HEALTH INFORMATION EXCHANGE (HIE) IN U.S 9
The Health Information Exchange (HIE) in U.S
Yehyun Park
Purdue University
01/02/2019
The impetus of Health Information Exchange in U.S
Health Information Exchange (HIE) is an information system that promotes a secure sharing of critical information as well the inclusive access critical medical information about a patient electronically (Abdelhak et al, 2014). One merit of the use of such electronic systems in the U.S is that they occur in different verities. The HIE also offer different types of services. Evidently, a recent development has enabled the HIE systems to promote the Marketplace and regional institutional services concerning the health sector. The merit of HIE applications included the improvement of speed, Quality, safety and reduced relative prices of charge per patient for care. This is made possible by the quick sharing of critical information among the doctors, pharmacists, nurses among all the relevant health personnel. The HGIE systems are such that, they are technically enabled to provide quick response to information demand with the relevant urgency and thus aids in the making of vital patient’s data and medical progress devoid of medical errors, readmissions, and duplicate testing. The resulting system has a generally improved diagnosis.
HIE enables three line of services in general: directed exchange, Query-based Exchange a consumer-mediated exchange services. Direct Exchange is the sending or receiving data electronically in the aid of coordination by caregivers. Whenever heath care provider wants to consult with other providers about a planned care, they employ the Query-based exchange while consumer-mediated Exchange enables patients to manage through control of the use of their personal information (Abdelhak et al, 2014). The availability of the three forms of health information Exchange makes the strong point of HIE since their integration in use is guided by some predetermined policies, technology, principles, and policies provision which have already been piloted before. The three forms are completely available throughout. With the Consumer-mediated Exchange system, the patient can be able to monitor the use of his personal medical information by their care provider. The patients can make a participation in their care enhancing through providing alternative providers with their heath condition, describe their heath information give the health missing or incorrect information, track and manage their own health.
Describe basic HIE organizational structures, architectures, and services
The commonly known architecture types of HIE includes the centralized hybrid and the federated models of HIE. The centralized HIE model is enabled with one Clinical Data Repository (CDR). The CDR is managed by HIE authority that is under the governance of the representatives from the relevant hospitals (Abdelhak .
BRIEF COMMUNICATIONS DATA HYGIENE: IMPORTANT STEP IN DECISIONMAKING WITH IMPL...hiij
Medical and health data that have been entered into an electronic data system in real-time cannot be
assumed to be accurate and of high quality without verification. The adoption of the electronic health
record (EHR) by many countries to the support care and treatment of patients illustrates the importance of
high quality data that can be shared for efficient patient care and the operation of healthcare systems.
This brief communication provides a high-level overview of an EHR system and practices related to high
data quality and data hygiene that could contribute to the analysis and interpretation of EHR data for use
in patient care and healthcare system administration.
BRIEF COMMUNICATIONS DATA HYGIENE: IMPORTANT STEP IN DECISIONMAKING WITH IMPL...hiij
Medical and health data that have been entered into an electronic data system in real-time cannot be
assumed to be accurate and of high quality without verification. The adoption of the electronic health
record (EHR) by many countries to the support care and treatment of patients illustrates the importance of
high quality data that can be shared for efficient patient care and the operation of healthcare systems.
This brief communication provides a high-level overview of an EHR system and practices related to high
data quality and data hygiene that could contribute to the analysis and interpretation of EHR data for use
in patient care and healthcare system administration.
Chapter 4 Information Systems to Support Population Health Managem.docxketurahhazelhurst
Chapter 4 Information Systems to Support Population Health Management Learning Objectives To be able to understand the data and information needs of health systems in managing population health effectively under value-based payment models. To be able to discuss key health IT tools and strategies for population health management including EHRs, registries, risk stratification, patient engagement, and outreach, care coordination and management, analytics, health information exchange, and telemedicine and telehealth. To be able to discuss the application and use of data analytics to monitor, predict, and improve performance. The enactment of the Affordable Care Act (ACA) brought about sweeping legislation intended to reduce the numbers of uninsured and make health care accessible to all Americans. It also ushered in an era in which changing reimbursement and care delivery models are driving providers from the current fragmented system focused on volume-based services to an outcomes orientation. As a result, the health care system now taking shape is one in which value-based payment models financially reward patient-centered, coordinated, accountable care. Against this backdrop, providers' increasing use of evidence-based medicine and growing capabilities in managing volumes of clinical evidence through sophisticated health IT systems will mean that treatments can be tailored for the individual and interventions can be made earlier to keep patients well. Furthermore, patient engagement is fast becoming a critical component in the care process, particularly in the area of population health management (PHM). Health care providers' interest in improving population health appears to be increasing because of the sudden ubiquity of the phrase, because many are participating in accountable care organizations (ACOs), and because even hospitals not participating in an ACO increasingly have incentives to reduce their number of potentially unavoidable admissions, readmissions, and emergency department visits (Casalino, Erb, Joshi, & Shortell, 2015). In this chapter we'll not only seek a common understanding of PHM but also explore how the advent of shared accountability financial arrangements between providers and purchasers of care has created significant focus on PHM. We'll also review the core processes associated with accountable care and examine the strategic IT investments and data management capabilities required to support population health management and enable a successful transition from volume-based to value-based care. PHM: Key to Success Although the ACO model is still new and evolving, approximately 750 ACOs are in operation today, covering some 23.5 million lives under Medicare, Medicaid, and private insurers. Although not all ACOs have demonstrated success in delivering better health outcomes at a lower cost, many have achieved promising results (Houston & McGinnis, 2016). As such, significant ACO growth is expected. In fact, it is predicte ...
Running Head THE HEALTH INFORMATION EXCHANGE (HIE) IN U.S 1.docxtodd521
Running Head: THE HEALTH INFORMATION EXCHANGE (HIE) IN U.S 1
THE HEALTH INFORMATION EXCHANGE (HIE) IN U.S 9
The Health Information Exchange (HIE) in U.S
Yehyun Park
Purdue University
01/02/2019
The impetus of Health Information Exchange in U.S
Health Information Exchange (HIE) is an information system that promotes a secure sharing of critical information as well the inclusive access critical medical information about a patient electronically (Abdelhak et al, 2014). One merit of the use of such electronic systems in the U.S is that they occur in different verities. The HIE also offer different types of services. Evidently, a recent development has enabled the HIE systems to promote the Marketplace and regional institutional services concerning the health sector. The merit of HIE applications included the improvement of speed, Quality, safety and reduced relative prices of charge per patient for care. This is made possible by the quick sharing of critical information among the doctors, pharmacists, nurses among all the relevant health personnel. The HGIE systems are such that, they are technically enabled to provide quick response to information demand with the relevant urgency and thus aids in the making of vital patient’s data and medical progress devoid of medical errors, readmissions, and duplicate testing. The resulting system has a generally improved diagnosis.
HIE enables three line of services in general: directed exchange, Query-based Exchange a consumer-mediated exchange services. Direct Exchange is the sending or receiving data electronically in the aid of coordination by caregivers. Whenever heath care provider wants to consult with other providers about a planned care, they employ the Query-based exchange while consumer-mediated Exchange enables patients to manage through control of the use of their personal information (Abdelhak et al, 2014). The availability of the three forms of health information Exchange makes the strong point of HIE since their integration in use is guided by some predetermined policies, technology, principles, and policies provision which have already been piloted before. The three forms are completely available throughout. With the Consumer-mediated Exchange system, the patient can be able to monitor the use of his personal medical information by their care provider. The patients can make a participation in their care enhancing through providing alternative providers with their heath condition, describe their heath information give the health missing or incorrect information, track and manage their own health.
Describe basic HIE organizational structures, architectures, and services
The commonly known architecture types of HIE includes the centralized hybrid and the federated models of HIE. The centralized HIE model is enabled with one Clinical Data Repository (CDR). The CDR is managed by HIE authority that is under the governance of the representatives from the relevant hospitals (Abdelhak .
BRIEF COMMUNICATIONS DATA HYGIENE: IMPORTANT STEP IN DECISIONMAKING WITH IMPL...hiij
Medical and health data that have been entered into an electronic data system in real-time cannot be
assumed to be accurate and of high quality without verification. The adoption of the electronic health
record (EHR) by many countries to the support care and treatment of patients illustrates the importance of
high quality data that can be shared for efficient patient care and the operation of healthcare systems.
This brief communication provides a high-level overview of an EHR system and practices related to high
data quality and data hygiene that could contribute to the analysis and interpretation of EHR data for use
in patient care and healthcare system administration.
BRIEF COMMUNICATIONS DATA HYGIENE: IMPORTANT STEP IN DECISIONMAKING WITH IMPL...hiij
Medical and health data that have been entered into an electronic data system in real-time cannot be
assumed to be accurate and of high quality without verification. The adoption of the electronic health
record (EHR) by many countries to the support care and treatment of patients illustrates the importance of
high quality data that can be shared for efficient patient care and the operation of healthcare systems.
This brief communication provides a high-level overview of an EHR system and practices related to high
data quality and data hygiene that could contribute to the analysis and interpretation of EHR data for use
in patient care and healthcare system administration.
6/29/2016 library.ahima.org/PB/DataStandards#appxA
http://library.ahima.org/PB/DataStandards#appxA 1/20
Data Standards, Data Quality, and Interoperability (2013
update)
Remove from myBoK
Editor's note: This update replaces the 2007 practice brief "Data Standards, Data Quality, and Interoperability."
Data quality and consistency are critical to ensuring patient safety, communicating delivery of health services, coordinating
care, and healthcare reporting. Assessing the quality and consistency of data requires data standards. This practice brief
provides health information management (HIM) professionals with a clear understanding of data standards as a tool to
enable interoperability and promote data quality.
The online version of this practice brief [...] is accompanied by an appendix that provides HIM professionals with a list of
standards to reference in data dictionary development, electronic health records, the exchange of health information, and
general data management processes to ensure information integrity and reliability. Evaluation of data validity, reliability,
completeness, and timeliness are accomplished through a combination of human and machine processes in healthcare, and
the list of data standard sources is a helpful reference guide when more detailed information is required.
Data Standards and Regulatory Framework
Data standards are "documented agreements on representations, formats, and definitions of common data. Data standards
provide a method to codify invalid, meaningful, comprehensive, and actionable ways, information captured in the course of
doing business." Rules to describe how the data is recorded to ensure consistency across multiple sources is another way to
think of data standards. Without data standards and data quality, the future of interoperability is bleak. Data fields and the
content of those fields need to be standardized.
Standards development organizations (SDOs) address a variety of aspects of health information and informatics. For
example, the American Society for Testing and Materials (ASTM) and Health Level Seven (HL7) target clinical data
standards. Insurance and remittance standards are a focus of the Accredited Standards Committee (ASC) X12. Standards to
transmit diagnostic images are developed through Digital Imaging and Communications in Medicine (DICOM). The
National Council for Prescription Drug Programs (NCPDP) represents pharmacy messages.
The Institute of Electrical and Electronics Engineers (IEEE), HL7, ASTM, and others develop data models and
frameworks. See the table on page 65 for a breakdown of regulatory agencies responsible for working with the American
National Standards Institute (ANSI) to drive data standards to achieve interoperability.
The AHIMA Leadership Model states that HIM professionals should serve as the leaders in healthcare organizations and in
their professional community for ensuring that data content standards are identified, understood, implemented, a.
6/29/2016 library.ahima.org/PB/DataStandards#appxA
http://library.ahima.org/PB/DataStandards#appxA 1/20
Data Standards, Data Quality, and Interoperability (2013
update)
Remove from myBoK
Editor's note: This update replaces the 2007 practice brief "Data Standards, Data Quality, and Interoperability."
Data quality and consistency are critical to ensuring patient safety, communicating delivery of health services, coordinating
care, and healthcare reporting. Assessing the quality and consistency of data requires data standards. This practice brief
provides health information management (HIM) professionals with a clear understanding of data standards as a tool to
enable interoperability and promote data quality.
The online version of this practice brief [...] is accompanied by an appendix that provides HIM professionals with a list of
standards to reference in data dictionary development, electronic health records, the exchange of health information, and
general data management processes to ensure information integrity and reliability. Evaluation of data validity, reliability,
completeness, and timeliness are accomplished through a combination of human and machine processes in healthcare, and
the list of data standard sources is a helpful reference guide when more detailed information is required.
Data Standards and Regulatory Framework
Data standards are "documented agreements on representations, formats, and definitions of common data. Data standards
provide a method to codify invalid, meaningful, comprehensive, and actionable ways, information captured in the course of
doing business." Rules to describe how the data is recorded to ensure consistency across multiple sources is another way to
think of data standards. Without data standards and data quality, the future of interoperability is bleak. Data fields and the
content of those fields need to be standardized.
Standards development organizations (SDOs) address a variety of aspects of health information and informatics. For
example, the American Society for Testing and Materials (ASTM) and Health Level Seven (HL7) target clinical data
standards. Insurance and remittance standards are a focus of the Accredited Standards Committee (ASC) X12. Standards to
transmit diagnostic images are developed through Digital Imaging and Communications in Medicine (DICOM). The
National Council for Prescription Drug Programs (NCPDP) represents pharmacy messages.
The Institute of Electrical and Electronics Engineers (IEEE), HL7, ASTM, and others develop data models and
frameworks. See the table on page 65 for a breakdown of regulatory agencies responsible for working with the American
National Standards Institute (ANSI) to drive data standards to achieve interoperability.
The AHIMA Leadership Model states that HIM professionals should serve as the leaders in healthcare organizations and in
their professional community for ensuring that data content standards are identified, understood, implemented, a ...
Due to diversity, heterogeneity and complexity of the existing healthcare structure, providing suitable
healthcare services is a complicated process. This work describes the conceptual design of an e-healthcare
system, which implements integration strategies and suitable technologies that will handle the
interoperability problem among its essential components. The proposed solution combines intelligent agent
technology and case based reasoning for highly distributed applications in healthcare environment.
Intelligent agents play a critical role in providing correct information for diagnostic, treatment, etc. They
work on behalf of human agents taking care of routine tasks, thus increasing speed and reliability of the
information exchanges. CBR is used to generate advices to a certain e-healthcare problems by analyzing
solutions given to previously solved problems and to build intelligent systems for disease diagnostics and
prognosis. Preliminary experimental simulation based on Agent Development Framework (JADE)
demonstrated the feasibility of this model.
