California’s Healthcare Associated Infections Map

The California Department of Public Health’s (CDPH) Healthcare Associated Infections map provides an intuitive and informative online tool to the state’s hospitals, health providers and residents.

by Sam Gill, Indi Dutta-Gupta and Brendan Roach, Data-Smart City Solutions / June 26, 2014

This is the fourth in an article series based on the paper "Gaining Ground: A Guide to Facilitating Technology Innovation in Human Services." It was originally published by Data-Smart City Solutions.

When advocacy groups pushed for greater transparency in California’s hospitals to better inform consumer decisions, the result was the passage of new laws in 2006 and 2008 which mandated the publication of a broad set of infection data. While this was a breakthrough for citizens, it posed a new challenge to state officials who needed a user-friendly presentation of health data that consumers could use. To solve this problem, California drew on its strong tradition of strong civic engagement to develop an impressive use of technology to promote public health: the California Healthcare Associated Infections (HAI) map.

The California Department of Public Health’s (CDPH) Healthcare Associated Infections map provides an intuitive and informative online tool to the state’s hospitals, health providers, and residents. The map collects information on common infections and from surgical procedures from each of the Golden State’s over 400 hospitals and overlays the information on a map of the state. The map reports infection rates for a range of common medical procedures which state hospitals are required to make publicly available.

Partnering for Better Technology

In response to new legislative requirements that healthcare associated infection rates be made publicly available, the California Department of Public Health (CDPH) released the mandated information in the form of a report, downloadable as a PDF file. Strong feedback from advocacy and consumer groups forced the Department to rethink its approach to releasing the information. Given the often abstruse nature of health data, it was clear that CDPH needed a different approach to presenting information in a comprehensible manner to the general public.

To conceptualize a new path forward, CDPH looked to its longstanding collaborative relationship with the California Health Care Foundation (CHCF). The organization had recently undertaken a project to identify “departments in state government that had information but needed help releasing it in a way that helps people,” as one CHCF executive said. When CHCF learned of CDPH’s need to improve the public presentation of its healthcare-associated infections data, CHCF arranged for a three-way grant that would partner its team with CDPH and Stamen, a mapping firm with whom CHCF had worked previously. Funds from CHCF would be disbursed directly to Stamen, who would work with CDPH personnel in creating the map.

The HAI map partnership merged CDPH’s program expertise with Stamen’s design acumen. This arrangement was not without its challenges, however. One member of the Stamen team noted that “the main challenge was the legibility of the data,” as the map was tasked with communicating complex information to the general public. This required considerable collaboration between CDPH and the Stamen graphic team. Meetings between CDPH staff and Stamen personnel helped determine accurate but comprehensible language, and even addressed granular details such as color schemes.

Using Public Input to Drive Improvements

Public input also contributed to the map’s design. A public advisory committee consisting of both lay individuals and medical professionals met quarterly to discuss CDPH’s vision of the map and suggest changes. Feedback was also collected from three focus groups held in locations across the state with 31 members of public. Given the complex nature of health information in general and healthcare-associated infections information in particular, the public advisory committee helped ensure a final product that was useful to Californians. As an example, one committee member cited Medicare regulations to recommend that CDPH use language comprehensible to an individual with a sixth-grade education. The public advisory committee working with a CDPH health educator served as a useful arbiter in the project’s design, allowing the product to be tested with end users and adjusted accordingly by Stamen and CDPH.

New releases of the map have aimed to address concerns raised by end users and voiced by a public advisory committee that helps to shape the project. As CDPH rolls out each new version, the agency “share[s] it with the advisory committee and solicit[s] additional ideas based on the things they’re seeing,” according to one CDPH staffer involved in the project. The department then works to incorporate these ideas into subsequent releases of the map. For example, the CDPH team has been working towards building an HTML version of the map in response to feedback received about difficulties viewing the current Flash version on some tablet and mobile devices.

The innovative Healthcare Associated Infections map represents not only a cutting-edge approach to using technology to better inform the public, but also demonstrates how political institutions can spur technology innovation in public agencies. The initial law requiring transparency for healthcare associated infection information prompted CDPH to publish this information, and public feedback catalyzed efforts to better communicate health data to the general public, resulting in the Healthcare Associated Infections map. Engagement at multiple levels of the political process, far from impeding technology innovation, was directly responsible for instigating innovative thinking at the Department of Public Health, to the benefit of all Californians.

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