Introduction to Informatics

      Informatics in Health

      International Training in Informatics 

      Conclusions

    Informatics in Health

The focus of my remarks today will be to talk about the opportunities Informatics brings to us.  The purpose of my presentation is not to explain to you in great detail the technologies involved in informatics, but to explore with you the vision of what informatics can contribute to our practice of public health, medicine and research. [Slide1]

Public Health and medical practice, while similar, emphasize different areas of informatics in the application of this technology and we’ll talk a little bit more about how these differences manifest themselves.  However the mission of our work with our collaborating institutions here in Peru is to support research, both applied and clinical research, through the application of informatics to those efforts.  Research tends to fuse aspects of both public health and medicine.  In medicine we have the one provider one patient focus which is demonstrated in many medical decision support systems and electronic medical record systems.  However in public health we have the one provider to the community scenario.  Thus large databases may be handled through informatic solutions in Public Health.  Research efforts also rely on populations of subjects and therein the population bases of these informatics applications are similar to those seen in public health.

Informatics is a term which is variously defined and in this slide I have provided you with two definitions in this slide.  Medical informatics is defined in the textbook “Computers applications in Health Care and Biomedicine by Dr. Shurtliff and his colleague as the storage, retrieval, sharing, and optimal use of biomedical information data and knowledge for problem solving and decision making.  Public health informatics is defined as the systematic application of information and computer science and technology to public health practice, research and training.  This is the definition provided by Dr. O’Carroll and his colleagues and their recent review article on this subject.[Slide2].

Thus both of these definitions demonstrate that informatics is a basic science discipline, while it involves the development of new methods and new theories.  At the same time informatics is tightly coupled to application domains.  This illustration borrowed again, from Shurtliff’s text on informatics demonstrates this as we see the flow of development from conceptual changes in informatics to the technical applications in the variety of applied fields, including public health informatics, ethical informatics, nursing informatics, veterinary informatics, dental informatics, imaging informatics and bio-informatics.[Slide3] 

This next slide [Slide4] also demonstrates how closely the applications and conceptual changes in informatics are meant to be.  In fact, each of the applied fields of informatics contributes to the further conceptual development of methods, techniques and theories in the field.  In fact, many authors and workers believe that conceptual development in informatics is almost entirely led by concepts which feedback into the basic science discipline through careful application and study.  Basic research occurs in informatics as an out growth of real world needs.  In other words this is not a highly theoretical science rather, it is an applied science.  The research agenda in informatics is driven by the needs within the domains of medicine and patient care, public health and population surveillance and other areas where informatics technologies are applied.  The field is evolving rapidly.  It evolves both with the introduction of new technological capacity through innovation in computing, innovation in algorithms, innovation in models, innovations in other areas of pure conceptual informatics and;  more importantly, it evolves as new applications are applied and lessons are learned through those applications, and these application needs are the intellectual “drivers”.  The purpose of this talk however; is not to discuss with you the nature of informatics because after two weeks you will certainly know or have a feeling for what exactly informatics is and what it can do for you in your work, in medicine, in research, in library and in the other areas of endeavor in which you are involved. 

      International Training in Informatics 

The purpose of this presentation is to give you a vision of how others in Latin America are using informatics in the work that is being funded by Fogarty and other funders in the region.  I will be presenting to you the international training and medical informatics program funded by the Fogarty foundation at the National Institute of Health and then; secondly, I would like to go over with you some examples of another coincident initiative in the region; which is funded by The Global Emerging Infections Program.  The International Training Program in Medical Informatics was funded by Fogarty in 1999.  The goals of this program [Slide5] are to improve informatics capacity in developing country institutions and to advance research and surveillance in those areas, to provide targeted short-term training and longer-term training for developing country researchers in order to increase this capacity.  And finally, to enhance collaboration internationally in research ventures. 

