Public health

Grand Rounds October 4, 2024: Health Trends Across Communities – A Novel Health System-Public Health Data Partnership (Tyler Winkelman, MD, MSc; David Johnson, MPH)

Posted on by Sophia Ramirez

Speakers

Tyler Winkelman, MD, MSc
Division Director, General Internal Medicine
Hennepin Healthcare
Co-Director, Health, Homelessness, and Criminal Justice Lab
HHRI

David Johnson, MPH
Health Informatics and Epidemiology
Program Manager
Hennepin County

Keywords

Electronic Health Record; Data Sharing; Public Health; Health Systems; Partnerships

Key Points

  • Collaboration across public health and health care is essential to developing actionable data for both sectors. Electronic Health Record (EHR) data can be used to fill the gaps in public health data and foster collaboration.
  • During the COVID-19 pandemic, it became clear that data infrastructure in the U.S. was underdeveloped. This made addressing COVID-19 challenging, is currently making addressing the overdose crisis challenging, and puts the country at risk for any future epidemics.
  • The Minnesota EHR Consortium (MNEHRC), formed in March 2020, facilitated collaboration between health systems in order to address gaps in COVID-19 data sharing and communication. They were able to develop the technical infrastructure to aggregate and share EHR data for real-time public health needs. Over time, the prioritization of data sharing for developing broader community health indicators became possible.
  • MNEHRC’s mission is to improve health by informing policy and practice through data-driven collaboration among members of Minnesota’s health care community. Dashboards are publicly available at www.mnehrconsortium.org.
  • Dr. Winkelman described how they built out a common data model at each of the MNEHRC health systems using Observational Medical Outcomes Partnership (OMOP), a common language for EHR data. OMOP was chosen because it’s open-source; it has a robust international online community; and some sites in the state had experience with OMOP, which helped with capacity building.
  • MNEHRC and Hennepin County’s Center for Community Health partnered to build Health Trends Across Communities (HTAC-MN), a unique data collaboration of health systems and public health agencies. They seek to develop comprehensive community health data infrastructure in Minnesota, ultimately strengthening community capacity to build healthy communities and promoting health equity.
  • Next steps for HTAC include developing and implementing processes to identify and prioritize new conditions; evaluating HTAC; and developing a plan for long-term sustainability.

Discussion Themes

Developing a central data model facilitated the collaboration.

Onboarding Federally Qualified Health Centers (FQHCs) to the consortium takes longer because of their internal capacity restraints. The team has had to be creative with figuring out how to onboard them; they are adding FQHCs in Hennepin County through EPIC affiliate agreements with Hennepin Healthcare and other sites through Minnesota’s quality measurement agency.

This is a new tool with a lot of potential, especially for the field of public health; researchers could use it to measure the impact of large-scale public health interventions. The HTAC team hopes that they’ll be able to further define the value that the data source can offer over the next few years.

Grand Rounds August 16, 2024: Methodological Insights and Lessons Learned from Conducting a Pragmatic Randomized Trial on Surgical Face Masks (Runar Solberg, PhD; Atle Fretheim, PhD)

Posted on by Sophia Ramirez

Speakers

Runar Solberg, PhD
Scientist
Centre for Epidemic Interventions Research (CEIR)
Norwegian Institute of Public Health

Atle Fretheim, PhD
Research Director
Norwegian Institute of Public Health

Keywords

Face Masks; Masking; Respiratory Infection; Public Health; COVID-19

Key Points

  • Observational evidence supports a reduction in respiratory infection with face mask use. However, randomized trials face challenges–especially in achieving sufficient statistical power–that contribute to uncertainty in their findings.
  • The study team conducted a pragmatic randomized trial aimed at assessing the personal protective efficacy of wearing a surgical face mask in public settings.
  • Adherence varied between the control and intervention groups, with higher rates of adherence within the control group (no mask).
  • Participants were recruited from multiple locations across Norway. Advertising and the researchers’ appearance on Norwegian television, radio, and other media helped raise awareness about the study.
  • Reviewers acknowledged that the primary outcome–self-reported respiratory symptoms–was clinically meaningful and well-defined. However, the reliance on self-reported data led to concerns about bias and accuracy, as there was no in-person verification of masking.
  • To mitigate these concerns, future studies may opt to use registry data or incorporate mandatory PCR testing of participants.

Discussion Themes

An open and important question about masking effectiveness relates to the durability of the intervention: Does it flatten the curve early or delay the peak?

Collecting data on components of the primary outcome–i.e. if more objective symptoms like fever were more or less impacted by the intervention than more subjective outcomes like malaise–may help address concerns about the reliability of self-reported outcomes.

Efficacy depends on the degree of risk. Proving efficacy in a randomized controlled trial or pragmatic trial is tricky unless there is something to prevent. This depends on many factors that may cause heterogeneity of treatment effects (e.g. degree of exposure, physical proximity, virulence, etc.).