Digital Tools Adopted by Public Health Agencies to Support COVID-19 Case Investigation and Contact Tracing, United States, 2020-2021.

During the COVID-19 pandemic, public health agencies implemented an array of technologies and digital tools to support case investigation and contact tracing. Beginning in May 2020, the Association of State and Territorial Health Officials compiled information on digital tools used by its membership, which comprises 59 chief health officials from each of the 50 states, 5 US territories, 3 freely associated states, and the District of Columbia. This information was presented online through a publicly available technology and digital tools inventory. We describe the national landscape of digital tools implemented by public health agencies to support functions of the COVID-19 response from May 2020 through May 2021. We also discuss how public health officials and their informatics leadership referenced the information about the digital tools implemented by their peers to guide and refine their own implementation plans. We used a consensus-based approach through monthly discussions with partners to group digital tools into 5 categories: surveillance systems, case investigation, proximity technology/exposure notification, contact tracing, and symptom tracking/monitoring. The most commonly used tools included the National Electronic Disease Surveillance System Base System (NBS), Sara Alert, REDCap, and Maven. Some tools such as NBS, Sara Alert, REDCap, Salesforce, and Microsoft Dynamics were repurposed or adapted for >1 category. Having access to the publicly available technology and digital tools inventory provided public health officials and their informatics leadership with information on what tools other public health agencies were using and aided in decision making as they considered repurposing existing tools or adopting new ones.

A quasi-experimental text messaging trial to improve adolescent sexual and reproductive health and smoking knowledge in Indonesia.

Background To evaluate the feasibility and acceptability of a text message intervention to improve young people's knowledge of sexual reproductive health (SRH) and harms related to smoking in Indonesia. METHODS: A quasi-experimental short message service (SMS) trial of young people aged 16-24 years receiving twice weekly SMS over a 10-week intervention period. Pre- and post-online demographic and risk behaviour surveys were used to assess changes in knowledge. Among respondents who completed both surveys, we assessed changes in knowledge before and after SMS intervention using paired McNemar's test and differences in mean knowledge score using a paired t-test. RESULTS: In total, 555 eligible young people were enrolled into the SMS intervention; 235 (42%) completed a follow-up survey, of which 198 (84%) were matched to a baseline survey. Median age of participants was 19 years and the majority were female (63%). The mean knowledge score significantly increased between baseline and follow-up surveys for SRH questions [2.7, (95% CI 2.47, 2.94) vs 3.4 (95% CI 2.99, 3.81) (P = <0.01)] and smoking-related questions [3.8 (95% CI 3.66, 3.99) vs 4.1 (95% CI 3.99, 4.28) (P = 0.03)]. A majority of participants reported that the SMS intervention increased their knowledge (95%) and were a useful reminder (95%). CONCLUSIONS: An SMS intervention was feasible, acceptable and improved adolescents' SRH knowledge and smoking knowledge in a low- to middle-income setting. SMS interventions targeting young people need to be scaled up, with the potential to explore additional topics around healthy lifestyle, nutrition and physical activity.

Synonym-Based Word Frequency Analysis to Support the Development and Presentation of a Public Health Quality Improvement Taxonomy.

CONTEXT: Researchers and analysts have not completely examined word frequency analysis as an approach to creating a public health quality improvement taxonomy. OBJECTIVE: To develop a taxonomy of public health quality improvement concepts for an online exchange of quality improvement work. DESIGN: We analyzed documents, conducted an expert review, and employed a user-centered design along with a faceted search approach to make online entries searchable for users. To provide the most targeted facets to users, we used word frequency to analyze 334 published public health quality improvement documents to find the most common clusters of word meanings. We then reviewed the highest-weighted concepts and categorized their relationships to quality improvement details in our taxonomy. Next, we mapped meanings to items in our taxonomy and presented them in order of their weighted percentages in the data. Using these methods, we developed and sorted concepts in the faceted search presentation so that online exchange users could access relevant search criteria. RESULTS: We reviewed 50 of the top synonym clusters and identified 12 categories for our taxonomy data. The final categories were as follows: Summary; Planning and Execution Details; Health Impact; Training and Preparation; Information About the Community; Information About the Health Department; Results; Quality Improvement (QI) Staff; Information; Accreditation Details; Collaborations; and Contact Information of the Submitter. CONCLUSION: Feedback about the elements in the taxonomy and presentation of elements in our search environment from users has been positive. When relevant data are available, the word frequency analysis method may be useful in other taxonomy development efforts for public health.

Public Health Quality Improvement Exchange: A Tool to Support Advancements in Public Health Practice.