The collaborating institutions, [Slide6] are shown here.  The ITMI programs began in Africa and their funding has only recently extended to Latin America.  I would like to describe the countries in which each of these programs is active briefly to you so you can appreciate the geographic breadth of what the Fogarty foundation has undertaken.  There are programs in Malawi which relate to Johns Hopkins University in Baltimore; in Kenya a program related to the department of medicine in the Reigin Steif Institute in Indianapolis, Indiana;  in South Africa, at Zambia a program which relates to the New England medical center hospitals in Boston; in Maui a program which relates to the Tulane school of public health in tropical medicine; In Zambia, a program which relates to the University of Miami School of Medicine;  In Nigeria a program which relates to the medical University of South Carolina.  A second program in Nigeria, has also been started by the University of Pittsburgh.

However, what I would like to talk a little bit about is some of the applications seen through the three programs which are now funded in Latin America.  This would be the programs funded in Peru with the collaboration of Brigham and Women’s hospital  in Boston under the direction of Dr. Lucila Ohno-Machado, the program in Costa Rica which relates to the University of Rochester under the direction of Dr. Timothy De Ver Dye and our program here in Peru.[Slide7]

As we discuss the applications seen through this program I think it becomes apparent the projects are very diverse.  They include imaging technology development, medical records projects, data retrieval projects, decision support projects, connectivity projects and studies of the impact of innovation on communities.  In Latin America, as I mentioned the major collaborating institutions are in Costa Rica, Brazil and Peru.  In the InfoComm project in Costa Rica the [Slide8] University of Costa Rica collaborates with the Institute for Sustainable Development (a non-governmental organization in that country), and the University of Rochester for the realization of that program.  Basically, this project involves studying the impact of technology introduction in small communities and how that informed community decision making and political process.  There is an annual in-country short course which is given in Costa Rica on informatics which is somewhat similar to the course we will be giving over the next ten days.  In addition, focus has been to use the Lincos which is the little intelligence communities project or community information project as a training sight for students and eventually to study the impact of the introduction to these technology centers. [Slide9]

Basically the project Lincos recycles outdated storage containers and upgrades them to include computer labs, clinics and other information of technologies for the use of the communities to which they are introduced.  The Lincos Unit or “Box” is a retired shipping container and brings to the community computers, internet, video, telephone and teleconferencing.  The standard shipping container is covered with a tent-like tension structure to provide shade for people waiting to use the facility with and to keep the facility cool.  The container is energy self-sufficient, has a satellite link and integrated local wireless telephone communication, analytical laboratories, telemedicine services, a computer lab, electronic commerce and banking services and a multi-purpose information center.  The Lincos box stimulates community grass-root activity around it’s services and aspires to become a true community center.  Deployment has been possible in very remote communities without access to electricity.  It’s designed to be used in these marginal communities and to bring them in to the digital era [Slide10]. Although baseline studies of communications in the community have been done, little evaluation has taken place to-date as this will be an outgrowth of training and research.[Slide11]

In Brazil a consortium of Sao Paulo, State University of Rio, Federal University of Parena, Harvard Schools of Medicine, Public Health, Stanford, and the Massachusetts Institute of Technology have come together in the Fogarty funded training program.  Their annual computation in Medicine course is offered in Brazil, in addition, they have a number of shorter decision support courses which they offer.  The projects under this program have been in the areas of Telemedicine and Medical decision support.  Specifically [Slide12] in Telemedicine, they’re exploring the use of shared imagery of ultra-sounds for the diagnostic and consultation of Breast Cancer. The project, which is an applied research project, seeks to unite remote regions of Brazil with national and international expertise in Cancer.  This project is just getting under way and so basically the Telemedicine technology itself has been in the process of being implemented, so no impact studies have been done to date [Slide13].

Here in Peru [Slide14], you are entering the second annual country course.  In addition we are offering long term scholar training towards a Masters of Science in Biomedical and Health Informatics at the University of Washington.  Our program is a partnership of the University of Cayetano and the University of San Marcos and the University of Washington.  We also have developed agreements with the National Institute of Health and the Ministry of Health here in Peru.  We are in the process of reaching out to Ecuador and other projects in Peru through this course and you will meet some of your colleagues in the course from these institutions.  Our scholars are currently beginning their Masters Research projects in the area of distance learning and in the area of enhanced surveillance in hospitals for sexually transmitted diseases and their treatment.  You will hear more about these projects later on in this course. 

