Dr. Matthew Samore, M.D.

Professor, Division of Clinical Epidemiology

Title: RESEARCH CENTER OF EXCELLENCE IN PUBLIC HEALTH INFORMATICS- CENTER OF DISEASES CONTROL

We propose to create the Public Health Informatics, Decision-support, Evaluation, Analysis and Surveillance (IDEAS) Center. Its theme will be system alignment and data integration to support the public health functions of preparedness, evaluation, surveillance, analysis, decision-making, and response. The Center will be housed in the Department of Medical Informatics at the University of Utah, which is one of four National Library of Medicine (NLM)/Robert Wood Johnson (RWJ) Public Health Informatics training program site. It will bring together academia, state and local, regional, and national public health departments, integrated health care delivery systems, a successful Community Health Information Network (CHIN) and developing Regional Health Information Organization (RHIO), and myriad local, regional, and national public health and clinical data resources. The Center will unite the pursuit of state of the art research into public health informatics with a network of investigators, public health leaders and practitioners, hospital and clinical health care providers, computer scientists, and healthcare and community leaders.

The research aims of the Public Health IDEAS Center address key problems in public health, clinical care, and public health informatics. We will develop and evaluate methods to improve accuracy of date linkage of patient records from multiple date sources and location through probabilistic matching. The challenge of coordinating public health and health care system responses to threats to patient safety will be investigated. Reporting and monitoring function of public health will be matched with education and quality improvement activities, using surveillance and analytic tools that are based on linked patient data. We will implement information technologies that support communication between providers and public health personnel, enhance decision-making capacity, and improve the efficiency of retrieval of data for investigation of infectious disease and other public health related events. Finally, we will develop and apply advanced modeling, simulation, and geographic information system to better inform public health policy- and decision- making, not just for situation of high uncertainty and high risk, but also to improve control of more familiar infections. Our driving goal is to generate research that are widely generalizable for public health and its health care partners at the local state, and national levels.

SUB CORE - SCIENTIFIC CORE FOR PUBLIC HEALTH IDEAS CENTER

Director: Wu Xu

The Scientific Core has two complementary functions, one to provide methodologic, technical, and study coordination support to the Public Health IDEAS Center research projects and the other to lead research and infrastructure development projects in its own right. Core research projects are studies that are focused on data integration and on leveraged application of information technology to transform public health practice. Five general categories of experience and expertise exist in the Scientific Core: public health, informatics, data management, quantitative methods, and research coordination. Notable areas of strength include medical vocabulary, patient safety, data linkage, infectious disease epidemiology, and public health surveillance. One core research project will evaluate methods to link duplicate, missing or error-prone data in public health data sets. The other research project will demonstrate the application of linked data, while addressing the significant public health problem of increasing mortality due to prescription narcotic use. The work represented by the two infrastructure aims will improve the timeliness, efficiency, and completeness of public health surveillance through real-time clinical electronic notifiable disease reporting and enhanced syndromic surveillance. We believe that a dual role of support and primary investigation stimulates greater activation and engagement on the part the affiliated faculty and support staff and will augment the overall productivity of the Center with respect to academic contributions and other types of dissemination activities. It will also facilitate completion of smaller, pilot studies that lead to new sources of funding.

SUB CORE - ADMINISTRATIVE CORE

Director: Matthew Samore

The Administrative Core’s primary function is to supportive environment in which research excellence can thrive and new knowledge will be shared effectively. Support for innovation and multidisciplinary collaboration will be facilitated by managing daily operation and communication. Its operational responsibilities will include grant tracking and reporting, center coordination, Advisory Board, Steering Committee, and Privacy Committee support, web support, and human resources coordination.

Aims of the Administrative Core are to 1) develop mechanism for data sharing in a secure and confidential manner between institutions; 2) support dissemination of finding of basic and applied research in public health informatics; 3) support dissemination technologies, methods, and products to other local, state and national public health programs; and 4) support public access to appropriate public health data.

The Public Health IDEAS Center also depends upon the Administrative Core to evaluate its performance, progress, and outcomes.