Framework Architecture for Improving Healthcare Information Systems using Age...IJMIT JOURNAL
Due to diversity, heterogeneity and complexity of the existing healthcare structure, providing suitable healthcare services is a complicated process. This work describes the conceptual design of an e-healthcare system, which implements integration strategies and suitable technologies that will handle the interoperability problem among its essential components. The proposed solution combines intelligent agent technology and case based reasoning for highly distributed applications in healthcare environment. Intelligent agents play a critical role in providing correct information for diagnostic, treatment, etc. They
work on behalf of human agents taking care of routine tasks, thus increasing speed and reliability of the information exchanges. CBR is used to generate advices to a certain e-healthcare problems by analyzing solutions given to previously solved problems and to build intelligent systems for disease diagnostics and prognosis. Preliminary experimental simulation based on Agent Development Framework (JADE) demonstrated the feasibility of this model.
Adoption of Integrated Healthcare Information System in Nairobi County: Kenya...Editor IJCATR
Health care information systems are aimed at facilitating the smooth running and interoperability of the health care
delivery processes to ensure efficiency and effectiveness; however, the complexity, heterogeneity and diversity of the health care
sector especially in Kenya poses serious challenges especially in relation to integration of the systems. There is a large disconnect
between the public and private health care delivery systems characterized by fragmentation of services, locally within hospitals
(among primary, secondary and tertiary health care settings) and across different health care centers. This research is aimed at
examining the adoption of integrated healthcare information system in Nairobi County; Kenyatta National Hospital represents the
public sector and The Mater Hospital the private sector. A sample size of 100 users on information system from the two hospitals
picked from the primary secondary and tertiary levels were selected and questionnaires administered to them. Data was analyzed
through descriptive statistics with the aid of SPSS. The results of the study indicated that there was a huge disparity between
healthcare information system adoption in the public and private sectors with the private sector’s adoption being at an advanced
stage. The major barriers to adoption including social political barriers, financial constraints and technical/technological barriers
also presented.
Electronic health record (EHR) is a computerized patient-centric history of an individual’s health
care record that includes data from the multiple sources of care that the patient has used.
· Describe strategies to build rapport with inmates and offenders .docxgerardkortney
· Describe strategies to build rapport with inmates and offenders in a correctional treatment or supervision program.
· Describe the effect of group dynamics on facilitating programs.
· Describe techniques for establishing a therapeutic environment.
Generalist Case Management
Woodside and McClam
https://phoenix.vitalsource.com/books/9781483342047/pageid/44
https://phoenix.vitalsource.com/#/books/9781323128800
https://phoenix.vitalsource.com/#/books/9781483342047
https://phoenix.vitalsource.com/#/books/9781133795247
https://phoenix.vitalsource.com/#/books/1259760413
Use book and two outside sources.
At least 100 words per question
THANKS
1 The Role of the Correctional Counselor CHAPTER OBJECTIVES After reading this chapter, you will be able to: 1. Identify the functions and parameters of the counseling process. 2. Discuss the competing interests between security and counseling in the correctional counseling process. 3. Know common terms and concerns associated with custodial corrections. 4. Understand the role of the counselor as facilitator. 5. Identify the various personal characteristics associated with effective counselors. 6. Be aware of the impact that burnout can have on a counselor’s professional performance. 7. Identify the various means of training and supervision associated with counseling. PART ONE: A BRIEF INTRODUCTION TO COUNSELING AND CORRECTIONS There are many myths concerning the concept of counseling. Although the image of the counseling field has changed dramatically over the past two or three decades, much of society still views counseling and therapy as a mystic process reserved for those who lack the ability to handle life issues effectively. While the concept of counseling is often misunderstood, the problem is exacerbated when attempting to introduce the idea of correctional counseling. Therefore, the primary goal of this chapter is to provide a working definition of correctional counseling that includes descriptions of how and when it is carried out. In order to understand the concept of correctional counseling, however, the two words that derive the concept must first be defined: “corrections” and “counseling.” In addition, a concerted effort is made to identify the myriad of legal and ethical issues that pertain to counselors working with offenders. It is very difficult to identify a single starting point for the counseling profession. In essence, there were various movements occurring simultaneously that later evolved into what we now describe as counseling. One of the earliest connections to the origins of counseling took place in Europe during the Middle Ages (Brown & Srebalus, 2003). The primary objective was assisting individuals with career choices. This type of counseling service is usually described by the concept of “guidance.” In the late 1800s Wilhelm Wundt and G. Stanley Hall created two of the first known psychological laboratories aimed at studying and treating individuals with psychological and e.
· Debates continue regarding what constitutes an appropriate rol.docxgerardkortney
· Debates continue regarding what constitutes an appropriate role for the judiciary. Some argue that federal judges have become too powerful and that judges “legislate from the bench.”
1. What does it mean for a judge to be an activist?
2. What does it mean for a judge to be a restrainist?
· Although conservatives had long complained about the activism of liberal justices and judges, in recent years conservative judges and justices have been likely to overturn precedents and question the power of elected institutions of government.
3. When is judicial activism appropriate? Explain.
· To defenders of the right to privacy, it is implicitly embodied in the Constitution in the First, Fourth, Fifth, Ninth, and Fourteenth Amendments. To opponents, it is judge-made law because there is no explicit reference to it under the Constitution. The right to privacy dates back to at least 1890, when Boston attorneys Samuel Warren and Louis Brandeis equated it with the right to be left alone from journalists who engaged in yellow journalism.
4. In short, do you believe a right to privacy exists in the federal Constitution. Why or why not?
.
More Related Content
Similar to ORIGINAL ARTICLEAn informatics framework for public health.docx
6/29/2016 library.ahima.org/PB/DataStandards#appxA
http://library.ahima.org/PB/DataStandards#appxA 1/20
Data Standards, Data Quality, and Interoperability (2013
update)
Remove from myBoK
Editor's note: This update replaces the 2007 practice brief "Data Standards, Data Quality, and Interoperability."
Data quality and consistency are critical to ensuring patient safety, communicating delivery of health services, coordinating
care, and healthcare reporting. Assessing the quality and consistency of data requires data standards. This practice brief
provides health information management (HIM) professionals with a clear understanding of data standards as a tool to
enable interoperability and promote data quality.
The online version of this practice brief [...] is accompanied by an appendix that provides HIM professionals with a list of
standards to reference in data dictionary development, electronic health records, the exchange of health information, and
general data management processes to ensure information integrity and reliability. Evaluation of data validity, reliability,
completeness, and timeliness are accomplished through a combination of human and machine processes in healthcare, and
the list of data standard sources is a helpful reference guide when more detailed information is required.
Data Standards and Regulatory Framework
Data standards are "documented agreements on representations, formats, and definitions of common data. Data standards
provide a method to codify invalid, meaningful, comprehensive, and actionable ways, information captured in the course of
doing business." Rules to describe how the data is recorded to ensure consistency across multiple sources is another way to
think of data standards. Without data standards and data quality, the future of interoperability is bleak. Data fields and the
content of those fields need to be standardized.
Standards development organizations (SDOs) address a variety of aspects of health information and informatics. For
example, the American Society for Testing and Materials (ASTM) and Health Level Seven (HL7) target clinical data
standards. Insurance and remittance standards are a focus of the Accredited Standards Committee (ASC) X12. Standards to
transmit diagnostic images are developed through Digital Imaging and Communications in Medicine (DICOM). The
National Council for Prescription Drug Programs (NCPDP) represents pharmacy messages.
The Institute of Electrical and Electronics Engineers (IEEE), HL7, ASTM, and others develop data models and
frameworks. See the table on page 65 for a breakdown of regulatory agencies responsible for working with the American
National Standards Institute (ANSI) to drive data standards to achieve interoperability.
The AHIMA Leadership Model states that HIM professionals should serve as the leaders in healthcare organizations and in
their professional community for ensuring that data content standards are identified, understood, implemented, a.
6/29/2016 library.ahima.org/PB/DataStandards#appxA
http://library.ahima.org/PB/DataStandards#appxA 1/20
Data Standards, Data Quality, and Interoperability (2013
update)
Remove from myBoK
Editor's note: This update replaces the 2007 practice brief "Data Standards, Data Quality, and Interoperability."
Data quality and consistency are critical to ensuring patient safety, communicating delivery of health services, coordinating
care, and healthcare reporting. Assessing the quality and consistency of data requires data standards. This practice brief
provides health information management (HIM) professionals with a clear understanding of data standards as a tool to
enable interoperability and promote data quality.
The online version of this practice brief [...] is accompanied by an appendix that provides HIM professionals with a list of
standards to reference in data dictionary development, electronic health records, the exchange of health information, and
general data management processes to ensure information integrity and reliability. Evaluation of data validity, reliability,
completeness, and timeliness are accomplished through a combination of human and machine processes in healthcare, and
the list of data standard sources is a helpful reference guide when more detailed information is required.
Data Standards and Regulatory Framework
Data standards are "documented agreements on representations, formats, and definitions of common data. Data standards
provide a method to codify invalid, meaningful, comprehensive, and actionable ways, information captured in the course of
doing business." Rules to describe how the data is recorded to ensure consistency across multiple sources is another way to
think of data standards. Without data standards and data quality, the future of interoperability is bleak. Data fields and the
content of those fields need to be standardized.
Standards development organizations (SDOs) address a variety of aspects of health information and informatics. For
example, the American Society for Testing and Materials (ASTM) and Health Level Seven (HL7) target clinical data
standards. Insurance and remittance standards are a focus of the Accredited Standards Committee (ASC) X12. Standards to
transmit diagnostic images are developed through Digital Imaging and Communications in Medicine (DICOM). The
National Council for Prescription Drug Programs (NCPDP) represents pharmacy messages.
The Institute of Electrical and Electronics Engineers (IEEE), HL7, ASTM, and others develop data models and
frameworks. See the table on page 65 for a breakdown of regulatory agencies responsible for working with the American
National Standards Institute (ANSI) to drive data standards to achieve interoperability.
The AHIMA Leadership Model states that HIM professionals should serve as the leaders in healthcare organizations and in
their professional community for ensuring that data content standards are identified, understood, implemented, a ...
Due to diversity, heterogeneity and complexity of the existing healthcare structure, providing suitable
healthcare services is a complicated process. This work describes the conceptual design of an e-healthcare
system, which implements integration strategies and suitable technologies that will handle the
interoperability problem among its essential components. The proposed solution combines intelligent agent
technology and case based reasoning for highly distributed applications in healthcare environment.
Intelligent agents play a critical role in providing correct information for diagnostic, treatment, etc. They
work on behalf of human agents taking care of routine tasks, thus increasing speed and reliability of the
information exchanges. CBR is used to generate advices to a certain e-healthcare problems by analyzing
solutions given to previously solved problems and to build intelligent systems for disease diagnostics and
prognosis. Preliminary experimental simulation based on Agent Development Framework (JADE)
demonstrated the feasibility of this model.
Framework Architecture for Improving Healthcare Information Systems using Age...IJMIT JOURNAL
Due to diversity, heterogeneity and complexity of the existing healthcare structure, providing suitable healthcare services is a complicated process. This work describes the conceptual design of an e-healthcare system, which implements integration strategies and suitable technologies that will handle the interoperability problem among its essential components. The proposed solution combines intelligent agent technology and case based reasoning for highly distributed applications in healthcare environment. Intelligent agents play a critical role in providing correct information for diagnostic, treatment, etc. They
work on behalf of human agents taking care of routine tasks, thus increasing speed and reliability of the information exchanges. CBR is used to generate advices to a certain e-healthcare problems by analyzing solutions given to previously solved problems and to build intelligent systems for disease diagnostics and prognosis. Preliminary experimental simulation based on Agent Development Framework (JADE) demonstrated the feasibility of this model.
Adoption of Integrated Healthcare Information System in Nairobi County: Kenya...Editor IJCATR
Health care information systems are aimed at facilitating the smooth running and interoperability of the health care
delivery processes to ensure efficiency and effectiveness; however, the complexity, heterogeneity and diversity of the health care
sector especially in Kenya poses serious challenges especially in relation to integration of the systems. There is a large disconnect
between the public and private health care delivery systems characterized by fragmentation of services, locally within hospitals
(among primary, secondary and tertiary health care settings) and across different health care centers. This research is aimed at
examining the adoption of integrated healthcare information system in Nairobi County; Kenyatta National Hospital represents the
public sector and The Mater Hospital the private sector. A sample size of 100 users on information system from the two hospitals
picked from the primary secondary and tertiary levels were selected and questionnaires administered to them. Data was analyzed
through descriptive statistics with the aid of SPSS. The results of the study indicated that there was a huge disparity between
healthcare information system adoption in the public and private sectors with the private sector’s adoption being at an advanced
stage. The major barriers to adoption including social political barriers, financial constraints and technical/technological barriers
also presented.
Electronic health record (EHR) is a computerized patient-centric history of an individual’s health
care record that includes data from the multiple sources of care that the patient has used.
Similar to ORIGINAL ARTICLEAn informatics framework for public health.docx (20)
· Describe strategies to build rapport with inmates and offenders .docxgerardkortney
· Describe strategies to build rapport with inmates and offenders in a correctional treatment or supervision program.
· Describe the effect of group dynamics on facilitating programs.
· Describe techniques for establishing a therapeutic environment.
Generalist Case Management
Woodside and McClam
https://phoenix.vitalsource.com/books/9781483342047/pageid/44
https://phoenix.vitalsource.com/#/books/9781323128800
https://phoenix.vitalsource.com/#/books/9781483342047
https://phoenix.vitalsource.com/#/books/9781133795247
https://phoenix.vitalsource.com/#/books/1259760413
Use book and two outside sources.
At least 100 words per question
THANKS
1 The Role of the Correctional Counselor CHAPTER OBJECTIVES After reading this chapter, you will be able to: 1. Identify the functions and parameters of the counseling process. 2. Discuss the competing interests between security and counseling in the correctional counseling process. 3. Know common terms and concerns associated with custodial corrections. 4. Understand the role of the counselor as facilitator. 5. Identify the various personal characteristics associated with effective counselors. 6. Be aware of the impact that burnout can have on a counselor’s professional performance. 7. Identify the various means of training and supervision associated with counseling. PART ONE: A BRIEF INTRODUCTION TO COUNSELING AND CORRECTIONS There are many myths concerning the concept of counseling. Although the image of the counseling field has changed dramatically over the past two or three decades, much of society still views counseling and therapy as a mystic process reserved for those who lack the ability to handle life issues effectively. While the concept of counseling is often misunderstood, the problem is exacerbated when attempting to introduce the idea of correctional counseling. Therefore, the primary goal of this chapter is to provide a working definition of correctional counseling that includes descriptions of how and when it is carried out. In order to understand the concept of correctional counseling, however, the two words that derive the concept must first be defined: “corrections” and “counseling.” In addition, a concerted effort is made to identify the myriad of legal and ethical issues that pertain to counselors working with offenders. It is very difficult to identify a single starting point for the counseling profession. In essence, there were various movements occurring simultaneously that later evolved into what we now describe as counseling. One of the earliest connections to the origins of counseling took place in Europe during the Middle Ages (Brown & Srebalus, 2003). The primary objective was assisting individuals with career choices. This type of counseling service is usually described by the concept of “guidance.” In the late 1800s Wilhelm Wundt and G. Stanley Hall created two of the first known psychological laboratories aimed at studying and treating individuals with psychological and e.
