Health Informatics Management

Your Name Here

Ateneo School of Medicine

and Public Health
Schedule
12:30-1:00 Case study : Use of Google
Earth to strengthen public health
capacity

1:00-2:00 Exercise : Outbreak game

2:00-3:00 Public health informatics

3:00-4:00 Mobile and wireless in health

Health Informatics Management

Google Earth to
strengthen public
health capacity
Introduction
• Vector-borne diseases
• Geographic information systems
Google Earth
Organization/Subject
• Chetumal and Merida
• Polygon, line, point tools
DDSS
• Dengue Decision Support System
• Visual Basic
• PostgreSQL
• Keyhole Markup Language (KML)
file
Benefits
1. Free, simple, intuitive to use
2. Tools for placemarks and polygons
3. Standalone application
• Question : Why is being a standalone
application a benefit of Google Earth?
• Answer : This is important because
Internet access in developing countries
can be slow or inconsistent.
Benefits
4. Quality of images are sufficient
enough to distinguish individual
houses and city blocks
5. Quality of satellite imagery is
updated and improving
6. KML can export to other GIS
7. Google Earth developer
community
Limitations
1. Need for Internet access
2. Image quality
3. Limited tools
Conclusion
• Google Earth is an excellent
example of a freely accessible tool
with potential for improving public
health.
Question
• What is a GIS?
• Geographic information system.
System for input and output of
geographic information.
Question
• Name one of the five GIS software
mentioned in the article.
• Google Earth, Epi Info/Epi Map,
HealthMapper, SigEPI, ArcGIS
Question
• PostgreSQL was mentioned as the
database in the article. Name other
DBMS.
Question
• Why did they choose Google Earth
as the GIS?
• It is free, with satellite imagery, and
can be edited with simple
programming tools.
Health Informatics Management

Exercise :
Outbreak game
Outbreak game
• We will simulate the use of a manual geographic
information system using an online game.

• Goto http://www.mclph.umn.edu/watersedge/

• Click “Click here to play the game.”

• Simply follow the instructions. Solve the

outbreak within 30 minutes. Show the lecturer
the screen showing the diagnosis of the case.
Your time begins now.
Health Informatics Management

Public health
informatics
Public health informatics
• Definition
• Four principles
• Syndromic surveillance
• PHI in the Philippines
• Geographic information systems
Definition
• Application of technology to public
health
• “the systematic application of
information and computer science
and technology to public health
practice, research, and learning.”
Four principles of public health informatics

• The following questions are about

the four principles of public health
informatics detailed in the article by
Yasnoff.
Principle 1
• Public health informatics promotes
the health of individual patients.
True or false?
Answer
• False. Public health informatics
promotes the health of populations.
Principle 2
• Public health informatics focuses on
the treatment of disease. True or
false?
Answer
• False. Public health informatics
focuses on the prevention of
disease.
Principle 3
• Public health informatics focuses
only on the rural health unit. True or
false?
Answer
• False. Public health informatics
focuses on prevention at all points
in the causal chain.
Principle 4
• Public health informatics focuses on
the private sector. True or false?
Answer
• False. Public health informatics has
a governmental context.
History of public health informatics
• In 1854, there was a major cholera
outbreak in London
• 600 people died
• Dr. John Snow studied the epidemic
and drew a map of the patients
• Was able to determine that the
source of the disease was a
contaminated water pump located
on Broad Street.
• The pump still
stands there today.
• The points on the
map are the
addresses of the
patients.
Major challenges
1. Developing integrated national
public health information systems
– Somewhat addressed technically by
standards for data exchange such as
ICD and HL7.
– More of a human issue (as will be
shown in the challenges with the FHSIS
by the DOH).
Major challenges
2. Closer integration between public health and
clinicians
– There is lack of exchange of information between public
health and private practitioners
– There are notifiable diseases which are reported to the
DOH by private hospitals, but the system is not
monitored.
– Current public health data is still paper-based and
manual, although this is being addressed by PIDSR
(more on that later).
– Data is thus underreported
Major challenges
3. Security, privacy, and
confidentiality of data
– Currently addressed by technical
standards such as encryption, SSL,
encryption
– Legal issues are addressed with the E-
commerce Act.
Question
• What is syndromic surveillance?
Syndromic surveillance
• Defined as “real-time” public health
surveillance using data that is routinely
collected for other purposes
Syndromic surveillance
• Goals
– Early detection of large outbreaks
– Characterization of size, spread, and tempo of
outbreaks once detected
– Monitoring of disease trends
• Example
– Google search terms (Google Flu Trends. Goto
www.google.org/flutrends)
– Prescriptions of a particular drug in pharmacies. For
example, during the anthrax scare in the US, the
CDC monitored the prescription for ciprofloxacin.
PIDSR
• Philippine Integrated Disease
Surveillance and Response
• Disease surveillance system
• Provides early detection and
response to epidemics
• Includes involvement of the
community in disease surveillance
PIDSR
• Includes 12 immediately reportable
diseases, syndromes, or events
(category 1)
• And 15 weekly reportable diseases
(category 2)
Category 1
• Acute flaccid paralysis
• Anthrax
• Adverse event following immunization (AEFI)
• Human avian influenza
• Measles
• Meningococcal disease
• Neonatal tetanus
• Paralytic shellfish poisoning
• Rabies
• Severe acute respiratory syndrome (SARS)
• Unusual diseases or threats
• Clustering of diseases

