Policy and Technology In Health Information Systems Thoughts on the Haiti Experience
On 12 January 2010, infrastructure in Haiti disappeared
Physical data centers are fragile and the question of data sovereignty arises frequently. We need policy guidelines for the use of cloud computing (e.g. Amazon EC2 data centers), and details on safeguards that would help governments decide their data was adequately secure. We also need a little technical education for medical professionals around data storage. In many corners of the world patient information is currently sitting within Excel spreadsheets on a Gmail account server in Palo Alto, Oslo, Singapore, or Mumbai.
Surgery was done in the open air, on strangers.
There is a well-recognized tension between information transparency (with rapid information cycles, improved response times, and public safety), and privacy , with issues of ethics, trust, and personal safety. International guidelines should be developed, adopted, and incorporated into each HIS that recognize the tension between the two, transparency and privacy, and the need to address both sides of the question with variable weight, depending upon current needs.
The Health Information System was English words on bandages.
Lots of strangers arrived quickly. None spoke Creole.
We need collegial adherence to interoperability standards, with peer consequences for misbehavior. Interoperability is a common mantra in HIS development and the subject of multiple discussions at this Conference and elsewhere, but it is not yet reality. In Haiti we have again seen that we need medical records that can talk to indicator analysis spreadsheets, indicator spreadsheets that can talk to maps, maps that can talk to medical records, and so on, continuing seamlessly through necessary and expected tasks.
We need to establish parameters for how outside influences (e.g. academic research efforts, NGO interventions, and international grant awards) are determined to mesh with Ministry and population priorities in the introduction of technologies for assessment and management. A little courtesy can avoid unhelpful and unnecessary conflict.
If the HIS selected is not open-source, establish a code-escrow within the HIS license. That way, when the proprietary business fails, the HIS code held in escrow reverts to the users, is not orphaned, and can be redistributed for expansion, enhancement or technical support.
TELCOS have low-cost services to offer that provide significant humanitarian benefit, with positive subsequent media and financial return to their parent corporations. No-cost contracts for humanitarian shortcodes and humanitarian SMS messaging should be routine, whether national or corporate TELCO.
HIS implementations should incorporate, wherever possible, capacity building and exit strategies for the implementation team, eventually placing the Health Information System into the hands of the nationally responsible party. Do not build structures that circumvent the natural responsibilities governments have for their citizens.