· Debates continue regarding what constitutes an appropriate rol.docxgerardkortney
· Debates continue regarding what constitutes an appropriate role for the judiciary. Some argue that federal judges have become too powerful and that judges “legislate from the bench.”
1. What does it mean for a judge to be an activist?
2. What does it mean for a judge to be a restrainist?
· Although conservatives had long complained about the activism of liberal justices and judges, in recent years conservative judges and justices have been likely to overturn precedents and question the power of elected institutions of government.
3. When is judicial activism appropriate? Explain.
· To defenders of the right to privacy, it is implicitly embodied in the Constitution in the First, Fourth, Fifth, Ninth, and Fourteenth Amendments. To opponents, it is judge-made law because there is no explicit reference to it under the Constitution. The right to privacy dates back to at least 1890, when Boston attorneys Samuel Warren and Louis Brandeis equated it with the right to be left alone from journalists who engaged in yellow journalism.
4. In short, do you believe a right to privacy exists in the federal Constitution. Why or why not?
.
· Critical thinking paper · · · 1. A case study..docxgerardkortney
· Critical thinking paper
·
·
· 1.
A case study.
Deborah Shore, aged 45, works for a small corporation in the Research and Development department.
When she first became a member of the department 15 years ago, Deborah was an unusually creative and productive researcher; her efforts quickly resulted in raises and promotions within the department and earned her the respect of her colleagues. Now, Deborah finds herself less interested in doing research; she is no longer making creative contributions to her department, although she is making contributions to its administration.
She is still respected by the coworkers who have known her since she joined the firm, but not by her younger coworkers.
Analyze the case study from the psychoanalytic, learning, and contextual perspectives: how would a theorist from each perspective explain Deborah's development? Which perspective do you believe provides the most adequate explanation, and why?
2. Interview your mother (and grandmothers, if possible), asking about experiences with childbirth. Include your own experiences if you have had children. Write a paper summarizing these childbirth experiences and comparing them with the contemporary experiences described in the text.
3. Identify a "type" of parent (e.g., single parent, teenage parent, low-income parent, dual-career couple) who is most likely to be distressed because an infant has a "difficult" temperament. Explain why you believe that this type of parent would have particular problems with a difficult infant. Write an informational brochure for the selected type of parent. The brochure should include an explanation of temperament in general and of the difficult temperament in particular, and give suggestions for parents of difficult infants.
4. Plan an educational unit covering nutrition, health, and safety for use with preschoolers and kindergartners. Take into account young children's cognitive and linguistic characteristics. The project should include (1) an outline of the content of the unit; and (2) a description of how the content would be presented, given the intellectual abilities of preschoolers. For example, how long would each lesson be? What kinds of pictures or other audiovisual materials would be used? How would this content be integrated with the children's other activities in preschool or kindergarten?
5. Visit two day care centers and evaluate each center using the information from the text as a guide. Request a fee schedule from each center. Write a paper summarizing your evaluation of each center.
Note:
Unless you are an actual potential client of the center, contact the director beforehand to explain the actual purpose of the visit, obtain permission to visit, and schedule your visit so as to minimize disruption to the center's schedule.
6. Watch some children's television programs and advertising, examine some children's toys and their packaging, read some children's books, and listen to some children's recor.
· Coronel & Morris Chapter 7, Problems 1, 2 and 3
· Coronel & Morris Chapter 8, Problems 1 and 2
A People’s History of Modern Europe
“A fascinating journey across centuries towards the world as we experience it today. ... It is
the voice of the ordinary people, and women in particular, their ideas and actions, protests
and sufferings that have gone into the making of this alternative narrative.”
——Sobhanlal Datta Gupta, former Surendra Nath Banerjee
Professor of Political Science, University of Calcutta
“A history of Europe that doesn’t remove the Europeans. Here there are not only kings,
presidents and institutions but the pulse of the people and social organizations that shaped
Europe. A must-read.”
——Raquel Varela, Universidade Nova de Lisboa
“Lively and engaging. William A Pelz takes the reader through a thousand years of
European history from below. This is the not the story of lords, kings and rulers. It is the
story of the ordinary people of Europe and their struggles against those lords, kings and
rulers, from the Middle Ages to the present day. A fine introduction.”
——Francis King, editor, Socialist History
“This book is an exception to the rule that the winner takes all. It highlights the importance
of the commoners which often is only shown in the dark corners of mainstream history
books. From Hussites, Levellers and sans-culottes to the women who defended the Paris
Commune and the workers who occupied the shipyards during the Carnation revolution in
Portugal. The author gives them their deserved place in history just like Howard Zinn did
for the American people.”
——Sjaak van der Velden, International Institute of Social History, Amsterdam
“The author puts his focus on the lives and historical impact of those excluded from
power and wealth: peasants and serfs of the Middle Ages, workers during the Industrial
Revolution, women in a patriarchic order that transcended different eras. This focus not
only makes history relevant for contemporary debates on social justice, it also urges the
reader to develop a critical approach.”
——Ralf Hoffrogge, Ruhr-Universität Bochum
“An exciting story of generations of people struggling for better living conditions, and for
social and political rights. ... This story has to be considered now, when the very notions of
enlightenment, progress and social change are being questioned.”
——Boris Kagarlitsky, director of Institute for globalization studies and social
movements, Moscow, and author of From Empires to Imperialism
“A splendid antidote to the many European histories dominated by kings, businessmen
and generals. It should be on the shelves of both academics and activists ... A lively and
informative intellectual tour-de-force.”
——Marcel van der Linden, International Institute of Social History, Amsterdam
A People’s History
of Modern Europe
William A. Pelz
First published 2016 by Pluto Press
345 Archway Road, London N6 5AA
www.pluto.
· Complete the following problems from your textbook· Pages 378.docxgerardkortney
· Complete the following problems from your textbook:
· Pages 378–381: 10-1, 10-2, 10-16, and 10-20.
· Pages 443–444: 12-7 and 12-9.
· Page 469: 13-5.
· 10-1 How would each of the following scenarios affect a firm’s cost of debt, rd(1 − T); its cost of equity, rs; and its WACC? Indicate with a plus (+), a minus (−), or a zero (0) whether the factor would raise, lower, or have an indeterminate effect on the item in question. Assume for each answer that other things are held constant, even though in some instances this would probably not be true. Be prepared to justify your answer but recognize that several of the parts have no single correct answer. These questions are designed to stimulate thought and discussion.
Effect on
rd(1 − T)
rs
WACC
a. The corporate tax rate is lowered.
__
__
__
b. The Federal Reserve tightens credit.
__
__
__
c. The firm uses more debt; that is, it increases its debt ratio.
__
__
__
d. The dividend payout ratio is increased.
__
__
__
e. The firm doubles the amount of capital it raises during the year.
__
__
__
f. The firm expands into a risky new area.
__
__
__
g. The firm merges with another firm whose earnings are countercyclical both to those of the first firm and to the stock market.
__
__
__
h. The stock market falls drastically, and the firm’s stock price falls along with the rest.
__
__
__
i. Investors become more risk-averse.
__
__
__
j. The firm is an electric utility with a large investment in nuclear plants. Several states are considering a ban on nuclear power generation.
__
__
__
· 10-2 Assume that the risk-free rate increases, but the market risk premium
· 10-16COST OF COMMON EQUITY The Bouchard Company’s EPS was $6.50 in 2018, up from $4.42 in 2013. The company pays out 40% of its earnings as dividends, and its common stock sells for $36.00.
· a. Calculate the past growth rate in earnings. (Hint: This is a 5-year growth period.)
· b. The last dividend was D0 = 0.4($6.50) = $2.60. Calculate the next expected dividend, D1, assuming that the past growth rate continues.
· c. What is Bouchard’s cost of retained earnings, rs?
· 10-20WACC The following table gives Foust Company’s earnings per share for the last 10 years. The common stock, 7.8 million shares outstanding, is now (1/1/19) selling for $65.00 per share. The expected dividend at the end of the current year (12/31/19) is 55% of the 2018 EPS. Because investors expect past trends to continue, g may be based on the historical earnings growth rate. (Note that 9 years of growth are reflected in the 10 years of data.)
The current interest rate on new debt is 9%; Foust’s marginal tax rate is 40%, and its target capital structure is 40% debt and 60% equity.
· a. Calculate Foust’s after-tax cost of debt and common equity. Calculate the cost of equity as rs = D1/P0 + g.
· b. Find Foust’s WACC
· 12-7SCENARIO ANALYSIS Huang Industries is considering a proposed project whose estimated NPV is $12 million. This estimate assumes that economic conditions wi.
· Consider how different countries approach aging. As you consid.docxgerardkortney
· Consider how different countries approach aging. As you consider different countries, think about the following:
o Do older adults live with their children, or are they more likely to live in a nursing home?
o Are older adults seen as wise individuals to be respected and revered, or are they a burden to their family and to society?
· Next, select two different countries and compare and contrast their approaches to aging.
· Post and identify each of the countries you selected. Then, explain two similarities and two differences in how the countries approach aging. Be specific and provide examples. Use proper APA format and citation. LSW10
.
· Clarifying some things on the Revolution I am going to say som.docxgerardkortney
· Clarifying some things on the Revolution
I am going to say something, and I want you to hear me.
I am a scholar of the Revolution. That's the topic of my dissertation. Please believe me when I say that I know a lot about it.
I also happen to know--and this is well-supported by historians--that the Revolution was a civil war in which, for the first several years, Revolutionaries and Loyalists were evenly matched.
I will repeat that. Evenly matched. Loyalists were not merely too cowardly to fight, and they were not old fogies who hated the idea of freedom. Most had been in the Colonies for generations. Many of them took up arms for their King and their country. And when they lost, you confiscated their homes and they fled with the clothes on their back to Canada, England, and other places of the Empire. Both sides--both sides--committed unspeakable atrocities against civilians whom they disagreed with.
Now, a lot of you love to repeat some very fervent patriotic diatribe about how great the Revolution was. That's not history. That's propaganda. Know the difference.
History has shades of gray. History is complex and ambiguous. Washington, for instance, wore dentures made from the teeth of his slaves. Benjamin Franklin's son was the last royal governor of New Jersey. Did you know that the net tax rate for Americans--they always conveniently leave this out of the textbooks--was between 1.9 and 2.1%, depending on colony.? And that was if they had paid the extra taxes on tea and paper.
And, wait for it, people who support California independence use the same logic and arguments as they did in 1775. Did you know that the Los Angeles and Washington are only a few hundred miles closer than Boston and London? That many of the same issues, point by point, are repeating here in California? So put yourself in those shoes. How many of you would have sided with the Empire (whether American or British) based on the fact that you don't know how this will shake out? Would you call someone who supports Calexit a Patriot? Revolutionary? Nutcase? Who gets to own that word, anyway?
You can choose that you would have supported the revolutionaries--but think. Think about the other side. They matter, and their experiences got to be cleansed out of history to make you feel better about the way the revolutionaries behaved during the War. Acknowledge that they are there, and that their point of view has merit, even if you not agree with it.
· Clarifying Unit III's assignment
I have noticed a few consistent problems with the letter in the Unit III issue. Here are some pointers to make it better.
1. Read the clarifying note I wrote above. Note that the taxes aren't actually as high as you have been led to believe, but the point is that they should not be assigned at all without your consent.
2. Acknowledge that this is a debate, that a certain percentage are radicalized for independence, but there are is also a law-and-order group who find this horrific, and want .
· Chapter 9 – Review the section on Establishing a Security Cultur.docxgerardkortney
· Chapter 9 – Review the section on Establishing a Security Culture. Review the methods to reduce the chances of a cyber threat noted in the textbook. Research other peer-reviewed source and note additional methods to reduce cyber-attacks within an organization.
· Chapter 10 – Review the section on the IT leader in the digital transformation era. Note how IT professionals and especially leaders must transform their thinking to adapt to the constantly changing organizational climate. What are some methods or resources leaders can utilize to enhance their change attitude?
.
· Chapter 10 The Early Elementary Grades 1-3The primary grades.docxgerardkortney
· Chapter 10: The Early Elementary Grades: 1-3
The primary grades are grades 1-3.
Although educational reform has had an effect on all children, it is most apparent in the early elementary years. Reform and change comes from a number of sources and the chapter begins by reminding you of this. Let’s examine a few of these sources...
Diversity. There has been a rise in the number of racial and ethnic minority students enrolled in the nation's public schools; this number will (most likely) continue to rise. Teaching children from different cultures and backgrounds is an important piece to account for when planning curriculum.
Standards. Standards is a reason for reform. We've already looked at standards; these are something you must keep in mind when planning lessons.
Data-Driven Instruction may sound new, but it is not a new concept to you. We’ve done a great deal of discussing the outcomes of test-taking and assessments. You've probably all heard "teaching to the test."
Technology. Today’s students have had much experience with technology, therefore, it’s important to provide them with opportunities to learn with technology. It may take a while for you to be creative and think of ways to use it in your teaching (if you haven’ t been).
Health and Wellness. Obesity is a major concern in this country. Therefore, it is important to make sure that children have the opportunity to be active. Unfortunately, due to the pressure of academics, many schools have been taking physical education/activity time out of the curriculum.
Violence: One issue that I notice this new edition of the text has excluded is violence. However, I think that this topic is important; we need to keep children safe when they are at school. As a result of 9/11 (and, not to mention that many violent events have happened on school campuses in recent years), many school districts now have an emergency system in place that they can easily use if there is any type of incident in which the children’s safety is at risk.
WHAT ARE CHILDREN IN GRADES ONE TO THREE LIKE?
Your text explains that the best way to think of a child’s development during this time is: slow and steady. During this stage, there is not much difference between boys and girls when it comes to physical capabilities. Although it is always important to not stereotype based on one’s gender, it is especially important during these years. These children are also entering into their "tween" years, thus; being sensitive to the children's and parents' needs in regards to such changes is important.
It is important to remember that children in the primary grades are in the Concrete Operations Stage. This stage is children ages 7 to 12. The term operation refers to an action that can be carried out in thought as well as executed materially and that is mentally and physically reversible.
