Information science and technology are increasingly critical to the modern practice of public health. The effective use and management of a wide variety of scientific and policy information is fundamental to public health practice, and there is now widespread recognition that modern information technology—appropriately deployed and managed—is also essential to the effective practice of public health. As a result, many public health agencies are currently scrambling to acquire and make use of such technology. Yet today’s public health practitioners generally have no formal training in public health informatics, that is, the application of information science and technology to public health practice and research. This course is intended to address that deficiency, by providing practical, manager-oriented training in public health informatics. The course was specifically designed for CDC’s Public Health Advisor workforce.

In the Fall of 1995, the National Immunization Program/CDC and the Public Health Practice Program Office/CDC agreed to co-sponsor the development of an informatics training curriculum for mid-career public health advisors (PHAs). In general, the goal of this two-year effort is to develop a curriculum that provides PHAs with sufficient training in informatics principles and practices to help them to (a) serve as high-level advisors to policy makers and scientists at state and local health departments regarding the acquisition, development, and management of integrated, enterprise-wide public health information systems, and (b) become effective managers of discrete information technology projects.

The Year One pilot test of the informatics curriculum was conducted July 22-26, 1996, in conjunction with the Summer Institute of Public Health Practice (SIPHP) of the Northwest Center for Public Health Practice, University of Washington School of Public Health and Community Medicine in Seattle, Washington. By conducting this training in conjunction with SIPHP, attendees had the opportunity to take courses addressing other PHA core training needs. Thirteen CDC public health advisors participated in the 1996 course—eight from the National Immunization Program, three from the Division of Sexually Transmitted Diseases Prevention, NCHSTP, and two from the Division of Tuberculosis Elimination, NCHSTP.

Based on feedback from the 1996 pilot course participants, a Year Two version of the informatics course is again being offered in conjunction with 1997 Summer Institute for Public Health Practice (July 21-25, 1997). Twenty Public Health Advisors are participating, representing the Division of HIV/AIDS Prevention, the Division of STD Prevention, the Division of Tuberculosis Elimination (all in NCHSTP), and the National Immunization Program (NIP). As in 1996, each afternoon is devoted to informatics training, for a total of 20 contact hours. Each morning, PHAs attend up to two Summer Institute courses addressing other continuing education needs—an additional 20 contact hours. Morning course offerings include basic epidemiology, small area analysis, health policy development, managing change, public health law, and a public health approach to physical activity. Following an analysis of feedback from the 1997 course, a final report, recommendations, and final curriculum will be submitted to interested parties at CDC.

For more detailed descritpion of the background and rationale for this project, see Additional Background. CDC intends to re-focus the functions of its PHAs from the direct provision of services to a broader role of building state and local public health capacity. Toward that end, CDC leadership commissioned a review in 1995 of the role of CDC PHAs (and analogous public health workers at the state and local level), and the role of CDC in fostering their recruitment and development, to make sure they are meeting new and emerging public health needs and to determine if the CDC role in their recruitment and development needs to be modified. This review has explicitly focused on the recruitment and development of new "Public Health Program Specialists" for careers at CDC and in State, local, international, or private public health organizations.

Of course, many current, mid-career PHAs are eager to transition their own careers from direct implementation and program management roles to capacity-building roles. To fulfill such roles, many will require additional training across a variety of disciplines and skill sets (e.g., epidemiology, management, formal communication, and policy development and analysis).

One skill that is increasingly critical to the modern practice of public health is information management; yet today’s public health practitioners have almost no formal training in this discipline, or in the use of the technology associated with information management. At every level of public health functioning, there is a compelling need to quickly access, interpret, collate and present relevant information for decision-making. There is also a need to collect information (e.g., surveillance data) in a timely, robust, secure and efficient manner, and to store that information in a secure yet useful and accessible form. These needs are sure to increase in prominence as managed health care become more prevalent.

Many public health agencies throughout the country have now recognized that effective information management implies the use of appropriate information technology, and many agencies are currently scrambling to acquire and make use of such technology. Unfortunately, this new technology is often unfamiliar and even bewildering to today’s public health leaders and program managers. Furthermore, many are unaware of the importance of involving computer scientists and information management specialists in designing, developing, acquiring, and deploying new information systems. As a result, costly mistakes are made; inappropriate technology is procured; and numerous complex, stand-alone, single-function information systems are developed which must later be re-developed in order to be compatible with other information systems, to share data with outside users, etc. To date, PHAs and other public health managers charged with the development and management of computerized information systems have had little choice but to learn by experience--an inefficient and costly process.

For these reasons, the new training opportunities envisioned for PHAs should be supplemented with training in informatics--a combination of training in information management and in the use, procurement and deployment of associated information technology. Public Health Advisors currently assigned to state and local public health agencies by the National Immunization Program have a particularly acute need for training in informatics. These assignees have been tasked to assist states in the development of statewide immunization registries--an enormously challenging assignment at the technical level, even for seasoned computer scientists.

In the Fall of 1995, Edward Baker, Dave Ross, Tony Moulton and Mark Oberle of PHPPO approached Kathy Cahill of NIP to propose the development of an informatics curriculum tailored to the needs of existing PHAs. It was agreed that NIP would support this project, and that Patrick O’Carroll (then with IRMO) would join PHPPO to develop the curriculum. Dr. O’Carroll would be assigned to the State of Washington to develop a curriculum that could be pilot tested within eight months in conjunction with the University of Washington’s Summer Institute of Public Health Practice (SIPHP). Incorporating the new informatics training into the Summer Institute would allow for rapid deployment of the training program in the context of broader, PHA-appropriate training in epidemiology, small area analysis, policy development and analysis, and cultural issues in public health. Dr. O’Carroll’s assignment began December 1, 1995.

