Public health Information system

Public health Public health Information Information

system system 1.1. Introduction to PHIntroduction to PH

2.2. PH in US PH in US

3.3. PH in Sri Lanka PH in Sri Lanka

4.4. GIS GIS

Public Health Core Public Health Core FunctionsFunctions

Public Health

Response•Bioterrorism•Emerging infections•Other health status

Surveillance

Laboratory

Practice

Epidemic

Investigations

Workforce Capacity & Competency

Information & Data Systems

Organizational Capacity

Essential Capabilities

Basic Infrastructure

Pyramid of Public Health System Preparedness

CORE FUNCTIONS:CORE FUNCTIONS:A PRACTITIONER AND AN A PRACTITIONER AND AN AGENCY PERSPECTIVEAGENCY PERSPECTIVE

DIAGNOSIS ASSESSMENT

RULES OF PROFESSIONAL

PROTOCALS

POLICY DEVELOPMENT

TREATMENT ASSURANCE

ASSESSMENT IS…ASSESSMENT IS…

All the activities involved in community diagnosis:

• Surveillance

• Needs assessment

• Analysis of cause of problems

ASSESSMENT IS…ASSESSMENT IS…

• Collection and interpretation of data

• Case-finding

• Monitoring and forecasting trends

• Research and evaluation

ASSESSMENT DATA SOURCES:ASSESSMENT DATA SOURCES:Personal Health Data:Personal Health Data:

• Vital statistics• Epidemiology• Health screening• Special disease or

population registries

• Laboratory test data• Hospital discharge

data• Research• Behavioral Risk

Factor Data

ASSESSMENT DATA SOURCES:ASSESSMENT DATA SOURCES:Data about community concerns Data about community concerns & resources:& resources:

• Health resource inventory

• Public forums• Polling

• Special methods- APEX, PH part 2,

PATCH, MAPP, etc

• Information from private & non-profit providers

• Research

Four AssessmentsFour Assessments

• Community themes and strengths assessment

Identifies issues that interest the community, perceptions about quality of life, and community assets


• Local public health system assessment

Measures the capacity and performance of the local public health system-all organizations and entities that contribute to the public’s health


• Community health status assessment

Assesses data about health status, quality of life, and risk factors in the community


• Forces of change assessment

Identifies forces that are or will be affecting the community of the local public health system

ASSESSMENT DATA SOURCES:ASSESSMENT DATA SOURCES:Methods of distribution of Methods of distribution of

findings:findings:

• Annual vital statistics report

• Special projects report

• State health report

• Monographs• Fact sheets• Professional

publications• Media releases

ASSESSMENT DATA SOURCES:ASSESSMENT DATA SOURCES:Data on the range & quality of Data on the range & quality of

services:services:

• Selected treatment management review data

• Consumer complaint follow-up information

• Facility & professional licensure data

• Research

ASSESSMENT DATA SOURCES:ASSESSMENT DATA SOURCES:Environmental Health Data:Environmental Health Data:

• Sanitary survey

• Air & water monitoring

• Public reforms

• Facility inspections

• Laboratory test data

• Research

THE POLICY DEVELOPMENT THE POLICY DEVELOPMENT PROCESS ENTAILS…PROCESS ENTAILS…

• Collaboration

• Decision-making about problems

• Choice of goals and steps to meet them

• Conflict resolution and negotiation

THE POLICY DEVELOPMENT THE POLICY DEVELOPMENT PROCESS:PROCESS:

• Defines health needs• Sets priority health issues by analyzing the

outcome of assessment• Develops policies and plans to address the most

important health needs by setting goals & objectives with measurable objectives

• Develops alternative strategies for implementing plans

• Identifies necessary & available resources

THE POLICY DEVELOPMENT THE POLICY DEVELOPMENT PROCESS USES:PROCESS USES:

• Scientific information

• Data from the assessment process

• Information from concerned citizens & providers

THE POLICY DEVELOPMENT THE POLICY DEVELOPMENT PROCESS USES:PROCESS USES:

• Concepts of political & organizational feasibility

• Community values

• An open process, involving all private & public sectors by communicating, networking & building constituencies

THE ASSURANCE FUNCTION THE ASSURANCE FUNCTION INVOLVES:INVOLVES:

• Implementation of legislative mandates and statutory responsibilities

• Development of adequate responses to crises

• Support crucial services that have worked in the past


• Regulation of services and products provided in both the public and private sectors

• Maintain accountability to the people by setting objectives and reporting on progress


