NEJM Catalyst – Pediatric Asthma Surveillance System (PASS): Community-Facing Disease Monitoring for Health Equity
In 2024, the highly respected medical journals, The New England Journal of Medicine Catalyst, published a peer-reviewed paper authored by experts from PCCI, Parkland Health and the Dallas County Health & Human Services department about the innovative Pediatric Asthma Surveillance System (PASS) that allow Dallas County residents suffering from asthma understand their risks.
The PASS dashboard, hosted on the DCHHS website, has served the county for two years leveraging innovative data management that gives asthma risks down to the block level.
PCCI Publishing: Virtual Health Care Encounters for Lung Cancer Screening in a Safety-Net Population
Recently published in the Journal of Clinical Oncology, is a publication co-authored by George “Holt” Oliver, PhD, MBA, VP Clinical Informatics at PCCI, that examines how lung cancer screening was conducted during the COVID-19 pandemic to help determine the difference between virtual and in-person encounters in an urban, safety-net health care system.
PCCI Publishing: Supporting Access to HIV Pre-Exposure Prophylaxis in a Shifting Financial and Insurance Landscape
In a peer reviewed paper published in AJPM Focus, Jacqueline Naeem, VP of Clinical and Social Health at PCCI joined other experts to share information on efforts to expand the use of HIV pre-exposure prophylaxis with the support of community based organizations in Dallas, Texas.
Using Machine Learning to Identify Patients at Risk of Acquiring HIV in an Urban Health System
In the peer reviewed Journal of Acquired Immune Deficiency Syndrome (JAIDS), the identification of patients who are at risk for contracting HIV and are candidates for preventative measures is discussed as a machine learning model to predict risk for HIV may enhance patient selection for proactive outreach. This important paper’s authors include PCCI’s Arun Kumar Nethi, MS, Data & Applied Scientist, and Albert Karam, VP, Data Strategy Analytics.
BMJ Journal – 32 Diagnostic missed opportunities for diagnosis – addressing the unknown unknown with a safety net team
In this article, co-authored by Albert Karam, Vice President, Data Strategy Analytics at PCCI, missed opportunities for diagnoses are common in diagnostic imaging, particularly when incidental findings require follow-up.
Dallas County celebrates the second anniversary of PASS, a celebrated tool helping asthma sufferers understand their vulnerability
In March of 2023, Dallas County Health & Human Services (DCHHS) announced the unveiling of the Pediatric Asthma Surveillance System* (PASS) that is helping asthma sufferers better understand the harmfulness of their environment to their condition. In the two years since its deployment on the DCHHS website, PASS has positively impacted the residents of Dallas County and has supported the efforts of Parkland Health (Parkland) and DCHHS in reducing poor health outcomes related to pediatric asthma.
“Dallas County is one of the few, if not only, communities in the country that offer this kind of support to residents suffering from asthma,” said Steve Miff, PhD, CEO and President of Parkland Center for Clinical Innovation (PCCI). “We are very proud of the success of this model program showing how properly applied artificial intelligence systems can be used to directly inform and affect those in need in our community.”
PASS is a community-wide effort between Dallas County Health and Human Services, PCCI, and Parkland. Publicly available at the DCHHS website, it has been visited by more than 6,000 Dallas County residents, was honored by the Dallas County Commissioners for its service to asthma sufferers, and described by the Dallas Morning News as “a win for Dallas County.” PASS has also been featured in the highly respected New England Journal of Medicine Catalyst.
“PASS is the direct result of the joint Parkland-DCHHS Community Health Needs Assessment, which identified the need for an actionable dashboard to help stakeholders collaborate using a single source of truth,” said Teresita Oaks, Director of Community Health Programs at Parkland Health.“By integrating health and social data, PASS enables our community to take a proactive approach in addressing pediatric asthma and reducing disparities in care.”
PASS includes a novel, validated Pediatric Asthma Vulnerability Index that integrates health and social data insights to identify communities where children have higher vulnerability to poor asthma outcomes and highlight areas of health disparities. It can also predict the probability of a community-level asthma-related emergency department (ED) visit or hospitalization within three months, by incorporating the effect of 10 community indicators, such as socioeconomic conditions, demographic characteristics, medication use patterns, health services utilization, and environmental conditions, on community-level asthma risk.
“One of the most impactful outcomes of PASS has been the identification of neighborhoods with the highest burden of pediatric asthma,” Philip Huang, MD, MPH, Director/Health Authority, DCHHS. “By leveraging real-time data, PASS has enabled us to pinpoint geographic areas where asthma prevalence and hospitalizations are disproportionately high, so we can more effectively target our resources and interventions to the communities that need them the most.”