These children are at an age in which they can compare their abilities to their peers. And, therefore, children may develop learned helplessnes.
· Chap 2 and 3· what barriers are there in terms of the inter.docxgerardkortney
· Chap 2 and 3
· what barriers are there in terms of the interpersonal communication model?
Typically, communication breakdowns result from lack of understanding without clarification; often, there wasn't even an attempt at clarification. If barriers to interpersonal communication are not acknowledged and addressed, workplace productivity can suffer.
Language Differences
Interpersonal communication can go awry when the sender and receiver of the message speak a different language -- literally and figuratively. Not everyone in the workplace will understand slang, jargon, acronyms and industry terminology. Instead of seeking clarification, employees might guess at the meaning of the message and then act on mistaken assumptions. Also, misunderstandings may occur among workers who do not speak the same primary language. As a result, feelings may be hurt, based on misinterpretation of words or of body language.
Cultural Differences
Interpersonal communication may be adversely affected by lack of cultural understanding, mis-perception, bias and stereotypical beliefs. Workers may have limited skill or experience communicating with people from a different background. Many companies offer diversity training to help employees understand how to communicate more effectively across cultures and relate to those who may have different background experiences. Similarly, gender barriers can obstruct interpersonal communication if men and women are treated differently, and held to different standards, causing interpersonal conflicts in the workplace.
Personality Differences
Like any skill, some people are better at interpersonal communication than others. Personality traits also influence how well an individual interacts with subordinates, peers and supervisors. Extraversion can be an advantage when it comes to speaking out, sharing opinions and disseminating information. However, introverts may have the edge when it comes to listening, reflecting and remembering. Barriers to interpersonal communication may occur when employees lack self-awareness, sensitivity and flexibility. Such behavior undermines teamwork, which requires mutual respect, compromise and negotiation. Bullying, backstabbing and cut throat competition create a toxic workplace climate that will strain interpersonal relationships.
Generational Differences
Interpersonal communication can be complicated by generational differences in speech, dress, values, priorities and preferences. For instance, there may be a generational divide as to how team members prefer to communicate with one another. If younger workers sit in cubicles, using social networking as their primary channel of communication, it can alienate them from older workers who may prefer face-to-face communication. Broad generalizations and stereotypes can also cause interpersonal rifts when a worker from one generation feels superior to those who are younger or older. Biases against workers based on age can constitute a form of disc.
· Case Study 2 Improving E-Mail Marketing ResponseDue Week 8 an.docxgerardkortney
· Case Study 2: Improving E-Mail Marketing Response
Due Week 8 and worth 160 points
Read the following case study.
A company wishes to improve its e-mail marketing process, as measured by an increase in the response rate to e-mail advertisements. The company has decided to study the process by evaluating all combinations of two (2) options of the three (3) key factors: E-Mail Heading (Detailed, Generic); Email Open (No, Yes); and E-Mail Body (Text, HTML). Each of the combinations in the design was repeated on two (2) different occasions. The factors studied and the measured response rates are summarized in the following table.
Write a two to three (2-3) page paper in which you:
1. Use the data shown in the table to conduct a design of experiment (DOE) in order to test cause-and-effect relationships in business processes for the company.
2. Determine the graphical display tool (e.g., Interaction Effects Chart, Scatter Chart, etc.) that you would use to present the results of the DOE that you conducted in Question 1. Provide a rationale for your response.
3. Recommend the main actions that the company could take in order to increase the response rate of its e-mail advertising. Provide a rationale for your response.
4. Propose one (1) overall strategy for developing a process model for this company that will increase the response rate of its e-mail advertising and obtain effective business process. Provide a rationale for your response.
Your assignment must follow these formatting requirements:
. Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
. Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.
The specific course learning outcomes associated with this assignment are:
. Build regression models for improving business processes.
. Design experiments to test cause-and-effect relationships in business processes.
. Use technology and information resources to research issues in business process improvement.
. Write clearly and concisely about business process improvement using proper writing mechanics.
Read each discussion 1-4 and then write a 200 word response for each.
With your response, you can either expand on the initial post with similar, formally cited, specific examples or additional information regarding the original example(s) (be sure the additional information isn’t simply a re-statement of what has already been posted) or you can respond with a well-supported (based on formally cited information) counter point.
APA FORMAT
Response should have 1 source for each discussion
1. A message in sports is brought to sports economists in Jeremiah 29:11. This verse states, “For I.
· Briefly describe the technologies that are leading businesses in.docxgerardkortney
· Briefly describe the technologies that are leading businesses into the third wave of electronic commerce.
· In about 100 words, describe the function of the Internet Corporation for Assigned Names and Numbers. Include a discussion of the differences between gTLDs and sTLDs in your answer.
· In one or two paragraphs, describe how the Internet changed from a government research project into a technology for business users.
· In about 100 words, explain the difference between an extranet and an intranet. In your answer, describe when you might use a VPN in either.
· Define “channel conflict” and describe in one or two paragraphs how a company might deal with this issue.
· In two paragraphs, explain why a customer-centric Web site design is so important, yet is so difficult to accomplish.
· In about two paragraphs, distinguish between outsourcing and offshoring as they relate to business processes.
· In about 200 words, explain how the achieved trust level of a company’s communications using blogs and social media compare with similar communication efforts conducted using mass media and personal contact.
· Write a paragraph in which you distinguish between a virtual community and a social networking Web site
· Write two or three paragraphs in which you describe the role that culture plays in the development of a country’s laws and ethical standards.
QUESTION 1
Lakota peoples of the Great Plains are notably:
nomadic and followed the buffalo herds
Sedentary farmers, raising corn, northern beans, and potatoes
peaceful people who tried to live in harmony with neighboring tribes and the environment
religious and employed a variety of psychoactive plants during religious ceremonies
QUESTION 2
Tribal peoples of the Great Plains experienced greater ease at hunting and warfare after the introduction of:
Hotchkiss guns
smokeless gunpowder
horses
Intertribal powwows
all of the above
QUESTION 3
The Apaches and Navajos (Dine’) of the southwestern region of North America speak a language similar to their relatives of northern California and western Canada called:
Yuman
Uto-Aztecan
Tanoan
Athabaskan
Algonkian
QUESTION 4
The Navajo lived in six or eight-sided domed earth dwellings called:
wickiups
kivas
hogans
roadhouses
sweat lodge
QUESTION 5
Pueblo Indians, such as the Zuni and Hopi tribes, are descendants of the ancient people known as the:
Anasazi
Ashkenazi
Athabaskan
Aztecanotewa
Atlantean
2 points
QUESTION 6
1. Kachinas, or spirits of nature, were believed to:
Assist in the growth of crops and send rain
Help defend the Navajo against all foreign invaders
Provide medical assistance to the Hopi when doctors were not available
Combat evil spirits such as Skin-walkers or Diablitos
All of the above
2 points
QUESTION 7
1. The preferred dwellings among the Lakota Sioux were:
wickiups
adobe pueblos
pit houses
teepees
buffalo huts
2 points
QUESTION 8
1. Native Americansbenef.
· Assignment List· My Personality Theory Paper (Week Four)My.docxgerardkortney
· Assignment List
· My Personality Theory Paper (Week Four)
My Personality Theory Paper (Week Four)
DUE: May 31, 2020 11:55 PM
Grade Details
Grade
N/A
Gradebook Comments
None
Assignment Details
Open Date
May 4, 2020 12:05 AM
Graded?
Yes
Points Possible
100.0
Resubmissions Allowed?
No
Attachments checked for originality?
Yes
Top of Form
Assignment Instructions
My Personality Theory Paper
Instructions:
For this assignment, you will write a paper no less than 7 pages in length, not including required cover and Reference pages, describing a single personality theory from the course readings that best explains your own personality and life choices. You are free to select from among the several theories covered in the course to date but only one theory may be used.
Your task is to demonstrate your knowledge of the theory you choose via descriptions of its key concepts and use of them to explain how you developed your own personality. It is recommended that you revisit the material covered to date to refresh your knowledge of theory details. This is a "midterm" assignment and you should show in your work that you have studied and comprehended the first four weeks of course material. Your submission should be double-spaced with 1 inch margins on all sides of each page and should be free of spelling and grammar errors. It must include source crediting of any materials used in APA format, including source citations in the body of your paper and in a Reference list attached to the end. Easy to follow guides to APA formatting can be found on the tutorial section of the APUS Online Library.
Your paper will include three parts:
I. A brief description of the premise and key components of the theory you selected. You should be thorough and concise in this section and not spend the bulk of the paper detailing the theory, but rather just give enough of a summary of the key points so that an intelligent but uniformed reader would be able to understand its basics. If you pick a more complicated theory, you should expect explaining its premise and key components to take longer than explaining the same for one of the simpler theories but, in either case, focus on the basics and keep in mind that a paper that is almost all theory description and little use of the theory described to explain your own personality will receive a significant point deduction as will the reverse case of the paper being largely personal experience sharing with little linkage to clearly described key theory components.
II. A description of how your chosen theory explains your personality and life choices with supporting examples.
III. A description of the limitations of the theory in explaining your personality or anyone else’s.
NOTE: Although only your instructor will be reading your paper, you should still think about how much personal information you want to disclose. The purpose of this paper is not to get you to share private information, but rather to bring one .
· Assignment List
· Week 7 - Philosophical Essay
Week 7 - Philosophical Essay
DUE: Mar 22, 2020 11:55 PM
Grade Details
Grade
N/A
Gradebook Comments
None
Assignment Details
Open Date
Feb 3, 2020 12:05 AM
Graded?
Yes
Points Possible
100.0
Resubmissions Allowed?
No
Attachments checked for originality?
Yes
Top of Form
Assignment Instructions
Objective: Students will write a Philosophical Essay for week 7 based on the course concepts.
Course Objectives: 2, 3, & 4
Task:
This 4 - 5 full page (not to exceed 6 pages) Philosophical Essay you will be writing due Week 7 is designed to be a thoughtful, reflective work. The 4 - 5 full pages does not include a cover page or a works cited page. It will be your premier writing assignment focused on the integration and assessment relating to the course concepts. Your paper should be written based on the outline you submitted during week 4 combined with your additional thoughts and instructor feedback. You will use at least three scholarly/reliable resources with matching in-text citations and a Works Cited page. All essays are double spaced, 12 New Times Roman font, paper title, along with all paragraphs indented five spaces.
Details:
You will pick one of the following topics only to do your paper on:
· According to Socrates, must one heed popular opinion about moral matters? Does Socrates accept the fairness of the laws under which he was tried and convicted? Would Socrates have been wrong to escape?
· Consider the following philosophical puzzle: “If a tree falls in the forest and there's no one around to hear it, does it make a sound?” (1) How is this philosophical puzzle an epistemological problem? And (2) how would John Locke answer it?
· Evaluate the movie, The Matrix, in terms of the philosophical issues raised with (1) skepticism and (2) the mind-body problem. Explain how the movie raises questions similar to those found in Plato’s and Descartes’ philosophy. Do not give a plot summary of the movie – focus on the philosophical issues raised in the movie as they relate to Plato and Descartes.
· Socrates asks Euthyphro, “Are morally good acts willed by God because they are morally good, or are they morally good because they are willed by God?” (1) How does this question relate to the Divine Command Theory of morality? (2) What are the philosophical implications associated with each option here?
· Explain (1) the process by which Descartes uses skepticism to refute skepticism, and (2) what first principle does this lead him to? (3) Explain why this project was important for Descartes to accomplish.
Your paper will be written at a college level with an introduction, body paragraphs, a conclusion, along with in-text citations/Works Cited page in MLA formatting. Students will follow MLA format as the sole citation and formatting style used in written assignments submitted as part of coursework to the Humanities Department. Remember - any resource that is listed on the Works Cited page must .
· Assignment 3 Creating a Compelling VisionLeaders today must be .docxgerardkortney
· Assignment 3: Creating a Compelling Vision
Leaders today must be able to create a compelling vision for the organization. They also must be able to create an aligned strategy and then execute it. Visions have two parts, the envisioned future and the core values that support that vision of the future. The ability to create a compelling vision is the primary distinction between leadership and management. Leaders need to create a vision that will frame the decisions and behavior of the organization and keep it focused on the future while also delivering on the short-term goals.
To learn more about organizational vision statements, do an Internet search and review various vision statements.
In this assignment, you will consider yourself as a leader of an organization and write a vision statement and supporting values statement.
Select an organization of choice. This could be an organization that you are familiar with, or a fictitious organization. Then, respond to the following:
· Provide the name and description of the organization. In the description, be sure to include the purpose of the organization, the products or services it provides, and the description of its customer base.
· Describe the core values of the organization. Why are these specific values important to the organization?
· Describe the benefits and purpose for an organizational vision statement.
· Develop a vision statement for this organization. When developing a vision statement, be mindful of the module readings and lecture materials.
· In the vision statement, be sure to communicate the future goals and aspirations of the organization.
· Once you have developed the vision statement, describe how you would communicate the statement to the organizational stakeholders, that is, the owners, employees, vendors, and customers.
· How would you incorporate the communication of the vision into the new employee on-boarding and ongoing training?
Write your response in approximately 3–5 pages in Microsoft Word. Apply APA standards to citation of sources.
Use the following file naming convention: LastnameFirstInitial_M1_A3.doc. For example, if your name is John Smith, your document will be named SmithJ_M1_A3.doc.
By the due date assigned, deliver your assignment to the Submissions Area.
Assignment 3 Grading Criteria
Maximum Points
Chose and described the organization. The description included the purpose of the organization, the products or services the organization provides, and the description of its customer base.
16
Developed a vision statement for the organization. Ensured to accurately communicate the goals and aspirations of the organization in the vision statement.
24
Ensured that the incorporation and communication strategy for the vision statement is clear, detailed, well thought out and realistic.
28
Evaluated and explained which values are most important to the organization.
24
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate r.
· Assignment 4
· Week 4 – Assignment: Explain Theoretical Perspectives for Real-life Scenarios
Assignment
Updated
Top of Form
Bottom of Form
For each of the following three scenarios, use a chart format to assess how each traditional theoretical perspective would best explain the situation that a social worker would need to address. You may create your charts in Word or another software program of your choice. An example chart follows the three scenarios.
Scenario 1
You are a hospital social worker who is working with a family whose older adult relative is in end-stage renal failure. There are no advanced directives and the family is conflicted over what the next steps should be.
Scenario 2
You are a caseworker in a drug court. Your client has had three consecutive dirty urine analyses. She is unemployed and has violated her probation order.