• Maintenance of a level of service needed to attain an intended impact or outcome that is achievable given the resources and techniques available

ASSURANCEASSURANCEThe Assurance function calls upon The Assurance function calls upon public health agencies to:public health agencies to:

• Provide public health nursing services

• Provide environmental health services

• Encourage, purchase or provide additional population-based services

• Maintain emergency response capacity

ASSURANCEASSURANCEThe Assurance function calls upon The Assurance function calls upon public health agencies to:public health agencies to:

• Administer quality assurance

• Help recruit & retain health care practitioners

• Maintain administrative capacity

THE TEN ORGANIZATIONAL THE TEN ORGANIZATIONAL PRACTICES OF PUBLIC HEALTHPRACTICES OF PUBLIC HEALTH

Assessment 1. Assess the health needs of the community

2. Investigate the occurrence of health effects and health hazards in the community

3. Analyze the determinants of identified health needs


Policy

Development

4. Advocate for public health, build constituencies, and identify resources in the community

5. Set priorities among health needs

6. Develop plans and policies to address priority health needs


Assurance 7. Manage resources and develop organizational structure

8. Implement programs

9. Evaluate programs and provide quality assurance

10. Inform and educate the public

The capacity of the public health system is its The capacity of the public health system is its ability to perform the core functions of assessment, ability to perform the core functions of assessment, policy development, and assurance on a continuous, policy development, and assurance on a continuous, consistent basis made possible by maintenance of consistent basis made possible by maintenance of the basic infrastructure of the public health system, the basic infrastructure of the public health system, including human, capital, and technology resources. including human, capital, and technology resources. The smooth running of the system requires the The smooth running of the system requires the application of sound leadership skills at all levels of application of sound leadership skills at all levels of the public health system.the public health system.

-Modified from the -Modified from the Washington State Public Improvement Plan, March Washington State Public Improvement Plan, March 19941994

Public Health in the U.S.Public Health in the U.S.

Vision:Vision:Healthy People in Healthy Healthy People in Healthy

CommunitiesCommunities

MissionMission::Promote Physical and Mental Promote Physical and Mental Health and Prevent Disease, Health and Prevent Disease,

Injury, and DisabilityInjury, and Disability

Public HealthPublic Health• Prevents epidemics and the spread of

disease• Protects against environmental hazards• Prevents injuries• Promotes and encourages healthy

behaviors• Responds to disasters and assists

communities in recovery• Assures the quality and accessibility of

health services

Essential Public Health ServicesEssential Public Health Services

• Monitor health status to identify community health problems

• Diagnose and investigate health problems and health hazards in the community

• Inform, educate, and empower people about health issues

Essential Public Health ServicesEssential Public Health Services

• Mobilize community partnerships to identify and solve health problems

• Develop policies and plans that support individual and community health efforts

• Enforce laws and regulations that protect health and ensure safety

Essential Public Health Essential Public Health ServicesServices

• Link people with needed personal health services and assure the provision of health care when otherwise unavailable

• Assure a competent public health and personal health care workforce

Essential Public Health Essential Public Health ServicesServices

• Evaluate effectiveness, accessibility, and quality of personal and population-based health services

• Research for new insights and innovative solutions to health problems

Source. 1990 Centers for Disease Control and Prevention

Public Health: The foundation of a national Public Health: The foundation of a national health systemhealth system

Public Health System Infrastructure•Human Resources Development (Training)

•Information Systems•Community Planning Systems

Secondary Medical Care

Primary Medical Care

Essential Population-Based Public Health Services

•Human Resources Development(Training)

•Information Systems

•Community Planning Systems

Tertiary Medical

Care

Capacity to Deliver Public Health Services

The FutureThe Future

Health Information Health Information System in Sri LankaSystem in Sri Lanka

Dr Sunil SenanayakeDr Sunil SenanayakeMBBS, MSc, MDMBBS, MSc, MD

Director/Health InformationDirector/Health Information

by

Information System

Components of National HMIS:–Hospital Information System–Preventive Health Information System–Disease Surveillance System–Population Census–Surveys –Other special surveys (NCD Risk Factor

Survey)

Sources of Information

Hospital Information System:–Clinical Data–Diagnosis of diseases (Using ICD-10)–Procedures performed–Cancer Registry–Cause of Death (Hospital deaths)–Hospital facilities–Hospital services

Sources of Information ctd…

Preventive Health Information System:

–Maternal, Child Health and FP data–Food Sanitation, Environmental & Occupational Health data –Nutrition data–School Health data–Immunization data–Data from Disease Control Programmes

Sources of Information ctd…

Disease Surveillance System:–Mainly Communicable Diseases–Monitoring of disease trends –Leading causes of Hospitalization

•Ischaemic Heart Diseases•Hypertension and complications•Cancers•Diseases of elderly

Sources of Information ctd..

