Introduction: The Childhood Obesity Research Demonstration (CORD) project links public health and primary care interventions in three projects described in detail in accompanying articles in this issue of Childhood Obesity. This article describes a comprehensive evaluation plan to determine the extent to which the CORD model is associated with changes in behavior, body weight, BMI, quality of life, and healthcare satisfaction in children 2-12 years of age.Design/Methods: The CORD Evaluation Center (EC-CORD) will analyze the pooled data from three independent demonstration projects that each integrate public health and primary care childhood obesity interventions. An extensive set of common measures at the family, facility, and community levels were defined by consensus among the CORD projects and EC-CORD. Process evaluation will assess reach, dose delivered, and fidelity of intervention components. Impact evaluation will use a mixed linear models approach to account for heterogeneity among project-site populations and interventions. Sustainability evaluation will assess the potential for replicability, continuation of benefits beyond the funding period, institutionalization of the intervention activities, and community capacity to support ongoing program delivery. Finally, cost analyses will assess how much benefit can potentially be gained per dollar invested in programs based on the CORD model.Conclusions: The keys to combining and analyzing data across multiple projects include the CORD model framework and common measures for the behavioral and health outcomes along with important covariates at the individual, setting, and community levels. The overall objective of the comprehensive evaluation will develop evidence-based recommendations for replicating and disseminating community-wide, integrated public health and primary care programs based on the CORD model.

The PIC was a helpful tool to identify policies that promote healthy food environments across multiple settings and to measure and compare the overall policy environments across communities. There is need for improved coordination across settings, particularly in areas with greater concentration of youths and racial/ethnic minority populations. Policies to support healthy eating are not equally distributed across communities, and disparities continue to exist in nutrition policies.

Public Health immunization registries and the immunization ecosystem have evolved over the past two decades to become significant population health data assets. Clinical providers and pharmacists are reporting the immunizations given to their patients to public health registries in 49 states and all territories, creating consolidated immunization event patient records.Most of these immunization events are reported through the provider’s Electronic Health Record system (EHR), Pharmacy Management System (PMS), online, or through data uploads. Meaningful Use and health data standards (HL7) became the drivers that accelerated reporting to immunization registries and significantly improved the quantity and quality of the data. The infrastructure supporting the Immunization Ecosystem (IE) has enabled real-time compliance reporting and, more importantly, real-time patient queries. The provider community now has online access to a patient’s immunization history in over three quarters of the states, and growing. This access includes a forecast of the patient’s immunization gaps provided by public health decision support tools based upon the most recent ACIP recommendations. This is creating an opportunity for the provider and the patient to work together to reduce their risk of suffering a vaccine-preventable disease. This IE and the data in an Immunization Information System (IIS) are especially useful as pharmacies expand their immunization practices and create opportunities to reduce the adolescent and adult immunization gaps.In a few states, this provider-public health ecosystem has begun to extend to individuals by allowing them to access the IIS online through the use of MyIR. MyIR provides them with the electronic version of their immunization "yellow cards," recommendations for immunizations due, and the ability to print official certificates. This emerging consumer engagement creates opportunities to empower individuals to be more proactive in their family’s health care.This paper builds upon early experiments to empower individuals in this ecosystem by leveraging the value of these public health data assets and trusted communications, illustrating the possibilities for engaging consumers to support reducing the impact of emerging diseases, outbreaks and the next pandemic. This paper will suggest the value of the IE and the role individuals can play within their own social networks to advance public health efforts to manage disease events. In turn, this social mission would encourage consumers to be more proactive in managing their own healthcare.

