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From Intervention Informatics to Prevention Informatics Lessons .ppt

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					From Intervention Informatics to
     Prevention Informatics:
   Lessons & Opportunities for
           Research
         American Society for Information Science
         and Technology
         Lecture Series Award 2010
         First Annual Lecture, April 11, 2011
         School of Library and Information
         Science, University of Kentucky
         Lexington, Kentucky

                               Sherrilynne Fuller, MLS, PhD
                               Professor, Biomedical & Health Informatics
                               School of Medicine and
                               Information School (Joint)
                               Co-Director, Center for Public Health Informatics and
                               Senior Advisor, Dean, University Libraries
                               University of Washington, Seattle, WA
   Center for Public Health Informatics University of Washington
                            SFuller 2011
Center for Public Health Informatics University of Washington
                         SFuller 2011
   Souce: Rear Admiral Patrick O’Carroll, Region 10 Health Administrator
      Role of Medical Care in 20th
         Century Public Health
            Achievements*
Public Health Achievement                                       Due to Medical Care?
Vaccination                                                     Indirect
Motor-vehicle safety                                            No
Safer workplaces                                                No
Control of infectious diseases                                  +/-
 Coronary heart disease/stroke deaths                          +/-
Safer and healthier foods                                       No
Healthier mothers and babies                                    +/-
Family planning                                                 No
Safer drinking water                                            No
Recognition of tobacco as health hazard                         No
              *Rear Admiral Patrick O’Carroll, Region X Health Administrator
    Healthcare Costs Versus Results
•   How the United States compares with other O.E.C.D. (Organization
    for Economic Cooperation and Development) members
•   A country’s wealth usually dictates how much money it spends on
    health care, but spending in the United States is far beyond that of its
    peer countries.
•   Health care spending as a percentage of gross domestic product
    (2007)




       New York Times – June 5, 2010
             Center for Public Health Informatics University of Washington
                                      SFuller 2011
    Life Expectancy at Birth




New York Times – June 5, 2010


     Center for Public Health Informatics University of Washington
                              SFuller 2011
        Prevention Consultations
United States lags in basic preventive care, like annual checkups,
and relies heavily on expensive specialists rather than primary care
practitioners

Number of primary care visits/yearY




     New York Times – June 5, 2010

           Center for Public Health Informatics University of Washington
                                    SFuller 2011
                     “Risky Trade”*

Global Express: “the system that
 connects us across oceans, continents,
 national boundaries, cultures,
 languages, groups, ethnicity and trade
 systems”

*Kimball AM. Risky Trade: Infectious Disease in the Era of Global Trade.
   Ashgate, 2006


           Center for Public Health Informatics University of Washington
                                    SFuller 2011
     Trade Routes &
Cholera Epidemics – 1892*




 *Proust, A. (1892). La defense de L'Europe contre le cholera.
  Paris, G. Masson.


  Center for Public Health Informatics University of Washington
                           SFuller 2011
US Malaria Deaths, 1870




 Center for Public Health Informatics University of Washington
                          SFuller 2011
                   Complexity….

“Everything about malaria is so molded
  by local conditions that it becomes a
  thousand epidemiological puzzles. Like
  chess, it is played with a few pieces but
  is capable of an infinite variety of
  situations.” ….
      Hackett LW. 1937. Malaria in Europe: An Ecological Study. Oxford, UK:
      Oxford University Press.

