Capacity Building in e-health & Health Informatics in Developing Countries From Silos to Systems

Capacity Building in e-health & Health Informatics in Developing Countries From Silos to Systems Don E. Detmer, MD Senior Advisor, AMIA; Prof. Med. Ed., U Virginia Edward Shortliffe, MD, PhD President & CEO, AMIA Barbara Brown Director, Global Partnership Program 21 April, 2010

e-health & Health Informatics Capacity-Building Conference 2008 Organized by the American Medical Informatics Association (AMIA) in active collaboration with International Medical Informatics Association (IMIA) (with support from Rockefeller Foundation & Bill & Melinda Gates Foundation) Global South Country Perspectives Represented Argentina Brazil South Africa Thailand Turkey Uruguay including perspectives from Developing Countries: Peru Vietnam

The Rockefeller Foundation Bellagio Center 20-25 July, 2008

Bellagio - Summer 2008: Three Themes plus Recommendations & a Call to Action 1) Identify & support local health workers & relevant experts (worldwide), 2) Formalize partnerships with others, & 3) Build a collaborative AMIA Global Partnership Program for Health Informatics * ^. * Planning supported a grant from the Bill & Melinda Gates Foundation ^ Spring 2010 - GPP being created as a non-profit entity related to AMIA

Global Needs & Assuring e-health Capacity From Silos to Systems Policy & Leadership Human Capital (ehealth Workforce Capacity) State of Information/ Telecommunications Infrastructure Healthy Individuals & Populations Executive Seminars; Leadership ID, Training & Advocacy PhD; Masters Informatics; Non-degree Certificate Programs Clinician/Public Health Champions AMIA 10x10 Health Informatics Building Blocks (HIBBs) - Knowledge & Skills Offerings National Readiness Assessment Instrument; other tool kits Components Vision for e-health Workforce Detmer 2008

Emerging Assumptions regarding e-health Capacity-Building & Health Informatics (1) Access to sustained evidence-based public health & health care services in needed in many parts of the world. To move from Silos to Systems for sustained improvement in public health & high quality care implies key inputs: 1) Electronic health records (EHRs) for planning, care, & evaluation, 2) Information & Communications Technology (ICT) for access & education, & 3) Multiple levels of workers having relevant informatics knowledge & skills.

Emerging Assumptions regarding e-health Capacity-Building & Health Informatics (2) The local health workers need to be networked over time with others (including professionals in other centers of excellence near & far). Appropriate knowledge & skills can be enhanced through learning health care systems. Some of these workers will become fully professional informaticians integrated into the global informatics community. Viable sustained networks for personal development & professional recognition may mitigate brain drain.

Human Factors Terms: HICT Cognition, change resistance, behavior, learning Information Knowledge, meaning, semantics Communication Speaking & listening Technology Hardware, software = Easier to More Difficult Adapted from Niland 10

HICT & Informatics Human Brain Carbon-based intelligence w/ known limitations Information & Communications Technology Hardware & Software - Silicon, Fiber, Microwaves w/ known limitations Plug & pray Informatics: Harness knowledge & technology for desired ends, e.g., Grammar for meaningful sentences Informatics is the science of the use of information. - Informatics fine tunes carbon to silicon, fiber, & microwaves

Working with others, the AMIA Global Partnership Program seeks to address these needs.

Planning the AMIA Global Partnership Program Groups Steering Structure & Governance Participants & Sites Training Approaches & Content Research & Evaluation

AMIA Global Partnership Program Leadership Program Leaders: - Andrew Kanter & Ted Shortliffe, Pres/CEO, AMIA; (Bill Tierney) - Don Detmer, Senior Advisor, AMIA & Chair Steering Committee; - Barbara Brown, AMIA Director, GPP AMIA GPP Committee Leaders- Structure & Governance: Antoine Geissbuhler (Chair) & Alvin Marcelo (Co-chair) Participants & Sites: Andy Kanter (Chair) & Fernán Quirós (Co-chair) Training Approaches & Contents: Bill Hersh (Chair) & Paula Otero (Co-chair) Research & Evaluation: Chris Seebregts (Chair) & Chris Bailey (Co-chair)