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ObjectiveIf public health agencies used direct communication channels to individuals by building on existing immunization networks, the public would receive correct information quicker during a pandemic. Furthermore, there is value that can be leveraged from social networks to advance public health efforts to manage disease events and encourage consumers being more proactive in managing their own health care.IntroductionEpidemiologists and public health professionals work to ensure the risk and impact of existing and emerging diseases are minimized and do not turn into a pandemic. Timely and accurate information has become imperative as the world has become more interconnected through travel and technology.Recently, new information systems have played a key role in improving public health’s early warning and case management for disease outbreaks. Improved analytics to predict risk in populations have helped researchers open new doors to disease cures and medicines. The role of technology and public health to support these efforts has become more valuable.Health information systems are traditionally used for electronic medical records or payer billing systems and are not paired with technology advancements. Efforts today to link information and technology to engage consumers are championed by health plans and healthcare providers. Empowering individuals to be proactive when presented with their medical records is not a simple problem to solve. Information must be actionable but it still may not achieve the desired success.What if the health community engaged consumers with a social mission to help them fight disease outbreaks by becoming frontline activists to report occurrences and outcomes, and become “intelligent connections” to extend the right information to their social networks? This would encourage consumer technology to be better integrated with health information technology with continued investment in sustaining critical public health ecosystems.A large part of health information systems are immunization information systems (IIS) where administered vaccines are documented in a confidential computer based system in a specific geographic area1. The IIS can be used for disease surveillance purposes and provide valuable information to public health authorities2. Recently, MyIR was created where any IIS, pharmacy or provider can provide patients direct access to family immunization records. Providers can communicate to patients using MyIR to increase engagement and send vaccine reminders.MethodsA public-health engagement approach to empower consumers begins by offering individuals a mission they care about that will contribute to the social good and make them more attentive to their own healthcare. Our approach was to place a mission for every cell phone owner by using a commonly understood health event.The most significant public health event in the 20th century was the power of vaccines and the most significant action an individual can take to reduce their risk of a vaccine-preventable disease is to stay up-to-date on their immunizations3. However, there is a gap between believing in the value of immunizations and ensuring one’s immunizations are current. The challenge is to engage individuals, empower them to be advocates of their own health and in an outbreak, become sources of trusted public health messages as they communicate in their social network.A few experiments were conducted using MyIR.Increase SustainmentUsers who had not used MyIR in over 30 days were contacted. The baseline looked at users that were logging into MyIR more than once a month. The target was non-engaged users which were about 8,000 accounts.Customer Engagement IIn November 2017, an email was sent to 7,772 users that asked them, "Did you get your flu shot?" If they clicked Yes, they received positive affirmation. If they clicked No, the message was an encouragement to get their flu shot before Thanksgiving 2017.Customer Engagement IIIn January 2017, a Healthy Lifestyle page was created within MyIR. It featured a food blogger who offers readers nutritious easy meal ideas.Outreach EffortsMyIR Louisiana users were targeted who had failed to complete the two step enrollment process to access their immunization histories.Efficacy of FluIn April 2018, 212 MyIR users in Washington and Louisiana were asked: Did you get a flu shot this year? Do you feel like you got the flu this year?ResultsIncrease Sustainment27% of people opened the email and 3.6% of these individuals used MyIR within 30 days to access their records.Customer Engagement I9% answered the question with 80% saying “YES” they got their flu shot. As a result, 25 new immunizations were administered to these individuals within 60 days.Customer Engagement IIA 7.1% increase in returning users were tracked and a 9.1% increase in engaged users. There was a 6.7% increase in average session duration.Outreach Effort556 emails were sent which contained instructions to finalize enrollment for MyIR. There was a 30% open rate and 50 individuals completed the process.Efficacy of Flu78% responded they did receive the flu shot this year. Of these, 61.5% felt they got the flu this year which equates to a 38.5% efficacy rate. In February, CDC had determined the interim estimates for the effectiveness of the influenza were 36%4.ConclusionsOur aim was to show examples where public health agencies using direct communication channels to individuals could increase the efficacy of reaching the public with correct information. It was not designed to prove to be statistically effective but to show the potential of engaging individuals that have access to their immunization records. These early experiments and the growing data assets in IIS's help create a framework and technical platform to accelerate the potential value of engaging individuals in response plans for pandemic preparedness.Immunization information systems and technology have reached a point where information is available across wide networks of stakeholders. While health plans, providers and pharmacists struggle to engage their networks, by encouraging patients to be proactive in their healthcare, public health immunization assets may be the tipping point to accelerate this movement.Continued investment of immunization programs, private sector innovation, and consumer empowerment are essential to evolve and sustain data assets. As these assets create added value to each stakeholder, the investment will create a positive return. The value of this virtual ecosystem is untapped and opportunities to use it to drive down healthcare costs and improve patient outcomes are unlimited.References1. Centers for Disease Control Prevention (CDC). About Immunization Information Systems. Atlanta: CDC; 2012 May 15 [Cited 06 Jun 2018]. Available from: http://www.cdc.gov/vaccines/programs/iis/about.html2. Derrough T, Olsson K, Gianfredi V, et al. Immunisation Information Systems – useful tools for monitoring vaccination programmes in EU/EEA countries. Eurosurveillance [Internet];22(17):30519. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434883/#r13. Centers for Disease Control and Prevention (CDC). Ten great public health achievements--United States, 1900-1999. MMWR Morb Mortal Wkly Rep [Internet]. 1999 Apr 2;48(12):241-3 [Cited 06 Jun 2018]. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm4. Morbidity and Mortality Weekly Report (MMWR): Interim Estimates of 2017-18 Seasonal Influenza Vaccine Effectiveness – United States, February 2018. Centers for Disease Control and Prevention [Internet]. 2018 Feb [Cited 2018 Apr 24]. Available from: https://www.cdc.gov/mmwr/volumes/67/wr/mm6706a2.htm