SUB CORE - CENTERS OF EXCELLENCE PROJECT 2 " DSIDE"

DIRECTOR: Matthew Samore

Bio-defense, communicable disease control, and surveillance of emerging infections are essential functions of public health. Infectious disease threats to public health encompass deliberate attacks, novel organisms, novel variants of old pathogens, antimicrobial-resistant strains, and new susceptible human populations. However, even familiar microorganisms are still major causes of morbidity and mortality. Strategies to better guide public health policy- and decision-making, particularly in situations of high uncertainty and high risk, are urgently needed.

To address this problem, this project brings together four disciplines: public health, mathematical modeling of infectious diseases, computer simulation of complex systems, and cognitive psychology. The overall goal is create an integrated data and simulation environment for public health decision support adapted to the factors that drive public health decision-making. Three lines of research will proceed in parallel during the first half of the project. One line comprises the investigation of decision-making processes of public health epidemiologists and policy-makers using methods drawn from the discipline of cognitive psychology. Another line of research will entail the development of a detailed simulation of an urban population modeled after the Salt Lake Valley. A unique contribution of this specific part of the study is the evaluation of the impact of incorporating novel sources of data regarding demographics, activity levels, and health status into the establishment of the synthetic population. A third line of research will be to evaluate the conceptualization and interpretation of mathematical models of infectious disease by public health epidemiologists and policy-makers. These research lines will then come together in four significant ways. First, the computer simulations will provide a more precise instrument to probe the factors that influence decision-making. Second, the information obtained from the analysis of decision-making processes will in turn inform the design of the prototype simulation test bed. Third, the simulations will facilitate investigation of transmission model acceptability for public health personnel. Fourth, a prototype simulation test bed will be deployed interactively in which the public health epidemiologist and policy-maker will be able to visualize multiple course of action and their effects, when confronted with a simulated outbreak.

The long-range goals of this project are to advance incorporation of public health science into public health decision-making and to deploy information technology systems to support training, preparedness, policy-making, and real-time response.

SUB CORE - INFORMATION, NEW TECHNOLOGY EXCHANGE FOR RAPID ACTION, COMPLIANCE AND TREATMENT.

Director: Carrie Byington

Vaccine preventable communicable respiratory illnesses are major causes of morbidity and mortality in US children and adults represent a major challenge to public health and clinician providers. From a public health respective challenges include assuring immunization, especially in groups where immunization is voluntary, surveillance for these pathogens, case and contact investigation, and the public health burden of antibiotic resistance associated with treatment of viral respiratory infections. From a clinician perspective, time pressures limit their attention to the public health considerations associated with the prevention and treatment of vaccine-preventable respiratory infections. Treating physicians may have difficulty locating and interpreting public health guidelines, and these guidelines often lack specificity for treatment and do not include local surveillance data. We believe that these problems are fundamentally related to communication between public health and clinician providers. The goal of this project is to align public health and clinical practice by taking advantage of information technology to make public health practice more efficient and effective and to advance appropriate clinical management with respect to immunization, diagnostic testing, and prescribing of antiviral and antimicrobial medications. This project will focus on vaccine-preventable or potentially preventable respiratory infections due to influenza, pertussis, Neiserria meningitis, Streptococcus pneumonia, and respiratory syncytial virus. The specific aims are: 1) Extend a system for email communication, distribution of surveillance reports and retrieval of reference information to public health and clinician providers in Utah, 2) Measure the effect of electronic information exchange system on knowledge, awareness, efficiency, and communication on the part of clinicians and public health personnel, 3) Conduct a nested trial, randomly allocating urgent care centers and primary care clinics to receive surveillance reports for vaccine preventable respiratory illnesses with or without tailored clinical management recommendations, 4) Measure the effect of receiving surveillance reports coupled with tailored clinical recommendations on therapeutic management endpoints including antimicrobial and antiviral use and on secondary endpoints of immunization rates in targeted populations. The project will be referred to as the Information and New Technology Exchange for Rapid Action, Compliance, and Treatment (INTERACT).