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During the COVID-19 outbreak, information technology has played an important role in outbreak management. Many health information systems, Applications have been developed which aim to assist the outbreak monitoring and control. In your point of view, is there any Health IT project that you think could perform better if we applied some public health informatics knowledge and skills on it?
-Give an example of the existing project
-Problems or limitations of the project
-What knowledge and skills of health informatics could help improve the project? -
During the COVID-19 pandemic, information technology has played a vital role in containing the spread of infection. One of the good examples is contact tracing. Many big tech companies around the world developed systems that can assist the public health officials in monitoring and controlling the spread. However, they could have performed better if they had incorporated public health informatic knowledge and skills in some areas.
One such example is the “Privacy-Preserving Contact Tracing” system developed and partnered by Apple and Google. As its name stands, its target is to trace contacts and exposure and alert them by collecting minimal data. It uses Bluetooth technology to send out keys or beans to the devices that are in close proximity, match and alert them when someone in the link is exposed to the disease. The entire system is voluntary, and they do not collect location data as well as any data that can personally identify them (Apple & Google, 2020).
Though the system was a great assistance, there are some problems and limitations. Firstly, though they emphasized privacy, the adoption rate in many regions are not satisfactory, and the existence of the system in some regions are not well-known. Another problem is the interoperability of the system and the collected data. Since they collect minimal data, and work independently (de-centralized), it would be challenging then to incorporate it with other health information systems. Other limitations are functionality and the quality of data. Since it relies on Bluetooth, the accuracy of the data is dependent on the quality and compatibility of the device.
To improve the system, we should incorporate the following health informatics knowledge. Firstly, we should improve the people aspect of the system, which is to incorporate behavioral science and develop targeted public health campaigns to gain more trust in the system and communicate the benefits of the system. It should encourage more people to participate in the system and alert them in timely manner. Additionally, it would be better if we could improve the interoperability of the system so that we can use this framework and other health information systems to have comprehensive public health insights. Additionally, since it uses Bluetooth technology, the accuracy of the data is not as good as using other technology like GPS. It would be a better idea if they could incorporate a GPS system without violating the privacy of the users.
To conclude, the “Privacy-Preserving Contact Tracing” system by Apple and Google was a great initiative and was of some assistance in containing the spread of COVID-19 infection. But its effectiveness can be improved by incorporating the knowledge of public health informatics such as applying behavioral science to gain more trust in the system and encourage more people to participate (people aspect), interoperability, and improving the technology to enhance the quality and accuracy of the data.
References
Apple & Google. (2020). Privacy-preserving contact tracing. Retrieved from https://covid19.apple.com/contacttracing. -
During the COVID-19 pandemic, health informatics played a crucial role in managing the crisis effectively. The integration of information technology into public health strategies allowed for more efficient outbreak management, monitoring, and control, particularly through the development and implementation of various health information systems and applications.
One health IT project that could have benefited from more advanced public health informatics knowledge is the Pharmacy Partnership for Long-Term Care Program (PPP) and the Federal Retail Pharmacy Program (FRPP), which were responsible for administering COVID-19 vaccines across the United States. The FRPP, a large-scale public-private partnership involving 21 pharmacy organizations, played a key role in mass vaccination efforts during the pandemic. These pharmacies were required to report vaccine administration data to the CDC Data Clearinghouse (DCH) and state immunization information systems (IIS).
While the programs were successful in many aspects, they faced several challenges. The primary issues were data quality and delays in data reporting. Variations in pharmacy management systems led to inconsistencies, such as missing or inaccurate records. Different pharmacies used different systems, causing delays and errors in reporting crucial vaccine data. Real-time reporting was required, with pharmacies required to report vaccination data within 24 to 72 hours. However, frequent delays occurred due to technical issues with pharmacy systems, multi-jurisdictional reporting, and the complexity of maintaining accurate vaccine tracking, further complicated by the lack of standardization across the systems used by different pharmacy organizations.
