A Repository of Codes of Ethics and Technical Standards in Health Informatics

We present a searchable repository of codes of ethics and standards in health informatics. It is built using state-of-the-art search algorithms and technologies. The repository will be potentially beneficial for public health practitioners, researchers, and software developers in finding and comparing ethics topics of interest. Public health clinics, clinicians, and researchers can use the repository platform as a one-stop reference for various ethics codes and standards. In addition, the repository interface is built for easy navigation, fast search, and side-by-side comparative reading of documents. Our selection criteria for codes and standards are two-fold; firstly, to maintain intellectual property rights, we index only codes and standards freely available on the internet. Secondly, major international, regional, and national health informatics bodies across the globe are surveyed with the aim of understanding the landscape in this domain. We also look at prevalent technical standards in health informatics from major bodies such as the International Standards Organization (ISO) and the U. S. Food and Drug Administration (FDA). Our repository contains codes of ethics from the International Medical Informatics Association (IMIA), the iHealth Coalition (iHC), the American Health Information Management Association (AHIMA), the Australasian College of Health Informatics (ACHI), the British Computer Society (BCS), and the UK Council for Health Informatics Professions (UKCHIP), with room for adding more in the future. Our major contribution is enhancing the findability of codes and standards related to health informatics ethics by compilation and unified access through the health informatics ethics repository.     

Patterns and Correlates of Public Health Informatics Capacity Among Local Health Departments: An Empirical Typology

Objective: Little is known about the nationwide patterns in the use of public health informatics systems by local health departments (LHDs) and whether LHDs tend to possess informatics capacity across a broad range of information functionalities or for a narrower range. This study examined patterns and correlates of the presence of public health informatics functionalities within LHDs through the creation of a typology of LHD informatics capacities.Methods: Data were available for 459 LHDs from the 2013 National Association of County and City Health Officials Profile survey. An empirical typology was created through cluster analysis of six public health informatics functionalities: immunization registry, electronic disease registry, electronic lab reporting, electronic health records, health information exchange, and electronic syndromic surveillance system. Three-categories of usage emerged (Low, Mid, High). LHD financial, workforce, organization, governance, and leadership characteristics, and types of services provided were explored across categories.Results: Low-informatics capacity LHDs had lower levels of use of each informatics functionality than high-informatics capacity LHDs. Mid-informatics capacity LHDs had usage levels equivalent to high-capacity LHDs for the three most common functionalities and equivalent to low-capacity LHDs for the three least common functionalities. Informatics capacity was positively associated with service provision, especially for population-focused services.Conclusion: Informatics capacity is clustered within LHDs. Increasing LHD informatics capacity may require LHDs with low levels of informatics capacity to expand capacity across a range of functionalities, taking into account their narrower service portfolio. LHDs with mid-level informatics capacity may need specialized support in enhancing capacity for less common technologies.     

A Public Health Informatics Solution to Improving Food Safety in Restaurants: Putting the Missing Piece in the Puzzle

Foodborne illnesses remain an important public health challenge in the United States causing an estimated 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths per year. Restaurants are frequent settings for foodborne illness transmission. Public health surveillance – the continual, systematic collection, analysis, and interpretation of reports of health data to prevent and control illness – is a prerequisite for an effective food control system. While restaurant inspection data are routinely collected, these data are not regularly aggregated like traditional surveillance data. However, there is evidence that these data are a valuable tool for understanding foodborne illness outbreaks and threats to food safety. This article discusses the challenges and opportunities for incorporating routine restaurant inspection data as a surveillance tool for monitoring and improving foodborne illness prevention activities. The three main challenges are: 1) lack of a national framework; 2) lack of data standards and interoperability; and 3) limited access to restaurant inspection data. Tapping into the power of public health informatics represents an opportunity to address these challenges. Advancing the food safety system by improving restaurant inspection information systems and making restaurant inspection data available to support decision-making represents an opportunity to practice smarter food safety.     

