RML Rendezvous: Transcending Borders Globally

Transcending Borders Globally: Lessons and Opportunities for Librarians in Building Sustainable Health Information Systems* Sherrilynne Fuller, PhD Professor, Biomedical & Health Informatics School of Medicine Co-Director, Center for Public Health Informatics University of Washington, Seattle, WA *Based, in part, on presentations to the Society for Epidemiology Research, June 2010 and American Medical Informatics Association, November 2010 Center for Public Health Informatics University of Washington

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 Center for Public Health Informatics University of Washington

Trade Routes & Cholera Epidemics – 1892* Center for Public Health Informatics University of Washington *Proust, A. (1892). La defense de L'Europe contre le cholera. Paris, G. Masson.

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 Exchange Center for Public Health Informatics University of Washington

HIE* Challenges: Resource Constrained Countries
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
Center for Public Health Informatics University of Washington

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  HealthNet info network  HealthNet info network (2)     Register for immununization tracking    AMREF remote clinical diagnosis by specialists Mosoriot medical record system EMR for AIDs and TB care (2)    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    HealthNet info network 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 EMR for AIDs and TB care (2) HealthNet info network (6) HealthNet info network (8) Health Metrics Network Global / Regional WHO GoE GOARN Weekly EPI Record (WHO) NEDSS (CDC) Antimicrobial inform. bank FluNet and RABNET APEC EINET Health InterNetwork (US) Roland Koch Institute Country / local ... and many more HAN (CDC) eLearning to train nurses  Prevention  Access  Diagnosis  Delivery  Monitoring   Sample demonstrates wonderful progress, but significant fragmentation Center for Public Health Informatics University of Washington Adapted from: Karl Brown Rockefeller Foundation

Data Coordination – Mekong Basin Region Center for Public Health Informatics University of Washington

Global 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 UNIVERSITY OF NAIROBI Institute of Tropical & Infectious Diseases

Mission
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 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)
Fundamentals of health informatics short course for all fellows
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
Attachment in host institutions
Health Informatics speciality track training (5 fellows)
Project based on needs of host institution

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
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
The value of academic partnerships (south-south/north-south) to develop curricula, faculty and student training and promote R&D agendas
The importance of university collaboration with Ministries of Health
The value of collaboration with and among NGOs, donors and private sector to address health information systems fragmentation
The contributions and leadership of an active university-based research and development center for addressing challenges
The need for catalytic funding

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..

Conclusion
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

Conclusion
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 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 Case
2 nd Health Informatics Course for Students from throughout the Mekong Basin countries; Mahidol University, Bangkok, Thailand January 2010

Temple of the Dawn
Wat Arun Bangkok, Thailand, February 2010

Cambodian School Girls
Siem Reap, Cambodia February 2010

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

Peruvian Quipu – Museo Arqueológico Rafael Larco Herrera
QUIPU, 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 Center
Many villages lack electricity and even Nairobi has a very precarious power infrastructure with frequent outages.

Nchaan with Little Tano
David Sheldrick Wildlife Trust, Nairobi, Kenya
(orphan elephant & rhino rescue with HIGHLY successful return to wild as adults)

RML Rendezvous: Transcending Borders Globally

by National Network of Libraries of Medicine, Pacific Northwest Region on Feb 16, 2011

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RML Rendezvous: Transcending Borders Globally Presentation Transcript