Scenario 3
You are a school social worker. A teacher sends her 9-year-old student to you because he reports that he has not eaten in 2 days and there are no adults at home to take care of him.
Chart Example:
Your client, an 11-year-old girl, was removed from home because of parental substance abuse. She is acting out in her foster home, disobeying her foster parents and not following their rules.
Theory
Explanation for Scenario – please respond to the questions below in your explanation
Systems Theory
What systems need to be developed or put in place to support the child? Would Child Protective Services need to become involved? What other systems would support her and a successful outcome for being in foster care?
Generalist Theory
What is the best intervention or therapy to use based on this child’s situation? Given her circumstances, how could you best improve her functioning?
Behavioral Theory
What behaviors are being reinforced? What behaviors are being ignored or punished? What would you suggest to maintain this placement? Would this involve working with the foster parents?
Cognitive Theory
How would you help your client to examine her thinking, emotions, and behavior? What would this entail from a cognitive developmental framework?
Support your assignment with a minimum of three resources.
Length: 3 charts, not including title and reference pages
Your assignment should demonstrate thoughtful consideration of the ideas and concepts presented in the course by providing new thoughts and insights relating directly to this topic. Your response should reflect scholarly writing and current APA standards where appropriate. Be sure to adhere to Northcentral University's Academic Integrity Policy.
Assignement 3
State the function of each of the following musculoskeletal system structures: Describe the structures of the musculoskeletal system.
Skeletal muscle
Tendons
Ligaments
Bone
Cartilage
Describe each of the following types of joints:
Ball-and-socket
Hinge
Pivot
Gliding
Saddle
Condyloid
Newspaper Rubric
CATEGORY
4
3
2
1
Headline & Byline & images
16 points
Article has a .
· Assignment 2 Leader ProfileMany argue that the single largest v.docxgerardkortney
· Assignment 2: Leader Profile
Many argue that the single largest variable in organizational success is leadership. Effective leadership can transform an organization and create a positive environment for all stakeholders. In this assignment, you will have the chance to evaluate a leader and identify what makes him/her effective.
Consider all the leaders who have affected your life in some way. Think of people with whom you work—community leaders, a family member, or anyone who has had a direct impact on you.
· Choose one leader you consider to be effective. This can be a leader you are personally aware of, or someone you don’t know, but have observed to be an effective leader. Write a paper addressing the following:
· Explain how this leader has influenced you and why you think he or she is effective.
· Analyze what characteristics or qualities this person possesses that affected you most.
· Rate this leader by using a leadership scorecard. This can be a developed scorecard, or one you develop yourself. If you use a developed scorecard, please be sure to cite the sources of the scorecard. Once you have identified your scorecard, rate your leader. You decide what scores to include (for example, scale of 1–5, 5 being the highest) but be sure to assess the leader holistically across the critical leadership competencies you feel are most important (for example, visioning, empowering, strategy development and communication).
· Critique this individual’s skills against what you have learned about leadership so far in this course. Consider the following:
· How well does he/she meet the practices covered in your required readings?
· How well has he/she adapted to the challenges facing leaders today?
· If you could recommend changes to his/her leadership approach, philosophy, and style, what would you suggest? Why?
· Using the assigned readings, the Argosy University online library resources, and the Internet including general organizational sources like the Wall Street Journal, BusinessWeek, or Harvard Business Review, build a leadership profile of the leader you selected. Include information from personal experiences as well as general postings on the selected leader from Internet sources such as blogs. Be sure to include 2–3 additional resources not already included in the required readings in support of your leadership profile.
Write a 3–5-page paper in Word format. Apply APA standards to citation of sources. Use the following file naming convention: LastnameFirstInitial_M2_A2.doc.
By the due date assigned, deliver your assignment to the Submissions Area.
Assignment 2 Grading Criteria
Maximum Points
Explained how this leader has been influential and why you think the leader is effective showing analysis of the leader’s characteristics or qualities.
16
Analyzed the characteristics or qualities the leader possesses that have affected you most..
16
Rated your leader using a leadership scorecard and supported your rationale for your rating.
32
Criti.
· Assignment 1 Diversity Issues in Treating AddictionThe comple.docxgerardkortney
· Assignment 1: Diversity Issues in Treating Addiction
The complexities of working with diverse populations in treating disorders, such as addictions, require special considerations. Some approaches work better with some populations than with others. For example, Alcoholics Anonymous (AA) programs are spiritually based and focus on a higher power. Some populations have difficulty with these concepts and are averse to participating in such groups.
Select a population—for example, African Americans; Native Americans; or lesbians, gays, or bisexual individuals. Research your topic by using articles from the supplemental readings for this course or from other resources such as the Web, texts, experience, or other journal articles related to diversity issues and addictions.
Write a three- to five-page paper discussing the following:
· Some specific considerations for working with your chosen population in the area of addiction treatment
· Whether your research indicates that 12-step groups work with this population
· Any special problems associated with this population that make acknowledging the addiction and seeking treatment more difficult
· Any language or other barriers that this population faces when seeking treatment
Prepare your paper in Microsoft Word document format. Name your file M4_A1_LastName_Research.doc, and submit it to the Submissions Area by the due date assigned Follow APA guidelines for writing and citing text.
Assignment 1 Grading Criteria
Maximum Points
Discussed some specific considerations for working with your chosen population in the area of addiction.
8
Discussed whether your research indicates that 12-step groups work with your chosen population.
8
Discussed any special problems associated with this population that make acknowledging the addiction and seeking treatment more difficult .
8
Discussed any language or other barriers that this population faces when seeking treatment.
8
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources, displayed accurate spelling, grammar, and punctuation.
4
Total:
36
· M4 Assignment 2 Discussion
Discussion Topic
Top of Form
Due February 9 at 11:59 PM
Bottom of Form
Assignment 2: Discussion Questions
Your facilitator will guide you in the selection of two of the three discussion questions. Submit your responses to these questions to the appropriate Discussion Area by the due date assigned. Through the end of the module, comment on the responses of others.
All written assignments and responses should follow APA rules for attributing sources.
You will be attempting two discussion questions in this module; each worth 28 points. The total number of points that can be earned for this assignment is 56.
Minority Groups
Many minority groups experience stress secondary to their social surroundings. For example, a family living in poverty may face frequent violence. Limited income makes meeting the day-to-day need.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
ORIGINAL ARTICLEAn informatics framework for public health.docx
1. ORIGINAL ARTICLE
An informatics framework for public health
information systems: a case study
on how an informatics structure for integrated
information systems provides benefit in supporting
a statewide response to a public health emergency
Ivan J. Gotham • Linh H. Le • Debra L. Sottolano •
Kathryn J. Schmit
Received: 17 April 2013 / Revised: 8 October 2013 / Accepted:
23 January 2014 /
Published online: 8 February 2014
� Springer-Verlag Berlin Heidelberg 2014
Abstract This chapter illustrates how a well-established public
health informatics
framework provides an integrated information system
infrastructure that assures and
enhances the efficacy of public health emergency preparedness
(PHEP) actions
throughout the phases of the health emergency event life cycle.
Key PHEP activities
involved in supporting this cycle include planning; surveillance;
alerting; resource
2. assessment and management; data-driven decision support; and
intervention for
prevention and control of disease or injury in populations.
Information systems
supporting these activities are most effective in assuring
optimal response to an
emergent health event when they are integrated within an
informatics framework
that supports routine (day to day) information exchange within
the health infor-
mation exchange community. In late April 2009, New York
State (NYS) initiated a
statewide PHEP response to the emergence of Novel Influenza
A (H1N1), culmi-
nating in a statewide vaccination campaign during the last
quarter of 2009. The
I. J. Gotham (&)
School of Public Health, Department of Health Policy
Management University at Albany,
State University of New York , 1 University Place, Rensselaer,
NY 12144, USA
e-mail: [email protected]
L. H. Le � K. J. Schmit
New York State Department of Health, Office of Information
Technology Service,
3. Empire State Plaza, Room 148, Albany, NY 12237, USA
e-mail: [email protected]
K. J. Schmit
e-mail: [email protected]
L. H. Le
Department of Nursing, Sage College, Albany, NY 12180, USA
D. L. Sottolano
Center for Health Care Quality & Surveillance, New York State
Department of Health,
875 Central Avenue, Albany, NY 12206, USA
e-mail: [email protected]
123
Inf Syst E-Bus Manage (2015) 13:713–749
DOI 10.1007/s10257-014-0240-9
http://crossmark.crossref.org/dialog/?doi=10.1007/s10257-014-
0240-9&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s10257-014-
0240-9&domain=pdf
established informatics framework of integrated information
systems within NYS
conveyed significant advantages and flexibility in supporting
the range of PHEP
4. activities required for an effective response to this health event.
This chapter
describes, and provides, performance metrics to illustrate how a
public health
informatics framework can enhance the efficacy of all phases of
a public health
emergency response. It also provides informatics lessons
learned from the event.
Keywords Public health informatics � Information systems �
Public health emergency preparedness and response
1 Introduction
1.1 Public health informatics and information systems
While there are many definitions of ‘‘Information System’’ in
the literature, one
could distill the authors’ thoughts into the following
description:
An Information System is the arrangement of data, processes,
people, and
information technology that interact to collect, store and
communicate
information as needed to facilitate planning, control,
coordination and
decision making for a subject matter domain across an
enterprise. (See
5. Businessdictionary 2013; Whatis.techtarget 2013; Whitten and
Bentley 2007)
The practice of informatics is essential to assuring that
information systems are
successful and provide value (e.g. see Massoudi et al. 2012;
Chen et al. 2007). At
the most abstract level, Public Health Informatics (PHI) is
defined as ‘‘the
systematic application of information and computer science and
technology to
public health practice, research, and learning’’ (O’Carroll et al.
2003). The ultimate
goals of PHI, then, are to:
• assure development and governance of information systems
that can be
effectively used within the health enterprise to support routine
(day to day)
information exchange
• assure that those information systems provide value to both
Public Health
practitioners and their information trading partners (e.g. see
Massoudi et al.
2012).
PHI is therefore focused on implementing information systems
6. which support public
health activities that are integrated with, and supportive of, the
programmatic goals
of prevention and control of disease and injury in populations
(see Yasnoff et al.
2000; O’Carroll et al. 2003; Lombardo and Buckeridge 2007).
To be successful and
provide value, public health related information systems must
exist within an
operational informatics framework that embodies Health as an
enterprise and
supports the broader community of health information exchange
(e.g. see O’Carroll
et al. 2003; Kukafka and Yasnoff 2007; Gotham et al. 2010;
Massoudi et al. 2012).
Figure 1 depicts a paradigm for such a public health informatics
framework and,
as described below, public health emergency preparedness
(PHEP) provides an ideal
714 I. J. Gotham et al.
123
use case and means to evaluate its value proposition. The
7. framework, while
supported by technology, has as its focal point the health
information exchange
community sustained by value-added information trading
synergies (Fig. 1). This
information exchange community embodies the subject domains,
organizations and
jurisdictions of health as an enterprise. The synergy, or value
proposition, occurs
when information providers and recipients within that
community each derive
benefit through bi-directional ‘trading’, or exchange, of health
information. It is this
focus that drives the implementation of integrated information
systems governed by
the information needs, business rules, policies, regulations, and
data-sharing
agreements of the health enterprise.
Implementation of information systems is actualized by a
governance process
and based on measurable value and benefit as defined by the
enterprise (Fig. 1).
This process informs an agile informatics environment that is
able to respond
8. rapidly to both planned and emergent health information system
needs. This
environment is led by informaticians and health domain subject
matter experts and
supported by a team of technical experts, rapid development
tools, reusable services
and data (Fig. 1).
Within the context of a public health informatics framework,
these information
systems support public health activities such as disease
surveillance (see Chen et al.
2010; Lombardo and Buckeridge 2007) and outbreak
management, laboratory
reporting, health alerting, health care quality assurance, health
care resource
availability and capacity assessment, registry reporting and
situational awareness. A
model for assessing the value proposition of public health
information systems has
been developed by the Public Health Informatics Institute (PHII
2005). A detailed
business process and benefit analysis for interoperable
immunization registry data
9. exchange within a health information exchange community has
also been described
by Grannis, Dixon and Brand (2010). The Joint Public Health
Informatics Taskforce
has proposed a ‘‘consensus framework’’ to guide collaborations
across the public
health enterprise (JPHIT 2011).
The information systems within our model framework are in
turn supported by
enabling services (Fig. 1) that assure an arrangement and
interaction of data,
processes, people, and technology that effectively collects,
stores and communicates
heath information. These enabling services provide foundational
support for:
business rules and processes; effective use of information
systems; derivation of
information from data; reusable core functions and processes
that support multiple
information systems; as well as standardization and
interoperability of data and
information.
Services supporting business rules and processes would include
provision of user
10. account privileges and data access control management that
assures confidentiality
of data while at the same time providing seamless and
appropriate access to data
across information systems based on user role and need to
know. Services
underwriting effective use of information and underlying
systems include project
management, user training/support, common user interface and
single sign-on
across all information systems. Services supporting derivation
of information from
data include data analytics and visualization capabilities such as
GIS, dashboards,
integrated data reporting and query services, modeling and
statistical analysis
An informatics framework for public health information systems
715
123
packages. Services supporting standardization and
interoperability of data and
information include those standards that assure technical,
11. semantic and process
interoperability of health information exchange (see Benson
2012; IHE 2013).
Core functions and processes assure integration across
information systems and
sustainability through reuse of common services by those
systems. Examples
include:
• A common data layer service that assures all information
systems have the same
integrated view of health data and use the same authoritative
version of the
‘truth’.
• Common Directory services. These services include: a
communications
directory service that provides role and contact information for
organizations,
health providers and users; and a provider and health facility
directory service
which provides attribute information on health facilities (e.g.
geo-location,
staffed beds by specialty, isolation rooms, fixed equipment
assets) and providers
(e.g. certifications, practice status, populations served). Both
services provide a
12. common source of information to systems and users that is
consistent, reliable
and up to date.
• Common messaging, alerting and notification services that
allow the system and
its processes and users to transmit and confirm notifications to
organizations,
Fig. 1 Model Public Health Informatics Framework
716 I. J. Gotham et al.
123
users or other processes by multiple interoperable
communication venues (e.g.
voice, text, e-mail, XML).
• Common visualization and analysis services that allow users a
single interface to
information for a common operational picture of health
information or health
event status. The services allow information system processes to
automate
updating of those common operational pictures.
• A common permissions and access control interface provides
the authoritative
13. source for information systems to support workflow processes
and access rights
by user role.