      Center for Public Health Informatics University of Washington
                               SFuller 2011
   Why Are Global Prevention
  Information Systems Critical?
• New viruses travel more rapidly, transforming local afflictions
  into worldwide epidemics; increase in new and re-emerging
  infectious diseases -- 70% of which are zoonoses

• A modern lifestyle that travels just as fast, contributing to
  swelling epidemics of non-communicable diseases

• A human resources crisis directly linked to transnational labor,
  economics, migration and natural disasters

• The growth of vertical (e.g. HIV/AIDS, TB, malaria) initiatives
  has pushed advances for specific diseases but has also put
  pressure on individual countries’ public health systems

• Preventing and responding to these threats requires rapid and
  targeted exchange of accurate and detailed health information
                            Adapted from: AM Kimball, Risky Trade: Infectious Disease
                            in the Era of Global Trade. Ashgate, 2006
         Center for Public Health Informatics University of Washington
                                  SFuller 2011
                Definitions




             Adapted from Shortliffe, 2006 and Hersh, 2007.
Center for Public Health Informatics University of Washington
                         SFuller 2011
                        Definitions
Intervention Informatics:
  – Focus:
     • Individual
     • Patient with injury, disease, abnormal condition
     • Track: actions, procedures, diagnoses,
       therapies
     • Reactive – after the health problem occurs
  – Lacks Context:
     • Community (rural, urban, agricultural, inner city)
     • Family members/relationships
     • Individual (home, travel, hobbies, etc. .)
       Center for Public Health Informatics University of Washington
                                SFuller 2011
                       Definitions
Prevention Informatics:
  Focus:
     • Individual in context: family, community, the
       world
     • Health & well-being of individual & populations
     • Safe environment
        –   Hospital (preventing medical errors)
        –   Home (water & sanitation)
        –   Work (preventing injuries)
        –   Roads and travel conveyances
     • Proactive
     • Highly data-intensive and data-driven
       Center for Public Health Informatics University of Washington
                                SFuller 2011
Core Challenge: The Data Silo Problem




       Center for Public Health Informatics University of Washington
  Adapted from InStedd.org SFuller 2011
     New and Improved Approaches
     to Old Information Challenges in
                Prevention

• Classification, thesauri and ontologies
• Knowledge management
• Disease outbreak event detection and prevention
  systems utilizing:
   – satellite data
   – news media, published reports
   – crowd-sourcing
• Mobile technologies


        Center for Public Health Informatics University of Washington
                                 SFuller 2011
 Classification Systems: Building
 Blocks for Information Systems
What do these have in common?

• seventeenth-century mortality table whose causes of
death include "fainted in a bath," "frighted," and "itch");

• the assignment of subject headings to books in a
library;

• and the separation of machine-washable clothes from
hand-washables have in common??

All, of course, are examples of classification – upon
which information systems of all types are built.
         Center for Public Health Informatics University of Washington
                                  SFuller 2011
                  William Farr (1837)
 “The advantages of a uniform statistical nomenclature,
 however imperfect, are so obvious, that it is surprising no
 attention has been paid to its enforcement in Bills of
 Mortality. Each disease has, in many instances, been
 denoted by three or four terms, and each term has been
 applied to as many different diseases: vague, inconvenient
 names have been employed, or complications have been
 registered instead of primary diseases…
 The nomenclature is of as much importance in this
 department of inquiry as weights and measures in the
 physical sciences, and should be settled without delay.”
Sources:
http://www.who.int/classifications/icd/en/HistoryOfICD.pdf


              Center for Public Health Informatics University of Washington
                                       SFuller 2011
     International Classification of
        Diseases (ICD9, 10….)
   Inconsistency
   Lack of concept permanence
   Disregard for context
   Language translation
   Slow adaptation to new/emerging disease
    terminology
Cimino JJ. Desiderata for controlled medical vocabularies in the
  twenty-first century. Methods Inf Med. 1998 Nov;37(4-5):394-403

             Center for Public Health Informatics University of Washington
                                      SFuller 2011
.
Center for Public Health Informatics University of Washington
                         SFuller 2011
Center for Public Health Informatics University of Washington
                         SFuller 2011
          Knowledge Management
                Challenge
Neither the creation nor the distribution of
 information resources* upon which public
 health practitioners depend is managed or
 presented in any systematic or
 comprehensive way at the present time**