The Pediatric Asthma Vulnerability Index and all indicators are categorized as Very High, High, Moderate, Low, or Very Low Risk based on their impact on pediatric asthma vulnerability in the community. On the website dashboard, users can drill down from the Vulnerability Index view to specific indicator views by clicking on specific indicators of interest or navigating to the “Other Indicators” tab. The user can also navigate the map from a ZIP Code view to a census tract view and can select a specific geography of interest for further analysis.
At every geographic level, a risk-driven, color-coded map is displayed in the center with demographic data included below the map. The top indicators contributing to the Vulnerability Index are displayed to the right of the map. To the right of each gauge, an impact score shows the degree to which the indicator contributes to the Vulnerability Index within a selected geographic area. Each gauge has a central black line indicating the vulnerability quintile of the indicator within Dallas County.
“The two years PASS has been running have been a huge benefit to Dallas County as community residents and stakeholders have had single source of precise, timely, and actionable data insights at a highly localized level to identify areas at high-risk for poor asthma outcomes,” said Yolande Pengetnze, MD, Senior Vice President, Clinical Leadership at PCCI. “More importantly, PASS strengthens public health leaders’ ability to plan, design, deploy, and evaluate pediatric asthma programs because they now have a single source of truth as a robust data source.”
Additional indicators are presented under “Other Indicators.” While these indicators were not retained in the Vulnerability Index prediction model, they provide the user with additional, actionable insights into drivers of asthma vulnerability in the community, such as the proportion of the population reporting tobacco smoking in the neighborhood.
“In this example,” said Dr. Pengetnze, “If a child with poorly controlled asthma lives in a census tract with a high prevalence of smokers and low controller medication use, the clinical provider might initiate caregiver education about secondhand smoking and medication adherence. Additionally, public health entities might address access to medication and smoking cessation programming at the community level.”
The PASS supports Parkland’s and DCHHS’ communitywide pediatric asthma programming and has been has also been used to engage parents or caregivers to participate in Parkland’s educational, interactive, pediatric asthma text-messaging program designed to help parents manage their child’s asthma.
*This work is funded in part by Lyda Hill Philanthropies. Lyda Hill Philanthropies encompasses the charitable giving for founder Lyda Hill and includes her foundation and personal philanthropy. Our organization is committed to funding transformational advances in science and nature, empowering nonprofit organizations and improving the Texas and Colorado communities. Because Miss Hill has a fervent belief that “science is the answer” to many of life’s most challenging issues, she has chosen to donate the entirety of her estate to philanthropy and scientific research. For more details visit lydahillphilanthropies.org.
Five years after the chaos of COVID-19 comes a new era of AI innovation
By Steve Miff, PhD, President & CEO of PCCI
Five years ago this week, the COVID-19 pandemic threw our world into chaos. But that chaos also sparked an opportunity and a drive to accelerate innovation, through leveraging artificial intelligence with clinical knowledge in unprecedented ways. The results of these Covid-driven efforts have led to a fuller understanding of our community’s health, enabling the initiation of care further upstream and enhancing management of resources and costs in ways benefiting both patients and providers.
I can still remember that week five years ago. I had my bags packed and flight booked to travel to one of the biggest healthcare technology conferences, HIMSS, in Orlando, Fla., when the word came down. The government declared a full lockdown of the country thanks to the pernicious COVID-19 outbreak that the World Health Organization had declared a full-blown pandemic.
Sadly, the cost of COVID-19 in lives— 1.2 million deaths in the U.S. alone— was devastating and the reverberations of the pandemic still affect our daily lives.
However, the chaos and heartache also stimulated a new mindset for collaboration. While the lockdown closed our office doors, it opened new windows to collaborate with other stakeholders across our community. Our teams immediately partnered with Dallas County Health and Human Services (DCHHS), Parkland Health (Parkland) , and other local providers and governmental agencies to help support our North Texas public health leaders and families manage through the ever-changing nature of the COVID-19 pandemic. We deployed a transparent, data-driven set of analytics to inform the dynamic allocation of resources, guide triage protocols in emergency rooms, identify COVID-19 community hotspots, and predict rising waves of hospitalizations and capacity challenges. These collaborations would evolve into support for testing, vaccination distribution, and measuring of community-wide immunity to the infection.
While many of the solutions developed during COVID-19 were industry firsts, we continue today to leverage and expand on many of these same novel applications in AI and non-medical drivers of health (NMDoH) analytics.