Pakistan’s Response to COVID-19: Overcoming National and International Hypes to Fight the Pandemic

The COVID-19 outbreak started as pneumonia in December 2019 in Wuhan, China. The subsequent pandemic was declared as the sixth public health emergency of international concern on January 30, 2020, by the World Health Organization. Pakistan could be a potential hotspot for COVID-19 owing to its high population of 204.65 million and its struggling health care and economic systems. Pakistan was able to tackle the challenge with relatively mild repercussions. The present analysis has been conducted to highlight the situation of the disease in Pakistan in 2020 and the measures taken by various stakeholders coupled with support from the community to abate the risk of catastrophic spread of the virus.     

Leveraging Cloud Computing to Address Public Health Disparities: An Analysis of the SPHPS

As the use of certified electronic health record technology (CEHRT) has continued to gain prominence in hospitals and physician practices, public health agencies and health professionals have the ability to access health data through health information exchanges (HIE). With such knowledge health providers are well positioned to positively affect population health, and enhance health status or quality-of-life outcomes in at-risk populations. Through big data analytics, predictive analytics and cloud computing, public health agencies have the opportunity to observe emerging public health threats in real-time and provide more effective interventions addressing health disparities in our communities. The Smarter Public Health Prevention System (SPHPS) provides real-time reporting of potential public health threats to public health leaders through the use of a simple and efficient dashboard and links people with needed personal health services through mobile platforms for smartphones and tablets to promote and encourage healthy behaviors in our communities. The purpose of this working paper is to evaluate how a secure virtual private cloud (VPC) solution could facilitate the implementation of the SPHPS in order to address public health disparities.     

Morocco's National Response to the COVID-19 Pandemic: Public Health Challenges and Lessons Learned

This report aimed to provide an overview of the epidemiological situation of COVID-19 in Morocco and to review the actions carried out as part of the national response to this pandemic. The methodology adopted was based on literature review, interviews with officials and actors in the field, and remote discussion workshops with a multidisciplinary and multisectoral working group. Morocco took advantage of the capacities already strengthened within the framework of the application of the provisions of the International Health Regulations (IHR) of 2005. A SWOT analysis made it possible to note that an unprecedented political commitment enabled all the necessary means to face the pandemic and carry out all the response activities, including a campaign of relentless communication. Nevertheless, and despite the efforts made, the shortage of human resources, especially those qualified in intensive care and resuscitation, has been the main drawback to be addressed. The main lesson learned is a need to further strengthen national capacities to prepare for and respond to possible public health emergencies and to embark on a process overhaul of the health system, including research into innovative tools to ensure the continuity of the various disease prevention and control activities. In addition, response to a health crisis is not only the responsibility of the health sector but also intersectoral collaboration is needed to guarantee an optimal coordinated fight. Community-oriented approaches in public health have to be strengthened through more participation and involvement of nongovernmental organizations (NGOs) and civil society in operational and strategic planning.     

Identifying Opportunities to Strengthen the Public Health Informatics Infrastructure: Exploring Hospitals’ Challenges with Data Exchange

Policy Points

• Even though most hospitals have the technological ability to exchange data with public health agencies, the majority continue to experience challenges.
• Most challenges are attributable to the general resources of public health agencies, although workforce limitations, technology issues such as a lack of data standards, and policy uncertainty around reporting requirements also remain prominent issues.
• Ongoing funding to support the adoption of technology and strengthen the development of the health informatics workforce, combined with revising the promotion of the interoperability scoring approach, will likely help improve the exchange of electronic data between hospitals and public health agencies.

ContextThe novel coronavirus 2019 (COVID‐19) pandemic has highlighted significant barriers in the exchange of essential information between hospitals and local public health agencies. Thus it remains important to clarify the specific issues that hospitals may face in reporting to public health agencies to inform focused approaches to improve the information exchange for the current pandemic as well as ongoing public health activities and population health management.MethodsThis study uses cross‐sectional data of acute‐care, nonfederal hospitals from the 2017 American Hospital Association Annual Survey and Information Technology supplement. Guided by the technology‐organization‐environment framework, we coded the responses to a question regarding the challenges that hospitals face in submitting data to public health agencies by using content analysis according to the type of challenge (i.e., technology, organization, or environment), responsible entity (i.e., hospital, public health agency, vendor, multiple), and the specific issue described. We used multivariable logistic and multinomial regression to identify characteristics of hospitals associated with experiencing the types of challenges.FindingsOur findings show that of the 2,794 hospitals in our analysis, 1,696 (61%) reported experiencing at least one challenge in reporting health data to a public health agency. Organizational issues were the most frequently reported type of challenge, noted by 1,455 hospitals. The most common specific issue, reported by 1,117 hospitals, was the general resources of public health agencies. An advanced EHR system and participation in a health information exchange both decreased the likelihood of not reporting experiencing a challenge and increased the likelihood of reporting an organizational challenge.ConclusionsOur findings inform policy recommendations such as improving data standards, increasing funding for public health agencies to improve their technological capabilities, offering workforce training programs, and increasing clarity of policy specifications and reporting. These approaches can improve the exchange of information between hospitals and public health agencies.     

