by Timothy J. Carney; Christopher M. Shea

“ Problem/Issue complexity factors shaping knowledge environments An analogy for problem/issue identification and response within any public health knowledge environment is the human immune response in which the human immune system assesses threats on a constant basis and determines if a foreign agent is a “friend” or “foe.” Once identified in a healthy immune system, the proper immune response is triggered. For a friend response, facilitation/proliferation strategies ensue, and, for a foe response, elimination/mitigation strategies ensue. ”

“ A sensor grid should be viewed as a living and growing network of data/event collection activities that changes with evolving needs and priorities, and the level of granularity or specificity of detection must also be capable of changing within the grid as strategic priorities shift. The full list of indicators drawn from public health knowledge environment factors, stakeholder-levels, and unique views will largely shape the types of sensors, density of the network, and level of sensitivity needed for meaningful aberrant detection algorithms and monitoring system development. ”

“ More precisely, the primary function of any level of IPE — from simple department units to complex multiorganizational networks or health information exchanges — is to respond to what agents/actors need to know, when they need to know it, and to support the choices/decisions that must be made as shareholders navigate through the health system, defined here as actionable knowledge or intelligence. ”

“ In this era of informatics where the emphasis is on less tangible cognitive capacities (e.g., learning health systems, intelligent and smart systems, and complex adaptive systems) , a new public health informatics analytics approach may be required that is less information technology-driven and more knowledge-driven and defines new ways of demonstrating the added value of informatics in shaping health systems performance. ”

“ Where current cognitive pathways are robust and frequented, data and information systems are likely to be considered essential to decision-making, and where new and emerging cognitive pathways are observed or predicted, the likelihood exists for innovation and systems development to support emerging communities of practice, workgroups, department/divisions, and other formal or informal organizational structures. [38]
The public health application lies in understanding the public health system as an evolving complex network of individuals, organizations, groups, and knowledge resources. ”

“ A state of knowledge surplus results when the level of information or knowledge product supply exceeds the relative level of importance placed on the information or knowledge products (also understood as relevancy) . This state represents an opportunity for the elimination of outmoded or underused knowledge resources, information system redesign/upgrade, or other information technology strategic efforts to ensure long-term relevance of information resources, information systems, and knowledge products. ”

“ A technical view of informatics largely identifies more tangible products such as databases, decision-support tools, information systems, web portals, and mobile devices as the primary means of addressing complex health issues, improving care, and reducing health disparities. ”

“ Organizational complexity factors shaping public health knowledge environments We use a variety of organizational structures to facilitate interaction, communication, and knowledge representation in our quest to manage changes in our environment. ”

“ The organization is viewed as a dynamic, complex, and adaptive entity whose size, structure, and other organizational determinants must be constantly evaluated to promote its ability to respond to internal and external challenges, threats, and opportunities that will impact individuals and/or the collective leveraging of actionable intelligence to ensure success in health system management. ”

“ We have refrained from using this concept throughout this discussion, but at this point it is appropriate to recognize that some informatics literature describes the informatics continuum (earlier referred to as the data progression) as data to information to knowledge to wisdom. [26] Typically, finding objective measures of wisdom is not easy or universally accepted. However, we have chosen to substitute wisdom for decision and outcomes. As a result, our data progression extends to the following sequence: data to information to knowledge to decisions to outcomes. ”

“ Although most public health systems are prepared to deal with any event, some noticeable changes can occur in the face of uncovered vulnerabilities introduced by shock events. Such adjustments on the organizational side may present as unexpected leadership shifts, sudden changes in organizational command structures, abrupt shifts in policy and procedures, new strata of research funding to investigate and solve problems, or the addition or elimination of staff and key personnel. ”

“ Highly critical/low supply-resourced conditions are probably the most difficult to manage. In any public health knowledge environment, a continual assessment of stakeholder cognitive demand must be done—relative to the capabilities of the existing or evolving knowledge-base—as a means of satisfying current and/or projecting anticipated demands. ”

