This document summarizes a presentation on public and global health informatics from 2014. For public health informatics, it reviewed literature from 2013-2014 and found articles focused on syndromic surveillance, immunization registries, and population health. It noted ongoing challenges around interoperability and jurisdictional silos. For global health informatics, it described the search strategy and inclusion/exclusion criteria used to identify 199 relevant articles published between 2012-2013. The majority of global health informatics articles covered telemedicine, mHealth, and EMR/EHR technologies.

1. Public and Global Health
Informatics Year in Review
Brian E. Dixon, MPA, PhD, FHIMSS
Jamie Pina, PhD, MSPH
AMIA Annual Symposium
November 17, 2014

2. Disclaimers and Conflicts
• Brian is a federal employee at VA
– His comments are his own and do not represent
the views of the VA
• Jamie is an employee of RTI International and
Emory University
– His comments are his own and do not represent
the views of the views of either organization

3. Content for this session available:

4. About this session
• What this is NOT
– A systematic review
– A comprehensive review of everything
• If we did not include an article you think
should have been presented, accept our
apologies
– We did our best

5. A very special THANK YOU to
• Co-authors
– Hadi Kharrazi (JHU Pop Health Informatics)
– Janise Richards (CDC)
• Research Assistants and Reviewers
– Fardad Gharghabi (JHU Pop Health Informatics)
– Louis Imperiale (AMIA Summer Scholar)
• PHI and GHI WG Contributors

6. Agenda
• Public Health Informatics
– Representative Recent Literature
– Notable Events
• Global Health Informatics
– Representative Recent Literature
– Notable Events

7. Public Health Informatics
Brian E. Dixon, MPA, PhD, FHIMSS
Hadi Kharrazi, MD, PhD
Fardad Gharghabi, MD, MS

8. Search Strategy
• Independent searches of Ovid MEDLINE
– Indexed and In-process, English-only
– Oct 2013 – Sep 2014
– Abstract and full-text available for review
• Search terms included: public health
informatics, public health, medical
informatics, information system

9. Inclusion Criteria (PHI)
1. Informatics, information sciences, or computing is
the primary subject of study or a main component
of the study methodology; and
2. Focused on a topic of public health practice or
research:
1. Activities conducted by, with, or involving a local, state or
federal health agency;
2. Assessment or monitoring of disease and health
outcomes;
3. Primary/secondary prevention;

10. Exclusion Criteria (PHI)
1. Articles that do not constitute original research, such as
letters to the editor, editorials/perspectives, or comments;
2. Research or activities occurred principally in a low or
middle-income county (LMIC); this constitutes overlap with
the GHI working group;
3. Study protocols excluded.
4. Research or activities that focus primarily on clinical health
services or delivery (e.g., use of telemedicine to provide
remote diagnosis / treatment) even if performed by a public
health agency;

11. Overview of Selection Process
• Seek articles w
suggestions from WG
members
• Review abstracts –
multiple reviewers with
third adjudicator
• Full article review –
multiple reviewers
MEDLINE Search
N=160
Abstract Review
N=57
Full Review
N=20
Public Health

12. Article Types
25%
75%
Reviews
Original
Research

13. Areas / Technologies of Focus
(Original Research Only)
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Syndromic
Surveillance
Notifiable
Disease
Surveillance
Immunization
Information
System
Environmental Population
Health
Other

14. Areas/Technologies of Focus
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Syndromic
Surveillance
Notifiable
Disease
Surveillance
Immunization
Information
System
Environmental Population
Health
Other
(Review Papers Only)

15. Source of Data for Original
Research
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
EHR/EMR Social
Media
HIE Mobile Survey Other

16. Impact of Technology/System
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
Completeness Timeliness Accuracy User
Satisfaction
Pop Health
(Original Research Only)

17. Impact of Technology/System
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
Completeness Timeliness Accuracy User
Satisfaction
Pop Health
(Review Papers Only)

18. Jurisdiction
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Federal State County

19. Notable Events in PHI

20. • After a hiatus since 2011, CDC sponsored a
PHI conference in 2014
• Conferences will be held biennially*

21. Public Health & HIE Toolkit
• New Toolkit for Health Departments
– Learn about HIE: what is it, types
– What can a health department utilize HIE?
– What is the value proposition for HIE?
• www.himss.org/public-health-hie-toolkit
• Funded by CDC

22. Rollout of the PPACA and ACOs
• Health reform is driving the need for new and
better approaches to population health
management by PH and clinical orgs alike

23. The value of robust, integrated
infrastructure for PHI
• Several high profile
disease outbreaks
demonstrate that the
need for robust
syndromic surveillance
and integrated systems
between clinical and
public health has never
been greater

