National Association for Public Health Information Technology (IT)

The National Association for Public Health Information Technology (NAPHIT) is the dream organization that cares deeply about everything I have on this blog- I'm sort of disappointed that I had not explored them more until now. They came into existence in response to the masses of people that became very concerned about public health emergencies in the likes of bio-terrorism, after the September 11 attacks in 2001. Today they work towards a set of carefully laid out goals and objectives:

• To promote discussion and group action on issues involving public health information policy.
• To assist in the evaluation, selection and implementation of information technology in support of public health programs.
• To encourage professional development of leaders in public health information technology through training, education and the exchange of ideas.
• To further the role of information technology in public health by building relationships and collaborating with federal, state, and local public health agencies and other organizations that share our goals.

They are funded by a variety of organizations such as Microsoft, Novell, Northrop Gummen, Citrix, but two interesting ones among them are Advanced Business Software, an organization that focuses exclusively on developing and implementing information management software solutions for clients in the public health market, and HLN Consulting, LLC, a health information technology services company that provides a wide range of technology consulting services to public health agencies and their non-profit partners, in an effort to develop and support robust technical solutions addressing pressing public health needs. It is definitely a positive sign that many of these business are realizing the importance of combining their efforts and collaborating with one another to fund a national not-for-profit organization to accomplish these goals.

NAPHIT is headquartered in Baltimore, and in March 2009, formed an alliance with the Public Health Data Standards Consortium (PHDSC) to establish a Leadership Forum that is working to design and implement programs and activities that will allow public health IT leaders, public health and clinical professionals, as well as vendors to come together to standardize IT initiatives and allow interoperability between public health information systems and clinical information systems under the National Health Information Network (NHIN).

All of these initiatives are encouraging steps forward in the field of public health information technology. It is exciting to note the progress that has been made so far, and much is to be said about the potential for the future in the US- keeping in mind that many developing nations have yet to even recognize the importance of leveraging information technology to address public health needs. If an organization like NAPHIT is successful at building efficient models to introduce functional IT systems into public health within a highly disintegrated health care system, as is in the US, then there is hope for scalability and the replication of such efforts worldwide.

IT improving preparedness for public health emergencies

Today, we live in a world filled with endless possibilities for both natural, health and terrorism emergencies. Public health preparedness is a key ingredient to making sure our communities are ready to deal with the many tragedies that could easily become a part of our futures- natural disasters like earthquakes, hurricanes and floods; environmental degradation resulting in climate change refugees and drastically shifting weather conditions; health issues ranging from flu pandemics, regions with endemic cholera, malaria and HIV/AIDS prevalence, to new zoonotic diseases; political upheavals like civil war, and finally terrorist attacks ranging from chemical and biological warfare to 9/11 like incidents. These are not small matters, but how are we preparing ourselves for them?

It appears that information technology is playing a significant role in keeping us informed and encouraging us to be prepared. Keeping track of weather reports and following evacuation and alert signals allows us to move quickly and step out of the way of natural disasters coming in our direction. More and more, various states have begun to establish specific e-health preparedness portals to encourage people to keep themselves informed. For example, the Iowa Department of Public Health has started a an Office for Health Information Technology to lead a collaborative effort to plan and promote the use information technology in their public health planning. They have developed a vision, guiding principles and a framework for how health information can be exchanged through public-private partnerships that allow more efficient public health project management.

Similarly, the Vermont Department of Health has established an E-Ready module for public health preparedness to provide resources for families, information about biological, chemical and weather related threats, response plans, a list of response partners, as well as volunteer opportunities and any other information related to Vermont public health preparedness.

E-health endeavors such as these are paving the way for more states within the US to adopt e-friendly technology and resources that make keeping track of threats and responding to them in a timely and safe manner an efficient process that acknowledges the need for communities to prepare themselves adequately, as a priority.

Difficulties using ICT for Coordination of Care in La Romana, DR

La Romana, a city along the south eastern coast of the Dominican Republic keeps a unique but somewhat disturbing balance- wealthy American and Europeans expats enjoy the luxuries of low living expenses, pristine beaches and the tropical sun at the city center, while thousands of Haitian refugees work back-breaking days, at less than minimal-wage at the numerous sugarcane plantations that surround the city. These refugee families live in over 200 settlements, locally known as 'bataeys', where the conditions are less than optimal- 9 to 10 family members squeezed into single-room homes, severe water and sanitation issues , poorly developed education systems and very little access to health care.