The technical infrastructure layer of this framework assures that
information
systems and supportive enabling services are interoperable,
based on a Service
Oriented Architecture (SOA), secure, resilient and recoverable
from disasters,
highly available and able to accommodate surge in usage.
1.2 Benefit of an informatics framework and information
systems to public
health emergency preparedness
The US Federal Emergency Management Agency (FEMA 2011)
has established a
National Preparedness Goal (or NPG) for preventing and
responding to natural
disasters and terrorist attacks. The five components of the NPG
include: Prevention,
Protection, Mitigation, Response, and Recovery. These
components are cyclic in
nature, with lessons learned from response and recovery actions
from previous
14. emergency events feeding into improving the first three
components. The first three
components deal with actions to be taken in advance as
preparation for the potential
events through planning, drills/exercises, risk mitigation,
infrastructure develop-
ment and protection. In our discussion we will consolidate these
three components
into a single category: Preparedness.
Thus public health emergency preparedness (PHEP) is the
capability of public
health and healthcare systems, communities, and individuals to
prevent, protect
against, mitigate, quickly respond to, and recover from health
emergencies,
particularly those whose scale, timing, or unpredictability
threatens to overwhelm
routine capabilities. It is a state of sustainable ‘‘readiness to
act,’’ for all sectors and
stakeholders, that is achieved over time as part of the essential
public health
activities that health departments practice daily (see Gotham et
al. 2010).
This key point is an essential component of our model
15. informatics framework
(Fig. 1). PHEP activities/functions, if instantiated within such
an extensible or ‘dual
use’ framework, can be a value proposition of information
systems that are in daily
use for routine health information exchange by various health
organizations,
including Public Health. Indeed, as shown in preparedness drills
and exercises
(Gotham et al. 2007, 2010) and actual health events (Gotham et
al. 2001, 2007,
2008), the efficacy of information systems supporting PHEP is
optimized when
embedded within an established informatics framework
supporting a broad-based
community of health information trading partners engaged in
routine (day to day)
information exchange activities (Gotham et al. 2001, 2007,
2008, 2010).
An informatics framework for public health information systems
717
123
16. National Frameworks and Emergency Support Functions (ESF)
evolved as an
outcome of the NPG (see FEMA 2013). These define an
extensive list of core
capabilities and functions required to support the activities
involved in prepared-
ness, response and recovery. Among these are operational
coordination and
communication, threat and risk assessment, active and passive
surveillance,
detection, intelligence and information sharing, situational
awareness and decision
support, intervention campaigns, public information, resource
assessment for
response and recovery. These functions are singularly dependent
on bi-directional
exchange of information among response partners that is
authoritative, timely,
accurate, trusted, appropriate and up to date.
Effective information systems by our very definition are
absolutely critical in
assuring the efficacy of these activities and functions. Thus
effective public health
emergency preparedness requires rapid and agile leverage of
17. integrated information
systems that are readily adoptable in supporting novel emergent
situations as well as
core public health activities, such as planning and policy;
surveillance; alerting;
health resource assessment and management; situational
awareness, data-driven
decision support; and implementation, coordination and
management of public
health response and recovery interventions. Thus we can see
that our definition of
information system and our informatics framework are well
suited to encompassing
the needs of emergency preparedness.
In late April 2009, NY State (NYS) initiated a statewide PHEP
response to an
international health emergency: the emergence of Novel
Influenza A (H1N1). The
NYS response culminated in a statewide vaccination campaign
during last quarter of
2009. The established informatics framework of integrated
information systems
within NYS conveyed significant advantages and provided a
single point of input
18. and dissemination of critical information that supported the
range of PHEP activities
required for an effective response to this health event. This
chapter describes, and
provides, performance metrics that illustrate how a public
health informatics
framework and its information systems can enhance the efficacy
of all phases of a
Public Health emergency response. The chapter also provides
Informatics lessons
learned from the event.
2 A well established informatics framework and dual-use
information system
infrastructure plays an important role in preparedness for an
emergency
event
2.1 Established infrastructure needs to be in place prior to an
event
An element that is essential to the value proposition of our
informatics framework
paradigm (Fig. 1) is the ‘dual use’ nature of information
systems. That is, systems
that are familiar and in daily use by response partners for
routine health information
19. exchange are best suited for, and constitute a key aspect of the
‘‘preparedness’’
phases (prevent, protect, mitigate) that are necessary for
effective response and
recovery of an emergency event.
718 I. J. Gotham et al.
123
The NYSDOH informatics framework and its infrastructure have
evolved over
the past 17 years to support the state department of health’s
strategic approach to
information exchange within the community of its health
information trading
partners. The infrastructure, or Health Commerce System
(HCS), is a closed, web-
enabled portal, supporting secure information exchange
activities with all regulated
health entities in NY State (Gotham et al. 2001, 2007, 2008,
2010); see Table 1. The
flow of data and information within the HCS architecture and
its foundation
informatics framework (Fig. 1) are shown in Fig. 2
20. The information systems within the HCS support all health-
related, day-to-day
information exchange activities, from vital records and health
care quality assurance
and finance to disease registry and condition reporting,
statewide communicable
disease and laboratory reporting, arbovirus surveillance, child
health insurance
reporting, managed care, even prescription pad orders. Given
this mission, the HCS
architecture is multi-tiered, highly available, and with full off-
site disaster recovery
capabilities. That architecture, therefore, is a platform well
suited for responding to
public health emergencies, given its architecture and routine use
by partner
organizations who would be involved in the response. Thus,
based on our paradigm
(Fig. 1), an array of information systems has been implemented
within the HCS to
support both PHEP and routine core public health activities.
The PHEP functions and the HCS information systems used to
support them are
21. listed in Table 2 and their data flow within the HCS system is
shown in Fig. 2.
These systems support both routine and PHEP activities for
health alerting;
electronic laboratory and disease reporting; syndromic
surveillance; targeted health
facility patient surveillance; monitoring of health facility status
[e.g., Emergency
Department (ED) traffic]; health facility resource inventories
and antiviral inventory
tracking; general situational awareness; executive decision
support; school-based
surveillance and medical countermeasure administration (Table
2).
Of particular note is the Health Emergency Response Data
System, HERDS, an
information system that supports dynamic, real-time deployment
of ongoing
surveillance reporting and ad hoc surveys (see Gotham et al.
2007, 2010; Table 2).
HERDS is used for routine electronic reporting and surveys as
well as for
information exchange during emergency events. State, regional,
and local health
22. offices all have access to HERDS data as soon as it is reported
by health facilities.
Statewide data is typically available and integrated into
decision support systems
within 24 h of deployment of a HERDS survey (Table 2).
2.2 Routine, ongoing use of information systems leads to an
advance
preparedness advantage
The HCS PHEP information systems relevant to PHEP had been
in use for years
prior to the H1N1 Pandemic event and already had been used to
support statewide
responses to emergent infectious disease events, emergency
disaster declarations,
health resource shortages, elevated national threat levels and
high-profile national
security events (Gotham et al. 2001, 2007, 2008, 2010).
The HERDS system had been used to monitor statewide hospital
bed availability
and ED patient traffic reporting since June 2003, and provides
statewide, facility-
An informatics framework for public health information systems
719
23. 123
specific surveillance on bed availability by specialty type (e.g.,
adult and pediatric
medical/surgical, ICU, burn). The system has been used to
monitor ED patient
registrations, and had also been used to compile and maintain an
ongoing statewide
inventory of hospital assets since August 2004. The critical
asset survey, deployed
via HERDS, is an exhaustive inventory of current staffed and
surge capacity of beds
by specialty; special treatment capacities (e.g., trauma and burn
center, hyperbaric,
decontamination); transportation capacities; durable and fixed
equipment (e.g., adult
and pediatric ventilators, cardiac monitors); airborne infection
isolation room
capacity; staff capacities by specialty; communication and
generator capacities.
Reporting of laboratory-confirmed influenza cases, by age
group, among hospital
patients, has also been maintained on HERDS since December
2004. Along with
24. HCS dashboard analytics on the HCS (Table 2), HERDS was
instrumental in
supporting the NY State response to the national influenza
vaccine shortage in 2004
(Gotham et al. 2008).
Prior to the emergence of the H1N1 event, use of HERDS had
been expanded to
support routine surveillance and resource reporting by all Local
Health Departments
(LHDs), nursing homes, adult and home care entities, and
schools statewide.
Nursing home reporting of bed availability, critical assets, and
vaccination rates for
Table 1 NYS health commerce system (HCS) demographics and
usage as of July, 2009
Organization or user group Number Users
H1N1 vaccine providers 6,113 5,955
Clinical or environmental labs (Labs) 1,481 3,388
Clinics and treatment centers (Clinics) 1,498 7,369
Home and adult care facilities (adult care) 1,701 15,785
Hospitals 230
25. Local health departments (LHDs) 58 6,823
Medical professionals – 43,984
NYSDOH central health office 1 4,428
NYSDOH regional health offices 4 1,107
Nursing homes 663 12,287
School districts 1,311 4,259
Pharmacies 2,259 3,388
Other organizations 1,902 10,107
Usage statistics
250 applications
14,500 user logins per day
800,000 access hits per day
30 Gbytes in transactions per day
LHDs include NY City Department of Health and Mental
Hygiene
Other organizations include schools, fire and EMS, federal and
state agencies, tribal nations, managed
care organizations, etc. Organization counts are by physical
facility. Medical Professionals include MDs
and practices, dentists, veterinarians, physician assistants, nurse
26. practitioners
720 I. J. Gotham et al.
123
influenza and pneumococcal infection and other health care
surveillance is captured
in HERDS, as are reports, by all types of schools, of
vaccination rates and other
public health concerns. Given the established history of the
framework, information
systems and the technical infrastructure, the HCS infrastructure
had become an
integral component of NYS Health Department incident
management processes as
well as of NY State’s all-hazards and pandemic influenza plans
(see Gotham et al.
2007, 2010).
Emergency response plans and their underlying components
must be tested
periodically to assess their efficacy and revised according to
lessons learned. Thus
HCS and its information systems had been used as integral
functions in both routine
27. drills and full-scale exercises (Gotham et al. 2007). In spring of
2006, NY State
Department of Health (NYSDOH) conducted a full-scale
exercise simulating the
emergence of a novel influenza strain in the western region of
the state (Gotham
et al. 2010). The scenario was entirely data driven, lasted a
month in duration, and,
as part of NY’s pandemic influenza plan, leveraged its existing
informatics
infrastructure to support the ongoing ‘‘response.’’ The
information systems used by
the exercise participants to respond to the scenario included
health alerting,
epidemiological surveillance, health care resource and medical
countermeasure
management, and data-driven decision support through
integrated dashboard
visualization. Situational awareness was provided to all of the
organizational
Fig. 2 Health Commerce System (HCS) Technical Information
Architecture
An informatics framework for public health information systems
721
121. 1
9
)
An informatics framework for public health information systems
723
123
entities that might directly participate in the response or
contribute resources to
facilitate the response. Exercise participants included multiple
state agencies, state
and local health departments, and health care facilities.
The exercise provided the opportunity to measure the response
rates and
utilization metrics for the information systems supporting PHEP
activities. It
demonstrated that the presence of an established, integrated
informatics framework
for health information exchange conveys significant advantages
in advancing
preparedness in terms of rapid and accurate execution of
requested actions and
responses within a simulated emergency event (Gotham et al.
2010). Lessons
122. learned from the exercise were used to improve the information
system’s
capabilities for response to emergent events. The exercises and
drills were of
fortuitous benefit: in early spring 2009, nearly 3 years to the
day of the 2006
exercise, NYS activated its Incident Management System (IMS)
in response to the
emergence of Novel Influenza A (H1N1) within the state. All of
the HCS PHEP-
related information systems and informatics infrastructure was
called upon to
respond to the event.
3 Background and history of events surrounding NY state
response to a public
health emergency: Novel Influenza A (H1N1)
In mid-March, 2009, the Mexican government identified 3
separate events of
increased influenza-like illness (ILI) and pneumonia along with
rising death tolls
that caused it to close schools, cancel public events, and isolate
ill individuals at
places of work (WHO 2009). On April 24, 2009, NYSDOH
activated its Incident
123. Management System (IMS) in collaboration with NY City
Department of Health
and Mental Hygiene as a preparatory measure in anticipation of
positive test results
for what was then called Swine Origin Influenza A (H1N1)
among a cluster of
respiratory illnesses within a student cohort at a NY City school
(US CDC 2009a).
On Saturday, April 25, NYSDOH initiated a health alerting
process, providing
initial guidance to local health and health care entities in NY.
By April 26 several of
the NY City specimens had tested positive (US CDC 2009a) and
by April 28, 2009,
there were 45 confirmed cases in NY (US CDC 2009b),
NYSDOH IMS was in full
response mode, and all PHEP information systems were actively
engaged in
supporting the response.
The rapidly advancing geographic spread of the Novel Influenza
strain led the US
Government to declare the situation a public health emergency
on April 26 (US
124. CDC 2010a). On June 11, the World Health Organization
(WHO) raised the
pandemic alert level to Phase 6, signaling that a global
pandemic was under way
(US CDC 2010a). As of June 11, NYSDOH’s website reported
over a thousand
confirmed cases of H1N1 distributed across 40 NY counties and
NY City. By late
June 2009, the disease was becoming better understood (CDC
2009c, 2010a) and
early estimates by the CDC put the total US cases at between
1.8 and 5.7 million by
late July (Reed et al. 2009). Atypically, the H1N1 influenza
activity peaked in late
spring, decreased in midsummer, and increased again in fourth
quarter 2009 (see
CDC 2010b). The picture was complicated by the fact that (the
usual) ‘‘seasonal’’
724 I. J. Gotham et al.
123
influenza activity remained high throughout the summer and
displayed the same
125. multimodal pattern of activity (see CDC 2010b). The experience
reinforced the
importance of information systems and procedures for timely
communication, data
collection and analysis to support science-based public health
decisions in
responding to this event.
Absent a vaccine for H1N1 when the national public health
emergency was
declared, the Centers for Disease Control (CDC) Strategic
National Stockpile (SNS)
program began releasing inventories of antiviral medications
and respiratory and
personal protective equipment to the States, including NY (US
CDC 2010a). These
assets, in combination with NY State’s medical reserve cache,
were forward-
deployed to supplement potential shortages in medications and
infection control. In
June 2009, plans were under way to implement a national H1N1
vaccination
campaign to control the anticipated re-emergence of the disease
in fall of 2009 (see
CDC 2010a). The expected availability date of the H1N1
126. vaccine was October 2009.
