RML Rendezvous: Transcending Borders Globally

Transcending Borders Globally:

Lessons and Opportunities for Librarians in Building

Sustainable Health Information Systems*

Transcending Borders Globally:

Lessons and Opportunities for Librarians in Building

Sustainable Health Information Systems*

Sherrilynne Fuller, PhDProfessor, Biomedical & Health InformaticsSchool of MedicineCo-Director, Center for Public Health InformaticsUniversity of Washington, Seattle, WA

*Based, in part, on presentations to the Society for EpidemiologyResearch, June 2010 and American Medical Informatics Association, November 2010

Center for Public Health Informatics University of Washington

Why Are Global Health Information Systems Critical?

Why Are Global Health Information Systems Critical?

• New viruses travel more rapidly, transforming local afflictions into worldwide epidemics; new and re-emerging infectious diseases (70% of which are zoonoses)

• A modern lifestyle that travels just as fast, contributing to swelling epidemics of non-communicable diseases

• A human resources crisis directly linked to transnational labor, economics, migration and natural disasters

• The growth of vertical (e.g. HIV/AIDS, TB, malaria) initiatives has pushed advances for specific diseases but has also put pressure on individual countries’ public health systems

• Preventing and responding to these threats requires rapid and targeted exchange of accurate and detailed health information

Adapted from: AM Kimball, Risky Trade:Infectious Disease in the Era of Global Trade. Ashgate, 2006


Trade Routes &Cholera Epidemics – 1892*

Trade Routes &Cholera Epidemics – 1892*


*Proust, A. (1892). La defense de L'Europe contre le cholera. Paris, G. Masson.

The Animal-Human Connection:Vector-Borne Disease Spread

The Animal-Human Connection:Vector-Borne Disease Spread

World distribution of Dengue, 2005.

SOURCE: CDC (2005)

HIE* Challenges: Resource Constrained Countries


• Lack of birth and death (& cause of death) records • Predominantly print (if any) medical records • Health information systems investments focus

primarily on “counting events” (how many cases of HIV/AIDS, TB, malaria?)

• Siloed monitoring and evaluation systems by disease • One-way data flow (province/district/national); not

available to health workers on ground and workers not trained in applying evidence to problem

*Health Information ExchangeCenter for Public Health Informatics University of Washington



• Mismatch between “industrial”/”western” solutions and on-the-ground needs and realities (and, yes, this includes “libraries”)

• Severe shortage of trained health IT workers, educators, librarians and strategic leaders

• Lack of health informatics (and librarianship) academic programs in universities to train the next generation of practitioners and researchers

• Lack of easy, reliable access to the published literature


Health Information Systems “Silos”Broad range of initiatives, but few integrated interventions

Health Information Systems “Silos”Broad range of initiatives, but few integrated interventions

Telemedicine diagnosis

EMR for AIDs and TB care

EMR for AIDs and TB care (2)

Hospital Management Software for rural

hospitals

HealthNet Eritrea for health

information

Antiretroviral Therapy Information System (ARTIS)

Uganda Health Information Network

(UHIN)

HealthNet info network

HealthNet information network (2)

HealthNet information network



HealthNet info network (2)

Register for immununization tracking

AMREF remote clinical diagnosis by specialists

Mosoriot medical record system


Cell-Life clinic workers remotely monitor health patient problems

EMR for AIDs and TB care

HealthNet information network (3)

HIV-EMR system

Careware medical record system for HIV

treatment


Source: BCG research

Patient vaccination records

Monitor Vitamin A distribution

Voxiva disease survelliance system in Tamil Nadu

Remote eye diagnostics

East Bhutan Tele-ECG Telediagnostics

Telepathology

Assess availability of

HIV/AIDS-related services

AMREF remote clinical diagnosis by specialists

Regional HIV data center

Web based clinical information system for

researchers

PIH-EMR electronic medicalrecord

supports TB and HIV

SICLOM delivery ARV treatment

Teledermatology

District public health tracker

GENNET forum for gender issues

On Cue SMS drug reminders for TB patients




Health Metrics NetworkGlobal /

Regional

WHO GoE

GOARN

Weekly EPI Record (WHO)

NEDSS (CDC)

Antimicrobial inform. bankFluNet and RABNET

APEC EINET

Health InterNetwork (US)

Roland Koch Institute

Country/

local

... and many moreHAN (CDC)

eLearning to train nurses

Prevention Access Diagnosis Delivery Monitoring

Sample demonstrates wonderful progress, but significant fragmentationCenter for Public Health Informatics University of Washington

Adapted from:Karl BrownRockefellerFoundation



Data Coordination – Mekong Basin Region

Data Coordination – Mekong Basin Region


Global Health Informatics Educational TrendsGlobal Health Informatics Educational Trends

• Increasing demand for academically trained individuals who can:

– Research, develop and implement systems relevant to country needs

– Plan and lead integrated health information systems in hospitals, districts and Ministry of Health

– Educate the next generation of health information professionals AND health professionals

– Universities focusing on curriculum and faculty development

– Lead the development of academic health sciences libraries and information resources



UNITID Fellowship in Public Health

Management

UNITID Fellowship in Public Health

Management

UNIVERSITY OF NAIROBIInstitute of Tropical & Infectious

Diseases

MissionMission

To build the capacity of public health

professionals to provide evidence-based

and effective public health leadership and

management in the public and private health

sectors


Collaborating InstitutionsCollaborating Institutions

• U of Nairobi (UoN)– Institute for Tropical and Infectious Diseases (UNITID) – School of Business– School of Economics – School of Computing and Informatics