The El Buen Samaritano hospital in La Romana has been working for over 2 decades to establish programs that can provide quality and free health care to bataey-dwellers. Their mission is well supported with over 60 volunteer groups visiting them from North America every year, to provide medical care, assist with construction, conduct bible study camps, and provide resources, as needed. However, as can be expected with a situation like this, little to no coordination exists between these groups. Each team brings down experts they believe are needed, and while no team leaves without helping as much as they can, work is duplicated, medical supplies are brought at random, patients seen at the bataeys have no medical history recorded, and the system remains less efficient than there is potential for it to be.

Last week, I accompanied a team of young and enthusiastic clinical and public health specialists, on a 10 day mission to do our part. But this year, we were going to try something different- we wanted to put in place a coordination of care model that would use ICT to provide channels of communication between various mission groups and hospital staff, in order to improve the efficiency with which resources in time, energy, skills and money were distributed, and care was delivered in this setting. We soon realized that while this was definitely a noble cause, it was indeed a difficult one. Here are some of the issues we faced:

• We started a simple, easy-to-understand Electronic Medical Records system that assigned a code to every patient we treated, and attached it to a digital picture, and a brief record of the conditions that were seen and treated- all in a basic excel file. We spent hours trying to figure out the easiest way to get this system started, but realized that without a structured way to get buy-in from all of the stakeholders involved (the volunteer mission groups, as well as the hospital staff), there was no way the system would get off the ground.

• We wanted to develop a website that all visiting mission groups could access before they arrived in La Romana. This way everyone could get a common understanding of the long-term strategic plan at the hospital to ensure that their work was contributing constructively towards it. They could all keep track of the schedule for groups visiting the bataeys and of medical supplies that would be needed to be brought, as they ran out. It was not as easy as we thought it would be. It turned out that there were already atleast 3 main existing platforms, and atleast a few more less known ones that were attempting to do the same thing, but that had so far not had too much success:
  

1. El Buen Samaritano website
   
2. A website developed by an American nurse who has been working at El Buen Samaritano
   
3. A website developed by an American doctor who has spent many years working at El Buen Samaritano

With such a backdrop, would our website make things better, or simply add to the confusion?

• We started a record keeping system to record inventory of medical supplies- we used simple tags like 'none needed', 'need more', and need urgently' to describe the current situation for specific medical supplies, with the hope that we could hand this over to the next team coming, and convince them to do the same before they left. Again, as simple as this seemed at first thought, it has been incredibly hard to get follow through- no concrete schedule exists for visiting groups and without one website everyone goes to, there isn't a common space for an open source update by each group as they come and go.
  

These are just the beginnings of the many problems we foresee as we take our mission forward to use ICT to implement a coordination of care model that will improve efficiency in both theory and practice.

What does e-Health mean to Americans?

We all talk about e-health these days, but what does this buzzword really mean to most Americans? G. Eyesenbach, in an article published in the Journal of Medical Internet Research, explores this topic, in an attempt to develop a concrete definition for this term. He defines the term and the concept as follows:

e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology.

Furthermore, he goes on to suggest that there are 10 e's in "e-health":

• Improve the Efficiency of healthcare
  
• Enhance the quality of healthcare
  
• Make interventions Evidence-based
• Empowering consumers and patients
  
• Encouraging new relationships between patients and health professionals
  
• Educating physicians and consumers through online sources
  
• Enabling the standardized exchange of information and communications between healthcare centers
• Extending the scope of healthcare beyond its conventional borders
• E-health requires new forms of patient-physician interactions that put an emphasis on Ethics- informed consent, privacy and equity issues.
• Reducing the gap between the "haves" and the have-nots" by promoting Equity in access to healthcare
  

I think this is a useful framework. Understanding the meaning of e-health with defined boundaries, allows the millions of Americans trying to decide on the various bills being passed around e-health, to make informed decisions when they cast their votes, and voice their opinions.

Similarly, below is an interesting video created by students at Vancouver University, succinctly describing exactly how Electronic Health Records can benefit Americans, but also how it has the potential to cause trouble. It is simple and easy to follow, and is definitely the way forward with bringing Americans on-board our mission to promote e-health.

E-Health Infographic from Ira Hardy on Vimeo.

(Source: G. Eysenbach. 2001. What is e-Health? J. of Medical Internet Research, (2):e20)

Capacity for e-health in Africa

Yesterday, I returned from a whirlwind trip to Lagos, Nigeria- my first time in West Africa. I had heard so much about how I should expect it to be very different than East or Southern Africa, and it was- there was no mistake that I had just set foot into a bustling metropolitan, with the highest population density in the continent. From the second I got there, I kept thinking about the enormous potential this country had to become an emerging market ready to burst into success. A robust population, a thriving oil and gas industry with education and health beginning to take the forefront of discourse- I was excited at the thought of how much was possible!