Given the short time frame and competition for resources
needed for the seasonal
flu vaccine, however, it was anticipated that the supplies would
be limited. In late
July 2009, the CDC’s Advisory Committee on Immunization
Practices (ACIP)
released guidance on H1N1 vaccination administration based on
the disease
characteristics, concern over the potential for increased severity
upon re-emergence,
and limited availability of vaccine at the start. The guidance
assigned priority to
specific groups of individuals to receive the vaccine, including
health care workers
(see CDC 2010a). As in the 2004 vaccine shortage (Gotham et
al. 2008), States were
given local autonomy to sub-allocate CDC allocations. States
would identify
vaccination providers by priority group, determine the provider
sub-allocation, and
electronically place orders for specific products with the CDC;
the CDC would ship
the product to the designated provider through an independent
127. agent.
4 PHEP activities and information systems supporting response
to the event
The general pattern of PHEP activities and information system
use during the
response phase of the event lifecycle related to the emergence
of H1N1 was similar
to that which occurred during the emergence of West Nile Virus
in NY State in
1999 (see Gotham et al. 2001). The overall PHEP response to
the novel influenza
event occurred in three phases spread out over a period of 9
months. In analogy with
a foot race: Phase 1 was a sprint, immediately followed by a
long distance marathon
(Phases 2 and 3).
The initial response phase occurred from late April through
mid-June 2009.
During that time, NY State had to rely on the Pandemic flu
plan, HCS information
systems and informatics infrastructure that existed at the time.
In the second phase
(June to mid-September 2009), more was known about the
disease, its activity
128. ebbed and Federal vaccine response plans were in process.
In Phase 2 (June to mid-September 2009), PHEP activities
involved continued
monitoring and surveillance of disease activity for any changes
in status in the
community and health care settings. This phase also involved
intensive planning
and information system development/modification activities to
prepare for the re-
An informatics framework for public health information systems
725
123
emergence of the disease in fall 2009 and for a statewide
vaccination campaign to
start in October when that countermeasure would become
available. The planning
and information system development activities were based on
lessons learned from
Phase 1, NY State health executive governance policies and
needs (Fig. 1) and
federal vaccine response plans and policies.
129. The third phase involved implementation of the response plan,
which included
the H1N1 vaccine campaign as a public health intervention to
control the spread of
the disease (September 2009 to January 2010). Table 3 lists the
public health
activities, the HCS information systems supporting them, and
how they were used
throughout the phases of response.
4.1 Phase 1: established information systems supported the
initial response
to the emergency health event
The initial response required intensive health alerting and
communication of
situational awareness to, and among, response partners in the
health community;
rapid gathering and distribution of data related to surveillance
and assessment of
disease severity, geographic spread, and antiviral resistance;
assessment of the
impact on health care resources; control and mitigation of
infection in the health
care and community settings; management and distribution of
antiviral counter-
130. measures and respiratory and personal protective equipment.
There was an immediate imperative for situational awareness
and guidance from
a single authoritative source that could provide rapid
distribution of guidance,
advisories and updates and related communiqués statewide to
the global HCS
community (Figs. 1, 2; Table 1), including all Local Health
Departments (LHDs),
acute care and long-term care facilities, clinical laboratories,
and health providers.
The Integrated Health Alerting and Notification System
(IHANS) and event-specific
website within the HCS system provided the methodology for
distribution of these
materials (Table 3) and the HCS health information exchange
community provided
the venue (Figs. 1, 2; Table 1).
Access to event-specific information was also important:
laboratory and case
reporting of suspect and confirmed cases were supported by
existing HCS systems
(Tables 2, 3, see ECLRS and CDESS). Syndromic Surveillance
131. was maintained
through the HCS Emergency Department Surveillance System
(Tables 2, 3, see
EDSURV). Healthcare-based outbreaks were monitored via the
Nosocomial
Outbreak Reporting Applications (see NORA, Tables 2, 3). The
HERDS system
(Tables 2, 3) was leveraged to provide heightened surveillance
on increases in
patients presenting with febrile or Influenza-Like Illness (ILI)
at hospitals;
assessment of impact on health care status (e.g., ED traffic);
assessment of critical
healthcare resource inventories (e.g., Personal Protective
Equipment and antiviral
medications); tracking of antiviral medications distributed to
the state through the
Strategic National Stockpile (SNS); and assessment of vendor-
managed inventories
of antiviral medications available through pharmacy chains.
Additional baseline information was also required, including
seasonal influenza
surveillance data from acute health care facilities; inventories
of fixed health care
132. assets from acute and long-term care facilities (e.g., ventilators,
airborne isolation
726 I. J. Gotham et al.
123
infection rooms); and bed availability. As the demographics of
the viral infections
became better understood, guidances regarding school closings
and absenteeism
were distributed via the health alert system and event website
(Table 3). School
absenteeism surveillance, required to make decisions regarding
school closings, was
implemented through the HERDS system (Table 3), allowing all
schools across NY
State to report this data and receive event information in
exchange. The dynamic
nature of the HERDS information system allowed for real time
creation of reports
for each of these needs, with information provided on
appropriate levels to the
decision makers across the HCS domain of response partners
(see Tables 2, 3;
133. Gotham et al. 2007)
Situational awareness and decision support were paramount for
the executive
policy and decision makers across the domains of the health
information enterprise
of the HCS community. Data feeds from surveillance, health
care resource
monitoring, and health care facility status were integrated into
the HCS executive
dashboard and data visualization system as well as a Virtual
Health Operations
Center (Tables 2, 3) to provide situational awareness and
decision support for
executives within the Incident Management System (IMS)
(Table 3, see also
Gotham et al. 2010).
Thus the existing HCS information systems supported the
response to the initial
phase of the emergency response. However, the marathon phase
of the response was
about to begin.
5 Phase 2: an established informatics framework enabled agile
development
134. of new or modified information systems to support recovery,
planning
and preparedness for disease re-emergence and countermeasure
intervention
The second phase of the H1N1 event encompasses both the
‘‘recovery’’ phase of the
event lifecyle, that is, recovery from Phase 1 and re-initiation of
the cycle into
‘‘preparedness’’ for what, at the time, was envisioned as Phase
3: re-emergence of
the disease and medical countermeasures against it. One
component of Phase 2
involved ongoing monitoring and surveillance of disease
activity for any changes in
status in the community and health care settings as well as
alerting and situational
awareness reporting. These activities were supported by the
existing HCS
information systems (Tables 2, 3). A second component of
Phase 2 involved
engaging in intensive planning activities to prepare for the re-
emergence of the
disease and a vaccine countermeasure campaign in fall 2009.
Federal policies, distribution plans, reporting mandates, as well
as lessons
135. learned locally from Phase 1 by NY State dictated that
completely new intervention
and surveillance plans had to be developed to support a
federally-brokered, state
fiduciary-based vaccination campaign. The campaign was slated
to start that
October when federal entities would make the vaccine available
to providers and
states. The existing PHEP systems, such as HERDS, were well
tuned to the
information needs of an emergent event of short duration. The
existing Immuni-
zation Registry and clinic data management system were well
suited to monitoring
administration of vaccines by providers and mass vaccination
clinics (Tables 2, 3).
An informatics framework for public health information systems
727
123
T
a
b
le
285. v
is
u
a
li
z
e
r
sy
st
e
m
An informatics framework for public health information systems
731
123
However, no system existed to support transactional placement
of vaccine orders,
order and inventory tracking, and reporting for orders placed to
the CDC. Further,
there was no integrated allocation system to implement the
state’s requirements for
distribution and reporting. The situational awareness and
decision support
capabilities of the HCS also had to be attuned to this
information flow in order to
allow decision makers to assess need based on federally
286. mandated priority
populations, place orders for vaccine supply, and report the
number of vaccines
administered.
As described in our definition of information systems and our
informatics
framework (Fig. 1), people and processes form an important
infrastructure
component of each paradigm. Our model informatics framework
includes a
governance process which informs an agile informatics team of
the needs of the
enterprise, the team being tasked with the responsibility of
developing and
implementing the information system to meet them.
Thus, NY State maintains a staffing infrastructure of subject
matter experts in
technology, project management, informatics and health
knowledge domains who
make up an informatics team (see Fig. 1 for roles on that team).
That team was
tasked with the responsibility for design, development, and
implementation, by
287. October 1, 2009, of the systems required to order, manage, track
inventory, and
report the status of vaccination campaigns. Additionally, all
data feeds from these
new systems and existing information systems had to be
integrated into the
executive dashboard (Tables 2, 3) to enable a common
operational picture to
provide situational awareness as well as decision support in
ordering, prioritizing
and distributing vaccine among the NYS population.
The governance structure was centered around a series of Health
Knowledge
domain executive workgroups created to cover all programmatic
information
system needs for the response. The Informatics team
participated as an integral
component on all of these programmatic workgroups and was
tasked with the
responsibility of developing the informatics component of the
plan: a compre-
hensive approach to support (1) incident management; (2)
vaccination campaign;
(3) epidemiologic surveillance; (4) monitoring health care
288. facility status,
resource utilization and availability, surge capacity; (5)
community mitigation;
(6) alerting and communication; (7) situational awareness and
decision support
(see Tables 2, 3).
Executive workgroup products–objectives, response triggers,
guidance, policy,
protocols, and operational documents–were created and posted
within a Virtual
Health Operations Center (VHOC) within the HCS system
(Table 3). The VHOC
information system provided a vehicle to share and collaborate
on plan development
with external response partners within the information exchange
community of the
HCS. The VHOC also supported the IMS process through
electronic tracking of
assignments and collaborative production of daily reports
(Situation Reports) for
executive consumption.
A key deliverable of the Informatics team was to formulate a
cohesive and
289. comprehensive Master Data Management Plan (MDMP). An
MDMP was essential
to establishing a single integrated and authoritative source of
information to the data
layer services that would support the Information Systems to be
used in the response
732 I. J. Gotham et al.
123
(e.g. see Figs. 1, 2). This effort was largely focused on
identifying the data elements
that were well defined and reliable; used a standard vocabulary;
could be obtained
without overburdening the data providers; were needed to
support state and local
executive decision making and situational awareness and to
present a common
operational picture to the IMS staff; and would lead to
information products that
offered value back to the data provider. Defining data sharing
and access rules and
other key metadata elements was also included in the plan. A
data dictionary was
290. developed and linked to electronic data collection templates for
deployment in the
HERDS systems. Each template was tailored to the needs of
agreed-upon scenarios
of disease severity.
The informatics forum for developing the MDMP included
participants from
organizations that cross-cut the information exchange
community on the HCS:
NYSDOH health care and public health subject matter experts
(SMEs), New York
City Department of Health and Mental Hygiene (NYCDOHMH)
local public health
agency programs, LHDs, hospital associations, and long-term
care facilities. The
result of this effort was a well-defined and realistic MDMP that
was supported by
the health care and local health response partners. The MDMP
also addressed the
need for school closure and absenteeism surveillance. The
informatics workgroup
used a similar approach working with NYSDOH
epidemiologists, the NYS
Education Department, LHDs, and representatives from schools
291. and school districts
to design a plan for schools to report absenteeism via the
HERDS information
system. The data collected from these reporting streams would,
as part of the plan,
be integrated into the HCS executive dashboard visualization
system to provide a
common operational picture and situational awareness to
executive staff and the
IMS.
The informatics team engaged an agile project management
approach to
developing and implementing a Vaccine Ordering and
Management System
(VOMS). The process started with a ‘‘top-to-bottom’’ business
analysis of existing
vaccine ordering and distribution protocols and procedures to
gather requirements
and assess how technology could improve workflow and
streamline the process and,
further, allow the flexibility needed for rapid responses to
changes in vaccine supply
and demand at the national, state, or local level. The ability to
react to, and
292. accommodate, changes in the VOMS system was essential as the
vaccination
campaign itself presented complex and rapidly evolving state
and federal
requirements. An overview of the information and process flow
of the vaccine
campaign is shown in Fig. 3. VOMS requirements dictated that
the system must:
• Allow vaccination provider organizations to register
electronically and to
acknowledge their agreement to federally mandated conditions,
place orders,
receive order status updates, and make changes in orders online
• Allow local health departments to assess provider rankings in
priorities
• Support a data-driven allocation process
• Place orders with the Centers for Disease Control
• Accept reports from providers of vaccine doses administered
to priority
populations as identified in federal guidance
An informatics framework for public health information systems
733
123
293. • Be operational before October 19, 2009, when supplies of the
vaccine would be
available to fill state orders
The third phase involved implementation of the response plan,
which included the
vaccine campaign as a public health intervention to control the
spread of the disease
(September 2009 to January 2010). A common operational
picture of disease
surveillance data, health care facility status and resources,
vaccine ordering and
administration status, and infection control actions had to be
made rapidly available
to policy makers and response partners. The influenza vaccine
countermeasure
would be made available to vaccination providers according to
the federal
government’s prioritization recommendations. State allocation
decisions would be
informed by multiple data sources, including: surveillance,
healthcare status, and
reports of administered doses from mass clinics, school-based
clinics, hospitals,
community health centers, and private providers.
294. 5.1 Phase 3: implementation of information systems supporting
the revised
response plan and vaccine countermeasure campaign
The third phase involved implementation of the revised Phase 2
response plan. The
goal was to establish and sustain a ‘long-term’ public health
intervention campaign
designed to control the spread of the disease (September 2009
to January 2010). The
plan dictated the absolute need for decision makers and
response partners across the
HCS community to have real-time access to a common
operational picture of
disease surveillance data, health care facility status and
resources, vaccine ordering
and administration status, and infection control actions. The
influenza vaccine
orders placed with the CDC by the States would be made
available to vaccination
providers according to the federal government’s prioritization
recommendations and
the States’ allocation plans. Therefore, NY State orders to the
CDC for vaccine and
its allocation supplies must be informed by multiple data
295. sources, including:
surveillance, healthcare status, and reports of administered
doses from mass clinics,
school-based clinics, hospitals, community health centers, and
private providers.
5.1.1 Epidemiologic surveillance information systems
Using the MDMP, NYS implemented enhanced influenza
surveillance activities by
leveraging its existing information systems tracking both
severity and extent of both
novel influenza and seasonal influenza (see Tables 2, 3). These
systems included:
Electronic lab reporting system, HERDS, communicable disease
case reporting, and
syndromic surveillance. Thus, given the the long history of
HCS’s information
systems, surveillance data collected in previous years could be
used as baselines for
comparison against any changes in seasonal trends in activity or
patient attributes in
the data collected during Phase 3 (see Fig. 4).