Public health informatics could have improved the project in the following ways:
1. Data Standardization: Implementing more rigorous data standards and ensuring that all pharmacy systems were equipped to meet these standards could have reduced inconsistencies. Health informatics professionals could have designed and enforced these standards across all participating pharmacies, resulting in more reliable and timely data reporting.
2. Interoperability: Strengthening the interoperability between pharmacy management systems and public health databases would have facilitated smoother data exchange. Public health informatics knowledge could have been applied to create better integration between systems, allowing for easier and more accurate data sharing across jurisdictions.
3. Real-time Data Analytics: Using advanced analytics tools to monitor data in real-time could have flagged inconsistencies or errors in vaccine reporting, enabling quicker identification and resolution of issues, thus improving the overall response.
4. Training on Health Data Systems: Informatics professionals could have provided training to pharmacy staff and healthcare workers on the effective use of IT systems and the importance of data reporting requirements. This would have ensured that data was captured and reported in the required format, reducing delays and improving data quality.In conclusion, applying these public health informatics skills could have enhanced the PPP and FRPP by addressing key challenges like data quality, system interoperability, and real-time reporting. Through improved data standardization, better integration between systems, and targeted training, these programs could have achieved more accurate and timely vaccine reporting, ultimately improving the effectiveness of the COVID-19 vaccination.
Reference: Jones-Jack N, El Kalach R, Yassanye D, Link-Gelles R, Olorukooba A, deMartino AK, et al. Advancing public health informatics during the COVID-19 pandemic: Lessons learned from a public–private partnership with pharmacies. Vaccine. 2024:125667.
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Hello Wannisa Wongkamachan, thank you for sharing a good example that underscores the significance of data standardization and interoperability in immunization information system (IIS). Yes, improving data standardization and interoperability requires training health informatics in the related fields of frameworks and standardization methods. It would be a better system if you could improve above-mentioned areas in the immunization information system.
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I led the development of a disease surveillance system application capable of monitoring, surveillance and reporting disease outbreaks, including COVID-19, vaccine preventable diseases and communicable diseases. This native Android application was integrated as a modular component under the COVID-19 vaccination system and is widely used by various local health actors.
System Limitations:
The application is designed to detect and report disease outbreaks using both event based and indicator based reporting in real time. However, inconsistent internet access across local health organizations has posed challenges, making it difficult for some organizations to report data in a timely manner.Role of Health Informatics:
In version 2, HIS team led by Aye Thinzar Oo modified the application to allow offline data recording and added synchronization functions to upload data to the cloud once internet access is available. Key variables and disease classification standards were aligned with ICD-11 to ensure standardized data usage and facilitate data exchange between local health actors. Backend was refined to accommodate the updated variables and disease classification.-
Hello Alex, thank you for sharing your project and areas needed to be improved. Yes, having a stable internet access in Myanmar is a challenging issue for the health informatics and using offline feature was a ingenuous way to improve the operability of the information system. Additionally, applying data standardization references like ICD-11 can ensure the wide adaptability and enhanced interpretability of your system.
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During the COVID-19 pandemic, I worked on a project related to Vaccine Decision-Making for COVID-19 using the COVID-19 International Modelling Consortium (CoMo Consortium) to simulate COVID-19 models.
The CoMo Consortium is a project developed to provide tools for modeling the spread of infectious diseases, particularly COVID-19, and to support policymakers in making informed decisions regarding public health interventions.
Project Details:
CoMo App (https://github.com/ocelhay/como) is effective at simulating the COVID-19 model. However, using it requires multiple skills:– Programming Skills: Users need to know how to install and run code.
– Vaccine Knowledge: An understanding of vaccine-related concepts, such as severity, susceptibility, and transmission, is crucial.
– Data Handling: The app requires users to work with Excel templates, which involve understanding vaccine models, population models, and COVID-19 models.