I was in Lagos to conduct a workshop to train representatives from the media, private sector and select NGO's on the benefits of being advocates for pneumonia prevention. The four days I was there went by quickly- too quickly to absorb much- but being stuck in a 3 hour long traffic jam on the way back to the airport (usually a 20 minute drive when it is not rush hour), forced me to mull over the serious issues of infrastructure and governance, that were hard to miss in Nigeria. And ofcourse, e-health came to mind.

I started to wonder what was really holding the developing world back from lapping up information technology for healthcare. First, I recognized the problem of low institutional capacity- issues with infrastructure and connectivity, the legal and regulatory environment, as well as weak administrative structures. Closely following suite, were the limits on human capacity- there is a notable shortage of e-practitioners, or health workers who are capable of leveraging information technology, there is a lack of incentivising programs within the MoH that give eHealth-corps clear career prospects, and most importantly it is very hard to transform informed citizens from passive observers to active participants in the e-care giving process. These are all definitely deal breakers, and big hurdles to cross.

Here is an interesting presentation made at the 2009 ECOSOC Africa Regional Ministerial Meeting, showcasing the progress as well as the challenges in the use of information and communication technology in health.

ICT Infrastructure in Africa and the uptake of e-Health

View more presentations from Francisco J Grajales III.

There are definitely big hurdles to cross before a country like Nigeria becomes e-health friendly, but even as I arrived much too late to check-in for my flight, and somewhat nauseous from the long and bumpy car ride, I was certain that these were problems that could be overcome.

Leveraging IT advantages in the developing world

Thomas Friedman, in his masterpiece, The World is Flat, writes about the flatteners that have propelled globalization, and reduced the world from a size medium to a size small, now even heading towards being a size extra-small. He lists outsourcing, off-shoring, open-sourcing, in-sourcing, supply-chaining, informing through giants like Google and Yahoo, and the final boost of wireless access as agents that have acted as steroids, pushing the world into a smaller and tighter corner. He points out that this is giving hitherto 'developing' giants like China, India and Russia the leverage they need to drive an existing giant like the US into a tight spot. Competition is getting tougher, the numbers of people with the skills and the ability to work efficiently from any corner of the world have increased, and as the world gets flatter, the tides are changing to shift economic prowess into new hands.

This is an exciting time for developing nations- not just India, China and Russia, but even for countries lagging behind on the development ranks. I see it as a thrilling opportunity, especially in the field of healthcare. For more than a decade now, the US has been battling disintegrated Electronic Medical Records (EMR) systems that result in high health care expenditures and a myriad of inefficiencies in health care delivery. No one system works for everyone, but it seems like it is almost impossible to get the existing ones uprooted to embed a uniform EMR system that improves effectiveness and efficiency. There is a lesson to be learned for developing nations, still working on paper, and filing away records manually- they are fortunate enough to know what mistakes not to make. Thomas Friedman labels the new developing nations jumping into the playing field as "legacy free" and I agree with him wholeheartedly- they don't have to worry about the sunken costs of old systems, but instead have the potential to move fast and leap right into new technologies by adopting innovative, state-of-the-art information systems that allow them to quickly the bridge gaps, and maybe even fire-away ahead of what we know today.

It is clear that there is untapped potential, and much to be learned from mistakes made. Developing nations have an advantage, but it is now in their hands to find a way to pick it up, and run with it!

(Source: It's a Flat World After All, Thomas Friedman, The New York Times, April 3rd, 2005)

Play a Social Media Game for Diabetes!

The developed world has made its epidemiological transition from infectious to chronic diseases, but the developing world is not far behind- today, diabetes, cardiovascular disease, cancer and respiratory conditions are the major cause of death and disability world-wide. This is indeed a significant concern.

I light of this, the Joslin Diabetes Center, affiliated with the Harvard Medical School, has been working since 1898 to ensure that people with diabetes live long, healthy lives and to offer real hope and progress towards diabetes prevention and cure. Just recently though, they launched an innovative social media intervention, HealthSeeker, that may become the prototype for social media efforts to prevent and treat chronic conditions.

HealthSeeker is a game on Facebook that allows players to make specific lifestyle changes that focus on healthy eating. While the game is available to everyone, it specifically allows players with diabetes to make informed lifestyle decisions through channels that compliment their daily use of social media. The game utilizes the players own Facebook friends as sources of support and inspiration, by allowing players to publicly receive experience and award points every time they meet 'lifestyle goals' such as eating more healthfully, achieving or maintaining a healthy weight, improving one's diabetes control or lowering cardiovascular risk factors. This sort of motivation allows people to take simple, everyday steps towards meeting their health goals, and has so far proven to be very successful.

Watch this video to learn more, add the application on your own Facebook account and play!

