Global Health Informatics

How Information Technology Can Change Our Lives in a Globalized World

Heimar Marin, Eduardo Massad, Marco Antonio Gutierrez, Roberto Jaime Rodrigues, Daniel Sigulem

• Publisher: Academic Press
• Year: 2016
• ISBN:
  9780128046173
• Topic: Medicine
• Subtopic: General Health

Global Health Informatics: How Information Technology Can Change Our Lives in a Globalized World discusses the critical role of information and communication technologies in health practice, health systems management and research in increasingly interconnected societies. In a global interconnected world the old standalone institutional information systems have proved to be inadequate for patient-centered care provided by multiple providers, for the early detection and response to emerging and re-emerging diseases, and to guide population-oriented public health interventions. The book reviews pertinent aspects and successful current experiences related to standards for health information systems; digital systems as a support for decision making, diagnosis and therapy; professional and client education and training; health systems operation; and intergovernmental collaboration.

• Discusses how standalone systems can compromise health care in globalized world
• Provides information on how information and communication technologies (ICT) can support diagnose, treatment, and prevention of emerging and re-emerging diseases
• Presents case studies about integrated information and how and why to share data can facilitate governance and strategies to improve life conditions

Chapter 1

Global Health Informatics—An Overview

Y. Quintana^1,2 and C. Safran^1,2, ¹Beth Israel Deaconess Medical Center, Boston, MA, United States, ²Harvard Medical School, Boston, MA, United States

Abstract

Global Health Informatics is a growing multidisciplinary field that combines research methods and applications of technology to improve healthcare systems and outcomes. Healthcare systems are facing many challenges including a growing population, the increasing complexity of care services, and limited resources to deliver services. These challenges will require more innovative approaches to scale healthcare services to larger numbers of people. This chapter outlines health informatics systems that have been developed to address these problems.

Keywords

Informatics; global health; clinical informatics; bioinformatics; eHealth

Contents

Introduction 1

Global Health Informatics 3

Electronic Medical Records 3

Telehealth Systems 4

Mobile Health Systems 5

Research Translational Systems 6

Training Programs 7

Challenges 8

Conclusions 9

References 9

Introduction

Healthcare services are facing growing challenges as a result of rapidly growing populations, people living longer with chronic diseases, advanced treatments involving more healthcare providers, and a limited number of resources to deal with these growing challenges. The World Health Organization has reported that between 2008 and 2030, noncommunicable diseases (WHO, 2008) will dramatically rise worldwide with the burden being the biggest in developing countries (Reardon, 2011). With the advancement of medical science, treatments are becoming more complex, and patients with diseases such as cancer, diabetes, asthma, and cardiovascular diseases are living longer with these conditions and seeing multiple healthcare providers.

The United Nations estimates that the global population aged 60 years and older is expected to more than triple by the year 2050 and will reach 2 billion people (UN, 2015). In 2050, 44% of the world’s population will live in countries with at least 20% of the population aged 60 years or older, and one in four people will live in a country where more than 30% of people are above aged 60 years or older. This growing elderly population will require more healthcare services and care coordination.

There will also be a shortage of healthcare providers globally. The global population is growing at a faster rate than the number of available providers who are graduating. From 1970 to 2010 the US physician-to-population ratio increased by 98% (from 161 per 100,000 to 319 per 100,000) (Smart, 2012). Many countries have critical health workforce shortages.

Healthcare providers are often not distributed where they are needed most. More than 50% of foreign-born doctors and 40% of foreign-born nurses in the United States are from Asia (Smart, 2012). Numerous countries in the Middle East have a significant shortage of local talent and rely on expatriot communities for both the nursing and physician workforce. In the 2008 WHO/Global Health Workforce Alliance report, the WHO (2008) noted that there is a shortfall of 4.3 million trained healthcare workers globally, with the greatest shortages occurring in the poorest countries. Africa has 10% of the world’s population but bears 24% of the global disease burden. It also has 3% of the world’s healthcare workforce and less than 1% of the world’s financial resources for health. The number of caregivers in 36 countries in Africa is inadequate to deliver even the most basic immunization and maternal health services (Deloitte, 2014). It is estimated that sub-Saharan Africa will need 1.5 million more healthcare workers to provide basic services for its population.

The global migration of patients and healthcare providers is also creatingchallenges. When patients move from their current city, they often do not carry with them their full patient history to their next healthcare provider. This makes it more challenging for healthcare providers to provide continuity of care for patients and may require duplication of diagnostics tests. Expenditures for global health services are increasing more than 10% in most countries (Deloitte, 2014). There is a global need to find more efficient ways to deliver healthcare services and share medical data while reducing costs and improving outcomes. Moreover, migration creates cultural diversity which presents additional challenges for a healthcare system.

