CDC also has made initial efforts to develop needed education programs through the public health informatics fellowship, a public health informatics course, and a cooperative effort with the National Library of Medicine to help train public health workers in the effective use of the information resources available on the Internet.

Most current public health workers, lacking the knowledge and skills necessary to apply information and science technology, are unable to take advantage of its potential to enhance and facilitate public health activities (Lasker et al., 1995). For general public health practitioners, it may be adequate to have a basic understanding of well-established processes used in information systems development as well as an understanding of the roles public health practitioners should play in those processes. For public health professionals wishing to specialize, a higher-level proficiency in informatics is needed as it relates to project management; organizational behavior and management, information and knowledge development (data standards, security, privacy, and confidentiality); systems development, planning, and procurement; fundamental aspects of IT research, decision-making, and outcomes research. Facilitating advanced public health applications of information technology will require a cadre of public health professionals with advanced informatics training in addition to significant improvements in the basic technology literacy of the general workforce in public health, and ongoing training to continuously update information skills (Lasker et al., 1995).

Ideally, public health informatics education would include developing degree and certificate granting programs, and instructional courses for public health agencies and collaborators. Informatics training is becoming increasingly widespread, although training varies by institution, some offering graduate degrees or certificates in informatics, others a course for graduate credit or continuing education. Several graduate programs in public health already offer an informatics course, and a few are offering degrees specializing in informatics. Efforts to provide informatics training through distance education also are increasing. The Association of Schools of Public Health (ASPH) has sponsored conferences on public health informatics and distance learning that focused on how people and technology can work together to positively impact public health practice. The User Liaison Program (ULP) of the Agency for Healthcare Research and Quality (AHRQ) has broadcast a Web-assisted audio teleconference series via the World Wide Web and telephone designed to help state and local policy makers make policy decisions and allocate resources related to health care informatics. Expansion of these and other efforts are important to provide the public health informatics education for the current and future public health workforce.

Research efforts are also required to investigate the applicability of information science and technology to public health. Public health infor-



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