Steering: A warm Thank You to AMIA GPP Committee members Walter Curioso, Antoine Geissbuhler, Lyn Hanmer, Bill Hersh, Andy Kanter, Alvaro Margolis, Paula Otero, Chris Seebregts, Chris Bailey, Luu Ngoc Hoat, Alvin Marcelo, (Bill Tierney) Structure & Governance: Maurice Mars, Alvaro Margolis, Najeeb Al-Shorbaji, Cindy Gadd, Stephen Settimi Participants & Sites: NT Cheung, Marion Ball, Solomon Shiferaw, Hamish Fraser, Helen Ayles; Bill Tierney (Chair until 12/31/09), Training Approaches & Contents: Luu Ngoc Hoat, Alvaro Margolis, Peter Murray, Janise Richards, Lyn Hanmer Research & Evaluation: Rosemary Foster, Ghislain Khouematchoua, Heimar Marin, Walter Curioso, Jorn Braa, Sundeep Sahay, Siaw-Teng Liaw

And, Thank you to AMIA & AMIA GPP Staff Barbara Brown Meryl Bloomrosen Tia Abner Ebele Okwumabua Nancy Roslyn Rappaport Elaine Steen

Current Priorities Formalize relevant Partnerships Educate via AMIA 10x10 & AMIA i10x10 Programs Identify & collaborate with others on HIBBs Mature a Global Informatics Network for Informatics Education & Training Seek funding for Global Informatics Fellowships

Know what you are doing. Support formal education/training in Applied Clinical Informatics. 1) Now: US AMIA -10x10 or AMIA i10x10 (http://www.amia.org/10x10/) Clinical, Public Health, Translational Bioinformatics, Nursing Informatics 2) Coming: Medical Sub-certification in Applied Clinical Informatics

Health Informatics Building Blocks (HIBBs) Goals Mechanism to coordinate & provide distance learning for informatics training & education. Collect, create, test & deploy appropriate informatics training content Modular, adaptable, updatable Catalyze & develop a sustainable pipeline of health care workers with informatics skills applicable to their work at the grassroots levels Concept A focused informatics training module designed to advance knowledge & skills for individuals who use health information & communications (HICT) to provide health care &/or public health services, make HICT-related policy decisions or manage the HICT infrastructure for an organization. Initial Funding Rockefeller Foundation project planning grant ehealth Capacity Building Conference Planning Meeting London, Wellcome Trust

Health Informatics Building Blocks (HIBBs) Short courses, webinars, learning packages (CDs) Web-based E-Learning center Learning modues for teaching in villages for local leaders or citizens/patients & informal caregivers, &/or for health workers, &/or professionals, &/or policy leaders Content Basic IT, CT, & Informatics Attitudes, Knowledge & Skills Ex: DPRC certification & examination

Digital Patient Record Certification Examination and Study Guide* Who should use DPRC certification? Any academic institution training qualified healthcare professionals that will use a digital input device to manage patient records in a HIS & thereby can effect the outcome of a patients treatment or legal rights. www.dprcertification.com * A collaboration between AMIA & CS Placement

AMIA Global Partnership Program: HIBBs Development Collaboration Example : Carl Leitner Intrahealth.org Tanzania 3 day training workshop with Univ. of Dar es Salaam April 2010 General topics appropriate for consideration as HIBBs: The importance of using data standards System & database administration & backup Using source control software to maintain large projects. Public Health Informatics" topics: Interoperability among HIS components (e.g. DHIS and ihris) Data ownership and access rights Design and Development of public health data-portals

AMIA GPP: Health Information Building Blocks (HIBBs) Program Currently Creating 3 Prototypes HIBBs PLAN: 1) Launch Prototypes at Medinfo (Cape Town, So. Africa 12-15 Sept 2010) 2) Field test after Medinfo as proof of concept. We are building our HIBBs team & developing HIBBs specs with help from partners like OpenMRS, Intrahealth, HMN, & others. Funding - Rockefeller Foundation

e-health Capacity-Building & Health Informatics - Conclusions A useful vision & charge to action was developed at Bellagio in 2008 Essential elements for long term success in low resource environments will likely entail: 1) A sufficient ICT infrastructure 2) Evolving health care processes based on evidence appropriate for the local culture 3) A fresh view toward educational preparation among health workers to include basics of ICT & informatics 4) Focused & sustained policy support at national / regional level 5) Ongoing applied (practical) research & development 6) A thriving global network among informaticians, including telemedicine/telehealth 7) AMIA working with IMIA seeks to be a key global partner for years to come.

Thank you & best wishes. Comments & Questions detmer@amia.org barbara@amia.org