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RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
RML Rendezvous: Transcending Borders Globally
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RML Rendezvous: Transcending Borders Globally

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Dr. Sherri Fuller's presentation on RML Rendezvous February 16, 2011

Dr. Sherri Fuller's presentation on RML Rendezvous February 16, 2011

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  • Over a hundred years ago, there was research to identify and track cholera epidemics based on trade routes (sea as well as on land– while the methods used to collect and map the data were crude by today’s standards, they didn’t have to deal with the rapidity of movement of humans, animals!) Today, the speed of movement of humans and animals means that infections can be spread globally before we even know there is an outbreak. We need more accurate and speedier ways of identifying disease outbreaks and preventing their spread.
  • Increased vector movement may be just as important as increased human movement in contributing to the global spread of infectious diseases. There is perhaps no better illustration of this point than the global spread of Aedes aegypti and the worldwide resurgence of dengue, as described above. This same mosquito has also been responsible for yellow fever outbreaks worldwide; endemic zones include every country in South America except for Brazil and more than half the countries in Africa. Global climate change is expanding the habitat for disease vectors resulting in expansion of numerous mosquito borne diseases. Vectors are usually introduced into new areas inadvertently via vehicles used to transport people or commodities (e.g., airplanes) or via commodities that are being transported. It has been demonstrated experimentally that a number of different disease vectors can survive in the wheel wells of jet aircraft at high altitudes for long intercontinental flights. Mosquitoes also hitchhike on used car tires that are being transported for retreading or other purposes. For example, the Asian tiger mosquito, Aedes albopictus , a denguevirus vector, was introduced to the North American continent on rubber tires shipped to Houston. The United States–Mexico border, a dumping ground for used tires, is an important breeding site for Aedes mosquitoes. Animal importations are another potential source of introduced zoonoses. Before its first appearance in New York City in 1999, West Nile virus was not present in the western hemisphere. It has now spread throughout the North American continent, into Canada, Mexico, Central America, and the Caribbean. This example of the potential for the introduction of a vectorborne infectious disease into a new hemisphere also illustrates how a multitude of factors can converge to provide a ripe opportunity for emergence: the most common vector of West Nile virus in the United States, the common household mosquito ( Culex pipiens ), was already ubiquitous in the New York metropolitan area; the marshy habitat where the disease emerged was an ideal mosquito breeding ground; the location of emergence was near a major international airport; and international travelers are constantly arriving in Queens, which houses perhaps one of the most ethnically diverse populations in the world. Although the virus was almost certainly introduced via a transportation vehicle, it is unclear whether it was introduced via a vector mosquito or some other means. Other possibilities include the arrival of an infected human, an infected bird on an airplane or other transportation vehicle, an infected migrating bird, or an infected animal reservoir in the New York City area. At this point, there may be no way to trace the precise means of introduction, which in any case is somewhat immaterial, as the virus is well established in animal populations and has spread rapidly down the East Coast of the United States.
  • Problem isn’t that we have NO health information systems – if anything we have too many and they are fragmented and duplicative and wasteful of health workers precious time; have to enter the same data multiple times; silos of databases; lack of connection between important databases;
  • Based upon agreed upon standards for data collection, disease definition and using mobile technologies for data collection and sharing, advanced geographic mapping systems and significant coordination across country boundaries disease surveillance in the Mekong Basin region is greatly improving the ability to identify disease outbreaks
  • Transcript