*data of all types, guidelines, research findings, maps,
   policies, laws, evaluation metrics, teaching materials,
   etc.
**Revere, D., A. M. Turner,… Fuller, SF. (2007). "Understanding the information
   needs of public health practitioners: a literature review to inform design of an
   interactive digital knowledge management system." J Biomed Inform 40(4): 410-
   21.
             Center for Public Health Informatics University of Washington
                                      SFuller 2011
      Knowledge Management
            Approach
• Research workflow and information needs of
  public health practitioners for decision
  support

• Develop and optimize a knowledge
  management system to support iterative
  refinement of a set of retrieval and
  information management tools for public
  health practitioners


         Center for Public Health Informatics University of
                            Washington
Center for Public Health Informatics University of Washington
                         SFuller 2011
   Clinical     Public Health
   Information Interchange –
       Research Questions
• Clinical information to support chronic and infectious disease
  interventions in communities: what is the minimum data set?
• PH clinical data (e.g. immunization, disease status, relevant
  community information) to electronic health record (EHR)?
• Timely approaches to people (care providers) and directory type
  information interchange?
• Research finding: how to extract from the literature and present
  to practitioners?
• Utilization of community health information for decision support
  for individual patients?



         Center for Public Health Informatics University of Washington
                                  SFuller 2011
Disease Outbreak Detection and
 Prevention Systems: Mapping

 – Satellite data; airline data; non-
   prescription drug purchases
 – News media, published reports from
   local newspapers
 – Internet activity -- google concepts
   searches
 – Citizen-reported information
    Center for Public Health Informatics University of Washington
                             SFuller 2011
Using Satellite Data to Predict
Infectious Disease Outbreaks




  Anyamba A et al Proc. Natl Acad Sci 2009:106(3):955-959
          Center for Public Health Informatics University of Washington
                                   SFuller 2011
Data Coordination – Mekong Basin
             Region
      Healthmap.org




Center for Public Health Informatics University of Washington
                         SFuller 2011
USING AIRLINE DATA TO PREDICT EMERGING INFECTIOUS
DISEASE TRANSMISSION

                                                         Biodiaspora.com




          Center for Public Health Informatics University of Washington
                                   SFuller 2011
Center for Public Health Informatics University of Washington
                         SFuller 2011
Google Public Data Explorer Tool




Center for Public Health Informatics University of Washington
                         SFuller 2011
     Volunteered Geographic Information
 for Disaster Relief: Harnessing the Wisdom
           and Power of the Public

A Case Study of the Haitian
 Earthquake*

• Lack of detailed maps for emergency
  response led to the use of crowd-sourced
  contributions to build critical maps

*Zook, M University of Kentucky; Graham M University of Oxford;
Shelton T University of Kentucky; Gorman, S FortiusOne. World Medical & Health Policy
Vol. 2: Iss. 2, Article 2 (2010)
            Center for Public Health Informatics University of Washington
                                     SFuller 2011
Center for Public Health Informatics University of Washington
                         SFuller 2011
Center for Public Health Informatics University of Washington
                         SFuller 2011
   MOBILE TECHNOLOGIES:

Faster and more reliable data collection and
sharing for decision making by health providers
as well as consumers




       Center for Public Health Informatics University of Washington
                                SFuller 2011
                OpenData Kit (ODK)*

• Lack of reliable infrastructure makes data
  collection difficult
• Paper is still primary way data is collected
  around the world
• ODK – open-source (non-proprietary) suite of
  tools for using mobile devices to collect,
  visualize and share data
*ODK=developed at University of Washington
http://change.washington.edu/projects/odk

          Center for Public Health Informatics University of Washington
                                   SFuller 2011
Paper-based
Systems




         Center for Public Health Informatics University of Washington
                                  SFuller 2011
OpenData Kit
(ODK) for Mobile
Data Collection




       Center for Public Health Informatics University of Washington
                                SFuller 2011
         Summary:
Research Opportunities Abound

