Global Health Informatics Research Overview

Dr. Sansanee Craig, CHOP Global Health Informatics Program Director, began collaborating with the CHOP Global Health Center in 2019 to implement digital data tools in a rural Dominican Republic clinic caring for medically underserved children and families. As a pilot, the electronic data capture tool was superior to paper data entry with regard to data completeness and accuracy, resulting in a 14.3% increase in the success of a local deworming campaign.

With the integration of the electronic health record into health systems a growing global priority, a multidisciplinary team comprising health and technology partners designed and deployed a mobile tablet-based electronic data capture tool at Niños Primeros en Saluda (NPS) CHOP-affiliated outpatient clinic in Consuelo, Dominican Republic.

The team has used digital data on the individual level for passive decision support and on the aggregate level for clinical outcome evaluations of bi-annual deworming campaigns in surrounding neighborhoods. In the project pilot phase, 78.7% of eligible children were dewormed at least once, up from 64.4% before the data capture tool. Compared to manual data entry, electronic data entry was more complete and more accurate with low rates of missed or wrong patient documentation. However, the team discovered software limitations that could jeopardize long-term success, including integration into the daily clinical workflow, the cost of the tool, and the scalability to meet more complex data needs.

The CHOP Global Health Informatics Team is establishing partnerships with key institutions including Universidad Central Del Este, PUCAMIMA, and the Dominican Republic Ministry of Health regional offices. These collaborations aim to facilitate the implementation of a mobile, modular electronic medical record system at NPS, enhancing clinic care for pediatric patients and their families. Shared expertise across Health and technology teams will leverage their shared expertise to deploy effective and usable health information technology that promotes better health outcomes for children and their communities in the Dominican Republic.

This study in Botswana focused on the challenges of integrating numerous healthcare data systems in pediatric clinics, as highlighted by two national health strategies: the Botswana Health Data Collaborative Roadmap Strategy (2020-24) and the Botswana National eLearning strategy (2020). The study used surveys to assess their views on data sharing and its impact on service delivery, engaging frontline workers from more than 30 healthcare facilities. Key findings included the need for data science education among healthcare workers and how frontline workers benefitted from improved access and education about accessing healthcare data, prompting the initiation of targeted workshops to enhance data management skills.

GHI team leaders head numerous initiatives to advance equitable health information systems within CHOP, regionally, and nationally. The Digital Health Navigator Program has been pivotal in extending healthcare accessibility with its integration of race, ethnicity, language, and social determinants of health indices (REaL+) data stratification into enterprise dashboards. The program also shepherded the deployment of multilingual telehealth services and a Spanish-language patient portal.

Stratification of data by REaL+ within patient portal messaging and Epic Refuel optimization projects have enriched awareness of the importance of evaluating the impact on equity in all areas. Equity impact evaluation requirements within remote patient monitoring vendor selection processes have set a high standard for future vendor selections. The establishment of Health Equity Checklists ensures that technology and projects prioritize equity, while language-concordant applications and interpreters in video visits have improved patient engagement. As we implement an institutional Digital Equity Subcommittee to develop a digital health equity roadmap, we are poised to further advance digital health equity, setting a strong example for the broader healthcare community.

Related publications

Szymczak JE, Fiks AG, Craig S, Mendez DD, Ray KN. Access to What for Whom? How Care Delivery Innovations Impact Health Equity. J Gen Intern Med. 2023 Apr;38(5):1282-1287. Epub 2023 Jan 10. PMID: 36627525; PMCID: PMC9831366.

Craig S, McPeak KE, Madu C, Dalembert G. Health information technology and equity: Applying history's lessons to tomorrow's innovations. Curr Probl Pediatr Adolesc Health Care. 2022 Jan;52(1):101110. Epub 2021 Dec 30. PMID: 34974991.

CHOP Informatics Faculty lead health informatics leadership seminars in Mexico and Austria, in conjunction with Open Medical Institute, with topics ranging from data privacy to artificial intelligence. Fellows from Eastern European countries train in bi-annual seminars in Austria. Learn more about upcoming trainings.

The inaugural seminar in Mexico City in 2023 hosted 25 fellows from Mexico and the Dominican Republic who attended a three-day course led by faculty members from the United States and Mexico. Course content included topics like electronic health record systems, data privacy and security, change management for health information technology, artificial intelligence, and a clinical decision support workshop.

In 2023, CHOP teams also partnered with the University of Botswana to lead workshops that advance data science skills for health workers in Botswana, training staff across three cities.

Past Events

• Mexico City, Mexico
• Salzburg, Austria

CHOP partners with researchers in Ghana to study strengths and gaps within electronic health record data to improve care processes and promote health outcomes of patients in the neonatal intensive care unit (NICU).

The retrospective chart review study aims to evaluate the quality of data captured in the electronic medical record (EMR) system at the NICU of Korle Bu Teaching Hospital. The study seeks to determine whether data related to newborn admissions, care, and discharges in the EMR is complete and accurate when compared to traditional paper-based record-keeping methods. The study aims to identify areas that may require improvement in data collection within the EMR system, thereby building confidence in using this data for clinical decision-making, research, and quality improvement initiatives.

Specific objectives include assessing the completeness and accuracy of both newborn and maternal health data, quantifying the number of neonates with missing EMR data, and identifying areas within the EMR that require improvements in data collection. The ultimate goal is to enhance the quality of health data and, in turn, improve healthcare outcomes at both the population and individual patient levels. The study will also provide valuable insights into data completeness and accuracy in a resource-limited healthcare setting.

Tuberculosis (TB) contact tracing is typically conducted in resource-limited settings with paper forms, but this approach may be limited by inefficiencies in data collection, storage and retrieval, as well as poor data quality. In Botswana, a CHOP study team developed, piloted, and evaluated a mobile health (mHealth) approach to TB contact tracing that replaced the paper form-based approach for a period of six months.

For both approaches, the researchers compared the time required to complete TB contact tracing and the quality of data collected. For the mHealth approach, they also administered the Computer System Usability Questionnaire to two healthcare workers who used the new approach, and they identified and addressed operational considerations for implementation.

Compared to the paper form-based approach, the mHealth approach reduced the median time required to complete TB contact tracing and improved data quality. The mHealth approach also had favorable overall rating, system usefulness, information quality, and interface quality scores on the Computer System Usability Questionnaire. Overall, the mHealth approach to TB contact tracing improved on the paper form-based approach used in Botswana. This new approach may similarly benefit TB contact tracing efforts in other resource-limited settings.

CHOP faculty and clinical informatics fellows, in collaboration with CHOP partner University of Botswana (UB), implemented a REDCap Instance on a Botswanan web server to aid in data accessibility and security. Through REDCap, online surveys, and database management, software was made more accessible and secure for faculty trying to do health research and quality improvement.

The team held workshops with 21 trainees, heavily focused on sustainability and education in the eResearch unit of the university. They gave lectures at UB Teaching Hospital and UB Health Sciences building to a total of 50 participants, mostly faculty from computer science, health sciences, medical school students, and information science students.

As of July 11, 2017, the UB REDCap Instance had 64 unique users, 15 of whom were active on the platform since June 2017. Of 33 unique registered projects not for demonstration or learning purposes, 15 had at least 50 items, 14 had been edited or accessed in the past four weeks, and four were in production status. The REDCap server had only one downtime independent of the UB internet.