Characterizing the Access of Clinical Decision Support Offered by Immunization Information System in Minnesota

Background: Healthy People 2020 aims to improve population health by increasing immunization rates to decrease vaccine-preventable infectious diseases. Amongst the many strategies, role of immunization information systems (IIS) are recognized by studies and taskforce reports. IIS are unique in their offering of clinical decision support for immunizations (CDSi) which are utilized by healthcare providers. Federal initiatives such as Meaningful Use (MU) and Affordable Care Act (ACA) aim to improve immunization rates through use of technology and expanding access to immunization services respectively. MU, the Electronic Health Record (EHR) incentive program includes use of IIS CDSi functionality as part of Stage 3. It is essential to understand access and use patterns of IIS CDSi, so as to utilize it better to improve immunization services.Objectives: To understand the utilization of clinical decision support for immunizations (CDSi) offered by immunization information system in Minnesota and to analyze the variability of its use across providers and EHR implementations.Methods: IIS in Minnesota (Minnesota Immunization Information Connection: MIIC) offers CDSi that is accessed through EHRs and branded as Alternate Access (AA). Data from MIIC and technical documents were reviewed to create details on organizations which implemented AA functionality. Data on EHR adoption in clinics and local health departments was obtained from Minnesota eHealth assessment reports. Data on access were tracked from January 2015 through mid-October 2015 through weekly specialized reports to track the queries by organization, volume and day of the week. Data were analyzed, findings were synthesized and reviewed with subject matter experts.Results: Currently 25 healthcare systems/organizations which represent 599 individual provider sites have implemented the AA functionality. Analysis of their EHR platform pointed to two EHRs (Epic and PH-Doc) as dominant products in Minnesota for private and public providers respectively. Use of this function was even across study time period. The query volume correlated to size of the organization, with the exception of an outlier organization with huge query count. Query was able to successfully locate a single matching record for 59% of searches, could not find a record for 5% and 31% resulted in blank/error and the match rates varied across health systems.Conclusion: High EHR adoption offers a great opportunity to promote use of IIS CDSi at point of care. Analysis did not track use at individual clinic level and how the queries were being generated. Additional research is needed to understand the provider level use of this CDSi and other organizational and technical factors which influence access to IIS. This is essential for IIS as they execute projects to improve population-level immunization rates, plan provider outreach and prioritize their system enhancements to meet federal requirements.     

Artificial Intelligence–Enabled Social Media Analysis for Pharmacovigilance of COVID-19 Vaccinations in the United Kingdom: Observational Study