• University of Washington:– Center for Public Health Informatics – Department of Global Health

• International Training and Education Center for HIV (I-TECH)• Population Leadership Program (PLP)• International AIDS Research and Training Program (IARTP),

• US Centers for Disease Control and Prevention




U. Nairobi - Fellowship Training (2 years)

U. Nairobi - Fellowship Training (2 years)

1. Fundamentals of health informatics short course for all fellows 2. Core Fellowship training (over two years)

– HIV Science, Epidemiology– HIV Program Management and leadership– HIV Program implementation sciences core

• Training Skills • Health Economics• Grant Writing

3. Attachment in host institutions4. Health Informatics speciality track training (5 fellows)5. Project based on needs of host institution


African Workshop on Academic Health Informatics Program Development:

Nairobi, Kenya, December 7-9, 2009*

African Workshop on Academic Health Informatics Program Development:

Nairobi, Kenya, December 7-9, 2009*

Faculty, university leaders, MOH leaders from ten African Countries, Peru, Brazil, England, US, Health Metrics Network, World Health Organization, and Microsoft Research in order to:– Identify best practices in the development and delivery of university-

based health informatics programs– Explore their role in capacity building in health information systems

development and– Identify potential contributions to the delivery of quality health

information systems and services– Synergize activities in Africa

Co-Sponsored by the University of Nairobi and the UW Center for Public Health Informatics. Funding provided by the Rockefeller Foundation. Center for Public Health Informatics University of Washington

Academic Health Informatics Programs

Academic Health Informatics Programs

African universities with health informatics programs (represented at Nairobi workshop):

– Addis Ababa University, Ethiopia

– University of Gondar, Ethiopia

– University of Nairobi, Kenya

– Kenya Medical Training College, Nairobi, Kenya

– Kenyatta University, Nairobi, Kenya

– National Universities Commission, Nigeria

– University of Dar es Salaam, Tanzania

– University of KwaZulu-Natal, South Africa


Findings from Nairobi Workshop: Academic Health Informatics

Programs

Findings from Nairobi Workshop: Academic Health Informatics

Programs1) The value of academic partnerships

(south-south/north-south) to develop curricula, faculty and student training and promote R&D agendas

2) The importance of university collaboration with Ministries of Health

3) The value of collaboration with and among NGOs, donors and private sector to address health information systems fragmentation

4) The contributions and leadership of an active university-based research and development center for addressing challenges

5) The need for catalytic funding


It’s a Two-Way Street…It’s a Two-Way Street…

• What we learn from our colleagues globally can provide solutions relevant here

• E.g. Swedish Medical Center, Public Health Seattle/King Co. and others have recently announced a Global to Local initiative..



ConclusionConclusion

A key antidote to the fragmented global health information infrastructure lies in University-based educational, library and R&D programs

Increasing international focus on health informatics educational programs with diverse funding sources and partners:– Rockefeller Foundation– Fogarty International Center– CDC/PEPFAR


ConclusionConclusion

Significant opportunities to partner to create synergistic educational programs with partners around the world:• Faculty, Student, Librarian Exchanges• Shared training programs• Joint development of curricula and course

materials (e.g.case-based resources)• Shared library and information resources and tools• Fulbright scholar opportunities for librarians (

http://fulbright.state.gov/about.html• AND????????????


Selected ReferencesSelected References

• Fuller SS Tracking the Global Express: New Tools Addressing Disease Threats Across the World Epidemiology 21(6):1-2, 2010 [Invited]

• Kimball AM. Risky Trade: Infectious Disease in the Era of Global Trade. Ashgate, 2006

• Curioso, W., S. Fuller, et al. (2010). Ten Years of International Collaboration in Biomedical Informatics and Beyond: The AMAUTA Program in Peru. Journal of the American Medical Informatics Association Fall Symposium Supplement 17(4): 477-480.


Students Discussing CaseStudents Discussing Case2nd Health Informatics Course for Students from throughout the Mekong Basin countries; Mahidol University, Bangkok, Thailand January 2010


Temple of the DawnTemple of the DawnWat Arun Bangkok, Thailand, February 2010


Cambodian School GirlsCambodian School GirlsSiem Reap, Cambodia February 2010


Bach Thao Park, Hanoi, Vietnam Bach Thao Park, Hanoi, Vietnam Cultural Festival – September 2010


Peruvian Quipu – Museo Arqueológico Rafael Larco HerreraPeruvian Quipu – Museo Arqueológico Rafael Larco HerreraQUIPU, a Quechua word that means knot, describes an ancient system used throughout the Andes by the Incas to record and distribute information. QUIPU is also a project lead by the Universidad Peruana Cayetano Heredia in Lima, Peru, with participation from the U.S. Naval Medical Research Center Detachment in Lima, the University of Cauca in Colombia, and the University of Washington in Seattle.


Kenyan Mobile Phone CenterKenyan Mobile Phone CenterMany villages lack electricity and even Nairobi has a very precarious power infrastructure with frequent outages.


Nchaan with Little TanoNchaan with Little TanoDavid Sheldrick Wildlife Trust, Nairobi, Kenya

(orphan elephant & rhino rescue with HIGHLY successful return to wild as adults)


Health & Medicine

RML Rendezvous: Transcending Borders Globally