The HERDS school surveillance information system was
activated to provide a
296. tool for schools and LHDs to collect and track absenteeism data
in a consistent way
across the state, to facilitate monitoring of potential increases in
illness, and to
provide objective data to support local decision making
regarding possible
734 I. J. Gotham et al.
123
community mitigation actions, such as school closures. All
related data feeds from
these surveillance activities were integrated into the executive
dashboard decision
support system, informing the vaccination campaign as well as
assisting in
providing a common operational picture of disease extent across
the state (see
Figs. 4, 5).
5.1.2 Information systems monitoring and tracking health care
facility status,
resource utilization and availability, surge capacity
The MDMP called for a staged approach to monitoring health
facility status and
297. resource utilization or shortfalls across the continuum of acute
and long-term care
facilities, based on severity of the disease (Tables 2, 3). The
intent was to monitor
status, assess the level of ‘‘stress’’ the facilities were
experiencing due to hospital or
ED admissions, and activate IMS intervention processes to
allocate physical or
staffing resources if needed to help maintain the ability of
facilities to provide
routine care or respond to even greater demands. The HERDS
system was used to:
• Track bed availability and utilization, by service category
(e.g., adult/pediatric
ICU, medical/surgical, monitored, isolation), in comparison to
the total staffed
beds at health care facilities
Fig. 3 Interrelation and Information Flow between Information
Systems Supporting the Vaccination
Campaign
An informatics framework for public health information systems
735
123
298. • Track supplies of personal and respiratory protective
equipment
• Track critical life support equipment (e.g., ventilators)
• Track pharmacy supplies
• Assess facility stress levels as indicated by activation of surge
plans, emergency
operations centers, diversion status, cancellation of elective
procedures, etc.
• Assess health care worker shortages
The data feeds from both acute care and long-term care
facilities were also
integrated into the executive dashboard (see Fig. 5) to inform
the IMS leads and
also the vaccination campaign.
5.1.3 Information systems supporting the vaccination campaign
The complex data and workflow needed to support the VOMS
system as well as
other supportive information systems (Fig. 3) were integrated
using the SOA and
reusable core services within NY’s framework (Figs. 2, 3). This
allowed NY State
to effectively take orders for vaccine from providers, allocate
them according to
ACIP priority groupings, place orders with the CDC and track
299. all portions of the
transaction. Using the executive dashboard decision support
system (Fig. 5) with
information integrated in real time from the provider
registrations and orders from
allocated H1N1 vaccine doses and types from the CDC,
NYSDOH was able to
allocate the available doses of vaccine to appropriate providers
and target the groups
recommended by ACIP to receive vaccine.
Once allocated, vaccine orders were transmitted electronically
to CDC for
distribution to providers either directly from CDC or via state
or local health
departments. NYSDOH also automatically tracked each vaccine
shipment and
Fig. 4 Hospital patients testing positive for influenza virus,
New York State, October 2007–May 2010
736 I. J. Gotham et al.
123
provided information to state and local health officials for
distribution planning and
300. tracking and to providers via the Order History Report for
immunization scheduling
and coordination with patients. After vaccine was administered,
providers were
required to report the number of administered doses via one of
three mechanisms:
H1N1 Vaccine Administered Doses Reporting System, which
utilized a dual phone
and web data entry interface, Clinical Data Management System
for mass
Fig. 5 Example of NYSDOH Executive Situational Awareness
Dashboard and Data Visualizer System
An informatics framework for public health information systems
737
123
vaccination clinics hosted by local health departments, and NYS
Immunization
Information System (Tables 2, 3). If providers needed to
redistribute vaccine to
others, they could also report through a web interface so the
data could be used for
both allocation and tracking purposes. Based on the MDMP, all
301. information from
these systems were integrated into a centralized data layer so
they could be analyzed
and visualized for operational decision support and situational
awareness via the
executive dashboard and other visualization tools (Fig. 5).
5.1.4 Situational awareness and decision support
The MDMP developed by the Informatics team provided the
framework for assuring
the effectiveness of data-driven decisions throughout the Phase
3 response. The
Executive Dashboard and Data Visualizer tool (Tables 2, 3)
provided a single,
seamless, and highly visual interactive interface for executive
decision makers and
IMS managers to have access to a common operational picture
based on
standardized and agreed-upon data elements and visual objects
(Fig. 5). The
dashboard provided summary information as well as interactive
drill-down into
aggregated and time-series data views from HERDS, laboratory
surveillance
302. systems, syndromic data, hospital resource availability, bed
utilization, school
absenteeism, and vaccine ordering and administration for state
and local health
officials.
Access to these data informed the vaccine allocation process,
providing all
information necessary to formulate, execute, and communicate
executive and
operational decisions in vaccine management, allocation, and
distribution across
providers, jurisdictions, and DOH programs. Of key importance
was that all
decision makers and supporting analysts used a common
operational picture and
standard data sets on which to base their decisions and actions.
Resulting data-
driven executive policies, vaccine administration and reporting
procedures, and
other patient care–related information regarding the vaccination
campaign were
flash-transmitted to a cohort of some 5,500 vaccination provider
organizations via
the IHANS system (Tables 2, 3). Information about the response
303. and vaccination
campaign was regularly made available to the HCS health
information exchange
community via the event-specific website (Tables 2, 3).
Information on the website
included daily vaccine campaign status reports of doses ordered,
allocated, shipped,
and administered for all local health departments.
6 Value of an informatics framework and information systems
in supporting
emergency preparedness and response
We have discussed the role of a model Informatics Framework
and the information
systems it encompasses in providing value throughout the cycle
of Public Health
Emergencies: Preparedness, Response and Recovery (Figs. 1,
2). The final stage,
recovery, is considered in Sect. 4. In this section we review
some of the beneficial
outcomes of this Framework.
738 I. J. Gotham et al.
123
304. 6.1 Preparedness benefit: well established and routinely used
informatics
framework
NY State’s existing informatics framework conveyed the
following advantages in
responding to the novel influenza event:
• The dual use nature of the HCS and its information systems
entrained and
cultured a community of electronic heath information exchange
partners that
cross-cut health organizations across the state. Thus all needed
response partners
were already using the HCS systems and their role and contact
information was
captured in the communications directory at the time of the
event (Tables 1, 2, 3).
• Lessons learned from a history of responding to health events
such as West Nile
Virus, 9/11, natural disasters, and health care resource shortages
allowed
systems to evolve to support routine and emergency use (e.g.
Gotham et al.
2001, 2007, 2008). Thus NY State had the information systems
in place to
305. respond immediately to the health event.
• existing information systems not only allowed for rapid
response to the event but
also provided a history of baseline data for monitoring changes
in trends during
the event.
• Ongoing exercises and drills that use and test the informatics
framework and its
information systems resulted in both user and information
system preparedness
to respond to the health event (see Gotham et al. 2010).
• A governance process and an existing and experienced team of
experts in
informatics, health domain subjects, project management and
information
technology enabled NY State to rapidly develop and modify
information
systems and MDMP to meet the information and planning needs
of the longer
term response to the health event. The existence of the HCS
information
exchange community provided a source of health organizations
able to
contribute to the MDMP as well as provide input into the
development of
306. new information systems based on their knowledge and use of
the existing HCS
systems.
6.2 Response benefit: health alerting and notification: rapid
communication
of critical event-related information across response partners
The Integrated Health Alerting and Notification System
provides general and
targeted health alerting and notification, using multiple
communications modalities:
automated phone, cell, e-mail notifications with
acknowledgements (Tables 2, 3;
Fig. 2) (see Le et al. 2010). Routine health alerting drills are
conducted with local
health departments and health facilities assure proficiency in its
use (see Gotham
et al. 2007, 2010; Le et al. 2010). The IHANS serves multiple
purposes during an
emergency response: (1) notifying targeted organizations as to
new health alert
postings or materials posted on the event website within the
HCS (see below); (2)
direct distribution of documents and information to targeted
HCS organizations; (3)
307. notifying targeted organizations of surveys activated within the
HERDS systems. In
the initial weeks of the novel influenza response (April 24–June
1, 2009) the IHANS
An informatics framework for public health information systems
739
123
was used to transmit 309 separate event-related notifications to
an aggregate total of
396,014 users. The targeted organizations included LHDs,
hospitals, nursing homes,
adult and home care organizations. Table 4 presents
representative examples of
average time to alert pickup by key HCS organizations during
the initial phases of
the PHEP response.
6.3 Response and recovery benefit: decision support, situational
awareness:
informing decision-makers, response partners and the health
information
exchange community in general
308. Situational awareness for the HCS community was provided via
two mechanisms:
(1) health alert postings within the HCS Health Alert Network
(HAN) Viewer
system; and (2) an event-specific website within the HCS portal
itself. IHANS is
used to notify targeted HCS groups that new postings are
available. As described
earlier and indicated in Table 1, the HCS portal is a diverse
information exchange
platform. The NYSDOH response protocol for a health event is
to establish an
event-specific website within the HCS portal system (Tables 2,
3; Gotham et al.
2010). This site is the focal point for access to all event-related
postings,
applications, information, and data. This includes links to the
HCS Health Alert
Viewer as well as to collections of electronic documents. The
documents posted in
the HAN Viewer and the website included case definitions,
infection control
protocols, clinical and treatment guidance, specimen handling
and biosafety
309. procedures, laboratory testing protocols; school closing and
surveillance recom-
mendations; guidance for EMS workers and facility-specific
guidance for long-term
care, educational, child care, and correctional facilities and
summer camps.
Between April 24 and June 1, 2009, some 482,681 event-related
documents were
downloaded by 32,185 distinct HCS users from the Alert Viewer
and event website.
Table 5 presents the document access distribution among key
organizations from
April 24 through December 31, 2009. Over this period of time,
over 45,000 users
downloaded approximately 1.3 million documents from HCS.
On average, 70 % of
these users were repeat users, defined as having downloaded
materials on 3 or more
separate days. LHDs were the highest user group in terms of
both volume of
documents downloaded and percent of repeat users. Medical
practitioners as a group
constituted the greatest number of users accessing event-related
materials.
310. 6.4 Preparedness, response and recovery benefit: flexible and
dynamic
surveillance, visualization and reporting systems deployed and
in routine
use across the organizations within the health information
exchange
community: immediate responsiveness to information needs for
any event
or routine health program initiative
The HERDS system is completely dynamic and does not require
programing to
develop and deploy information gathering and reporting
applications (see Gotham
et al. 2007). This information system was used throughout the
response to support a
wide array of ongoing and customized information and data
collection needs
dictated by the event and the phase of the response to the event.
It supported event-
740 I. J. Gotham et al.
123
related data reporting required for epidemiologic surveillance,
311. reporting of resource
and bed availability, assessment of facility stress level due to
patient influx, and
oversight of vaccination rates in the healthcare setting (Tables
2, 3). The system was
used for data exchange by facilities ranging from acute care
hospitals to long-term
care facilities and schools, and it simultaneously supported
customized surveillance
needs of the NYCDOHMH. As HERDS has been in use since
2003–2004 for
periodic reporting of bed availability, critical assets, and
seasonal influenza testing
by hospitals, the NYSDOH had historical trend data to provide
baseline information
for comparison against the evolving seasonal and H1N1
influenza patterns. For
example, hospital reporting of patient admissions with
laboratory-confirmed
influenza (any type) showed a dramatic shift in pattern during
the spring and fall
of 2009 over previous years (Fig. 4). The integrated information
architecture of the
HCS system (Figs. 1, 2) assures that the diverse data streams
312. flow into a central data
repository and are available for visualization and provision of a
common operational
picture via a single dashboard system (Fig. 5; see also Gotham
et al. 2010). Table 6
presents the composite access transactions against HERDS
instances for hospitals,
nursing homes, and schools from April 24 through December
31, 2009. Over this
period of time, there were over 6.6 million access transactions
(submitting data or
retrieving reports) by over 14,000 users. On average, across all
organizations 43 %
of these users were repeat users, accessing the system on 3 or
more days.
6.5 Preparedness and response benefit: existing informatics
framework assures
rapid, effective response to new information systems needs:
case study-
vaccine ordering and administration system
The Vaccine Ordering and Management System (VOMS) was
required to manage
the ordering and distribution of vaccine, short in supply, and to
assure that the
313. majority of organizations providing vaccinations to the
federally designated priority
groups met certain requirements. The information system
required linkage of a
complex information and process workflow (Fig. 3). Physicians
were required to
register to order the H1N1 vaccine, to report the number of
patients they serve in the
priority population groups, and to attest their agreement
(electronically) to a
federally required vaccine receipt agreement. It was critical that
the majority be
registered and able to place orders in advance of the availability
of vaccine (October
19, 2009) to allow NYSDOH executive decision makers the
ability to execute the
allocations according to provider attributes (e.g. priority
populations served) and
other critical information available from the common
operational picture presented
in the dashboard system (Figs. 2, 4, 5).
A shortage of vaccine and delays in production at the onset of
the campaign
314. created unanticipated demand and increased pressure to
distribute limited supplies
of vaccines. These events had a significant impact on planning
assumptions. Rapid
and frequent changes in business rules were required during the
development of the
Vaccine Ordering and Management System (VOMS).
Nevertheless, given the rapid
development environment within NYS informatics framework,
combined with the
adoption of agile methodology, the process—requirement
gathering, business rule
definition, and technical development of VOMS—was
completed in only 1 month.
An informatics framework for public health information systems
741
123
T
a
b
le
4
E
x
377. lt
h
A
g
e
n
c
y
An informatics framework for public health information systems
743
123
The process of registration and order placing for vaccine was
expedited by the fact
that 95 % of the vaccination provider organizations were
existing members of the
HCS system and had used it for other applications. Owing to the
existing HCS
infrastructure, its experienced user community, and the agility
of VOMS, approx-
imately 80 % of vaccine providers were registered in VOMS and
placing orders by
October 20, when H1N1 vaccine was available at the federal
level for distribution. As
shown in Fig. 6, a total of 5,509 provider organizations
378. registered over the course of
the event. Eighty percent of the providers had registered prior to
the deadline and had
placed orders with the state for some 750,000 doses. By the end
of the year the
providers had placed orders for nearly 13 million doses of
vaccine (Fig. 6).
7 Conclusions and lessons learned
The presence of an established integrated informatics
framework for health
information exchange and PHEP in NY State conveyed
significant advantages in
Table 5 H1N1 Influenza-related Documents Downloaded from
Event Website and Integrated Health
Alerting and Notification System (IHANS) by NYSDOH Health
Commerce System (HCS) Organizations
(April 24 through December 31, 2009)
Organization
type
Organizations
downloading
Documents downloaded