Background The rollout of vaccines for COVID-19 in the United Kingdom started in December 2020. Uptake has been high, and there has been a subsequent reduction in infections, hospitalizations, and deaths among vaccinated individuals. However, vaccine hesitancy remains a concern, in particular relating to adverse effects following immunization (AEFIs). Social media analysis has the potential to inform policy makers about AEFIs being discussed by the public as well as public attitudes toward the national immunization campaign.Objective We sought to assess the frequency and nature of AEFI-related mentions on social media in the United Kingdom and to provide insights on public sentiments toward COVID-19 vaccines.Methods We extracted and analyzed over 121,406 relevant Twitter and Facebook posts, from December 8, 2020, to April 30, 2021. These were thematically filtered using a 2-step approach, initially using COVID-19–related keywords and then using vaccine- and manufacturer-related keywords. We identified AEFI-related keywords and modeled their word frequency to monitor their trends over 2-week periods. We also adapted and utilized our recently developed hybrid ensemble model, which combines state-of-the-art lexicon rule–based and deep learning–based approaches, to analyze sentiment trends relating to the main vaccines available in the United Kingdom.Results Our COVID-19 AEFI search strategy identified 46,762 unique Facebook posts by 14,346 users and 74,644 tweets (excluding retweets) by 36,446 users over the 4-month period. We identified an increasing trend in the number of mentions for each AEFI on social media over the study period. The most frequent AEFI mentions were found to be symptoms related to appetite (n=79,132, 14%), allergy (n=53,924, 9%), injection site (n=56,152, 10%), and clots (n=43,907, 8%). We also found some rarely reported AEFIs such as Bell palsy (n=11,909, 2%) and Guillain-Barre syndrome (n=9576, 2%) being discussed as frequently as more well-known side effects like headache (n=10,641, 2%), fever (n=12,707, 2%), and diarrhea (n=16,559, 3%). Overall, we found public sentiment toward vaccines and their manufacturers to be largely positive (58%), with a near equal split between negative (22%) and neutral (19%) sentiments. The sentiment trend was relatively steady over time and had minor variations, likely based on political and regulatory announcements and debates.Conclusions The most frequently discussed COVID-19 AEFIs on social media were found to be broadly consistent with those reported in the literature and by government pharmacovigilance. We also detected potential safety signals from our analysis that have been detected elsewhere and are currently being investigated. As such, we believe our findings support the use of social media analysis to provide a complementary data source to conventional knowledge sources being used for pharmacovigilance purposes.     

Virtual primary care in high-income countries during the COVID-19 pandemic: Policy responses and lessons for the future

BackgroundTelemedicine, once defined merely as the treatment of certain conditions remotely, has now often been supplanted in use by broader terms such as ‘virtual care’, in recognition of its increasing capability to deliver a diverse range of healthcare services from afar. With the unexpected onset of COVID-19, virtual care (e.g. telephone, video, online) has become essential to facilitating the continuation of primary care globally. Over several short weeks, existing healthcare policies have adapted quickly and empowered clinicians to use digital means to fulfil a wide range of clinical responsibilities, which until then have required face-to-face consultations.ObjectivesThis paper aims to explore the virtual care policies and guidance material published during the initial months of the pandemic and examine their potential limitations and impact on transforming the delivery of primary care in high-income countries.MethodsA rapid review of publicly available national policies guiding the use of virtual care in General Practice was conducted. Documents were included if issued in the first six months of the pandemic (March to August of 2020) and focussed primarily on high-income countries. Documents must have been issued by a national health authority, accreditation body, or professional organisation, and directly refer to the delivery of primary care.ResultsWe extracted six areas of relevance: primary care transformation during COVID-19, the continued delivery of preventative care, the delivery of acute care, remote triaging, funding & reimbursement, and security standards.ConclusionVirtual care use in primary care saw a transformative change during the pandemic. However, despite the advances in the various governmental guidance offered, much work remains in addressing the shortcomings exposed during COVID-19 and strengthening viable policies to better incorporate novel technologies into the modern primary care clinical environment.     

Cost-Effectiveness of Antiviral Treatments for Pandemics and Outbreaks of Respiratory Illnesses,Including COVID-19: A Systematic Review of Published Economic Evaluations

ObjectiveTo review published economic evaluations of antiviral treatment for pandemics and outbreaks of respiratory illnesses.MethodsWe conducted a systematic review to identify economic evaluations of antiviral treatment for pandemics and outbreaks of respiratory illnesses, including coronavirus disease 2019 (COVID-19). We searched Medline (EBSCOhost), EMBASE (Ovid), EconLit (Ovid), National Health Service Economic Evaluation Database (Ovid), and Health Technology Assessment (Ovid). The search was last rerun on July 5, 2020. Citation tracking and reference checking were used. Only full economic evaluations published as peer-reviewed articles in the last 10 years were included. Studies were quality assessed using the National Institute for Health and Care Excellence economic evaluation checklist.ResultsOverall, 782 records were identified, of which 14 studies met the inclusion criteria. The studies were mostly conducted in high-income countries. All were model-based. Seven (50%) were cost-utility analyses, 4 (28.6%) were cost-effectiveness analyses, 2 (14.3%) were cost-consequences analyses, and 1 (7.1%) was a cost-benefit analysis. Strategies including antiviral treatment were found to be either cost-saving or cost-effective, at the study-specific willingness-to-pay thresholds. Empirical treatment was more cost-effective than test-guided treatment for young adults but less so for older adults.ConclusionsAntiviral treatment for managing pandemics and outbreaks of respiratory illnesses that have very high case fatality rate, similar to COVID-19 pandemic, are likely to be cost-effective either as a standalone intervention or part of a multifaceted strategy. Investing in the development of such curative treatments and promptly evaluating their cost-effectiveness, relative to other strategies in use at the time of their introduction should be the focus going forward to inform resource allocation decisions particularly in low- and middle-income countries.     