OBJECTIVES: The Public Health Quality Improvement Exchange(PHQIX) is a free, openly available online community that supports public health practitioners in the rapidly evolving landscape of public health quality improvement (QI). This article's objective is to describe the user-centered development of PHQIX and its current content and examine how elements of a QI initiative may vary by an organization's characteristics or QI experience. METHODS: PHQIX was developed by taking a user-centered iterative design approach, seeking early and continued input from users to gather requirements for the website. We performed an exploratory analysis of the published QI initiative descriptions, reviewing all QI projects that PHQIX users shared as of January 1, 2018. RESULTS: PHQIX features 193 QI initiatives from a variety of health departments and public health institutes using a wide range of QI methods and tools. DISCUSSION: Submitted QI initiatives focus on many public health domains and favor the PDCA/PDSA cycle; Kaizen; and fishbone diagrams, flowcharts, process maps, and survey methods. Limitations include data coming only from users who represent health departments with sufficient time to complete the PHQIX submission template. Additionally, many initiatives were submitted in part to fulfill a grant requirement, which could skew results. CONCLUSION: As the field of QI in public health practice evolves, resources targeted to QI practitioners should build on and advance the available resources. Findings from this study will provide insight into QI initiatives being performed and the types of projects that can be expected as organizational experience and collaboration grow.

Evaluation of a Quality Improvement Resource for Public Health Practitioners.

OBJECTIVES: Quality improvement is a critical mechanism to manage public health agency performance and to strengthen accountability for public funds. The objective of this study was to evaluate a relatively new quality improvement resource, the Public Health Quality Improvement Exchange (PHQIX), a free online communication platform dedicated to making public health quality improvement information accessible to practitioners. METHODS: We conducted an internet-based survey of registered PHQIX users (n = 536 respondents) in 2013 and key informant interviews with PHQIX frequent users (n = 21) in 2014, in the United States. We assessed use of the PHQIX website, user engagement and satisfaction, communication and knowledge exchange, use of information, and impact on quality improvement capacity and accreditation readiness. RESULTS: Of 462 respondents, 369 (79.9%) browsed quality improvement initiatives, making it the most commonly used site feature, and respondents described PHQIX as a near-unique source for real-world quality improvement examples. Respondents were satisfied with the quality and breadth of topics and relevance to their settings (average satisfaction scores, 3.9-4.1 [where 5 was the most satisfied]). Of 407 respondents, 237 (58.2%) said that they had put into practice information learned on PHQIX, and 209 of 405 (51.6%) said that PHQIX had helped to improve quality improvement capacity. Fewer than half of respondents used the commenting function, the Community Forum, and the Ask an Expert feature. CONCLUSIONS: Findings suggest that PHQIX, particularly descriptions of the quality improvement initiatives, is a valued resource for public health practitioners. Users reported sharing information with colleagues and applying what they learned to their own work. These findings may relate to other efforts to disseminate quality improvement knowledge.

Use of mobile technology in a community mental health setting.

INTRODUCTION: mHealth holds promise in transforming care for people with serious mental illness (SMI) and other disadvantaged populations. However, information about the rates of smartphone ownership and usage of mobile health apps among people with SMI is limited. The objective of this research is to examine the current ownership, usage patterns, and existing barriers to mobile health interventions for people with SMI treated in a public sector community mental health setting and to compare the findings with national usage patterns from the general population. METHODS: A survey was conducted to determine rates of ownership of smartphone devices among people with SMI. Surveys were administered to 100 patients with SMI at an outpatient psychiatric clinic. Results were compared with respondents to the 2012 Pew Survey of mobile phone usage. RESULTS: A total of 85% of participants reported that they owned a cell phone; of those, 37% reported that they owned a smartphone, as compared with 53% of respondents to the Pew Survey and 44% of socioeconomically disadvantaged respondents to the Pew Survey. DISCUSSION: While cell phone ownership is common among people with SMI, their adoption of smartphone technology lags behind that of the general population primarily due to cost barriers. Efforts to use mHealth in these populations need to recognize current mobile ownership patterns while planning for anticipated expansion of new technologies to poor populations as cost barriers are reduced in the coming years.

What's Past is Prologue: A Scoping Review of Recent Public Health and Global Health Informatics Literature.

OBJECTIVE: To categorize and describe the public health informatics (PHI) and global health informatics (GHI) literature between 2012 and 2014. METHODS: We conducted a semi-systematic review of articles published between January 2012 and September 2014 where information and communications technologies (ICT) was a primary subject of the study or a main component of the study methodology. Additional inclusion and exclusion criteria were used to filter PHI and GHI articles from the larger biomedical informatics domain. Articles were identified using MEDLINE as well as personal bibliographies from members of the American Medical Informatics Association PHI and GHI working groups. RESULTS: A total of 85 PHI articles and 282 GHI articles were identified. While systems in PHI continue to support surveillance activities, we identified a shift towards support for prevention, environmental health, and public health care services. Furthermore, articles from the U.S. reveal a shift towards PHI applications at state and local levels. GHI articles focused on telemedicine, mHealth and eHealth applications. The development of adequate infrastructure to support ICT remains a challenge, although we identified a small but growing set of articles that measure the impact of ICT on clinical outcomes. DISCUSSION: There is evidence of growth with respect to both implementation of information systems within the public health enterprise as well as a widening of scope within each informatics discipline. Yet the articles also illuminate the need for more primary research studies on what works and what does not as both searches yielded small numbers of primary, empirical articles. CONCLUSION: While the body of knowledge around PHI and GHI continues to mature, additional studies of higher quality are needed to generate the robust evidence base needed to support continued investment in ICT by governmental health agencies.

