September 2007

e-Health 2.0 : Opportunities for Public Health Informatics

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Diseases pose an immense challenge to those affected by them as well as for the care providers. Regular visits to the clinics and frequent investigations are required to monitor and prevent complications. This paper describes ideas for development of intuitive web based monitoring tools that could be of immense value in public health.

Public health informatics deals with the use of Information and communication technologies for addressing the health issues of the population rather than of individuals. In India, Public health informatics is still in its infancy. Most of IT deployment in health care is in the area of hospital management systems and telemedicine; one rarely comes across IT deployment for public health. There are some efforts by the Government of India to set up disease surveillance systems.

The key difference in deploying IT for public health as compared to a healthcare IT deployment is in that the former focuses on preventive and promotive health. It aims to alter the risk of the populations for disease and disability through intelligent use of “information” through leveraging Technology.

Background

It is generally believed that deploying Information technology solutions would drastically transform existing operational challenges. It is because of this popular notion that most of health care IT deployment has been limited to the niche areas of hospital management and telemedicine. It is rather unfortunate that intelligent use of information is not the focus,  instead the hype about technology eclipses the entire arena.  As a result the present generation of IT solutions deployed in India are rudimentary in terms of its real potential.

Public health informatics depends heavily on the “information” rather than the technology. It is the intelligent capture, analysis and interpretation of “information” that has the potential to decrease the risk of disease and disability. Since India is still in its infancy with regard to deploying IT in the health sector, we could redesign our health systems based on available information and deploy a large country wide public health network that could radically transform the health of the populations.

This calls for two radical changes in mindset- first being that “information” will remain at the core of all deployment of technology. The technology must match upto the requirements that information collection, collation and processing demands. This would necessarily mean that users will be the ones driving and defining the need in contrast to the present trend of vendors pushing technology down people's throats. It is expected that the Industry will see rampant growth when the users start defining the needs and technology is improvised to meet the growing demand.

The second change in mindset requires that the concept of return on Investment be redefined; returns in terms of health risk reduction of the populations will take years to demonstrate. Technology must help us redesign the health systems rather than attempting to automate the existing workflows / practices.

What is health 2.0 ?

Health 2.0 derives its definition from the definition of web 2.0, where the technologies used allowed intelligent interaction between the users and the deployed solutions. Currently available technologies allow users to actively participate and contribute to the information that is front ended using web interfaces.

Empowering the end user to add to the information pool would hold the key to a public health informatics network. Given the limitations of the present day health care and public health system in the country, current technologies offer avenues for re engineering processes by which end users contribute as well as benefit from the system.

Since information is the key focus, technology should not be a bottleneck to the use of information, instead the systems must evolve such that standards are open (such as W3C), protocols are shared and everyone is able to use the systems irrespective of the technologies or tools they would like to use. The Industry must mature to a level where growth and penetration is seen beyond their quarter end metrics.

Disease Surveillance

One potential application of Health 2.0 concepts is in the area of disease surveillance. This could be used both during epidemics as well as non epidemic situations. Assume a particular geographic location is under threat for an emerging epidemic such as avian influenza. The population can be sensitized about the symptoms when “bird flu” is to be suspected; they could then be asked to upload the demographic details of the person at risk through a cell phone or a toll free number. The disease surveillance team then records the details into a database. The epidemiologist could use data mining tools to locate the geographical areas with maximum disease intensity and target the interventions based on the intelligent information available, that would actually be contributed by the affected people. In this way the burden on the public health system could be drastically reduced so that they could meaningfully engage themselves in implementing interventions.

using Health 2.0 concepts for Dengue outbreaks:

Dengue outbreaks are a matter of great concern as they take several hundred lives year after year. Deploying a dengue information and management system could drastically improve the situation. Well before the dengue season, a dengue monitoring unit could be set up. This would have a web interface where users (affected people, health care workers, volunteers) could register themselves and log in to use the information (about prevention and precautions).

They could add information about a particular locality where many cases are having the suggestive symptoms and signs. This could be done using an SMS gateway, web interface or a toll free call centre facility. The information that is added through these different channels could then be integrated into a database that is interfaced to a Geographic Information System for complex analysis, outbreak prediction and geographic spread.

Besides the information about the cases, the portal could also provide information about the health facilities that are providing the primary services (screening), the lab support services, testing for platelet counts, and special services such as dengue serology and platelet transfusions. The intelligent capture and use of information could avoid unnecessary delay and anarchy that one witnesses during every dengue season.

The system should be capable of integrating with other existing information systems such as the meteorological data, municipal corporations' data on high risk areas for vector breeding and vector control data.

The information available from this system could be made available to the electronic and online media, particularly for round-the-clock news channels, who would be able to disseminate intelligent information to their viewers and could potentially save lives rather than ruminate over some sore dengue related incidents or government's inability in avoiding such outbreaks.

The explosive growth of Internet penetration and information technology could translate into better health for the citizens of India.

Antibiotic Resistance: potential area for public health informatics

During episodes of infections, the human body is invaded by certain organisms that are viral, bacterial or fungal. The rapid multiplication of these organisms within the body leads to symptoms specific to the areas where they invade. It is common belief that any infection should be treated using antibiotics, therefore both medical professionals as well as the affected person use antibiotics indiscriminately.

Antibiotics are chemical substances that have a specific action against a specific group of organisms. If they are used indiscriminately then the organisms that they are meant to attack, develop resistance. As a result the antibiotics turn ineffective. From the public health perspective this poses a huge challenge. This could be effectively addressed through leveraging ICT initiatives.

Currently the information about organisms responsible for a particular type of presentation is only known to specific institutions that attempt to culture and identify the causative organism. Once the causative organism is identified,  antibiotic sensitivity pattern is carried out. This helps in identifying the most effective antibiotic. Despite several institutions doing this exercise, the information remains isolated as islands of knowledge.

Effective deployment of technology could be leverage to connect these islands of information and form bridges between them and the users ( Medical Practitioners ). Currently due to the paucity of this information, large number of medical practitioners rely on skewed information provided to them by representatives of the pharmaceutical industry, who are not known to act in the best interest of patients or science in general.

Imagine a system where antibiotic sensitivity pattern for common organisms are made available through a web portal to all practitioners in the country; assume they are able to query the system for specific diseases, seasonal patterns, multiple organisms with cross sensitivities. The practice of medicine could be radically transformed; there would be a significant transition towards evidence based practice of medicine rather than empirical prescription. This would save thousands of crores of rupees for the nation that is lost in unnecessary expenditure on drugs, something the pharma industry surely doesn't want to hear. But in a growing economy could one afford to have leaking taps?

Public health informatics is more about common sense than computer science, its about using information intelligently. India as a nation has seen its 60th year of freedom. It is time now that its citizens be made free to use the information and benefit from the information that is available.

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