Global Health Informatics

Information is essential to make evidence-based decisions on health care and prevention. In the age of the internet revolution, information has never been more available, and health providers and policymakers have the opportunity to use information effectively and efficiently. Let's start by considering what systems are required to produce, collect and collate health information. In later Topics, we will consider the uses to which the information can be put.

Health Information Systems (HIS)

Health information systems refer to any system that captures, stores, manages or transmits information related to the health of individuals or the activities of organisations that work within the health sector. This definition incorporates things such as district-level routine information systems, disease surveillance systems, and also includes laboratory information systems, hospital patient administration systems (PAS), and human resource management information systems (HRMIS). Information systems, particularly at lower levels of the health system (closer to the collection source), need to be simple and sustainable and not overburden health delivery staff or be too costly to run. (From the Pacific Health Information Network.)

The Health Metrics Network was established by WHO to “to help countries and other partners improve global health by strengthening the systems that generate health-related information for evidence-based decision-making.” The Network has completed its work and is no longer in existence, but their document Framework and Standards for Country Health Information System Development remains an important resource. You can see the full report, and the graphics below were taken from it. The picture of the Framework below is a good summary of how we can think about the various components of HISs and how to strengthen them:

From: Framework and standards for country health information systems / Health Metrics
Network, World Health Organization. – 2nd ed.

We can expand the first of these sections as follows:

• Health Information Systems Resources

These include the legislative, regulatory and planning frameworks required for a fully functioning health information system, and the resources that are required for such a system to be functional. Such resources involve personnel, financing, logistics support, information and communications technology (ICT), and coordinating mechanisms within and between the six components.

• Indicators

A core set of indicators and related targets is the basis for a health information system plan and strategy. Indicators need to encompass determinants of health; health system inputs, outputs and outcomes; and health status

• Data Sources

These can be divided into two main categories: (1) population-based approaches (censuses, civil registration and population surveys) and (2) institution-based data (individual records, service records and resource records). A number of data-collection approaches and sources do not fit into either of the above main categories but can provide important information that may not be available elsewhere. These include occasional health surveys, research, and information produced by community-based organisations.

• Data Management

This covers all aspects of data handling from collection, storage, quality assurance and flow, to processing, compilation and analysis

Levels and Domains

These can be applied at various levels and domains as in these further graphics from the Health Metrics Network report:

From: Framework and standards for country health information systems / Health Metrics
Network, World Health Organization. – 2nd ed.

From: Framework and standards for country health information systems / Health Metrics
Network, World Health Organization. – 2nd ed.

Data sources

It is also important to consider the various potential sources of data – institution and population.

From: Framework and standards for country health information systems / Health Metrics
Network, World Health Organization. – 2nd ed.

Electronic Health  Records (EHR)

EHRs have considerable potential (but see later in the course for an evaluation). Tierney et al have studied EHRs in Kenya and capture the potential as: "Effective and efficient patient care management requires information. Improving information capture and flow should allow low-resource countries to deliver the most care and realize the best outcomes possible for the restricted funds available for health care. EMRs can enhance the timely capture and use of key medical data by providers and health system managers."

Do we have the competences required?

As a basic, we need appropriate competence among the health workforce – Whittaker and colleagues found in Preparing for the data revolution: identifying minimum health information competencies among the health workforce “that staff at the facility level should be able to collect, collate and report data, and correctly use standard health system reporting forms. The competencies focused on both the generation and use of data at all levels of the health system, highlighting the importance of embedding a culture of information use.”

Information Technology

These are basics, but how can the Information Technology revolution help? CDC Atalanta on its website What is Public Health Informatics, has this picture. It gives a good indication of the types of information tools we can use to support Pubic Health:

From: Public Health Informatics, Centers for Disease Control and Prevention

'Big data' - using the internet to collect data

Examples of ways in which data can be obtained from the internet include: "the analysis of queries from Internet search engines to predict disease outbreaks (eg. influenza); monitoring peoples' status updates on microblogs such as Twitter for syndromic surveillance; detecting and quantifying disparities in health information availability; identifying and monitoring of public health relevant publications on the Internet (eg. anti-vaccination sites, but also news articles or expert-curated outbreak reports); automated tools to measure information diffusion and knowledge translation, and tracking the effectiveness of health marketing campaigns". - this list comes from a paper: Infodemiology and Infoveillance... By Eysenbach. This updated by Kostkova in Grand Challenges in Digital Health: "Recent achievements in mobile technology and sensor/wearable devices have created real-time geo-located big data streams, facilitating context-aware social media communication and participatory systems that are radically changing the way we monitor populations with unprecedented opportunities for disease surveillance, early-warning, preparedness, and rapid response." and by Njuguna et al "Electronic data collection using smartphones has potential to improve timeliness, data integrity and reduce costs."

Precision Public Health

In a challenging commentary, Four steps to precision public health, Dowell and colleagues state "The availability and use of precise data are becoming the norm in wealthy countries. But large swathes of the developing world are not reaping its advantages." They make the case for "Better surveillance data and analyses are urgently needed to control disease in the developing world". The paper is well worth a read.

Data science is a useful tool for understanding patterns and risk factors for substance abuse. This understanding helps to inform treatment and prevention programs, tailoring them to specific audiences and making them more effective overall. Watch the video from 42:50 to 50:05 to understand how data science can be applied in substance use treatment and prevention interventions.

Social media plays a major role in modern human society, and many individuals regularly post intimate details of their lives on social networks that they may be less likely to share in a face-to-face setting. Analyzing social media content can provide insight into risk factors for substance use and help to identify characteristics of high-risk individuals. Read the content from the heading "A Multidimensional Framework to Analyze Social Media Communications for Problematic Use of Prescription Drugs" to "Researcher's Responsibilities and Big Data Ethics in Studying Social Media Users with Substance Use Problems." (Optional)

This resource provides an overview of how informatics can be applied to various aspects of substance use treatment and prevention interventions. Read the content in the sections "Chapter 1: Public Health Informatics: An Overview" and "Using Informatics to Deliver Treatment Solutions." There are also links to other resources which you may choose to review for additional information.

Finally: As we update this resource, there will be plenty of new examples to show how Information Technology can help. But let's move on to discuss the ways in which we can make this information accessible.