Collaboration in Public Health Informatics

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Collaboration in Public Health Informatics

• Problems, Methods, and Tools

Within Creative Approaches to Collecting and
Linking Data and Systems to Improve the Health
of the Public
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Dengue Fever cases 1955 - 2005
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Questions in outbreak epidemiology

• What information isnt getting to those who need
  it?

What field reports and alerts should come faster?
Which systems need to share information?
Which groups should be making more decisions
together?
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A few disease-reporting problems weve found

• Cultural acceptance
• Geo-referenced imagery
• Languages and translation
• Unreliable communications
• Minimal Essential Data Sets
• Complex System Assessments
• Epidemiology Decision Support
• Rapid Assessment Consolidation
• Emergent Strategic Collaboration
• Consolidating Human-Animal-Environmental health
  impact

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Refugee management
Katrina response
In our view, collaboration, in outbreak
containment and humanitarian action, is THE
critical task
Cholera outbreak
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Responding to emerging infections

• Law and policy
• Collaborative information flow
• Critical infrastructure

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What we face in collaboration efforts

• Harsh field conditions
• Slow, unreliable networks
• Stressed users
• Disincentives for cooperation
• Unsuitable platforms
• Slow and misleading data collection
• Lack of tools for information sharing
• Poorly designed applications

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You must take responsibility for what you
know. President John F Kennedy
Innovative Support to Emergencies, Diseases, and
Disasters
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Credibility requires a process

• Problem statement
• Requirements extraction
• Specification listing (using accepted standards)
• Development of the new resource
• Implementation, evaluation, and iteration

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We think this is what collaboration requires in
2008
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Satisfycing mathematics A decision thats
good enough
Predictive modeling in decision support
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We create free and open-source softwarefor
collaboration toward collective action. We then
teach other people how to create it for
themselves
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We work on several principlesincluding respect
for our users

• Participatory, contextual design
• Agile development method
• Information flow in a mesh
• Internal capacity first
• Resilience by design

Innovation Lab
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We design our field tools for use here
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Mitigation strategies include good surveillance
(the lower the peak, the lower the impact on a
population)
The bottom-line metric is the reduction of
suffering.
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Hybrid Disease Surveillance
Surveillance Systems
Event Monitoring
Indicator Based
Event Based
Collect Analyze Interpret
Capture Filter Verify
Signal
Assess
Disseminate carefully
Alert
Investigate
Early and effective interventions
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Collaboration tools

• Problem
• Agencies cant (or wont) communicate effectively
  in crisis
• Requirements
• Effective, free, standards-based, easy to use,
  sustainable, measurable, and thoroughly
  interoperable
• Specifications
• Discussed with WHO, UNICEF, MoH, UCLA
• Development
• Built four tools as prototypes for MBDS
• Implementation in beta evaluation with all four

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InSTEDD tools for collaboration

• GeoChat
• I need to move information to and from teams in
  the field, and I need to know where those teams
  are.
• Mesh4x
• I need to translate and share information between
  systems
• Riff
• I need to engage with my colleagues when threats
  appear
• RNA
• I need help thinking carefully about context and
  decisions

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From a faint signal to collective action
Real-time exchange of information
Merge Analyze
Immediate analysis decision support
- Collective understanding - Response initiation
Informed collective action
Peer-to-peer information sharing and collaboration
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From a faint signal to collective action
Real-time exchange of information
Merge Analyze
Immediate analysis decision support
- Collective understanding - Response initiation
Informed collective action
Peer-to-peer information sharing and collaboration
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GeoChat

• Problem
• Need simple communication with teams in the field
• Requirements
• Multi-modal, geo-locating, broadcast, triage,
  history
• Specifications
• Established by users in Cambodia and USAR TF
• Development
• In Argentina and Cambodia. V 1.0 scheduled for
  October
• Implementation
• Small Beta during Hurricane Ike. Now reviewing
  results.