Population Census:

National Census:–Started in 1881–Every ten years (except 1991)–Wide range of information


Surveys:

1. Demographic and Health Survey:–Started in 1973–Every five years–Support Health Information–Confirm Health Information


Surveys: ctd…

2.Household Income Survey:–Nutritional status –Energy consumption–Common Health Problems–Expenditure pattern


Surveys: ctd…

3. Nutrition Survey:–Nutritional status–Nutritional disorders–Energy consumption–Vitamin deficiencies–Micro-nutrient deficiencies


Surveys: ctd…

4. Other Special Surveys (NCD RF Survey):

–NCD Risk Factor Survey–Injury Surveillance


Other Sources Health Related Data: –Alcohol and Drug Information Centre–National Dangerous Drugs Control Board & Police Narcotic Bureau–Non Governmental Agencies–Sri Lanka Customs –Trade and Commerce Ministry

•Food, tobacco, alcohol etc (imports & sales)

In the past ……………..In the past ……………..

-Well established health infrastructure-Very good preventive health care service-Eradication of diseases-One of the world best EPI programmes-Better health Indicators for the

investment-Model for low cost health services

-- Among many other things …...

Some of the remarkable achievements ….

Recent past …….Recent past …….

-Health for all by 2000-Primary Health care approach-MCH and FP-Immunization-Health Education-Disease prevention-Healthy environment etc……

Future problems …….Future problems …….

• Changing demography• Changing disease pattern • Changing life styles• High expectation of people• Equity• Responsiveness• Technological advances etc……

Our strategies ………….Our strategies ………….

-Improve ambulatory care-Concentrate on Non Communicable Diseases-Integrated Disease Surveillance-Rehabilitation in the community-Promote healthy lifestyles-Ensure equity-Exploit IT-Better dialogues between clinicians, public

health personnel, researchers & planners

Issues

There are many Issues: (Hospital) (Hospital) –Manual Record keeping system–Only inpatient data–Only from Government Hospitals–ICD10 at Hospital but aggregated groups are transmitted to the centre–Doctors do not concern about writing of diagnoses

Issues ctd…

There are many Issues: (Hospital) ctd… (Hospital) ctd… –Inadequate human resources–Untrained coders–Patient record formats –No established Medical Record Departments in some hospitals–No unique ID –Repeated admissions counted as new cases–Use of IT is minimal

Issues ctd…

There are many Issues: (Public Health) (Public Health) –Total system is manual–Behind time–Processing is difficult–No/weak data from

•Estate sector•Occupational health•Nutrition surveillance •Health education•NCDs

Issues ctd…

There are many Issues: (Other) (Other) –Poor Financial Information –No unit cost system–No Disease burden study–No routine NCD surveillance system–HIS policy has not been laid down

Challenges

Hospital System:–Re-designing the hospital record keeping system–Changing of record keeping formats–Adaptation of ICD 10 at all hospitals–Transmitting of data by ICD 10 4 digit level

Challenges ctd..

Hospital System: ctd..–Changing of attitudes of doctors–Introduction of ICD 10 to basic curriculums–Introduction of IT to hospitals (EPR)–Development of IT Networks in hospitals–Training of users –Quality of Medical Records

Challenges ctd..

Public Health System: –Introducing IT at lowest possible level–Development of suitable software–Development of routine NCD, nutrition and occupational disease surveillance systems–Integration of disease surveillance systems

Challenges ctd..

Other Systems: –Introduce a Unit cost system–Updating of Human Resource Information System–Mapping of Health Facilities (GIS)–Convincing Policy makers and decision makers on investment in IT in Health

Challenges ctd..

The biggest challenge is “get The biggest challenge is “get decision makers and policy makers decision makers and policy makers

to use information for decision to use information for decision and policy making.”and policy making.”

Therefore “evidence based decision Therefore “evidence based decision making culture” has to be making culture” has to be

promoted among them.promoted among them.

Challenges ctd..

Information dissemination would Information dissemination would be one of the strategies that could be one of the strategies that could

be adopted to overcome this be adopted to overcome this situation.situation.