You do not need to memorize this list for the exam.

Category 2
• Acute bloody diarrhea
• Acute hemorrhagic fever syndrome
• Acute viral hepatitis
• Bacterial meningitis
• Cholera
• Dengue
• Diphtheria
• Influenza-like illnesses
• Acute encephalitis syndrome
• Leptospirosis
• Malaria
• Non-neonatal tetanus
• Pertussis
• Typhoid and paratyphoid fever

You do not need to memorize this list for the exam.

PIDSR
• Utilizes Epi Info and data are sent as
MDB files which are integrated from
the rural level to generate reports at
the national level
FHSIS
• Field Health Service Information
System
• Consolidates public health statistics
from rural health units
• Reports statistics on maternal and
child health, family planning, and
communicable diseases
FHSIS dataflow
• Midwife records patients in the RHU
• Submits monthly report to the
nurse, who consolidates the report
• Submitted to the municipal,
provincial, regional, and then
national level
FHSIS dataflow
Fields in the FHSIS questionnaire
• It is very long and tedious to do.
• There are three (3) pages total to be
filled up.
Problems with the FHSIS
• Manual, error-prone
• Limited only to RHU data (does not include private
hospitals and practitioners)
• Lack of training in information management among
nurses, midwives, and even executives in DOH
• Non-compliance by municipalities
– In 2000, only 2 regions submitted data.
• Poor utilization of data for decision making
• Poor quality due to delayed or incomplete
submission
Geographic information system
• Systems which output geographic
or location-based information
– Online
– Mobile
– Public health
Question
• What is a virtual globe?
GIS: Online
• Virtual globes
– 3D software model of the earth
– Google Earth
– Nasa WorldWind
– Microsoft Virtual Earth
• Maps
– Wikimapia
– OpenMaps
– Google Maps
Google Earth
Google Maps
GIS: Mobile
• Nokia Maps
• Google Maps
• Garmin
Nokia Maps
Google Maps
GIS: Public health
• WHO HealthMapper
• CDC Epi Maps
• ESRI ArcView
HealthMapper
• Developed by the WHO
• Surveillance and mapping
application for infectious disease
• Malaria, filariasis, HIV/AIDS, etc.
Health Informatics Management

Mobile and
Wireless in Health
Mobile and wireless in health
• Key statistics
• Network technologies
• Services
• Phone technologies
• Medical software
Telcos in the Philippines (2010)
in millions

14

Smart
Globe
43 Sun
25
Comparative chart
Mobile Technologies
• SMS
• MMS
• LBS
– Location based services
– Can determine your location based on the
strength of your cellphone signal from
nearby cellsites
Terminology in LBS
• Cell ID
– Identifies the cell to which a user is connected (aka cell site)
– Only as accurate as the distance between cells, although
can work indoors
• GPS
– Global positioning system
– Accurate to 3-15 m, but requires line of sight. Does not
work indoors.
• A-GPS
– Assisted GPS
– Utilizes data from cell sites and satellite
– Most accurate and flexible of all
• WPS
– WiFi positioning
LBS
• A-GPS
– Assisted GPS
– Faster positioning (in 10 sec)
– Does not require line of sight with satellite
(i.e. can be used indoors)
– Accurate 5-50m
Health Informatics Management