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GeoChat

• SMS messages that put a dot and a message on a
  map
• I can reply from the map on my laptop, and it
  becomes a chat
• By phone, person, location, specialty any
  filter, single or groups
• I can see that dot from anywhere on the planet
• Just need a password and access to a web browser

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GeoChat Blast menu
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Geochat Preview
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Mesh4x

• Problem
• Interoperability is a persistent impediment to
  collaboration
• Requirements
• Data schema mapping and application awareness,
  SMS sync
• Specifications
• Intuitive, secure, deep understanding, visible
  events
• Development
• Created at the IT level, but no simple user
  interface yet
• Implementation
• JavaROSA, OpenMRS, KML within HIV Clinics in
  Tanzania

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Mesh4x

• Imagine a public health event or system many
  participants
• Redundant information (very common)
• Willingness to share (social issue)
• Now ability to share! (technical issue)
• Excel
• Access, Oracle, SQL, MySQL
• Google Earth, Virtual Earth, GeoRSS, ESRI, Google
  Maps
• Cell phones, PDAs, laptops, whatever
• I move my pushpin on Google Earth and your Excel
  spreadsheet changes.
• And we can do it only through cell phones. A
  stream of SMS messages.

Translation tool
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Mesh4x and Forms on Mobile Phones

• Collect information in the field
• Press sync
• The information on the phone can be linked by
  Mesh4x and SMS to
• spreadsheets
• databases
• Google Earth
• And to anywhere in the world

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Riff

• Problem
• Teams cant see an anomaly as a shared event.
  Fractured response.
• Requirements
• Letting a team see an anomaly and contribute
  information about it within a shared space
• Specifications
• Intuitive, flexible, forgiving, inclusive,
  elegant, helpful, informative, Web-based, with an
  offline client
• Development
• Core development done and robust. Multiple
  modules for contribution and analysis (31
  considered, 12 implemented), weak UI
• Implementation
• Internal use only for now.

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• Riff is a pure collaboration tool.
• Riff is a next-generation information browser
• GeoChat messages show up there, with ProMED,
  HealthMap, email
• When something interesting appears, teams can
  join in
• Regional health officers, CDC, parasitologists,
  vets, HAZMAT teams
• Tools are included in Riff for letting teams
  enhance information
• Commentary, annotation, analysis, translation,
  mapping, sharing
• Mathematics built in for collaborative decision
  support.

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Riff is a pure collaboration tool. It can
consume any information stream and then allow
further information and analysis to be added by
the Riff members very quickly.
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National Hotline

• Problem
• One Cambodian phone receiving national health
  surveillance warnings
• No history, process, depth, reproducibility,
  design, or interoperability
• Requirements
• Develop a tool, process, structure, and backup,
  with flexibility, feedback, and context
• Specifications
• As designed by Cambodians to be effective for a
  hotline operator with one arm, fully
  interoperable with health system, on local cell
  phone.
• Development
• Prototype completed on the InSTEDD platform in
  thee days. Now requested by the MBDS Regional
  Forum.
• Implementation
• None yet.

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Hotline
Dr. Teng Srey, Deputy Director, Cambodian CDC
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Prototyping the Cambodian national hotline3
days, using InSTEDD platform and open source
building blocks
National hotline operator
Calls and weekly reports
EWARN (or any other event-based system)
Online Mesh store
Provincial hotline operator / Avian influenza
operator
Caller
ProMED
Voice
Google news
Director and MOH Staff
SMS
Rapid Response Teams
Data Sync
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Prototyping the Cambodian national hotline3
days, using InSTEDD platform and open source
building blocks
National hotline operator
Calls and weekly reports
EWARN (or any other event-based system)
Online Mesh store
Provincial hotline operator / Avian influenza
operator
Caller
ProMED
Voice
Google news
Director and MOH Staff
SMS
Rapid Response Teams
Data Sync
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Field evaluations are starting. Cambodia Lao
this month Thailand Lao Vietnam in November
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Asking constantly

• What information isnt getting to those who need
  it?

What field reports and alerts should come faster?
Which systems need to share information?
Which groups should be making more decisions
together?
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Tracker

• Problem
• Many frustrating issues have possible solutions
  in the world but those options are invisible to
  health workers
• Requirements
• A place to show an interesting range of
  possibilities in a familiar and accessible format
  that breaches silos
• Specifications
• Seductive, broad-ranging, professional, archived
• Development
• Professionally designed internal resource
  development now
• Implementation
• Global release v1.0 on 01 October.

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Houston EOC links here
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Non-InSTEDD tools weve liked
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BioCaster Global Health Monitor (Japan)
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Ning social networking sites
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www.statref.com InSTEDD demo
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Sahana Disaster Management System
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EpiSurveyor
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OpenMRS
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Contact me about anything

• Rasmussen_at_InSTEDD.org