Dissemination of Information

•Annual Health Bulletin•Annual Administrative report•Weekly Epidemiology Bulletin•Quarterly Epidemiology Bulletin•Annual Family Health Report•Census reports•DHS reports•Survey reports•Health Ministry Website

Current status of IT Facilities IT Facilities available:IT Facilities available:

–Ministry of Health has a Local Area Network with a dedicated e-mail service and Internet services.

–All the Provincial Health Offices and most of the District Offices are connected to the LAN of the Ministry of Health via dial-up lines for electronic data transfer.

–Network will be expanded to MOH Offices and large hospitals by end of 2005.

Opportunities•Millennium Development Goals•Health sector master plan•WB assisted Health Sector Development project•E-Sri Lanka project•Government budget monitoring mechanism

Thank You!Thank You!

Dr Sunil [email protected]

[email protected]

Geographic Information SystemsGeographic Information Systems(GIS) (GIS)

for Epidemiology and Public for Epidemiology and Public HealthHealth

Dr. Ming-Hsiang TsouDr. Ming-Hsiang Tsou

Department of Geography, San Diego State Department of Geography, San Diego State UniversityUniversity

PPT slides: http://map.sdsu.edu/publications/GISpublichealthtsou.ppt

GIS is about geography and

about thinking

geographically.

--- Demers,

What is GIS ?(Movies)

AcknowledgementAcknowledgement

• Thank Dr. Brett A. Bryan for the permission of using his slides and GIS examples (from The University of Adelaide, AUSTRALIA.

• http://www.gisca.adelaide.edu.au/~bbryan/

What is “information”?What is “information”?• Data vs. Information (cooking example)• Example: weather information

What is “information What is “information system”?system”?

Information System is a chain of Information System is a chain of operations incorporating data operations incorporating data collection and digitization, data collection and digitization, data storage and analysis, and storage and analysis, and interpretation.interpretation.Examples: financial information systems Examples: financial information systems (ATM).(ATM).

GIS definitionsGIS definitions• Demers, 2000: GIS are tools that allow

for the processing of spatial data into information, generally information tied explicitly to, and used to make decision about, some portion of the earth.

•A data input subsystem•A data storage and retrieval subsystem

•A data manipulation and analysis subsystem

•A reporting subsystem (data output) •A data sharing mechanism

Medical GeographyMedical Geography

• Control of infectious disease very important

• Disease control requires understanding• Geography can provide intelligence• Location can influence health

John Snow's 1854 study – cholera mapping

• Spatial analysis can assist in solving medical problems

Dr. John Snow’s London Street Map (1854)

http://www.ph.ucla.edu/epi/snow/Snowpart2_files/frame.htm (slide 10-15)

• Integrate many different types of data– Spatial data + Non-spatial data

(statistical, texts,..)

• With GIS we can easily:– Draw maps and visualize

spatial distributions– Edit and alter existing data– Accurately measure distances and areas– Overlay maps of different areas

– Internet GIS for public access.

What GIS Can Do?What GIS Can Do?

Combine Combine

Geographic Geographic Locations with Locations with

Attribute DataAttribute Data

What GIS can help Public What GIS can help Public Health?Health?

• Research Tools and Planning– Constructing mathematical models– Service planning and optimisation– Making predictions

• Spatial Decision Support Systems– Infrastructure – roads, towns, services– Census – population statistics– Medical resource (hospitals, clinics, available

beds)

• Emergency Response Systems– Medicare records, 911 services– disease registers systems

GIS Applications in GIS Applications in EpidemiologyEpidemiology

1. Data Visualisation and Exploration

2. Data Integration3. Monitoring4. Geostatistics and Modelling5. Spatial Interaction and Diffusion6. Data Sharing and Web Services

• 2D visualisation capabilities – maps– Distibutions– Patterns– Clusters

• 3D visualisation capabilities - surfaces• 4D visualisation capabilities – temporal

– Animations– Eg. Applied to spread/retreat of disease

• Increases understanding of disease• Enables informed planning for disease

management

Data Visualisation and Data Visualisation and ExplorationExploration

DensityDensity

SurfaceSurface

Example 3DExample 3DVisualizationVisualization

3D 3D ExtrusioExtrusio

nn

• Thematic structure• Map Overlay • Compute new information • Research

– Integrated risk factor datasets to form risk model

– Used buffering, map algebra– Able to predict likelihood of elevated blood

lead levels, based on location of residence

Data IntegrationData Integration

Temporal Change: MalariaTemporal Change: Malaria

• Monitoring – scrutiny over space and time – Eg. Disease surveillance

• Through surveillance, a picture of disease activity is developed– Geographic distribution of disease– Patterns, clustering and hot spots

• GIS can provide data management and visualisation

• WWW can disseminate this information in real time

• Internet GIS ! (GEOG596 Internet Mapping)• Requirement – infrastructure and data update• SARS example.