Vulnerability Index
The development of the Covid Vulnerability Index and geo-mapped hotspotting created the dynamic dashboards that guided the local pandemic response, including the placement of the testing, and later vaccination sites. This novel approach later expanded into what’s now the Community Vulnerability Index, an industry leading NMDoH analytics method modeling community and neighborhood barriers to health and wellness.
Proximity Index
The Covid Proximity Index was used to predict the risk of infection daily at the individual level using advanced geomapping and data science techniques to guide personal awareness and behaviors, county-wide contact tracing, healthcare provider virtual care scheduling, and ED triage. We are so proud of the United States Patent for AI driven proximity index system and methods (US 12,087,449 B2) that was awarded to PCCI late last year. We’re now leveraging these methods alongside mobility data to understand access to vital services and placement of new access points in the community. The Proximity Index was also featured in the highly respected peer-reviewed New England Journal of Medicine Catalyst in a paper authored by Parkland’s CEO Frederick Cerise, MD and others.
Community Protection Modeling
The national Covid Community Protection Dashboard was launched in collaboration with the Institute for Healthcare Improvement (IHI), Civitas Networks for Health, and Cincinnati Children’s Hospital to model local behaviors and immunity patterns and help communities manage through new Covid variants and waves. We learned that the dynamic nature of modeling factors and a community’s protection depends on the characteristics of the most prevalent current variant and the immunity from prior vaccination and infections, adjusting for the time elapsed from the most recent immunizing event. These innovations translated into the development and deployment of the Pediatric Asthma Surveillance System (PASS), the soon to be released Diabetes/Hypertension Surveillance System, and the development of a novel Maternal Health Surveillance System. Each of the programs are (or will be) in use in Dallas County and provide life-saving support to its residents.
Better Preparedness for Future Crises
The pandemic brought Parkland, our main public health system, closer to DCHHS and many other public health leaders, working together with PCCI to build new policies and procedures to manage the COVID-19 emergency and future public health crises. And have no doubt about it, it is only a matter of when, not if, we will have more COVID-19-like outbreaks.
In the big picture for public health innovation, COVID-19 created a necessity for us to be innovative and try new ways to solve extremely difficult problems. This same way of thinking is helping us today as we tackle ongoing health challenges through improved collaborations and tools. For example, our Community Vulnerability Compass (CVC) is a tool that can provide deeps insights into the complexities of societal challenges to health, access, and community well-being affecting our neighborhoods throughout Texas. It can tell you, for example, what local daily challenges our residents face down to the block level. The CVC has been adopted by a variety of organizations around the state, led by the United Way of Metropolitan Dallas through its Data Capacity Building Initiative that, within five years, aims to equip over 200 community-based partners with robust data insights from the CVC.
And as previously mentioned, the PASS system is celebrating its two-year anniversary of providing residents of Dallas County unprecedented understanding of their vulnerability to asthma-related risks. PASS is a community-wide effort between the county, PCCI, and Parkland and is publicly available at the DCHHS website. It has been visited by thousands of Dallas County residents and was honored by the Dallas County Commissioners for its service to asthma sufferers and was described by the Dallas Morning News as “a win for Dallas County.” PASS has also been featured in the New England Journal of Medicine Catalyst.
The pandemic did put a damper on at least one of our innovations. The book, “Building Connected Communities of Care,” was due to drop via a major release at the Orlando HIMSS convention in March, 2020. The celebration and release was changed and conducted virtually and digitally. This guidebook helps communities and public health leaders create holistic community networks that support any number of health management issues. Thanks to its insights and easy-to-follow steps, “Building Connected Communities of Care” has become an invaluable resource for many public health leaders across the country. It was also featured in the New England Journal of Medicine Catalyst for its insights it offers in handling community healthcare crises.
The COVID-19 pandemic was not easy on anyone, but we are wise to remember what happened during those tough times and leverage the innovations and progress towards bigger and broader ongoing impact. We will continue to leverage the critical clinical and community health lessons COVID-19 taught us in innovative programs incorporating the newest AI technology. As a community, while we remember the terrible price COVID-19 cost our friends and families, we should feel some level of optimism that the next time we will be better prepared and stronger together.
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About Steve Miff
Dr. Steve Miff is the President and CEO of Parkland Center for Clinical Innovation (PCCI), a leading, research non-profit, artificial intelligence and cognitive computing organization affiliated with Parkland Health, one of the country’s largest and most progressive safety-net hospitals. Spurred by his passion to use next-generation analytics and technology to help serve the most vulnerable and underserved residents, Steve and his team focus on leveraging technology, data science, and clinical expertise to obtain unique non-medical-determinants-of-health data and incorporate those holistic, personal insights into point-of-care interventions.