24. Meaningful Use Criteria
http://www.healthit.gov/newsroom/onc-public-
health-surveillance

25. D-D-D-D-D DEFENSE
• Meaningful Use regulations and requirements
under scrutiny from Congress
– REBOOT report
– Why is interoperability still an issue?
• The HIT FACAs initially considered dropping
the PH related MU objectives from Stage 3
– Joint Public Health Informatics Taskforce (JPHIT)
responded quickly with help from AMIA PPC and
the PHI-WG leadership

26. PHI Summary / Conclusions
• PHI Evidence Base Remains Weak
– Challenging to find original research in PHI
– Many good editorials out there
• Yasnoff (Pop Health Mgmt), Mandl (JAMA), Cimino (JBI),
among others
• Articles from 2014 Focused on MU Functions
– ELR, Syndromic Surveillance, Immun Registries
– Population Health

27. PHI Summary / Conclusions
• Important Challenges Remain
– Interoperability / Architecture
– Governance / Jurisdiction Silos
– Workflow / Human Factors
• Should we Split or Lump PHI and Pop Health?
– About 3% of health care $$$ for public health
– ACOs and Large Health Systems more $$$; need to
perform pop health to meet their goals

28. Questions?
Answers
Brian E. Dixon, MPA, PhD, FHIMSS
Assistant Professor, IU Fairbanks School of Public Health;
Research Scientist, Regenstrief Institute;
Health Research Scientist, Department of Veterans Affairs
http://tinyurl.com/fsphbed
Twitter: @dpugrad01

29. RTI International
RTI International is a trade name of Research Triangle Institute. www.rti.org
Global Health Informatics
Annual Review
Jamie Pina, PhD, MSPH
Janise Richards, PhD, MPH, MS

30. RTI International
A very special THANK YOU to
 Reviewers:
– Glynda Doyle (British Columbia Institute of Technology)
– Stephen Brown (RTI International)
– James Kariuki (CDC)
– Soudabeh Khodambashi (Norwegian University of Science & Tech.)
– Onyinyechi Enyia Daniel (University of Illinois School of Public Health)
– Suranga Kasthurirathne (Indiana University School of Informatics)
– Saptarshi Purkayastha (Indiana University School of Informatics)
 GHI Working Group Contributors

31. RTI International
Global Health Informatics Characteristics
 Resource-constrained environments
– Training/knowledge
– Funding
– Infrastructure (physical and
organizational)
 Externaldonor funding from other
countries and philanthropies
 Weak commercial market for global
health informatics (GHI) products

32. RTI International
Search Strategy
We included Low and Middle income countries (LMIC) as defined
by the World Bank
As of 1 July 2013, the World Bank income classifications by GNI
per capita are as follows:
Low income: $1,035 or less
Lower middle income: $1,036 to $4,085
Upper middle income: $4,086 to $12,615