MonitoringMonitoring

San Diego Wildfire 2003

Http://map.sdsu.edu

(GEOG 596) Internet Mapping

• Explore statistical relationships in data– Build geostatistical surfaces– Detect clusters– Significant change over time and space – “Statistical Alarm Bell”– Display outlier or influential cases by

location

• Statistical analysis also useful in finding zones of significantly higher disease prevalence

Geostatistics and Geostatistics and ModellingModelling

People Per House by Block in the Eighth Quarter

P e o p l e p e r H o u s e

1 . 0 0 - 4 .0 0

4 . 0 1 - 6 .3 2

6 . 3 3 - 7 .6 7

6 . 5 4 - 6 .6 2

1 0 .0 0

N

0 1 2 K il o m e t e r s

Investigating Dengue in Iquitos, Peru(maps from Dr. Art Getis, SDSU faculty)

• Advanced spatial/non-spatial models can be built• Procedures such as regression, correlation,

ANOVA• Variables may be:

– Non-spatial – Eg. smoking/non-smoking, occupation– Spatial – Eg. proximity to factories

• Test hypotheses about disease patterns– Eg. Does low air quality increase likelihood of flu

because of weakened respiratory systems? – High density of flu cases in low air quality zones?

Geostatistics and Modelling Geostatistics and Modelling (cont.)(cont.)

Modeling of Dengue Modeling of Dengue TransmissionTransmission

Pictures from Dr. Dana A. Focks http://www.id-analysis.com/pages/

• Used widely to help explain the spread of disease• Spatial interaction models

– analyse & predict flows central to disease transmission– Eg. Model spread of flu by using interstate flight data &

intrastate road travel– Identify high risk pathways of disease transmission -

target intervention

• Spatial diffusion models– Model spatial & temporal dimensions of disease spread– Predict how diseases spread from source

Spatial Interaction and Spatial Interaction and DiffusionDiffusion

Application Examples Application Examples

• GIS currently underutilized generally

• Great potential in:– Epidemiological research– Communicable disease control– Health service planning and

optimization

Software ToolsSoftware Tools

• ESRI ArcView (entry level use)• ESRI ArcGIS (ArcMap, ARC/INFO)

advanced users• ESRI ArcIMS (Internet Map Server)• (www.esri.com)

• GRASS (public domain software)• Autodesk Map2000, Intergraph

GeoMedia

• Hospitalisations at LGA, CDs, towns

• Integrating service data – hospital beds

• Unit record ambulance response rates

• Surface building and hot spot analysis

Address MatchingAddress Matching• Convert patients’ addresses to the

geospatial location on maps.

Limitations of GISLimitations of GIS

• Communication Gaps between epidemiologists & spatial professionals

• Require uniform data standards– Eg. Address recording 1/32 Main St. or Unit

1 32 Main St.– Unit record data access– Consistent and meaningful areal units– Enable consistency & comparison

• Privacy issues and spatial aggregation

SummarySummary

• GIS can provides spatial dimension to epidemiological research (visualization, modeling…).

• GIS can be used for many public heath applications and services. (efficient allocation of health care resources, equity in accessibility to services…)

• Internet GIS can provide the public health information in real-time. (evaluation, decision support systems, emergency response…)

GIS Sources for Public GIS Sources for Public HealthHealth

• ESRI http://www.esri.com/industries/health/index.html

• Books: – GIS and Public Health by

Ellen Cromley and Sara McLafferty. The Guilford Press. 2002.

– Internet GIS by Zhong-Ren Peng and Ming-Hsiang Tsou. Wiley, 2003.

GIS course in Geography, SDSUGIS course in Geography, SDSU

• GEOG 381 (Maps and Graphic Methods)

• GEOG 484 (Intro GIS)• GEOG 584 (Intermediate GIS)• GEOG 596 (Internet Mapping)

– http://map.sdsu.edu/geo596

PPT slides: http://map.sdsu.edu/publications/GISpublichealthtsou.ppt

Assessment Assessment • As a ward In charge , you are

requested formulate a Project proposal to be given to the IT specialist in order to construct a hospital software to your Medical ward .

• 500 words

Public health Information system

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