Understanding Public Health Information Management Strategies That Support Situational Awareness in a Health Information Exchange: An Ethnographic Approach

When building tools for a public health environment, ethnographic methods can be effective in understanding information practices and workflows. In Washington State, the Northwest Public Health Information Exchange (NWPHIE) has funded the University of Washington's Center for Public Health Informatics (CPHI) to study the current means of communication, data sharing and real-time reporting mechanisms for health data and information on the local and state level.

Sources and consumers of information include health care practitioners, laboratories, hospitals, clinics, local and state public health agencies, pharmacies, and federal agencies. Information sharing can be hampered by lack of bi-directional communications both between (horizontal) and within (vertical) these groups. To better understand current means of communication, data sharing, and reporting we are utilizing an ethnographic approach that includes semi-structured interviews and naturalistic observations of public health practitioners and health care providers. The results are being used to inform system and design requirements for building tools to be used within a Health Information Exchange (HIE) for disease surveillance, case reporting and outbreak investigation.

Face-to-face semi-structured interviews of public health practitioners and physicians were conducted in a local health department serving a mixed urban/suburban/semi-rural population. Questions covered reporting, outbreak investigation, surveillance and the organizational structures that facilitate or create barriers in terms of timeliness, completeness or accuracy of information exchange. Interviews were analyzed using the Atlas.ti qualitative data analysis software. In this first study phase we learned about information availability, use and systems, and procedures for communication around the public health practice areas of case reporting, and surveillance. Situational awareness, the reduction of uncertainty and improvement of response effectiveness in the event of an emergency, depends on effective bi-directional communication of health data and information. Preliminary results and how these results are informing the approach used to build tools for a public health environment are presented.