33. RTI International
GHI megaQuery
("mhealth"[Title/Abstract] OR "mobile health"[Title/Abstract] OR "Electronic Health Records"[Mesh] OR
"electronic medical record"[Title/Abstract] OR "electronic medical records"[Title/Abstract] OR
"electronic health record"[Title/Abstract] OR "electronic health records"[Title/Abstract] OR
"Informatics"[Mesh] OR "Telemedicine"[Mesh] OR "information system"[Title/Abstract] OR "information
systems"[Title/Abstract]) AND ("developing country" OR developing countries OR "developing nation"
OR "developing nations" OR "developing population" OR "developing populations" OR "developing
world" OR "less developed country" OR "less developed countries" OR "less developed nation" OR "less
developed nations" OR "less developed population" OR "less developed populations" OR "less
developed world" OR "lesser developed country" OR "lesser developed countries" OR "lesser developed
nation" OR "lesser developed nations" OR "lesser developed population" OR "lesser developed
populations" OR "lesser developed world" OR "under developed country" OR "under developed
countries" OR "under developed nation" OR "under developed nations" OR "under developed
population" OR "under developed populations" OR "under developed world" OR "underdeveloped
country" OR "underdeveloped countries" OR "underdeveloped nation" OR "underdeveloped nations"
OR "underdeveloped population" OR "underdeveloped populations" OR "underdeveloped world" OR
"middle income country" OR "middle income countries" OR "middle income nation" OR "middle income
nations" OR "middle income population" OR "middle income populations" OR "low income country" OR
"low income countries" OR "low income nation" OR "low income nations" OR "low income population"
OR "low income populations" OR "lower income country" OR "lower income countries" OR "lower
income nation" OR "lower income nations” OR "lower income population" OR "lower income
populations" OR "underserved country" OR "underserved countries" OR "underserved nation" OR
"underserved nations" OR "underserved world" OR "under served country" OR "under served countries"
OR "under served nation" OR "under served nations" OR "under served world" OR "deprived country"
OR "deprived countries" OR "deprived nation" OR "deprived nations" OR "deprived population" OR
"deprived populations" OR "deprived world" OR "poor country" OR "poor countries" OR "poor nation"
OR "poor nations" OR "poor population" OR "poor populations" OR "poor world" OR "poorer country"
OR "poorer countries" OR "poorer nation" OR "poorer nations" OR "poorer population" OR "poorer
populations" OR "poorer world" OR "developing economy" OR "developing economies" OR "less
developed economy" OR "less developed economies" OR "lesser developed economy" OR "lesser
developed economies" OR "under developed economy" OR "under developed economies" OR
"underdeveloped economy" OR "underdeveloped economies" OR "middle income economy" OR
"middle income economies" OR "low income economy" OR "low income economies" OR "lower income
economy" OR "lower income economies" OR "low gdp" OR "low gnp" OR "lower gdp" OR "lower gnp"
OR lmic OR lmics OR "third world" OR "lami country" OR "lami countries" OR "transitional country" OR
"transitional countries" OR Africa OR Asia OR Caribbean OR West Indies OR South America OR Latin
America OR Central America OR Afghanistan OR Albania OR Algeria OR Angola OR Antigua OR Barbuda
OR Argentina OR Armenia OR Armenian OR Aruba OR Azerbaijan OR Bahrain OR Bangladesh OR
Barbados OR Benin OR Byelarus OR Byelorussian OR Belarus OR Belorussian OR Belorussia OR Belize OR
Bhutan OR Bolivia OR Bosnia OR Herzegovina OR Hercegovina OR Botswana OR Brazil OR Bulgaria OR
Burkina Faso OR Burkina Fasso OR Upper Volta OR Burundi OR Urundi OR Cambodia OR Khmer Republic
OR Kampuchea OR Cameroon OR Cameroons OR Cameron OR Camerons OR Cape Verde OR Central
African Republic OR Chad OR Chile OR Colombia OR Comoros OR Comoro Islands OR Comores OR
Mayotte OR Congo OR Zaire OR Costa Rica OR Cote d'Ivoire OR Ivory Coast OR Croatia OR Cuba OR
Cyprus OR Czechoslovakia OR Czech Republic OR Slovakia OR Slovak Republic OR Djibouti OR French
Somaliland OR Dominica OR Dominican Republic OR East Timor OR East Timur OR Timor Leste OR
Ecuador OR Egypt OR United Arab Republic OR El Salvador OR Eritrea OR Estonia OR Ethiopia OR Fiji OR
Gabon OR Gabonese Republic OR Gambia OR Gaza OR Georgia Republic OR Georgian Republic OR Ghana
OR Gold Coast OR Greece OR Grenada OR Guatemala OR Guinea OR Guam OR Guiana OR Guyana OR
("mhealth"[Title/Abstract] OR "mobile
health"[Title/Abstract] OR "Electronic Health
Records"[Mesh] OR "electronic medical
record"[Title/Abstract] OR "electronic medical
records"[Title/Abstract] OR "electronic health
record"[Title/Abstract] OR "electronic health
records"[Title/Abstract] OR
"Informatics"[Mesh] OR "Telemedicine"[Mesh]
OR "information system"[Title/Abstract] OR
"information systems"[Title/Abstract])

34. RTI International
Inclusion Criteria (GHI)
 Published in a peer-reviewed journal.
 Features informatics, information science, or
information systems as the primary subject of
study or a main component of the study
methodology.
 Focused on a topic of global health practice or
research. We define the topics of global health
as delineated by this paper: Koplan, J.P. et al.,
Towards a common definition of global health.
Lancet, 2009. 373(9679): p. 1993-5.

35. RTI International
Inclusion Criteria (GHI)
 Focus is within a resource-constrained
environment Constraints include reduced
human resources, financial resources,
infrastructure, etc.
 Written (or translated into) English
 Full abstract and text are available.
 Systematic reviews are included

36. RTI International
Exclusion Criteria (GHI)
 Narrative reviews and articles that do not
constitute original research, such as letters to
the editor, editorials/perspectives, or comments
 Work focused on domestic outcomes
 Research where an information system is used
but the system is not the focus of the study

37. RTI International
What Were Reviewers Asked?
 Type – Type of article -
review/research/methods/models
 Category – The main keywords for the article (one or
two words)
 Objective – Focus of the article – main objective
 Principal Findings – Main findings of the study
 Impact Rank – On a scale of 0-10, how much will this
article potentially impact the field of GHI?
 Other Notes – Anything that may be important to note
about the article

38. RTI International
Overview of Selection Process - GHI
 Seek articles with
suggestions from GHI
WG members
 9 professional
informaticians reviewed
titleabstracts based on
the inclusion criteria
 Today’s analysis is based
on data provided by
reviewers
MEDLINE
Search
N=819
Abstract
Review
N=417
Included
N=199