Knowledge Management for Immunization Policy

The buzz words, knowledge management are used to describe a range of strategies and practices that an organization can use to identify, present, distribute, and enable the adoption of specific insights and experiences gained through formal or informal networks formed among employees and other stakeholders. It seems like this term has become everyday language to corporations- each one boasting of how their networks have proved to improve competitive advantage, performance, innovation and integration. Although knowledge management strategies are not as clearly defined in public health and development efforts, it has infact become an integral part of advocacy efforts for vaccine/immunization policy.


Many vaccines are implemented very slowly, especially in developing countries. Every year, close to 11 million children die from vaccine-preventable diseases. An article in the McKinsey Quarterly highlighted the importance of building stakeholder network maps to determine the informal channels through which knowledge can flow, specifically with regards to decision-making around vaccine adoption. In maps such as this one, the nodes itself represent various influencers, the colors of the nodes indicate organizational affiliation, and the size of the nodes show the level of input sought from the person/organization it represents. Understanding who influences the process of vaccine adoption in developing countries allows international funding and advocacy agencies such as GAVI & AVI-TAC to direct their resources and efforts towards the optimal channels in order to accelerate the adoption of life-saving vaccines into national immunization schedules.

( Figure from 'A better way to speed the adoption of new vaccines: Mapping the way decision makers interact could hasten the introduction of vaccines.' McKinsey & Company. The McKinsey Quarterly. August 2008.)

Sex Education goes for IT

IT has been integrated into public health efforts more extensively than you might imagine- especially in the field of sexual health education. I was first drawn to the sheer vastness of efforts in this area when I, along with colleagues from The Women's Collective, presented SisterAct: Utilizing Technology to Address Challenges to Intergenerational Communication about Sexual Health, at the 2009 Sex::Tech Conference in San Fransisco. We introduced, with some enthusiasm, the various innovations we had incorporated into our curriculum to ease the process of intergenerational communication about sexual health issues, usually a tabooed subject among African American women and girls- social networking sites, blogs, educational movie clips, and personal video journals as a means for our clients to open up necessary communication channels, otherwise hindered by stigma and fear.

But it doesn't stop where we started-there are a number of examples of how IT has become the foundation for sexual health education. The Text4Baby Campaign allows low-income, expectant mothers in the US to receive free text messages timed with their due dates, about nutrition, immunization, birth defect prevention and a range of other educational topics. Businesses such as L'oreal have incorporated media efforts such as the I Am Worth It Campaign their corporate social responsibility portfolios, encouraging young women to be proud of their womanhood, and maintain high-self esteem in their sexual relationships. In South Africa and Kenya, an SMS test messaging program for HIV positive individuals has allowed people to overcome the problems of an overburdened health system and limited access to doctors- One World in Kenya and Cell Life in South Africa, provide both mass-messaging preventative education services, and allow HIV positive users to text their questions and concerns to doctors available to assist immediately.


So that's right. I was as shocked as you might be at the idea of conferences recurring annually, dedicated solely to the integration of information technology and sexual health education. But given these impressive innovations it is clear that there is a promising future in the overlay of IT and health education.

Making Introductions

Public health with its traditional focus on altruism and aid, and business, in the diametric opposite corner, known to drive corporate hunger with its clamor for profits and growth- it's easy to see why one might think these fields are somewhat incompatible. But as a fresh graduate from an MPH/MBA dual degree program at Johns Hopkins University, I am keeping this blog in the hope of convincing you otherwise.

I grew up in Bangalore, India, today known to be the Silicon Valley of the East. But after some years of struggling to compete amidst the crowds of hard-working, success-driven citizens India boasts of, I found my way to the West, attempting to live the American Dream- I was hoping for a good education, a comfortable job and a Green Card somewhere in the mix. However, four years of college at Grinnell- a liberal haven if there ever was one- interrupted by a stint of public health work in Botswana, worked together to quickly change that goal for me. Today, my interests lie in contributing towards the effort to allow other parts of the world to have the chance to live their own versions of the American Dream, not needing to go as far as I went, looking for it- an ambitious goal I realize.

There is a glimmer of hope though. I believe that in order for us to successfully reach many of the health-related targets of the Millennium Development Goals by 2015, public health efforts cannot continue in isolation from the macro-economy they rest within. In the intersection of public health and information technology, corporate social responsibility and private sector support, as well as the education of the masses to grasp the benefits of social enterprise, lie the answers to many of the 21st centuries health and development concerns. Like the internet accelerated globalization, I'm certain leveraging functional business models/tools/strategies to harness their benefits into health and development efforts can without a doubt accelerate the rate at which the world will rise out of poverty and sickness. This blog is my attempt to muse on this idea, and others, and perhaps even captivate you enough to be an advocate for thoughtfully integrating such efforts into your own work.