Health IT

Dear Francis,

I also sense the same thing. However, I do not think that vertical programmes are harming efforts. The programmes are very important. I think it is the parochial thinking that serves to disintegrate the system.

One thing we are trying to do right now in the Philippines is to 'reuse' data. For example, data on a pregnancy report (under the maternal care program) can also be used to predict for vaccine demand (under EPI) and for schooling (public education planning). The data was collected vertically (by maternal care) but could be spun and viewed from a different by another programme.

The challenge is to make these reusable data points horizontally accessible to the vertical programs.

alvin

Dear Alvin,
Thanks for your response and I am excited at the knowledge that you are blowing open the bubbles that entrap most vertical programmers. I work in Uganda but one of the biggest challenges that policy makers at the local level face is the inability to access data from the various programs and extraporating this to serve a system wide information support. Even where data can be accessed the way it is renders it unusable to the policy maker because it is not designed to serve that purpose. I would really love to hear more about how you have been able to turn it around in the Phillipines and what strategies you have used.

I agree that Vertical programs are very useful and that they have been very instrumental in turning some of the terrible trends in health in many countries. But it is also true that we need a more coordinated approach such that there is more communication amongst themselves, and most importantly feeding into the mainstream systems that they aim to compliment.

Hi Francis,

Thanks for the compliments but we are in the middle of research as well. So no praises are in order yet :)

We try to implement the HMN framework in our projects because it is justifiable and well documented. I think the key strategy is to create a credible, auditable data collection center which can serve as
repository for the data. This data center should be acceptable to all parties. The processes should be open and well documented. The technology is the easy part. The hard part is getting it legislated.

Once that agency gets the support of all stakeholders (for its purpose as repository), the next challenge is making the data flow. Here it may mean just getting very simple routine data (report of pregnancy), and extrapolating it to inform other programs (eg, vaccine supply chain).

I can't tell you if it will work for now, but HMN-wise (the way Iunderstood HMN), it is within the development framework. Time will tell. There is much we can achieve with discussions like these..

Alvin

Dear Francis,

Greetings from Siddhartha, India.

At the outset, I would like to thank you for initiating a useful discussion
on HMIS. I work in the field of Immunization and happen to observe the same
condition of many vertical programmes engulfing the whole of health scenario
in India.

I personally opine that vertical programmes are beneficial for some years to
start with but it must necessarily be integrated in the existing system. In
every sense, the vertical programmes must not be such that it derails the
existing system of operation due to its un-due importance of singleton
operation and due to more focused approach. But it should pave the way of
strengthening the existing system and get itself engulfed within the merit
of the system.

I understand its very much difficult due to many confounding factors as
demand of the hour for the job of finishing the task of vertical programmes,
commitment of the country policy makers towards the task of vertical
programmes and also the competing priority of the donors towards the
vertical programmes.

The most important factor which needs to be addressed is the volumes of data
generated from each vertical programmes. The data needs to be pooled ...

Dear Francis,

Greetings from Siddhartha, India.

At the outset, I would like to thank you for initiating a useful discussion
on HMIS. I work in the field of Immunization and happen to observe the same
condition of many vertical programmes engulfing the whole of health scenario
in India.

I personally opine that vertical programmes are beneficial for some years to
start with but it must necessarily be integrated in the existing system. In
every sense, the vertical programmes must not be such that it derails the
existing system of operation due to its un-due importance of singleton
operation and due to more focused approach. But it should pave the way of
strengthening the existing system and get itself engulfed within the merit
of the system.

I understand its very much difficult due to many confounding factors as
demand of the hour for the job of finishing the task of vertical programmes,
commitment of the country policy makers towards the task of vertical
programmes and also the competing priority of the donors towards the
vertical programmes.

The most important factor which needs to be addressed is the volumes of data
generated from each vertical programmes. The data needs to be pooled in one
single system and analysed for corrective action. But often because of its
innate character of vertical programme, this pooling of data does not happen
and the generation of the data and transmission of this data is also very
much vertical in nature.

I would like to let you know, that in the State of Uttar Pradesh in India,
we have tried many innovations so as to streamline the reporting system.
Having strengthened the Integrated Disease Surveillance System of Government
which deals with all disease surveillance system of the state, thereby
report is generated by one single system and further fragmented by
individual department for corrective action by them. Also that we have
streamlined the reporting of Maternal and Child Health reporting system
which also includes Immunization, Nutritional Supplementation and Cold Chain
System reporting within the same format. These have started to give results,
in the form of more authentic data transmitted with less confusion in field
to fill many reporting formats and also that the policy framers can now have
access to the final data sheet in a more comprehensive way.

It would be good to hear from others on this interesting topic.