39. RTI International
Comparison to 2013 Annual Review
In 2013 we collected and reviewed
422 articles, with a search range of
24 months.
In 2014, we collected and reviewed
819 articles, with a search range of
12 months.
Our new query is more sensitive

40. RTI International
Article Types
27, 14%
24, 12%
108, 54%
40, 20%
Methods
Model
Research
Review

41. RTI International
GHI Article Categories (Keywords)
0 10 20 30 40 50 60 70 80
Telemedicine
mhealth
EMREHR
Other
Decision Support
National System
Epidemiology
ICT
Training
GIS
Emergency Response

42. RTI International
GHI Article Categories (Keywords)
0 10 20 30 40 50 60 70 80
Telemedicine
mhealth
EMREHR
Other
Decision Support
National System
Epidemiology
ICT
Training
GIS
Emergency Response “Other” included:
“Interoperability”
“Ontology”
“Security”
“Social Network”
“NLP”
“Big Data”
“Cloud”
“Dental Informatics”
“Registry”

43. RTI International
Impact Rankings
0
5
10
14
38
27
40 41
8
0
0
5
10
15
20
25
30
35
40
45
1 2 3 4 5 6 7 8 9 10
Reviewer Impact Rankings

44. RTI International
Themes in the GHI literature - 2014
Scaling up and evaluating mhealth interventions
mhealth interventions were used for measurement of:
Psychiatric disorders, total healthwellness, surveillance of
rabies, infant feeding, drug adherence, measure impact of
perinatal intervention, evaluate mobile survey platforms
mobile apps to improve X (waiting time, order entry)
Kaonga NN, Labrique A, Mechael P, Akosah E, Ohemeng-Dapaah S, Baah-Sakyi J, Kodie R, Kanter AS,
Levine O. Mobile phones and social structures: an exploration of a closed user group in rural Ghana. BMC
Medical Informatics and Decision Making. 2013;13:100.

45. RTI International
Themes in the GHI literature - 2014
Implementation and Adoption of EMREHR
Measuring impact of EMREHR adoption on one or more health
outcomes
EMR relationship to: Data quality, Adherence of ART
Factors that lead to adoption
Identifying minimum data sets
Standardized EHR Grading

46. RTI International
Themes in the GHI literature - 2014
“Readiness Studies”
Studies that assess training, human resources, availability
of hardware, of providers, patients, andor hospitals, phone
ownership and data access.

47. RTI International
Themes in the GHI literature - 2014
Reviews and Systematic Reviews
Impact of mhealth interventions on healthcare quality
Mobile health potential impact
Use of open-source EHRs,
HIS in 14 SSA countries
mobile phone interventions for consumer health
overcoming shortage of human health resources in
developing countries

48. RTI International
Themes in the GHI literature - 2014
Information and Communication Technology (ICT)
Measuring system and power outage
Security and privacy enhancements
Cloud-based migrations and implementations
Measuring hospital’s ability to outsource effectively
Data transformationsmapping to multiple standards

49. RTI International
Themes in the GHI literature - 2014
Imaging and Radiology
Improving services by integrating systems, reducing cost,
using mobile devices, and applying new techniques
Exploring new methods to identify and compare data in
images

50. RTI International
Themes in the GHI literature - 2014
Emergency Response and Preparedness
Research that explores health-related technologies used
during and after an emergency.
Post-flood information needs of physicians

51. RTI International
Notable Events in GHI - 2014

52. RTI International
The conferenced feature a
GHI track
Workshop focused on a
developing a Global
Agenda for GHI held
GHI Track at Public Health Informatics
Conference in 2014

53. RTI International
The mHealth Summit had
a global health track
Provided a specific
platform for mhealth
discussion in a global
health context
mHealth Summit 2014

54. RTI International
The WHO’s eHealth
Technical Advisory Group
will support the work of the
WHO in their eHealth
efforts including policy and
governance,
standardization and
interoperability, research
and global surveys,
eLearning and capacity
building.
WHO forms new eHealth TAG

55. RTI International
Call for papers now open!
Serving the Underserved:
Integrating Technology and
information for Better Care
Global Telehealth 2015 Announced

56. RTI International
A structured methodology
to provide a
comprehensive
assessment of the capacity
of the human resource
support system for a
country’s supply chain.
USAID Deliver Project

57. RTI International
Articles about contact tracing in
The Economist
Increased use of (and news
coverage about) disease tracking
systems and predictive tools
including Epi Info, eHARS,
Healthmap, etc.
The Ebola Crisis has increased awareness
of Global Health Informatics activities

58. RTI International
Questions?
Brian Dixon, IU FSPH / Regenstrief / VA
bedixon@regenstrief.org
Jamie Pina, RTI International and Emory University
jpina@rti.org
We intend to submit these findings for
publication to the Online Journal of
Public Health Informatics.
Thank you!