    • 1. 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
    • 2. Why Are Global Health Information Systems Critical? <ul><li>New viruses travel more rapidly, transforming local afflictions into worldwide epidemics; new and re-emerging infectious diseases (70% of which are zoonoses) </li></ul><ul><li>A modern lifestyle that travels just as fast, contributing to swelling epidemics of non-communicable diseases </li></ul><ul><li>A human resources crisis directly linked to transnational labor, economics, migration and natural disasters </li></ul><ul><li>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 </li></ul><ul><li>Preventing and responding to these threats requires rapid and targeted exchange of accurate and detailed health information </li></ul>Adapted from: AM Kimball, Risky Trade: Infectious Disease in the Era of Global Trade. Ashgate, 2006 Center for Public Health Informatics University of Washington
    • 3. 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.
    • 4. The Animal-Human Connection: Vector-Borne Disease Spread World distribution of Dengue, 2005. SOURCE: CDC (2005)
    • 5. HIE* Challenges: Resource Constrained Countries <ul><li>Lack of birth and death (& cause of death) records </li></ul><ul><li>Predominantly print (if any) medical records </li></ul><ul><li>Health information systems investments focus primarily on “counting events” (how many cases of HIV/AIDS, TB, malaria?) </li></ul><ul><li>Siloed monitoring and evaluation systems by disease </li></ul><ul><li>One-way data flow (province/district/national); not available to health workers on ground and workers not trained in applying evidence to problem </li></ul>*Health Information Exchange Center for Public Health Informatics University of Washington
    • 6. HIE* Challenges: Resource Constrained Countries <ul><li>Mismatch between “industrial”/”western” solutions and on-the-ground needs and realities (and, yes, this includes “libraries”) </li></ul><ul><li>Severe shortage of trained health IT workers, educators, librarians and strategic leaders </li></ul><ul><li>Lack of health informatics (and librarianship) academic programs in universities to train the next generation of practitioners and researchers </li></ul><ul><li>Lack of easy, reliable access to the published literature </li></ul>Center for Public Health Informatics University of Washington
    • 7. 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
    • 8. Center for Public Health Informatics University of Washington
    • 9. Center for Public Health Informatics University of Washington
    • 10. Data Coordination – Mekong Basin Region Center for Public Health Informatics University of Washington
    • 11. Global Health Informatics Educational Trends <ul><li>Increasing demand for academically trained individuals who can: </li></ul><ul><ul><li>Research, develop and implement systems relevant to country needs </li></ul></ul><ul><ul><li>Plan and lead integrated health information systems in hospitals, districts and Ministry of Health </li></ul></ul><ul><ul><li>Educate the next generation of health information professionals AND health professionals </li></ul></ul><ul><ul><li>Universities focusing on curriculum and faculty development </li></ul></ul><ul><ul><li>Lead the development of academic health sciences libraries and information resources </li></ul></ul>Center for Public Health Informatics University of Washington
    • 12. Center for Public Health Informatics University of Washington
    • 13. UNITID Fellowship in Public Health Management UNIVERSITY OF NAIROBI Institute of Tropical & Infectious Diseases
    • 14. Mission <ul><li>To build the capacity of public health </li></ul><ul><li>professionals to provide evidence-based </li></ul><ul><li>and effective public health leadership and </li></ul><ul><li>management in the public and private health </li></ul><ul><li>sectors </li></ul>Center for Public Health Informatics University of Washington
    • 15. Collaborating Institutions <ul><li>U of Nairobi (UoN) </li></ul><ul><ul><li>Institute for Tropical and Infectious Diseases (UNITID) </li></ul></ul><ul><ul><li>School of Business </li></ul></ul><ul><ul><li>School of Economics </li></ul></ul><ul><ul><li>School of Computing and Informatics </li></ul></ul><ul><li>University of Washington: </li></ul><ul><ul><li>Center for Public Health Informatics </li></ul></ul><ul><ul><li>Department of Global Health </li></ul></ul><ul><ul><ul><li>International Training and Education Center for HIV (I-TECH) </li></ul></ul></ul><ul><ul><ul><li>Population Leadership Program (PLP) </li></ul></ul></ul><ul><ul><ul><li>International AIDS Research and Training Program (IARTP), </li></ul></ul></ul><ul><li>US Centers for Disease Control and Prevention </li></ul>Center for Public Health Informatics University of Washington
    • 16. Center for Public Health Informatics University of Washington
    • 17. Center for Public Health Informatics University of Washington
    • 18. U. Nairobi - Fellowship Training (2 years) <ul><li>Fundamentals of health informatics short course for all fellows </li></ul><ul><li>Core Fellowship training (over two years) </li></ul><ul><ul><li>HIV Science, Epidemiology </li></ul></ul><ul><ul><li>HIV Program Management and leadership </li></ul></ul><ul><ul><li>HIV Program implementation sciences core </li></ul></ul><ul><ul><ul><li>Training Skills </li></ul></ul></ul><ul><ul><ul><li>Health Economics </li></ul></ul></ul><ul><ul><ul><li>Grant Writing </li></ul></ul></ul><ul><li>Attachment in host institutions </li></ul><ul><li>Health Informatics speciality track training (5 fellows) </li></ul><ul><li>Project based on needs of host institution </li></ul>Center for Public Health Informatics University of Washington