• Improved vocabularies, thesauri and ontologies of
  concepts are transforming ability to aggregate data
  and information across disparate information
  resources and databases
• Enhanced collection techniques and new
  combinations of data and information to:
   – Generate new hypothesis and approaches to preventing
     infectious disease outbreaks
   – Respond more rapidly to natural disasters and human-
     caused emergencies
   – Support two-way communications with individuals

       Center for Public Health Informatics University of Washington
                                SFuller 2011
          Summary:
 Research Opportunities Abound
• Opportunity to optimize timely data exchange of
  critical information between clinical and public health
  information systems to improve quality of response
  for individual and community health
• Citizen generated information offers new means to
  respond to disasters as well as offer communities of
  practice to support resource-constrained
  environments
• With the availability of instant communications need
  to recognize and prepare for unexpected “crowd”
  reactions to threats
         Center for Public Health Informatics University of Washington
                                  SFuller 2011
Center for Public Health Informatics University of Washington
                         SFuller 2011
                         Resources
1. Fuller, S. (2010). "Tracking the Global Express: new
   tools addressing disease threats across the world."
   Epidemiology. 21(6): 769-771.
2. Proust A. La Defense de L’Europe Contre le Cholera.
   Paris: Masson; 1892.
3. Kimball A. Risky Trade: Infectious Disease in the Era of
   Global Trade. Aldershot, United Kingdom: Ashgate
   Publishing; 2006.
4. Brown C. Emerging diseases: the global express. Vet
   Pathol. 2010;47: 9–14.


        Center for Public Health Informatics University of Washington
                                 SFuller 2011
                         Resources
5. Chretien JP, Burkom HS, Sedyaningsih ER, et al.
   Syndromic surveillance: adapting innovations to
   developing settings. PLoS Med. 2008;5:e72.
6. Brownstein JS, Freifield CC, Madoff LC. Digital
   disease detection—harnessing the web for public
   health surveillance. N Engl J Med. 2009;360:2153–
   21576..
7. Mekong Basin Disease Surveillance Network.
   Available at:
   http://www.mbdsoffice.com/index_2008.php.
   Accessed July 31, 2010.
.
        Center for Public Health Informatics University of Washington
                                 SFuller 2011
                          Resources


8. Open Data Kit (ODK)—open source tools for
   collecting, managing and retrieving data. Available at:
   http://change.washington.edu/projects/odk.
9. GeoChat—an open source, group communications
   technology. Available at: http://instedd.org/geochat.
10. Ushahidi—an open source tool for information
   collection, visualization and interactive mapping.
   Available at: http://www.ushahidi.com/.




         Center for Public Health Informatics University of Washington
                                  SFuller 2011
                       Resources
11. Yi Q, H. R., Hillringhouse EA, Sorensen SS, Oberle
  MW, Fuller SS, Wallace and JC. (2008). "Integrating
  open-source technologies to build low-cost
  information systems for improved access to public
  health data. ." Int J Health Geogr. 2008 Jun 9;7:29 7:
  29-.
12. Zook M, Graham M, Shelton T, et al. Volunteered
  geographic information and crowdsourcing disaster
  relief: a case study of the Haitian earthquake. World
  Med Health Policy. 2010;2:2. Available at:
  http://www.psocommons.org/wmhp/vol2/iss2/art2


       Center for Public Health Informatics University of Washington
                                SFuller 2011
                         Resources

13. US Malaria Deaths, 1870 - The Scientist - Magazine
  of the Life Sciences (http://www.the-
  scientist.com/article/display/57476/#ixzz1HBiuunjp)
14. Revere, D., A. M. Turner,… Fuller, S. (2007).
  "Understanding the information needs of public
  health practitioners: a literature review to inform
  design of an interactive digital knowledge
  management system." J Biomed Inform 40(4): 410-
  21.


        Center for Public Health Informatics University of Washington
                                 SFuller 2011

				
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