Resources Lesson 1: Using Information for Evidence-based Practice and Policy
We can consider the uses of health informatics under two main headings - clinical and public health (although there is overlap between these categories)
Clinical care and prevention
An excellent summary from an old but still highly relevant paper, E-Health Technologies Show Promise In Developing Countries identifies eight categories corresponding to the typical applications used in developing countries. “The order of these categories does not infer any priority:
(1) Electronic health record: an electronic record of health-related information on an individual that can be created, managed, or consulted by clinicians or staff. In literature, the term electronic medical record is used interchangeably and is used as a synonym in this paper.
(4) Patient registration or scheduling system: any system used to monitor and manage the movement of patients through multistep processes or to maintain a census. An example is admissions-discharge-transfer systems.
(5) Monitoring, evaluation, and patient tracking system: any system used for aggregate reporting of information, program monitoring, and tracking of patients’ status. Examples include district health information systems or health management information systems.
(6) Clinical decision support system: system designed to improve clinical decision making, in which characteristics of individual patients are matched to a computerized knowledge base and software algorithms generate patient-specific recommendations.
Piette et al, in Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here? have another classification of the impact of e-health
- systems facilitating clinical practice; includes systems facilitating clinical practice include electronic medical record systems, picture archiving and communication systems for managing digital medical images, and laboratory information systems that automate laboratory workflow and reporting.
- institutional systems: include systems for health information and management, early disease warning and disaster management. These systems aggregate data from health facilities and patients to create community-wide views of disease trends and clinical activity.
- systems facilitating care at a distance; include the use of a short message service (SMS) or other text messaging to improve outcomes through patient reminders; between-visit monitoring and/or health education; videoconferencing facilities for live consultations and asynchronous communication between clinicians, and automated telephone calls with recorded messages (sometimes called interactive voice response calls).
Another group of potential applications to clinical practice, and not really included in the categories above, is how clinical diagnosis can be aided by technology, such as in this paper: Acceptability, Usability, and Views on Deployment of Peek, a Mobile Phone mHealth Intervention for Eye Care in Kenya: Qualitative Study. "The Portable Eye Examination Kit (Peek) is a mobile phone–based ophthalmic testing system that has been developed to perform comprehensive eye examinations. Shortages in ophthalmic personnel, the high cost, and the difficulty in transporting equipment have made it challenging to offer services, particularly in rural areas. Peek offers a solution for overcoming barriers of limited access to traditional ophthalmic testing methods and has been pilot tested on adults in Nakuru, Kenya, and compared with traditional eye examination tools."
The open online journal, JMIR mHealth and uHealth, is well worth following for papers such as this.
Digital healthcare. The Digital Healthcare Leap is a very interesting paper which concludes: "Digital technology has the potential to bridge time, distance, the affordability of healthcare and the expectation gap between consumers and clinicians."
Public health surveillance: As discussed in The Role of Public Health Informatics in Enhancing Public Health "Surveillance has benefitted from, and has often pioneered, informatics analyses and solutions. However, the field of informatics also serves other facets of public health including emergency response, environmental health, nursing, and administration. Public health informatics has been defined as the systematic application of information and computer science and technology to public health practice, research, and learning".
Ebola: Post EBOLA – Exploring a National Disease Surveillance System for Nigeria - is a good example of the potential for public health surveillance.
Zika: The paper Digital Participatory Surveillance and the Zika Crisis: Opportunities and Caveats says that "Managing the global threat of Zika requires innovative solutions. This article examines the potential of Digital Participatory Surveillance to support the management of global disease outbreaks by enabling citizens to report signs of infection." However, “Investing in DPS initiatives is likely to be worthwhile but integrating research and evaluation is vital for informing public health policies and programmes “
Internet-based surveillance: Internet-based surveillance systems for monitoring emerging infectious diseases suggests that "The increase in emerging infectious diseases has led to calls for new technologies and approaches for detection, tracking, reporting, and response. Internet-based surveillance systems offer a novel and developing means of monitoring conditions of public health concern, including emerging infectious diseases. We review studies that have exploited internet use and search trends to monitor two such diseases: influenza and dengue. Internet-based surveillance systems have good congruence with traditional surveillance approaches. Additionally, internet-based approaches are logistically and economically appealing. However, they do not have the capacity to replace traditional surveillance systems; they should not be viewed as an alternative, but rather an extension".
Dengue: An example of potential, yet caution, comes from Evaluation of Internet-based dengue query data: Google Dengue Trends. "Google Dengue Trends (GDT) which uses near real-time search query data to create an index of dengue incidence that is a linear proxy for traditional surveillance. Studies have shown that GDT correlates highly with dengue incidence in multiple countries on a large spatial scale...While GDT seems to be a less robust indicator of local transmission in areas of low incidence and unfavorable climate, it may indicate cases among travelers in those areas. Identifying the strengths and limitations of novel surveillance is critical for these types of data to be used to make public health decisions and forecasting models".
This caution is bourne out by the fact that Google Flu Trends and Google Dengue Trends has ceased reporting new data and Google says "It is still early days for nowcasting and similar tools for understanding the spread of diseases like flu and dengue – we're excited to see what comes next"
Digital Technology as a Tool for Public Health is an excellent summary of the potential role of informatics in Public Health. The information below comes directly from their website:
EHealth interventions - Overall, study results indicated that eHealth interventions are feasible in controlled settings and that individuals are generally open to using technology to monitor and improve health behaviours, attitudes and beliefs. Examples include using technology to increase testing for sexually transmitted infections, and access to personal immunization records, schedules and information; Increasing health literacy;
Global health surveillance “Just as the Internet and social media can provide individuals with important information, they can also be a source of invaluable data for public health professionals and official organizations around the world.“ The Global Public Health Intelligence Network GPHIN is an electronic public health early-warning system developed by the Public Health Agency of Canada to help identify globally significant disease outbreaks and other health threats from around the world by taking advantage of the existing globalized virtual communications.
Syndromic surveillance, just as its name suggests, aims to track symptoms associated with a defined syndrome, such as influenza-like illness or acute respiratory illness, rather than depending on laboratory-confirmed disease data. Google has taken that concept and created Google Flu Trends, although this is not currently active in 2016 due to the inaccuracies in the data that it produced.
“Infectious disease outbreaks and trends are not the only things that can be captured through the mining of Internet and social media activity. People's online searches, discussions and postings can also provide information useful in identifying issues surrounding chronic diseases, including mental illness. For example, social media mining can show pockets of poor mental health or mental illness in communities, thereby allowing the relevant health service to develop early intervention strategies”
Unfortunately, at the time of developing this course, the impact of IT on health care and prevention is mainly theoretical, as we will see in the next section on evaluation. The Canadian report concludes: “There are endless ways in which public health and technology do, can and will come together. Although the role of technology in public health in the future is as yet unknown….“