Limitations of the Project:
One limitation is that the app doesn’t offer automatic updates. If you need new features or adjustments, you must modify the code yourself. In my part of the project, I simulated different vaccine efficacy models, which required repeated runs, often taking significant time to complete.How Health Informatics Knowledge Could Help:
Applying health informatics skills ,particularly in programming and vaccine knowledge,could improve the project. We could optimize the app to run models faster, add new features and make it more user-friendly, reducing the need for advanced technical skills to operate it.-
Hello Tanaphum Wichaita, thank you for sharing your experience and projects that you have collaborated. Yes, it would be a great idea to incorporate concepts related to immunization, epidemiology, and health informatics skills to make the application a better one. Additionally, making it more user-friendly can enhance its interoperability if the developers could reduce the technical skill requirements like programming language.
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As an example of COVID-19 outbreak monitoring and control, I would like to mention Saw Saw Shar developed by the Myanmar Computer Federation (MCF) under the Ministry of Transport and Communication (MOTC) and the Ministry of Health and Sports (MOHS), and the Government of Myanmar.
Problems or limitations of the project:
The app name “Shaw Shaw Shar” means “Trace Early”. The app has only two features: reporting form and logging current GPS location. The report form asks for GPS location and signs and symptoms (good, sick, cough, exhausted, difficulty breathing). There are problems with this project, I will elucidate in the following paragraphs how it can be improved.
Transparency: There is no privacy statement. Even the project lead claimed in a BBC interview that there were privacy concerns but life was more than privacy (Win, 2020). In reality, using the app cannot save people’s lives. Therefore, respecting privacy is one essential need in making the app before being shared with the public. Another concern is that there is neither any white paper nor any explanation of how they collect data and process it.
GPS limitation: GPS can malfunction in areas such as tunnels, skyscrapers, and indoor environments. Solely relying on GPS would be challenging in accuracy and a high chance of margin of error.
Just app: Behind every successful app is a strong operational backbone. In the end, the app was seen as dead or unhelpful to both the people and healthcare workers. The reasons are that there is no follow-up call or further assistance based on the data collected. Until a strong operation and management team is formed, it will be just a shell app that everyone can develop.
Improvement as a health informatician
Full user control and transparency: Sharing the user’s location or not is an individual right. The app should implement a control feature on these because other users would use them for reading health education articles and dashboard reports.
The most trusted technology would be utilizing decentralized network exchange. Even if it is discouraged for data quality (others might abuse dummy data on the network), data can be decentralized (separated access) at the state level or township level.
Bluetooth combined: If users are willing to assist with data accuracy for contact tracing, implementing Bluetooth would be beneficial, especially in areas like indoor environments, and vertical floors.
Operation management: The follow-up management and operation are the backbone of the app, not the app for the people. Solely reliance on technology does not contribute to the benefits of the people.
Even if Bluetooth and GPS data are combined, there are still challenges in data accuracy which can be verified by human-led contact tracing further interview. In the BlueTrace protocol made by the Government of Singapore, despite a good design as well as privacy-preserving protocol, a human-in-the-loop system is adopted as necessary to allow judgment to be applied for the likelihood of exposure and infection (Bay et al., 2020).
This is because the operation and management behind the app are the heart of the project. A health informatician is responsible for coordinating and managing the project in alignment with the goal of the project.
References:
Win, N. (2020, May 18). Prevent Covid-19 virus by using contact tracing apps (Contact Tracing မိုဘိုင်း App သုံးပြီး ကိုဗစ်-၁၉ ကာကွယ်မယ်) [Video]. In BBC Burmese News. Facebook. https://web.facebook.com/BBCnewsBurmese/videos/586202878684537/
Bay, J., Kek, J., Tan, A., Hau, C. S., Yongquan, L., Tan, J., & Quy, T. A. (2020). BlueTrace: A privacy-preserving protocol for community-driven contact tracing across borders. In *Government Technology Agency*. https://bluetrace.io/static/bluetrace_whitepaper-938063656596c104632def383eb33b3c.pdf
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During the COVID-19 pandemic, information technology has played important role in the outbreak management.
Information Technologies are provided timely data for decision-making and resource allocation essential in the global response to the pandemic area or placed. Many applications have been developed to assist the outbreak and facilitated the management of patient information, coordinated care and monitoring, control and supporting to the population.
One powerful tool for the healthcare system and policy maker is health informatics.
