After watching hurricanes blow in from the Gulf of Mexico for so many years, Houston officials had a good sense of how the city's land reacts. They knew which areas will flood first, how severely and for how long.
But when it came to predicting how the population will be affected, they knew their data could be better. One major concern was identifying the people who, for health reasons, would need extra help during an evacuation. "Having data for who lives where, in terms of their vulnerabilities, gives you the ability to plan ahead for the type and quantity of supplies, and craft the messages that we need to get out to those folks," said Frank Levy, bureau chief of Public Health Preparedness at the Houston Department of Health and Human Services.
Though the city had already set up an emergency registry system, few of Houston's at-risk residents were signed up. Officials learned quickly that mapping the city's human landscape would require a more active effort. It would take an understanding of the community resources that could encourage people to sign up for the registry, and it would require a scientifically sound method for projecting that data across the entire population.
To analyze the data, the city found the right institution for the job in a unique school on the city's southwest side that's devoted to improving the way information is collected, analyzed and shared. Emergency preparedness officials teamed with the University of Texas School of Health Information Sciences at Houston, the only school in the nation devoted entirely to biomedical informatics, the science of handling medical information.
Studying Medical Informatics
Improving Houston's evacuation registry became just one part of a broad public health initiative called HealthQuilt, run by one of the school's professors, Dr. Kim Dunn. Dunn's project is a public health application. Along with preparing the medical support system for disasters, the project also aims to improve the exchange of health information and bring more specialty health care to the public health sector through telemedicine.
A guiding principle at the school is strengthening the medical system by working at the intersection of several different fields. The school itself is grounded in engineering, biomedicine, computer science and cognitive science. The school's academics say the flexibility to incorporate each area to varying degrees and also branch out into other fields, when appropriate, is something not possible at other universities with less-independent medical information science programs.
"Medical informatics is a unique discipline that has a set of tools that can be used in all these contexts," said Dr. Jack W. Smith, the school's dean. "I think we're certainly pioneers in creating a school that tries to tackle data info and knowledge problems across all these disciplines -- biomedical discovery, health care and public health. Because of the entrepreneurial and forward-looking culture of Texas, it's not surprising that the first school of this type would be in Texas."
In the years since the school's founding in 1997, the tools used to gather biomedical data have progressed so much that organizing and interpreting those numbers has emerged as a key growth area in medical research. Smith cited the Human Genome Project -- which decoded the map of human DNA -- as a prime example of the wealth of data available to researchers. "That's a tremendous challenge to manage and take advantage of that information. Increasingly vast storehouses of this information are digital," Smith said.
Focusing on Electronic Records
At the same time, the school is engaged in projects to improve the way patients' information is stored and passed along between health-care providers -- a chain at times as inscrutable as the blueprint of a DNA molecule. Electronic medical records (EMR) are a big cause that's gaining traction nationwide. "It's
been successful to a greater extent ... in large-scale systems and large group practices," Smith said of EMR adoption. "It's been quite challenging to take those ideas and provide that technology at the level of the individual practitioner."
Even with the best intentions, Dunn said convincing people to adopt EMR is often a tough sell. "It's a problem getting acceptance from the doctors and nurses because you're changing the way people are doing things. It's a big challenge," she said. "You have to think of what the benefits to them are -- it will create financial benefits, and it will improve the efficiency in their clinical process."
Tack on the reluctance of insurers and medical groups to pay for something that isn't immediately necessary, Dunn said, and you begin to see why some nationalized systems in Europe, for instance, have historically outpaced the U.S. in health information solutions. Still, she said people at the top levels of health-care management are beginning to see the wisdom of investing in health-information science. For example, the UT school regularly secures federal research grants and works with giants like the National Institutes of Health and the U.S. Defense Department. "Hospitals are willing to fund some IT projects and corporations are starting to see the benefit," Dunn said. "Information is the currency of health care, so you may as well pay a little more for managing it."
Texas has an especially bold attitude toward new health-information systems, Dunn said. For example, statewide efforts to implement electronic health records for foster children have become models for programs designed in other parts of the country. Along with a willingness to shake up the status quo, Houston makes a fitting petri dish for experimentation in public health because so many of its residents are uninsured. "In Houston, anywhere from 20 to 30 percent of people don't have health insurance," Dunn said.
Dunn has already established an effective model for health-information exchange among private health-care providers, called the Your Doctor Program. While incorporating disaster preparedness, HealthQuilt also will smooth the transfer of medical information between doctors, hospitals and other care providers, and make specialty care more accessible by opening channels for telemedicine.
Fred Trotter, HealthQuilt's lead programmer, said some of Houston's largest medical networks have developed effective systems for transmitting information across their own networks. Many of the hospitals serving Houston's at-risk populations, though, are by necessity less coordinated. "We're trying to focus on safety-net clinics, and the uninsured," Trotter said. "We have this massive indigent-care problem, and so we're trying to focus on bringing efficiency to what is known as the safety net."
So far, HealthQuilt is a promising model for public health-care management, though its pilot programs are still relatively new. Because the program is rooted in the School of Health Information Sciences, its results will be well documented when the time comes to grow the model to something larger. "How many organizations actually go back and study the results of that rollout?" Trotter asked. "Because of the partnership with this institution, we have the resources to study just about everything we do."
For researchers at the school, the real work begins only after successfully rolling out a project (e.g., after collecting data for city evacuation plans). "My passion right now is trying to get an accountable health-care system," Dunn said. "It really does come down to aligning roles and developing feedback loops for quality assuredness."
"It's like when you leave a doctor's office, what do they tell you? 'If you're not better, come back.' We should be doing better than that, right?"
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