Regards,
Siddhartha

Dr. Siddhartha Sankar Datta,
MBBS, MD (Community Medicine)

Hi All.

This is a topic close to my heart! Having worked for the World Health Organization in Manila and in India on Immunization and TB databases respectively, I have a whole lot to say but not enough time and space in this format!

A universal, standards based, comprehensive, community health data model does not exist. Valiant efforts are usually made by individuals or groups of individuals that usually does not translate to the programmes at large in, say, places like Uganda. Having had prior industrial strength IT management experience working with ESRI, the GIS mapping company, in designing and buiding spatial disease surveillance systems at an enterprise level, I cannot empahasize enough the need for such a comprehensive model on paper, prior to building systems.

A friend and I have been toying with the idea of working with a google app for use by anybody/any program in the world with Internet access, to use a comprehensive standards based system, for free, providing accessability while preserving confidentiality and security for their data.

If there is an interest by anyone on this forum for such an app development intitative, please do let me know!

Dr . Jayanth Devasundaram, MBBS, MPH
Pennsylvania ...

Hi All.

This is a topic close to my heart! Having worked for the World Health Organization in Manila and in India on Immunization and TB databases respectively, I have a whole lot to say but not enough time and space in this format!

A universal, standards based, comprehensive, community health data model does not exist. Valiant efforts are usually made by individuals or groups of individuals that usually does not translate to the programmes at large in, say, places like Uganda. Having had prior industrial strength IT management experience working with ESRI, the GIS mapping company, in designing and buiding spatial disease surveillance systems at an enterprise level, I cannot empahasize enough the need for such a comprehensive model on paper, prior to building systems.

A friend and I have been toying with the idea of working with a google app for use by anybody/any program in the world with Internet access, to use a comprehensive standards based system, for free, providing accessability while preserving confidentiality and security for their data.

If there is an interest by anyone on this forum for such an app development intitative, please do let me know!

Dr . Jayanth Devasundaram, MBBS, MPH
Pennsylvania Environmental Public Health Tracking Program

Hi Jayanth,

If you're interested in google maps and open standards, you should check out this OpenMRS:Google maps project I just heard about from @OpenMRS on twitter today.

http://www.youtube.com/watch?v=5hEYn7cXZPY

cheers
Isaac

I have been working on a data agnostic globe information viewer that might answer some of these questions. It takes csv data with a location name somewhere in the table and modifies an icon color based upon the number in one field and stacks it in verticall sequence according to another. It is a very simple start, but it is 3d and works nicely on files such as are downloadable from the UN MDG site.

(I know about Faraday Software however that have accomplished this and a lot more already in a fully functional suite that is entirely web based and can be deployed in an enterprise.)

Since the likelyhood of a universal data format standard to emerge is poor, I am advocating for development of interchange technology between spreadsheet information and globe visualization.

I feel that a lot of analysis can be accomplished before the data is actually located on a map, and subsequent changes or additions can be handled through an interface that is outside of the GIS application with results that are mapped again and displayed.

So essentially, I'm talking about a spreadsheet (or csv) paradigm for universal data management with an additional layer where field ...

I have been working on a data agnostic globe information viewer that might answer some of these questions. It takes csv data with a location name somewhere in the table and modifies an icon color based upon the number in one field and stacks it in verticall sequence according to another. It is a very simple start, but it is 3d and works nicely on files such as are downloadable from the UN MDG site.

(I know about Faraday Software however that have accomplished this and a lot more already in a fully functional suite that is entirely web based and can be deployed in an enterprise.)

Since the likelyhood of a universal data format standard to emerge is poor, I am advocating for development of interchange technology between spreadsheet information and globe visualization.

I feel that a lot of analysis can be accomplished before the data is actually located on a map, and subsequent changes or additions can be handled through an interface that is outside of the GIS application with results that are mapped again and displayed.

So essentially, I'm talking about a spreadsheet (or csv) paradigm for universal data management with an additional layer where field descriptions and terminology can be related on a case by case basis. It sounds unwieldy, but semantic technologies can go a long way to produce synonyms and contextual searching in order to associate the data fields for subsequent analysis or reporting. Also, once accomplished, the 'rosetta stone' will not have to be recreated often as long as the majority of systems remain somewhat constant in their information tracking methods.

As far as the mapping part goes, most applications will take csv information if formatted correctly. The GIS system doesn't care what the descriptive data is, so long as it knows where to place each data point. We can leave the interpretation of these views to each end user.

As long as links to the original numbers exist, collaborative analysis can progress, with views being shared for reference.

I think making GIS do analysis is unwieldy, and having spreadsheets is already ubiquitous, so making translator modules for the data fields will be easier and allow use of all existing information.