The goal of this effort is to provide PHAs with sufficient training in informatics principles and practices to help them to (a) serve as high-level advisors to policy makers and scientists at state and local health departments regarding the acquisition, development, and management of integrated, enterprise-wide public health information systems, and (b) become effective managers of discrete information technology projects. Note that the idea is not to turn participants into computer scientists, programmers, or network engineers; rather, it is to help PHAs become effective interlocutors between such computer technologists on the one hand and public health scientists and policy makers on the other. While the subject matter for this curriculum was chosen with the specific needs of CDC public health advisors in mind, the curriculum is intended to be broadly useful to mid- and senior-level public health managers in general.

Specifically, it is expected that students who receive this training will:

• be familiar with the appropriate roles and domains for computer scientists, epidemiologists, policy makers and programmers in information system development;
• be able to think in terms of information systems and underlying technologic infrastructure (information architecture), rather than in terms of individual computer applications;
• be familiar with accepted models and processes for developing information systems and for managing information resources;
• have a basic understanding of computer networking, and be able to describe the cost and support implications of various networking solutions;
• understand the basics of database management systems and current database technology, and be able to describe and employ principles of good database design;
• be familiar with data standards for storage and transmission, and understand the domains of public health-relevant standards and standard-setting bodies;
• understand the respective roles of policy and security in protecting privacy and confidentiality, and place a high priority on assuring privacy and confidentiality when designing information systems;
• be able to use the Internet and the World Wide Web effectively, for communications, information acquisition, and information dissemination
• be able to apply traditional management skills to the management of information technology personnel and projects;
• be able to evaluate technology options and procure information technology for the enterprise in a cost-effective and justifiable manner;
• be able to effectively consult with and advise colleagues on proposed information technology projects;
• be able to provide leadership toward the development of integrated, cost-effective public health information systems within their public health enterprise.

The following principles guided the development of this informatics training:

• The informatics curriculum should be developed so as to be broadly useful to (a) mid-career PHAs in all CIOs, and (b) public health managers in general;
• NCHSTP should be encouraged to join NIP and PHPPO in the guidance of the curriculum development, and PHAs from NCHSTP should be encouraged to attend the course during its two-year development process;
• The informatics curriculum should be developed so that it might serve as one component module in future training efforts that address the broader spectrum of core training needs for PHAs and other public health program managers (as summarized in the "Knowledge, Skills and Abilities" section of the 1989 CDC report, Core Training Resource Directory for Public Health Advisors);
• The informatics training should be offered in conjunction with other training relevant to PHAs, such as epidemiology, management, and policy development;
• PHA trainees should be encouraged to think "outside of the box" of their current assignment, in terms of the enterprise-wide information systems needs of the public health agency to which they are assigned;
• Classroom lectures in information management and technology should be supplemented with hands-on exercises;
• Ideally, the nature of the assignments of PHAs who receive supplemental training in informatics and other disciplines should eventually be modified in accordance with the capacity-building model envisioned by CDC.

Public health advisors with certain kinds of background, experience, and personal skills and interests will be able to make the best use of this informatics training. Ideally, PHAs receiving this training in informatics ought to have (a) a substantial familiarity with personal computers (preferably with DOS-based computers and the MS-DOS/MS Windows operating systems); (b) an interest in information systems and information technology; (c) at least a rudimentary familiarity with computer networking; (d) experience in using at least one computerized information system, e.g., NETSS; (e) excellent "people" skills, especially as they relate to communicating ideas to fellow and senior public health managers, to explaining technical issues to non-technical audiences, and to managing and encouraging change within public health bureaucracies; (f) at least three years experience working in health departments; and (g) a desire to improve the nature and practices of information management throughout the public health enterprise to which they are assigned. Attendees working in "information systems-friendly" health departments (wherein the value of investing in information systems development is understood) will be able to make the best use of this training.

Please refer to the course syllabus on the next page.

The informatics lectures will be held each afternoon from 1:00 to 5:30pm, July 21-25, 1997, in Room T473 of the University of Washington Health Sciences Center (UW HSC), Seattle, Washington, in conjunction with the Summer Institute of Public Health Practice (SIPHP). (Note: the "hands on" World Wide Web session will be held at 1:00pm, July 23, 1997 in the Health Sciences Library and Information Center, Room T-351.)

During the morning hours, PHAs will attend other courses offered by the SIPHP. The main office for the 1997 Summer Institute is in Room F-363, UW HSC. Summer Institute course materials will be available there starting at 7:00am, Monday, July 21, 1997.

The textbook for this course is Building enterprise information architectures: Reengineering information systems, by Melissa A. Cook (Upper Saddle River, NJ: Prentice Hall PTR, 1996). Students may purchase this book from the Information/Will Call Desk of the University Book Store, 4326 University Way NE (Copies are being held under Dr. O’Carroll’s name). Other readings are specified in each of the session outlines.

The following books are also recommended for general background or reference:

• Digital Literacy, by Paul Gilster (New York: John Wiley & Sons, Inc., 1997)

• Every manager’s guide to information technology: A glossary of key terms & concepts for today’s business leader, 2^nd ed., by Peter G.W. Keen (Boston, MA: Harvard Business School Press, 1995).

The entire course curriculum, including many of the references, is also accessible via the World Wide Web at:

http://weber.u.washington.edu/~ocarroll/infrmatc/