Leveraging Health Information Exchange to Support Public Health Situational Awareness: The Indiana Experience

Public health situational awareness is contingent upon timely, comprehensive and accurate information from clinical systems. Ad-hoc models for sending non-standard clinical information directly to public health are inefficient and increasingly unsustainable. Information sharing models that leverage Health Information Exchanges (HIEs) are emerging. HIEs standardize, aggregate and streamline information sharing among data partners, including public health stakeholders, and HIE has supported public health practice in Indiana for more than 10 years. To accelerate nationwide adoption of HIE-supported situational awareness processes, the CDC awarded three HIEs across the nation, including Indiana, New York and Washington/Idaho. The Indiana partners included Indiana University School of Medicine, Regenstrief Institute, Indiana Health Information Exchange, Indiana State Department of Health, Health & Hospital Corporation of Marion County, and Children’s Hospital Boston. Activities included augmenting biosurveillance processes, enabling bi-directional communication, enhancing automated detection of notifiable conditions, and demonstrating technological advances at national forums. HIE transactions destined for public health were enhanced with standardized clinical vocabulary and more complete physician contact information. During the 2009 H1N1 flu outbreak, the HIE delivered targeted public health broadcast messages to providers in Marion County, Indiana. We will review the partnership characteristics, activities, accomplishments and future directions for our health information exchange.     

Testing an Extended Theoretical Framework to Explain Variance in Use of a Public Health Information System

Objectives:

This study examined determinants of using an immunization registry, explaining the variance in use. The technology acceptance model (TAM) was extended with contextual factors (contextualized TAM) to test hypotheses about immunization registry usage. Commitment to change, perceived usefulness, perceived ease of use, job-task changes, subjective norm, computer self-efficacy and system interface characteristics were hypothesized to affect usage.

Method:

The quantitative study was a prospective design of immunization registry end-users in a state in the United States. Questionnaires were administered 100 end-users after training and system usage.

Results:

The results showed that perceived usefulness, perceived ease of use, subjective norm and job-tasks change influenced usage of the immunization registry directly, while computer self-efficacy and system interface characteristics influenced usage indirectly through perceived ease of use. Perceived ease of use also influenced usage indirectly through perceived usefulness. The effect of commitment to change on immunization registry usage was insignificant.

Conclusion:

Understanding the variables that impact information system use in the context of public health can increase the likelihood that a system will be successfully implemented and used, consequently, positively impacting the health of the public. Variables studied should be adequate to provide sufficient information about the acceptance of a specified technology by end users.     

The Last Mile: Using Fax Machines to Exchange Data between Clinicians and Public Health

There is overlap in a wide range of activities to support both public health and clinical care. Examples include immunization registries (IR), newborn screening (NBS), disease reporting, lead screening programs, and more. Health information exchanges create an opportunity to share data between the clinical and public health environments, providing decision support to clinicians and surveillance and tracking information to public health. We developed mechanisms to support two-way communication between clinicians in the Indiana Health information Exchange (IHIE) and the Indiana State Department of Health (ISDH). This paper describes challenges we faced and design decisions made to overcome them.We developed systems to help clinicians communicate with the ISDH IR and with the NBS program. Challenges included (1) a minority of clinicians who use electronic health records (EHR), (2) lack of universal patient identifiers, (3) identifying physicians responsible for newborns, and (4) designing around complex security policies and firewalls.To communicate electronically with clinicians without EHRs, we utilize their fax machines. Our rule-based decision support system generates tailored forms that are automatically faxed to clinicians. The forms include coded input fields that capture data for automatic transfer into the IHIE when they are faxed back. Because the same individuals have different identifiers, and newborns’ names change, it is challenging to match patients across systems. We use a stochastic matching algorithm to link records. We scan electronic clinical messages (HL7 format) coming into IHIE to find clinicians responsible for newborns. We have designed an architecture to link IHIE, ISDH, and our systems.     