Now I would like to turn to some other projects which are underway in Latin America which may be of interest to you which focus more on Public Health aspects of Informatics.  Public Health priorities currently in the area of informatics include assuring surveillance information accuracy and security as we move into an era when we are able to do disease [Slide15] surveillance through networking.  Syndromic surveillance for alert system, bioterrorism and advanced warning of epidemic disease has also been a focus in North America [Slide16]. Finally, the whole area of networking, working across cultures, and sharing information both formally and informally; is an active area of investigation and is increasingly coming to the fore in public health because in essence, this is what we do in our discipline on a day to day basis and this is really one of the key aspects of promoting successful public health programs. 

I’d like to discuss with you some projects underway in Latin America under the sponsorship of the Global Emerging Infections Program.  The first of these is a network project to establish an electronic network in the Caribbean basin.  This network has recently been completed the obstacles that were outlined by participating countries in implementing this network program included an inadequate infrastructure for telecommunications and limited financial resources [Slide17].  The objectives of this collaboration between CAREC, PAHO CDC and GEIS are shown in this slide [Slide18].  The focus is trying to create a surveillance network that provides a uniform infrastructure of computers and also a good access through the internet.  In addition, these parties have instituted systematic training on the public information system for laboratories or PHLIS in this region.  This project was recently completed [Slide19] and this shows you the flow of information, which is now occurring to CAREC from 15 national laboratories to enhance disease surveillance. [Slide20] This concept of networking for disease surveillance is also being mounted here in Peru through a similar collaboration between the National Institutes of Health in Lima and the GEIS program. 

This slide [Slide21] shows the projected project in the region of the Andes.  This will also be a laboratory based project [Slide22] which will move from the local to the regional to the central level of the National Institutes of Health with disease reporting based on Laboratory evaluations.  This is a snapshot of the future plans for the disease network and certainly it is not my purpose here to describe this project in detail merely to cite it as another application of information technology and informatics in our region [Slide23].

What I’ve tried to do in this presentation then, is to outline for you the real and potential project areas that informatics will open to you in your work.  Disease surveillance, information access and retrieval, distance learning, decision support, Telemedicine, Telelaboratories, and networking are all potential project areas, which are on the verge of being realized in Latin America and North America concurrently [Slide24].  There are many areas I haven’t had time in this presentation to cover probably, most importantly, library, but I would emphasize to you two aspects of our effort which are key.  The first is imagination, looking at common problems that we have in public health, in research and medicine and thinking about the kinds of algorithmic thinking or computer applications which can be most helpful.  There is great technology at our fingertips if we just have the imagination to apply it.  The second aspect, which is very important, for a course like this, is interpersonal networking.  In fact in our own work on surveillance and networking we found that there is nothing as important to collegial relationships as trust between the parties, no amount of technology will enhance collaboration in and of itself.  Collaboration depends on getting to know one another and developing strong working relationships.  Thus during this course I hope an important aspect of what you do in the laboratory and in the classroom is to get to know your peers and to work closely together towards common solutions. 

      Conclusions

In conclusion [Slide25].Latin America has joined North America in the information revolution.  The International Training and Medical Informatics Program of the Fogarty has extended to Latin America and provides another avenue towards realizing the vision of applying information technology to health problems in Latin America.  Research and development and Biomedical and health informatics are driven by practical biomedical and public health needs.  These solutions can be imagined and applied and evaluated and researched using technologies available to us.  These technologies you will learn in this course.  Imagination and creativity are key, but a strong background in the actual technologies that we have at hand will be important as well.  We hope to give you the beginning of this background in this course and I thank you very much for your attention. 

This project is a joint effort of the University of Washington School of Public Health and Community Medicine
and the United States Centers for Disease Control. It is an approved APEC project.