    • 19. African Workshop on Academic Health Informatics Program Development: Nairobi, Kenya, December 7-9, 2009* <ul><li>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: </li></ul><ul><ul><li>Identify best practices in the development and delivery of university-based health informatics programs </li></ul></ul><ul><ul><li>Explore their role in capacity building in health information systems development and </li></ul></ul><ul><ul><li>Identify potential contributions to the delivery of quality health information systems and services </li></ul></ul><ul><ul><li>Synergize activities in Africa </li></ul></ul>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
    • 20. Academic Health Informatics Programs <ul><li>African universities with health informatics programs (represented at Nairobi workshop): </li></ul><ul><ul><li>Addis Ababa University, Ethiopia </li></ul></ul><ul><ul><li>University of Gondar, Ethiopia </li></ul></ul><ul><ul><li>University of Nairobi, Kenya </li></ul></ul><ul><ul><li>Kenya Medical Training College, Nairobi, Kenya </li></ul></ul><ul><ul><li>Kenyatta University, Nairobi, Kenya </li></ul></ul><ul><ul><li>National Universities Commission, Nigeria </li></ul></ul><ul><ul><li>University of Dar es Salaam, Tanzania </li></ul></ul><ul><ul><li>University of KwaZulu-Natal, South Africa </li></ul></ul>Center for Public Health Informatics University of Washington
    • 21. Findings from Nairobi Workshop: Academic Health Informatics Programs <ul><li>The value of academic partnerships (south-south/north-south) to develop curricula, faculty and student training and promote R&D agendas </li></ul><ul><li>The importance of university collaboration with Ministries of Health </li></ul><ul><li>The value of collaboration with and among NGOs, donors and private sector to address health information systems fragmentation </li></ul><ul><li>The contributions and leadership of an active university-based research and development center for addressing challenges </li></ul><ul><li>The need for catalytic funding </li></ul>Center for Public Health Informatics University of Washington
    • 22. It’s a Two-Way Street… <ul><li>What we learn from our colleagues globally can provide solutions relevant here </li></ul><ul><li>E.g. Swedish Medical Center, Public Health Seattle/King Co. and others have recently announced a Global to Local initiative.. </li></ul>Center for Public Health Informatics University of Washington
    • 23. Center for Public Health Informatics University of Washington
    • 24. Conclusion <ul><li>A key antidote to the fragmented global health information infrastructure lies in University-based educational, library and R&D programs </li></ul><ul><li>Increasing international focus on health informatics educational programs with diverse funding sources and partners: </li></ul><ul><ul><li>Rockefeller Foundation </li></ul></ul><ul><ul><li>Fogarty International Center </li></ul></ul><ul><ul><li>CDC/PEPFAR </li></ul></ul>Center for Public Health Informatics University of Washington
    • 25. Conclusion <ul><li>Significant opportunities to partner to create synergistic educational programs with partners around the world: </li></ul><ul><ul><li>Faculty, Student, Librarian Exchanges </li></ul></ul><ul><ul><li>Shared training programs </li></ul></ul><ul><ul><li>Joint development of curricula and course materials (e.g.case-based resources) </li></ul></ul><ul><ul><li>Shared library and information resources and tools </li></ul></ul><ul><ul><li>Fulbright scholar opportunities for librarians ( http://fulbright.state.gov/about.html </li></ul></ul><ul><ul><li>AND???????????? </li></ul></ul>Center for Public Health Informatics University of Washington
    • 26. Selected References <ul><li>Fuller SS Tracking the Global Express: New Tools Addressing Disease Threats Across the World Epidemiology 21(6):1-2, 2010 [Invited] </li></ul><ul><li>Kimball AM. Risky Trade: Infectious Disease in the Era of Global Trade. Ashgate, 2006 </li></ul><ul><li>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. </li></ul>Center for Public Health Informatics University of Washington
    • 27. Students Discussing Case <ul><li>2 nd Health Informatics Course for Students from throughout the Mekong Basin countries; Mahidol University, Bangkok, Thailand January 2010 </li></ul>Center for Public Health Informatics University of Washington
    • 28. Temple of the Dawn <ul><li>Wat Arun Bangkok, Thailand, February 2010 </li></ul>Center for Public Health Informatics University of Washington
    • 29. Cambodian School Girls <ul><li>Siem Reap, Cambodia February 2010 </li></ul>Center for Public Health Informatics University of Washington
    • 30. Bach Thao Park, Hanoi, Vietnam <ul><li>Cultural Festival – September 2010 </li></ul>Center for Public Health Informatics University of Washington
    • 31. Peruvian Quipu – Museo Arqueológico Rafael Larco Herrera <ul><li>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. </li></ul>Center for Public Health Informatics University of Washington
    • 32. Kenyan Mobile Phone Center <ul><li>Many villages lack electricity and even Nairobi has a very precarious power infrastructure with frequent outages. </li></ul>Center for Public Health Informatics University of Washington
    • 33. Nchaan with Little Tano <ul><li>David Sheldrick Wildlife Trust, Nairobi, Kenya </li></ul><ul><li>(orphan elephant & rhino rescue with HIGHLY successful return to wild as adults) </li></ul>Center for Public Health Informatics University of Washington

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