Synonym-based word frequency analysis to support the development and presentation of a public health quality improvement taxonomy in an online exchange.

Word frequency analysis has not been fully explored as an input to public health taxonomy development. We used document analysis, expert review, and user-centered design to develop a taxonomy of public health quality improvement concepts for an online exchange of quality improvement work (www.phqix.org). Online entries were made searchable using a faceted search approach. To present the most relevant facets to users, we analyzed 334 published public health quality improvement documents using word frequency analysis to identify the most prevalent clusters of word meanings. We reviewed the highest-weighted concepts and identified their relationships to quality improvement details in our taxonomy. The meanings were mapped to items in our taxonomy, and presented in order of their weighted percentages in the data. Using this combination of methods, we developed and sorted concepts in the faceted search presentation so that relevant search criteria were accessible to users of the online exchange. Word frequency analysis may be a useful method to incorporate in other taxonomy development and presentationwhen relevant data is available.

Building the foundations of an informatics agenda for global health - 2011 workshop report.

Strengthening the capacity of public health systems to protect and promote the health of the global population continues to be essential in an increasingly connected world. Informatics practices and principles can play an important role for improving global health response capacity. A critical step is to develop an informatics agenda for global health so that efforts can be prioritized and important global health issues addressed. With the aim of building a foundation for this agenda, the authors developed a workshop to examine the evidence in this domain, recognize the gaps, and document evidence-based recommendations. On 21 August 2011, at the 2011 Public Health Informatics Conference in Atlanta, GA, USA, a four-hour interactive workshop was conducted with 85 participants from 15 countries representing governmental organizations, private sector companies, academia, and non-governmental organizations. The workshop discussion followed an agenda of a plenary session - planning and agenda setting - and four tracks: Policy and governance; knowledge management, collaborative networks and global partnerships; capacity building; and globally reusable resources: metrics, tools, processes, templates, and digital assets. Track discussions examined the evidence base and the participants' experience to gather information about the current status, compelling and potential benefits, challenges, barriers, and gaps for global health informatics as well as document opportunities and recommendations. This report provides a summary of the discussions and key recommendations as a first step towards building an informatics agenda for global health. Attention to the identified topics and issues is expected to lead to measurable improvements in health equity, health outcomes, and impacts on population health. We propose the workshop report be used as a foundation for the development of the full agenda and a detailed roadmap for global health informatics activities based on further contribution from key stakeholders. The global health informatics agenda and roadmap can provide guidance to countries for developing and enhancing their individual and regional agendas.

Reusable design: a proposed approach to Public Health Informatics system design.

BACKGROUND: Since it was first defined in 1995, Public Health Informatics (PHI) has become a recognized discipline, with a research agenda, defined domain-specific competencies and a specialized corpus of technical knowledge. Information systems form a cornerstone of PHI research and implementation, representing significant progress for the nascent field. However, PHI does not advocate or incorporate standard, domain-appropriate design methods for implementing public health information systems. Reusable design is generalized design advice that can be reused in a range of similar contexts. We propose that PHI create and reuse information design knowledge by taking a systems approach that incorporates design methods from the disciplines of Human-Computer Interaction, Interaction Design and other related disciplines. DISCUSSION: Although PHI operates in a domain with unique characteristics, many design problems in public health correspond to classic design problems, suggesting that existing design methods and solution approaches are applicable to the design of public health information systems. Among the numerous methodological frameworks used in other disciplines, we identify scenario-based design and participatory design as two widely-employed methodologies that are appropriate for adoption as PHI standards. We make the case that these methods show promise to create reusable design knowledge in PHI. SUMMARY: We propose the formalization of a set of standard design methods within PHI that can be used to pursue a strategy of design knowledge creation and reuse for cost-effective, interoperable public health information systems. We suggest that all public health informaticians should be able to use these design methods and the methods should be incorporated into PHI training.

Task analysis in action: the role of information systems in communicable disease reporting.

In order to improve the design of information systems for notifiable conditions reporting, it is essential to understand the role of such systems in public health practice. Using qualitative techniques, we performed a task analysis of the activities associated with notifiable conditions reporting at a large urban health department. We identified seventeen primary tasks associated with the use of the department's information system. The results of this investigation suggest that communicable disease information management takes place in a dynamic environment where changing needs may require new solutions for system users. Additionally, our work suggests that task analysis, when applied to document the use of a legacy information system, can provide local public health agencies with valuable information about their information management needs, and can become a part of their information management decision-making strategy.

Using participant observation for organizational discovery and systems analysis: global AIDS program Uganda.

Recent scaling up of HIV/AIDS treatment at one of the Global AIDS Program's (GAP) major partner organizations required the CDC's informatics team in Uganda to develop a clinical information system during a time of significant growth and change within the organization. Analysis of system utilization revealed numerous discrepancies between system functionality and the workflow of the clinic it was designed for. Participant observation was an effective data collection method for documenting the impact of the clinical information system on the organization, and for assessing the suitability of the system for the intended clinic.