“ Cognitive mapping Once the knowledge inventory and relative measures of importance are assessed and the corresponding process and information flows have been identified, the public health informatics professional can now engage in the process of creating cognitive maps or models of both existing and emerging knowledge and communication pathways. ”

“ We organize ourselves in response to external and internal drivers/stressors and increasing environmental complexity as a means of reducing or removing any impediments toward fast, reliable, and pertinent data, information, and knowledge resources. ”

“ One common public health system problem-solving strategy used throughout the US and worldwide involves formulating networks of individuals and organizations to coordinate global-, national-, state-, regional-, county-, city-, or even community-level responses to health threats to individuals or populations. ”

“ Such a strategy should yield objective operational measures and capabilities designed to ensure that individual agents, organizations, and networks have sufficient knowledge to mount an intelligent response to solve complex public health problems. In other words, the strategy should support development and maintenance of smart health systems, that is, a system that "incorporates functions of sensing, actuation, and control in order to describe and analyze a situation, and make decisions based on the available data in a predictive or adaptive manner, thereby performing smart actions. ”

“ For example, we can only speculate on how much stored memory has been gathered with respect to the Ebola crisis that may more easily mitigate another outbreak or similar outbreaks of other diseases in related conditions. The emergence of rapid learning health networks deals with some aspects of this challenge by streamlining the processing of research evidence into practice and gathering knowledge stores of what works best in achieving better health outcomes. ”

“ The public health application of this measure of relative cognitive demand or the need to know is illustrated by the recent Zika outbreak. It became evident that the population at greatest risk for the disease was pregnant or soon-to-be pregnant women. The demand for information regarding protective measures, travel restrictions, the rate of transmission, the relative threat to fetal health, and signs and symptoms once infected created large pockets of health consumer uncertainty, stress, and anxiety. ”

“ Systems memory simply asks to what degree are phenomena captured and labeled as favorable or unfavorable and response algorithms developed and made available for expedient consumption by the same and/or other agents within the knowledge environment. ”

“ More involved and long-term problems may require increasing levels of complexity within the organizational response. These long-term or complex organizational responses may be represented in the form of permanent departments or divisions within an organization, or they may even extend beyond organizational boundaries to include coalitions, collaborations, taskforces, and interagency network arrangements. ”

“ As a result, sensors must capture intelligence from portals through which information travels in and out of the system in all forms. Finally, the level of completeness must be defined to determine what represents an adequate level of coverage. A poorly designed or partial Public Health Situation Room sensor grid that allows large levels of undetected activity would not be useful on long-term. ”

“ Given the severe level of risk to pregnant women and their developing babies, the demand for knowledge of what to do for protection was highly critical. The window of transmission of the Zika virus from mother to fetus was highly uncertain, the effectiveness of preventive measures was hard to measure, and travel decisions to affected areas were rather unclear, resulting in conditions of highly critical and low-resourced knowledge profiles for many health consumers and stakeholders at all levels. ”

“ Public Health Situation Room needs and priorities vary widely by organization and may include but not be limited to disease management, outbreaks investigation, emergency preparedness, disaster response, community health assessments, and even healthcare access, equity, and quality. ”

“ Similarly, physicians and nurses rely on telemetry to monitor patient vital signs, drivers use dashboards to detect changes in automobile status, and investors use tickers to track global investments. These forms of monitoring and tracking systems have one feature in common: they all make use of a grid system or network of core indicators as validated predictors of overall system health. ”

“ In other words, a health system or public health agency that has undergone frequent leadership changes, high staff turnover, frequent redrafting of strategic plans, and reorganizations in a relatively short span of time serves as a strong indicator of the lack of overall public health knowledge environment maturity. ”

“ Rapid research was needed to identify proven measures against the invading mosquito population. Public health departments throughout the affected areas were scrambling to model the spread of the disease, measure the impact of the preventive measures, and manage the reports of news cases. Meanwhile, the public was constantly demanding new answers and updates on a daily basis. ”