Research gaps in routine health information system design barriers to data quality and use in low‐ and middle‐income countries: A literature review

Despite the potential impact of health information system (HIS) design barriers on health data quality and use and, ultimately, health outcomes in low‐ and middle‐income countries (LMICs), no comprehensive literature review has been conducted to study them in this context. We therefore conducted a formal literature review to understand system design barriers to data quality and use in LMICs and to identify any major research gaps related understanding how system design affects data use. We conducted an electronic search across 4 scientific databases—PubMed, Web of Science, Embase, and Global Health—and consulted a data use expert. Following a systematic inclusion and exclusion process, 316 publications (316 abstracts and 18 full papers) were included in the review. We found a paucity of scientific publications that explicitly describe system design factors that hamper data quality or data use for decision making. Although user involvement, work flow, human‐computer interactions, and user experience are critical aspects of system design, our findings suggest that these issues are not discussed or conceptualized in the literature. Findings also showed that individual training efforts focus primarily on imparting data analysis skills. The adverse impact of HIS design barriers on data integrity and health system performance may be even bigger in LMICs than elsewhere, leading to errors in population health management and clinical care. We argue for integrating systems thinking into HIS strengthening efforts to reduce the HIS design‐user reality gap.     

Consumer Health Informatics: The Application of ICT in Improving Patient-Provider Partnership for a Better Health Care

Background

There is a growing interest concerning the potential of ICT solutions that are customized to consumers. This emerging discipline referred to as consumer health informatics (CHI) plays a major role in providing information to patients and the public, and facilitates the promotion of self-management.The concept of CHI has emerged out of the desire of most patients to shoulder responsibilities regarding their health and a growing desire of health practitioners to fully appreciate the potential of the patient.

Aim

To describe the role of ICT in improving the patient-provider partnership in consumer health informatics.

Methods

Systematic reviewing of literature, identification of reference sources and formulation of search strategies and manual search regarding the significance of developed CHI applications in healthcare delivery.

Results

New consumer health IT applications have been developed to be used on a variety of different platforms, including the Web, messaging systems, PDAs, and cell phones. These applications assists patients with self-management through reminders and prompts, delivery of real-time data on a patient’s health condition to patients and providers, web-based communication and personal electronic health information.

Conclusion

New tools are being developed for the purposes of providing information to patients and the public which has enhanced decision making in health matters and an avenue for clinicians and consumers to exchange health information for personal and public use. This calls for corroboration among healthcare organizations, governments and the ICT industry to develop new research and IT innovations which are tailored to the health needs of the consumer.     

Texas Public Agencies’ Tweets and Public Engagement During the COVID-19 Pandemic: Natural Language Processing Approach

BackgroundThe ongoing COVID-19 pandemic is characterized by different morbidity and mortality rates across different states, cities, rural areas, and diverse neighborhoods. The absence of a national strategy for battling the pandemic also leaves state and local governments responsible for creating their own response strategies and policies.ObjectiveThis study examines the content of COVID-19–related tweets posted by public health agencies in Texas and how content characteristics can predict the level of public engagement.MethodsAll COVID-19–related tweets (N=7269) posted by Texas public agencies during the first 6 months of 2020 were classified in terms of each tweet’s functions (whether the tweet provides information, promotes action, or builds community), the preventative measures mentioned, and the health beliefs discussed, by using natural language processing. Hierarchical linear regressions were conducted to explore how tweet content predicted public engagement.ResultsThe information function was the most prominent function, followed by the action or community functions. Beliefs regarding susceptibility, severity, and benefits were the most frequently covered health beliefs. Tweets that served the information or action functions were more likely to be retweeted, while tweets that served the action and community functions were more likely to be liked. Tweets that provided susceptibility information resulted in the most public engagement in terms of the number of retweets and likes.ConclusionsPublic health agencies should continue to use Twitter to disseminate information, promote action, and build communities. They need to improve their strategies for designing social media messages about the benefits of disease prevention behaviors and audiences’ self-efficacy.