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.