From Intervention Informatics to Prevention Informatics: Lessons & Opportunities for Research Sherrilynne Fuller, MLS, PhD Professor, Biomedical & Health.

From Intervention Informatics to Prevention Informatics:

Lessons & Opportunities for Research

From Intervention Informatics to Prevention Informatics:

Lessons & Opportunities for Research

Sherrilynne Fuller, MLS, PhDProfessor, Biomedical & Health InformaticsSchool of Medicine andInformation School (Joint)Co-Director, Center for Public Health Informatics andSenior Advisor, Dean, University LibrariesUniversity of Washington, Seattle, WA

Center for Public Health Informatics University of Washington SFuller 2011

American Society for Information Science and TechnologyLecture Series Award 2010 First Annual Lecture, April 11, 2011School of Library and Information Science, University of KentuckyLexington, Kentucky

Souce: Rear Admiral Patrick O’Carroll, Region 10 Health Administrator


Role of Medical Care in 20th Century Public Health

Achievements*

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 ResultsHealthcare 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

Life Expectancy at BirthLife Expectancy at Birth



Prevention Consultations

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


“Risky Trade”*“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


Trade Routes &Cholera Epidemics – 1892*

Trade Routes &Cholera Epidemics – 1892*


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

US Malaria Deaths, 1870US Malaria Deaths, 1870


Complexity….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.

Why Are Global Prevention Information Systems Critical?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


DefinitionsDefinitions


Adapted from Shortliffe, 2006 and Hersh, 2007.


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. .)



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


Core Challenge: The Data Silo ProblemCore Challenge: The Data Silo Problem

Adapted from InStedd.orgCenter for Public Health Informatics University of Washington

SFuller 2011

New and Improved Approaches to Old Information Challenges in

Prevention

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


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.

Classification Systems: Building Blocks for Information SystemsClassification Systems: Building Blocks for Information Systems


William Farr (1837)William Farr (1837)


Sources: http://www.who.int/classifications/icd/en/HistoryOfICD.pdf

“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.”

International Classification of Diseases (ICD9, 10….)

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



Knowledge Management

Challenge

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

Knowledge Management Approach

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


Clinical Public Health Information Interchange –

Research Questions

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?


Disease Outbreak Detection and Prevention Systems: Mapping

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 informationCenter for Public Health Informatics University of Washington

SFuller 2011

Using Satellite Data to PredictInfectious Disease OutbreaksUsing Satellite Data to PredictInfectious Disease Outbreaks


Anyamba A et al Proc. Natl Acad Sci 2009:106(3):955-959

Data Coordination – Mekong Basin Region

Data Coordination – Mekong Basin Region


Healthmap.org


USING AIRLINE DATA TO PREDICT EMERGING INFECTIOUS DISEASE TRANSMISSION

Biodiaspora.com



Google Public Data Explorer Tool

Volunteered Geographic Informationfor Disaster Relief: Harnessing the Wisdom

and Power of the Public

Volunteered Geographic Informationfor 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)



MOBILE Technologies:MOBILE Technologies:

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


OpenData Kit (ODK)*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



Paper-based Systems


OpenData Kit (ODK) for Mobile Data Collection

Summary: Research Opportunities Abound

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


Summary:Research Opportunities Abound

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



ResourcesResources

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.


ResourcesResources

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.

.


ResourcesResources


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/.

ResourcesResources

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


ResourcesResources

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.


From Intervention Informatics to Prevention Informatics: Lessons & Opportunities for Research Sherrilynne Fuller, MLS, PhD Professor, Biomedical & Health.

Documents

public health achievementdue

health administrator

health hazardno

health problem

health care spending

detailed health information

definitions center

kentucky slide