So it will be the challenges faced by health informatics in supporting healthcare professionals and public health authorities in the world.
Let me share our developed some projects for COVID-19 prevention period. There are to give certificate of Volunteer Mobile applications, mobile medical team applications and disease surveillance system (COVID-19) and COVID-19 tested records application. During developing applications, it needed to incorporate public health informatic knowledge and
skills on information technology. At the “Certificate of volunteer Mobile applications”, included collecting minimal data of individual volunteer, tracing assigned shift timely schedule function and timely reports data.
“Mobile Medical Team (MMT)” as only use by project period in COVID-19 situation, it was developed by native Android application.
The function of MMT as like telehealth.
The medical doctor consult with the COVID-19 patient and patient got the instruction from the doctor.
After that MMT team member will go to patient house and treatment the patient. In the application can see which patient was treatment by MMT or not.
It was used by organizations level as project period.Problem and System Limitation:
Even the system can apply, there are some problem and limitations of the application.
For the certificate of volunteer Mobile apps, it needs to incorporate with volunteer workflow. And also need authorities from organizations level to handle it. The challenges on the internet access issue in some area. So it difficult to get real time report data.
knowledge and skills of health informatics:
Applying health informatic skill, programming skill, volunteer health worker flow, and vaccine
information, to add new features and make more user-friendly. Health informatician is deal with stakeholder, and alignment with project needs.
To improve that system, we should incorporate health informatics knowledge and gain more trust in the system and communicate the benefits of the system.-
Hello Aye Thinzar Oo, thank you for sharing your experience and your projects during COVID-19. The two applications you have mentioned: “Certificate Issuance” and “Mobile Medical Team” are great initiatives but as you have already mentioned, there are certain challenges like involvement from the decision-making level. It can be overcame by harnessing the communication skills of an informatician. Additionally, internet has became a challenging issue in the country and developing offline application that can promote the data collection as well as educating people related to COVID-19 would be another improvement.
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An example of an existing Health IT project is COVID-19 Contact Tracing Apps.
COVID Alert (Canada): An app developed to notify users if they have been in close contact with someone who has tested positive for COVID-19. (Reference: COVID Alert: Canada’s exposure notification app – Canada.ca)
Problems or Limitations of the Project:
1) Privacy Concerns: Many users hesitate to use contact tracing apps due to concerns about data collection, usage, and sharing. There are fears about surveillance and misuse of personal information.
2) Data Integration: Integrating data from various sources, such as public health records and test results, can be challenging. This may result in gaps in data and inefficiencies in tracing and notification processes.
3) User Adoption and Engagement: The effectiveness of these apps relies heavily on high user adoption rates. Low download or inconsistent use can diminish the app’s effectiveness in contact tracing.
4) Technical Limitations: Issues such as false positives or negatives and inaccuracies in Bluetooth-based proximity measurements can affect the app’s ability to detect potential exposures accurately.Health Informatics Knowledge and Skills to Improve the Project:
1) Data Privacy and Security: Expertise in health informatics can enhance the design and implementation of robust privacy safeguards and encryption methods to protect user data. This includes developing clear privacy policies and ensuring transparency about data usage.
2) Data Integration and Interoperability: Knowledge of health information systems and standards (e.g., HL7, FHIR) can improve the integration of data from various sources, allowing the app to effectively combine information from different health records and testing sites.
3) User Engagement Strategies: Skills in health communication and behavioral science can help design user-friendly interfaces and engagement strategies that promote higher adoption and consistent use of the app. This includes understanding barriers to adoption and addressing them through targeted communication and incentives.
4) Evaluation and Optimization: Applying skills in data analysis and epidemiology can aid in evaluating the app’s effectiveness and identifying areas for improvement. This involves analyzing data to understand patterns and effectiveness and optimizing algorithms for more accurate contact tracing.
5) Public Health Expertise: Incorporating knowledge of public health principles and outbreak management can enhance the app’s functionalities to better support public health responses. This includes understanding the epidemiological aspects of contact tracing and integrating the app’s data with broader public health strategies.
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