Data is important for public health agencies to monitor populations and deliver services. In Missouri, there are 115 Local Public Health Agencies across the state that operate independently of one another and are all overseen by the Missouri Department of Health and Senior Services.
At the Columbia Boone County Public Health and Human Services building, the LPHA in Columbia, visitors are greeted by health information and resources as soon as they walk through the door. At a desk near the entrance, free condoms are available in grab-and-go unlabeled brown paper bags. Signs by the check-in desk advertise free rapid HIV testing services, and pamphlets with information of all sorts are displayed throughout the lobby .
Jordan Bales is a public health planner and epidemiologist at the Columbia/Boone County health department. She said local health departments largely decide which information to present and which resources to provide based on the needs of the community - and for that, Bales says they need data.
“We do receive notifications of reportable diseases, and so we're able to keep track of where those conditions are popping up. So for example, like STIs, we're able to do a little bit of heat mapping to figure out maybe where those cases are popping up and target our interventions to those areas,” Bales said.
At DHSS, one person decided he wanted to know more about Missouri’s public health data infrastructure - Josh Wymer, chief health information and data strategy officer for the state.
“We knew we needed to be better with our understanding of the current state of public health data in Missouri. And this project was an effort to develop that picture,” Wymer said.
Earlier this year, Wymer and his team analyzed the health of the state’s public health data infrastructure. The report collected information using a survey-based tool developed by the Health Information and Management Systems Society, or HIMSS.
Anne Snowdon is the HIMSS Chief Scientific Researcher who led development of the digital health indicator tool. She said Missouri was the first state or province across the world to use the tool to measure its entire public health system.
“What we did with the Missouri project is we worked with every one of the public health teams and measured - where are your digital strengths, where are the gaps? Because once you know that, now you can make very evidence-informed decisions to fill those gaps,” Snowdon said.
Wymer and the team also went directly to public health agencies across the state to ask about their needs in a series of town hall meetings. He said there was a consistent message in the feedback.
“Often those sets of data do not engage or exchange or aren't interoperable with each other, and ultimately end up being standalone,” Wymer said.
Allie Bodin is the health data analytics and informatics manager at the Missouri Public Health Institute, or MOPHI. Bodin said MOPHI participated in the listening sessions and heard this topic mentioned a lot - and she said part of it has to do with how Missouri’s public health landscape is structured.
“We're a decentralized state, which means that the Missouri Department of Health and Senior Services, as well as 115 local public health agencies, all have their own governance structure. And with that, that can really mean variable resources across these different agencies, as well as requirements and restrictions. So that does present a lot of challenges,” Bodin said.
Bodin said some agencies have entirely different technologies and systems of storing, analyzing and collecting data. Wymer said this can result in data silos, where information is stored separately and isn’t well-shared.
“When I think of a Data Silo, I think of really good data, probably really secure data, but it's also pretty lonely data, because it can't be cross pollinated with other relevant data that could make it more useful or add additional color to interpreting it,” Wymer said.
In addition to data silos, the report showed a need for better workforce training around technology, as well as more funding for technological advancements. The report included suggestions for addressing gaps and making improvements in the state’s data infrastructure, including more staff training, regular communication between agencies, and the creation of a so-called “data lake”
“What we're talking about, from a conceptual standpoint is that Missouri… is really looking to bring data into a secure, centralized, cloud based location,” Wymer said.
Wymer said many agencies could dip into the “data lake,” enabling better sharing between agencies. Wymer said this can come with challenges and concerns - mainly privacy and data security, which he said is the department’s main focus when it comes to developing more centralized resources.
At the Columbia/Boone County Health Department, Jordan Bales said data security has long been a primary concern.
“First and foremost, we are bound by HIPAA. We are all completely HIPAA compliant, and we take it extremely seriously. Breaching HIPAA can be a fireable offense. So everyone is very, very aware of that,” Bales said.
Among the feedback highlighted in the report, one of the common topics from LPHAs was a desire for more resources, not only in terms of technology but in terms of skilled laborers and health experts. Feedback from several different listening sessions expressed a need for more staff training, and multiple organizations said they would benefit from having an epidemiologist on staff. Epidemiologists, like Bales at the Columbia/Boone County Health Department, use data and other resources to investigate patterns of disease and injury.
“I will come in and I'll kind of monitor for trends. And so, because I always have kind of a finger on the pulse of the health of the community, or at least that's the goal, we're really able to kind of take a bird's eye view, look and say - Hmm, this is abnormal for this time of year or this population, or this is just an abnormal condition that we're seeing,” Bales said.
At MOPHI, Bodin said larger health departments in the state, like the ones located in Columbia, St Louis or Kansas City, may have multiple epidemiologists on staff - sometimes even for specific things, like maternal health. But for smaller, more rural areas - she said it’s a different story.
“When it comes to a lot of our small, small, rural, local public health agencies, we will work with a lot of different professionals that don't have a background in data analytics and are trying to use data to inform their intervention,” Bodin said. “So there are times where we have a lot of our smaller departments that may not have those epidemiologists on staff, whether it's not being able to afford to have them due to funding issues or potentially limitations in just being able to get those employees retained long term.”
Bodin said that MOPHI often works with these smaller agencies to provide epidemiological services and fill the gaps where they can, but she’s hopeful that more staff training at LPHAs and other recommendations outlined in the report can help improve data analytics and usability, too.
With an uncertain funding landscape due to federal budget cuts, it’s unclear just how far the transformations can go - but Wymer and public health teams across the state say the report has them convinced that taking a deep dive is a good step. At HIMSS, Snowdon said the digital health analysis put Missouri ahead of entire countries for some metrics - in one case, Missouri’s public health system outscored Australia in terms of “readiness”.
“One of the most impressive findings as I collected and did a lot of the interviews was how inspiring and inspired the public health teams in Missouri were. They were right on top of this, and - ‘yeah, here's what we've got, and we think we could do this and this and this in future if we advance our digital transformation.’ So we refer to that as a sense of readiness, if you will. Their readiness to take this on and do some incredibly impressive work was off the charts,” Snowdon said.
For now, Wymer said the team is already using that sense of readiness to put some of the recommendations into place - with plans to continue and complete improvements within the next few years.
