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Guest Blog: Advancing Health Information Technology Adoption Globally
Editor’s Note: On World Health Day 2022, Sansanee Suwaratana Craig, MD, a South Philadelphia Children’s Hospital of Philadelphia Primary Care attending and Clinical Informatics faculty member in the Department of Biomedical and Health Informatics, writes about the Global Health Informatics Program established at CHOP in 2021. The program focuses on leveraging technologies to close gaps in health disparities locally and globally. Initiatives include operationalizing digital health equity, embedding equity into clinical decision support design in pediatric primary care, and implementing electronic health data technology in low- and middle-income countries. Dr. Craig is also an assistant professor in the Department of General Pediatrics, Perelman School of Medicine at the University of Pennsylvania.
As a teenager growing up in Thailand, I translated English to Thai for United States, United Kingdom, Australian, and Singaporean teams of physicians, surgeons, and dentists during volunteer trips to hilltribe villages on the Myanmar-Thailand border. The number of patients seen, diseases cared for, and procedures done were recorded in notebooks that the teams would take back to their home countries. As these annual trips occurred over the years, I often wondered, “Are we going to see this person again next year to do the same dental procedure? Are these teams really making a difference?”
What is Global Health Informatics?
Health data that are recorded, stored, and used allow us to answer important questions and decide whether the interventions in our clinics, hospitals, and communities are making a lasting impact to help patients live healthier lives. Technology has the potential to make it easier to create, analyze, and interpret this wealth of health data.
Health informatics brings together the design expertise and technologies needed to improve healthcare and, ultimately, health outcomes for patients. The electronic health record (EHR) is the most familiar technology, but others include patient portals, mobile health apps, secure chat tools, and remote patient monitoring innovations. Global health efforts promote health across the globe, particularly in low-and middle-income countries (LMIC). Thus, global health informatics is at the intersection of both fields, combining health information technology implementation with global health principles in resource-limited settings.
Since the beginning of the computer age, the use of health information technology (IT) in LMICs has been expanding, including the design and implementation of open-source EHRs, telemedicine, and mobile health (mHealth) applications to track diseases such as tuberculosis and HIV. Over the past 20 years, we have learned that:
- Health information technology designed for the U.S. does not work well in LMICs without considering the data collection, data sharing, and workflow integration needs of local healthcare settings
- A sustainable, scalable, and capacity-building strategy is critical to avoid “pilotitis,” the oft-occurring phenomenon in which health IT tools such as an mHealth app fail to scale up beyond the pilot phase
- Local partners are key to catalyzing and sustaining change and should be engaged from early stages of design through implementation
- Global health informatics work needs to not only be collaborative but invited. When it isn’t, there is a high likelihood of causing more harm than good.
The COVID-19 pandemic accelerated the use of telemedicine services for access to healthcare, a particular boon to remote areas of LMICs with limited clinician access. Necessity, the mother of invention, has driven the innovative use of existing technology to address healthcare disparities. Recent examples highlighted in a Partners in Health webinar include the use of chatbots to identify and directly care for patients with depression, and the use of telemarketing call centers for COVID-19 contact tracing in rural areas of Mexico.
Despite the advances made in telemedicine adoption, the COVID-19 pandemic has shown us that there is a critical need for collaboration among the health informatics communities around the world to use health technologies that advance equitable health for all. Much of healthcare in resource-constrained settings is still primarily reliant on paper-based medical record systems, making it difficult to provide decision support at the point of care, share data across healthcare settings, and aggregate population-level data to inform research, quality improvement efforts, and public health policy.
We have opportunities for developing health information systems in LMICs differently from the way they have been built in the U.S. Our health information systems here in the U.S. are mainly large EHR systems that require uninterrupted connectivity to a secure server and connectivity to a power supply. EHR records, for the most part, must be accessed using desktop computers.
Additionally, most U.S. systems were initially designed to improve patient billing and not for direct patient care or population health. That has resulted in challenges whereby information is not easily shareable for research or quality improvement across different healthcare institutions and public health organizations. Many LMIC settings have the chance to develop patient-centered health information systems from the ground up and to make their data readily available for clinical level or population level decision making.
We still need to advance health information technology adoption in resource-constrained settings, and there is an urgent demand for evidence-based strategies to advance electronic health data implementation in LMICs. Despite readily available mobile technology, limited decision-making support tools are available to providers in LMICs.
