Global Health Informatics

In Focusing the Spotlight on Lack of Access to Health Information, the PloS Editors state: “Access to health information is a key component of a strong health system, but to be effective it requires evaluation and synthesis of evidence, translation of evidence into educational materials, and implementation and dissemination. Health information is one key component of the complex task of improving weak health systems, along with cooperation, political will, and funding. “In the 21st century, knowledge is the key element to improving health. In the same way that people need clean, clear water, they have a right to clean, clear knowledge”. This is how Sir Muir Gray, Director of the UK's National Health Service (NHS) National Knowledge Service, describes the importance of health knowledge. Knowledge underpins every medical advance, every intervention, and every clinical decision. However, access to reliable health information for even the most basic health needs remains elusive for much of the world's population. Neil Pakenham-Walsh and Molly Land argue that, because access to health information is a key determinant to the human right to the highest attainable standard of health, governments have a legal responsibility under international human rights law to provide access to healthcare information to citizens and health workers.”

"A key determinant to reach Sustainable Development Goal 3 (Ensure healthy lives and promote well-being for all at all ages)  is a resilient, well-functioning, and responsive health system that meets the basic needs of health workers and thereby empowers them to provide safe and effective care for all. Of all the basic needs of health workers, the need for reliable, appropriate healthcare information is fundamental to make informed decisions." This is a quote from the Health Information for All organisation whose vision is "A world where every person and every health worker will have access to the healthcare information they need to protect their own health and the health of those for whom they are responsible." HIFA

Health informatics and information access.

The task of Health Informatics is to improve access to information. How can this be achieved?

This can be at the level of the policy-maker, where despite the potential: “The problems preventing decision makers from having access to information are many and complex. The assessments identified no fewer than eight problem areas that impeded decision makers' access to information. The most common deficiencies were concerning the design of the system, ongoing training of personnel and dissemination of data from the system.” (Wilkins K et al) 

Or at the level of the clinician through electronic clinical decision support.

One interesting notion is to enable clinicians to seek remote consultations for conditions outside their comfort or knowledge zone. I've got 99 problems but a phone ain't one: Electronic and mobile health in low and middle income countries “By bringing down the costs of remote consultations and clinical audit, respectively, these projects offer the potential for clinics in resource-limited settings to deliver high-quality care.”

A study by Addison et al How doctors make use of online, point-of-care clinical decision support systems: a case study of UpToDate©  has found “Clinical staff use point-of-care online resources in a variety of ways. Disseminating instructive examples of innovative usage should improve clinical care and increase usage.” Although the evidence for this was only anecdotal.

Or at the level of the citizen: "We recently commissioned a survey of 1700 projects of mobile technology for health (known as mHealth). Our findings showed that none of these services provided essential, actionable, offline guidance for direct use by citizens addressing the range of acute health-care situations commonly encountered in low-resource settings, and very few provided any such content at all. There is clearly a huge and growing opportunity for citizens to have health-care information on their phones, available offline as and when they need it. Up to now, this opportunity has been constrained by three challenges. First, most mobile phones in low-resource settings are basic phones that can accommodate only voice and SMS text messaging with no internet connectivity or multimedia capability. Second, there is a shortage of appropriate content. Third, how to place the content onto individual phones?" (Royston G et al) 

To help take advantage of the potential for mHealth, HIFA has developed The First HIFA SMART Goal: Mobile Healthcare Information For All “Thousands of lives could be saved every day if all mobile phones had basic healthcare knowledge, including and especially first aid, maternal, and child health information for citizens” This goal was to be met by 2015 - and we are well past that now! We leave this in our resources, as the goal is still relevant, and largely unmet.

So, there does appear to be potential for informatics to improve access to information, however progress is slow and implementation is weak.