Data Travels at the Speed of Trust: Population Health Informatics for Population Health

by Gulzar H. Shah, PhD, MStat, MS; Kristie Waterfield, DrPH, MBA; Dr. Anjum Khurshid

Health Informatics Innovations and Applications highlights ways that health informatics innovations and applications are supporting stakeholders in public health practice and policy to advance their mission of improved population health. The series will also highlight innovations in health care informatics.

The more I learn about the population health approach, the stronger my conviction becomes that big data can be instrumental in facilitating population health. In “Data and Innovation” by Chip and Dan Heath, a chapter in Pamela Pavliscak’s 2015 anthology Data-Informed Product Design, Chip and Dan explain the following: “Data are just summaries of thousands of stories—tell a few of those stories to help make the data meaningful.” Inspired by this quote, I decided to reach out to Dr. Anjum Khurshid whose work on the topic has a convincing story. Dr. Khurshid is nationally recognized for his work in the fields of population health and health information technology. I first met him in person in 2012 when he was making a presentation on his Beacon Community Project, although we’d had electronic introductions nearly a decade before that through a common mentor, Dr. Tom Pullum, a great demographer and population health expert.

Population Health

I was first introduced to the concept of population health in the 1990s, when during my training as a sociologist, I learned about the German sociologist Max Weber’s theory of Life Chances, which proposed that opportunity structures determine people’s access to basic human needs such as food, shelter, education, security, and health. The definition of population health as we know it today is somewhat new. In the following podcast interview with Dr. Khurshid, we discuss the definition of population health and how it has evolved in recent decades. Here is part of Dr. Khurshid’s definition: “I think one part, and the important part, of the definition of population health is how we define health. We all follow the broader definition of health that was given by WHO that is still relevant in that health is not the absence of disease, but it is the physical, mental, and social wellbeing of the individual. So… the population health definition that we follow is… we are looking at the entire population, everyone that is residing within a certain geographic area and [asking], ‘How can we improve their physical, mental, and social wellbeing?’ Population health is a relatively new concept for healthcare, has gotten more attention recently, which is why the Dell Medical School at the University of Texas at Austin is one of only a handful of medical schools in the US to have a population health department.”

Dr. Anjum Khurshid is the Director of Data Integration and the Co-Chief of Health Information and Data Analytic Sciences, as well as, an Assistant Professor of Population Health and Affiliate Faculty, Center for Health Communication at the Dell Medical School at the University of Texas at Austin.

Read the full transcript here.

Healthcare Informatics as a Key Part of Population Health Outcomes

What opportunities do population health informatics provide to improve population health outcomes? As our podcast conversation unfolds, Dr. Khurshid points out the role of big data in population health: “One of the important things to remember is that healthcare is mainly an information intensive business. We collect a lot of information at different points, and we need a lot of information to make responsible decisions to ensure the health of all the people that we are serving. So, therefore, healthcare informatics, or health informatics, becomes a key part of the strategy for achieving the population health outcomes improvement.” He also points out that the efficiency of the system, the effectiveness of the treatments, and strategies regarding the quality of the services depends on the five rights: getting the right information to the right people in the right place in the right format at the right time. He then goes into detail regarding the 3 by 3 approach he uses. As he explains, the 3 by 3 approach includes 3 realities and 3 challenges that must be realized when working with healthcare informatics. The 3 realities: 1) datafication, which means that most of the data in healthcare are digitized and are electronic, 2) the movement toward value-based care and value-based payments, and 3) health and healthcare are moving to be more personalized, providing precision medicine. The 3 challenges: 1) healthcare data are highly fragmented, 2) the processes to get this data aggregated are also very complex, and 3) the data are technical and captured not for the purpose of analysis but for the purpose of providing services.

Community Engagement and Informatics

One of the unique aspects of the approach to population health that Dr. Khurshid and his colleagues at Dell Medical School employ is to work as an academic medical institution very closely with the community and to learn from the experiences of others nationally. Using a 3-pronged approach, the first step is to help with the interoperability among different systems. This allows the second step, which is building a community-wide effective health information exchange. Within the framework of social determinants of health, prevention, and health promotion, the health information exchange focuses on connecting electronic medical records, as well as data from sectors that can impact health outcomes at the population level. The third prong is “… thinking of a more personalized level of both the capture and delivery of data at an individual level and how individuals get access to that information so that they can use it effectively to maintain health and to stay healthy.”

Translating Previous Population Health Experience into Current Work

Prior to his role as Director of Data Integration and Co-Chief of Health Information and Data Analytic Sciences at Dell Medical School at the University of Texas at Austin, Dr. Kurshid worked with the Crescent City Beacon Community   (BCP) in New Orleans. He shares a number of experiences, competencies, practices, or lessons learned from the BCP that inform his current population health work. To begin, his work with the BCP involved determining strategies for achieving improvements in population health outcomes through the adoption of health information technology and datafication. That work in New Orleans was instrumental in shaping his current work. Additionally, the BCP work not only involved the use of electronic medical records but it also involved a lot of learning, hand holding, and culture change. Engaging individuals and engaging patients in their care was a key part of the strategy. By simply improving the processes, equipment, and staffing in the clinics one cannot expect that people will stay healthy unless they are themselves engaged in maintaining health. This is so, he says, “…because as we know, health outcomes are only affected by 10-15% of what happens within the healthcare entity; health outcomes for the most part are shaped by social behaviors, and socioeconomic as well as environmental factors. Building trust with data owners, assisting with interoperability of all sources of relevant community data is critical.” After all, as Dr. Khurshid reminds us, “Data travels at the speed of trust.”

To listen to our full conversation, check out my latest podcast here.

Dr. Gulzar Shah

Gulzar H. Shah, PhD, MStat, MS, currently serves as a Professor of Health Policy and Management and the Department Chair, Health Policy and Community Health, at the Jiann-Ping Hsu College of Public Health (JPHCOPH), Georgia Southern University. He served the JPHCOPH as an Associate Dean for Research before accepting the Department Chair position in 2017. Prior to moving into academia, Dr. Shah spent over 17 years serving in public health practice, first at the Utah State Department of Health, and subsequently at the National Association of Health Data Organizations (NAHDO) and National Association of County and City Health Officials (NACCHO). [Full bio.]



Dr. Kristie Waterfield

Kristie Waterfield, DrPH, MBA, is a Public Health Leadership Graduate at the Jiann-Ping Hsu College of Public Health, Georgia Southern University. She received a bachelor’s degree in Community Health Education and a MBA, Health Services Administration from Georgia Southern University. Kristie has over 15 years of experience in health administration, health care marketing, and management. She currently works as a graduate assistant and her research focuses on public health leadership, health inequities, and public health workforce.