We need strong health information systems across the globe that would benefit all, as evidenced by the rapid information sharing of the coronavirus Omicron variant thanks to the advanced health data infrastructure in South Africa. Both globally through the WHO’s digital health strategy and nationally through the Global Digital Health Partnership at the Office of the National Coordinator and the Department of Health and Human Services, collaborative initiatives around the world are working to harness the power of digital technologies as essential for achieving the Sustainable Development Goals.
Global Health Informatics at CHOP
By working with innovative partners at CHOP and around the globe, we want to leverage how health information technology advances healthy lives and promotes well-being for all children.
Examples include research collaborations with the Botswana-University of Penn Partnership on tuberculosis contact tracing and support for the introduction of electronic data capture in the Niños Primeros en Salud clinic in the Dominican Republic.
The Global Health Informatics Program’s goal is to expand these collaborations with our global partners to strengthen health information systems that reduce disparities in health and improve healthcare quality. In addition to our vital in-country partners, our team includes clinical informaticists trained in information systems architecture and the flow of data, information, and knowledge within a health system. We also leverage the expertise of other DBHi teams and the University of Pennsylvania’s Institute for Biomedical Informatics to build health informatics capacity.
Our current portfolio of work capitalizes on CHOP’s unique strengths in clinical informatics in the field of pediatric healthcare, helping to foster a culture of high-quality healthcare data, support population health surveillance, and amplify the impact of global health pediatric research. Current projects include:
- A descriptive study evaluating healthcare data collection, sharing, and use in Botswana
- Implementation of electronic data capture tools for deworming campaigns in rural areas of Consuelo, Dominican Republic
- Supporting optimization of a new EHR system in La Romana, Dominican Republic
- Creating a global health informatics curriculum for the Open Medical Institute, through the American Austrian Foundation
- Leading working groups within national and international organizations on global health informatics, open-source software, and interoperable messaging standards
Kagiso Ndlovu, computer science lecturer and coordinator for the eHealth Research Unit at the University of Botswana, describes health informatics “as where computer science meets medicine.” The Global Health Informatics Program has partnerships with the University of Botswana’s computer science department to educate the health informatics workforce.
Ndlovu always wanted to pursue medicine but studied Computer Science and then earned an Honors Degree in Informatics and an MSc in Computer Science. He worked with clinicians as an IT officer in one of the Health Training Institutions in Botswana.
“An opportunity came to attend the first Health Informatics Conference in Botswana, and while at it, my passion to meaningfully contribute in the medical field was reignited,” Ndlovu said. “A month later, an advertisement came out for the position of Health Informatics Coordinator. I didn’t think twice about applying for the job, and I emerged successful.”
Since then, Ndlovu has coordinated national projects, spoken at local, regional, and international meetings, published research articles, and contributed to eHealth strategies and curricula development in the field. He is pursuing a PhD in Telemedicine focusing on the development of an interoperability framework for linking various eHealth systems across the health sector.
Our global partners, like Ndlovu, are key to the work we do, leading the efforts to first identify the health information technology needs, then to co-design, implement, and optimize solutions that meet the needs of local clinicians and researchers. Our north star is to support our partners in advancing sustainable, scalable, and capacity-building health information technologies that make an impact on patients’ lives.
Our goal is to promote bidirectional capacity-building by connecting the wealth of resources in clinical informatics, data science, and analytics at CHOP to meet the needs identified by our local partners. We want to amplify the impact of CHOP Global Health and health equity researchers and learn from our partners' innovative approaches to using health information technology in complex health care systems to address health disparities.
As Elizabeth Lowenthal, MD, MSCE, CHOP Global Health Research Director, said, “It is a privilege to make a difference. In global health, that privilege is multiplied.”
The Global Health Informatics team is honored to be a part of this privilege, partnering to strengthen health information systems around the world so that healthcare, both locally and globally, is more effective, efficient, and equitable.
For more information, please visit our website, and join us for our Fall 2022 Global Health Informatics Speaker Series. Email ghi [at] chop.edu to receive the Speaker Series registration information.
For those with relevant submissions, consider submitting manuscripts to the JAMIA Global Health Informatics Special Focus edition, with deadline June 1, 2022.