Mobile phone
technologies
New(er) Mobile Phone Technologies
• Touch screen
• Screen gestures
• Motion gestures
Basic Touchscreen
• Resistive
– Measures the change in resistance between two
layers of material when it is touched
• Capacitive
– Works by measuring the difference in electric
charge between the screen and the user’s finger
• Multitouch
– Type of capacitive touchscreen
– Can handle multiple points being touched

Most modern touchscreens use capacitive.

Capacitive
Multitouch
• Has a grid of
sensing lines
• Apple iPhone
• Samsung Galaxy
Screen Gestures
• Controls using gestures such as
swipes
• 70% reduction in error rate
• 20% faster than tapping
• Same technology used by CNN in
the Election Magic Wall
• Perceptive Pixel video
Motion Gestures
• Mobile phone detects movement
• Done through the use of
accelerometers
• Nokia N95, iPhone, Nintendo Wii,
Blackberry Storm, Palm Pre
• Bump iPhone
Accelerometer
• Motion is detected when inertial
mass moves
Health Informatics Management

Mobile phone
platforms
Question
• Name some of the current mobile
operating systems.
Popular Mobile Phone Platforms
• Nokia Symbian
• Apple iPhone OS
• Windows Phone 7
• Google Android
• RIM Blackberry
Apple iPhone
Android
Windows Mobile
• Live tiles and hubs
– People
– Pictures
– Music and Videos
– Marketplace
– Microsoft Office
– Games
• People
– Address book
– Facebook friend list
Criteria for choosing a smartphone
• Two main considerations would be
the hardware and software.
Hardware
• Form factor
– Bar, slide, flip, clamshell
• Screen size
• Input type
– Keypad, QWERTY keyboard, touchscreen
• User interface/experience
– Primarily a function of the operating system
• Connectivity options
– WiFi, Bluetooth, infrared, GPRS, HSDPA
• Performance
– Call quality, battery life, speed
• Features
– Organizer, browser, email, messaging, camera, video,
music, radio, TV
Software
• Software store
– 300,000 iPhone apps (7 billion downloads)
– 30,000 Android apps
– 1,000 Windows Phone 7 apps
Health Informatics Management

Mobile applications
in health
Handheld Medical Software
• References
– Skyscape, Harrison’s, Emedicine
• Journal content
– JournalToGo
• Pharmacopeias
– Epocrates
Epocrates
HandHeld Medical Software
• Calculators
– Archimedes, Epocrates, MedCalc
• Patient list
– PatientKeeper
– HanDBase
– QuickOffice
Mobile Health Applications
• Health promotion
– Dietary intervention
• i-ExerM : diet facts through SMS
• WellNavi : photos of food taken were sent via MMS
– Smoking cessation
• Text messages sent telling user to quit smoking
– Physical activity intervention
• Motivational messages
• Report progress through SMS
Mobile Health Applications
• Health monitoring
– Cancer
• Wireless Health Outcomes Monitoring System)
• Monitored symptoms of cancer, especially
pain
– Asthma
• Sent messages to remind to take meds,
request to enter peak flow, data on sleep loss,
and medication dosage
Mobile Health Applications
• Philippines
– PPD : Text PPD <brand> to 2600.
• CHITS
– Community Health Information Tracking
System
– Linux-based system which sends health
data using SMS
Mobile Health Applications
• SPEED
– Surveillance Post Extreme Emergencies
and Disasters
SPEED
SPEED
Health Informatics Management

Preview of
Session 9
Session 9
• Final project presentations
• 20 minute presentation, 10 minute
QA per group
• Criteria for grading (20% each)
– Innovation/novelty of idea
– Prototype
– Delivery and presentation
– Correctness of answers in QA
– Written paper
Health Informatics Management

Thank you.