Health informatics can be defined as the acquiring, storing, retrieving, and using of healthcare information to foster better collaboration among a patient’s various healthcare providers. Another definition cited by the National Library of Medicine defines health informatics as “the interdisciplinary study of the design, development, adoption and application of IT-based innovations in healthcare services delivery, management, and planning” (NLM, 2016). The term e-health can be defined as “the cost-effective and secure use of information and communications technologies in support of health and health-related fields, including healthcare services, health surveillance, health literature, and health education, knowledge and research” (WHO, 2005). Increasing health informatics is a fundamental requirement for building effective and efficient health information systems at local, national, and global levels (Safran, 2009; McCaffery, 2009).

Other related terms include medical informatics, nursing informatics, clinical informatics, and biomedical informatics (BMI). The scientific study of informatics evaluates approaches to information and knowledge management in clinical care, and public health and biomedical research. The International Journal of Medical Informatics, the official journal of the European Federation for Medical Informatics (EFMI) and International Medical Informatics Association (IMIA), describes the field of medical informatics as encompassing the following areas (International Journal of Medical Informatics, 2016):

Information systems, including national or international registration systems, hospital information systems, departmental and/or physician’s office systems, document handling systems, electronic medical record systems, standardization, systems integration, etc.;

Computer-aided medical decision support systems using heuristic, algorithmic, and/or statistical methods as exemplified in decision theory, protocol development, artificial intelligence, etc.;

Educational computer-based programs pertaining to medical informatics or medicine in general;

Organizational, economic, social, and clinical impact, ethical issues, and cost–benefit aspects of IT applications in health care.

BMI is the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem-solving, and decision-making, motivated by efforts to improve human health. A formal definition of BMI was developed by the American Medical Informatics Association (AMIA) Academic Forum (American Medical Informatics Association, 2016). Subsequently a set of core competencies for BMI were published by the AMIA (Kulikowski et al., 2012).

Global Health Informatics

Health informatics systems have been widely developed to support health providers and patients in clinics, hospitals, and at home. In the following we review the goal of these systems, the challenges of their implementation, and evaluations of these systems in developed and developing countries (Blaya et al., 2010).

Electronic Medical Records

Electronic health record (EHR) systems record health-related information on an individual so that it can be consulted by clinicians or staff for patient care. One formal definition of an EHR is “an electronic version of a patient’s medical history, that is maintained by the provider over time, and may include all the key administrative and clinical data relevant to that person’s care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports” (CMS, 2016).

The EHR has the potential to streamline the clinician’s workflow and to support evidence-based decision support, quality management, and outcomes reporting (Safran et al., 1993; Bates et al., 1998; Kaushal et al., 2003). However, implementation of EHRs can be slow, expensive, and have usability problems (Koppel, 2010; Jamoom and Hing, 2015; Jha, 2011; Kushniruk et al., 2013). In the United States the Department of Veterans Affairs (VA) has developed and deployed the Vista Electronic Health Record system (Evans et al., 2006). Formal evaluations of EHR in developing countries have shown successful implementation. For example, the Indian Health Service’s Vista system showed that the majority of clinicians viewed its implementation positively and hence used it more (Sequist et al., 2007). The Mosoriot Medical Record System evaluation in Kenya showed improved staff productivity and reduced patient wait times (Rotich et al., 2003). OPENMRS system is an open source freely available system that has been implemented in Africa (Seebregts et ...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• List of Contributors
• Foreword
• Chapter 1. Global Health Informatics—An Overview
• Chapter 2. National Health Information Systems and Health Observatories
• Chapter 3. Information and Communication Technologies and Global Health Challenges
• Chapter 4. Standards for Global Health Information Systems
• Chapter 5. Data Systems and Global Health Informatics Research
• Chapter 6. Clinical Information Systems
• Chapter 7. The New Medicine: From the Paper Medical Record to the Digitized Human Being
• Chapter 8. Telemedicine, eHealth and Remote Care Systems
• Chapter 9. Analytics and Decision Support Systems in Global Health Informatics
• Chapter 10. Patient Engagement and Digital Health Communities
• Chapter 11. Ethical and Transborder Issues
• Chapter 12. Intergovernmental Collaboration in Global Health Informatics
• Author Index
• Subject Index