The delegation visiting the Georgia Department of Public Health.
Millions of people with HIV/AIDS now have extended life spans as a result of targeted HIV testing services and the scale-up of effective anti-retroviral therapy, resulting in an increased need to (1) effectively manage large volumes of data; (2) accurately track patient cohorts across space and time; (3) track utilization of human and material resources; and (4) support evidence-driven decisions.
Many countries lack the capacity to manage and use these data and the interoperable health information systems that enable data to flow to support effective and timely decision making. To address this challenge, CGH/DGHT/Health Informatics, Data Management and Statistics Branch (HIDMSB) created a program called “Inter-governmental Learning Exchange to Advance Data-driven Decision-making (I-LEAD).”
An I-LEAD learning exchange is a series of immersive activities between the public health agencies of two countries that aims to:
· promote the development of informatics capacity among health agency staff (informatics and non-informatics) through experiential learning,
· enable bidirectional knowledge exchange and discovery, and
· stimulate innovative and cross-cutting technical collaborations.
The envisioned outcomes for these activities include: a sustainable national e-health development approach that supports PEPFAR programs and the broader health system needs; increased organizational informatics resources and human capacity to address HIS-related scale-up activities; integration of national plans for HIS development in PEPFAR country operations plans; and a community of practice that shares best HIS practices to support PEPFAR programs. Preparations and activities for this visit entail engagement with the CDC CIOs, state and local health departments, and local non-government organizations.
For the initial I-LEAD visit in July, 2016, a delegation from the Thai Ministry of Health spent two and a half days in Atlanta and one day on a site visit at the Chicago Department of Public Health. For the second I-LEAD visit, the senior informatics officer from the Papua New Guinea CDC spent a week in Atlanta in November 2016.
HIDMSB just completed its third I-LEAD technical collaboration visit by hosting the Ministry of Public Health (MOPH) of the Government of Guyana and Caribbean Regional Office (CRO) of CDC from January 30 – February 3, 2017. The delegation from the Guyana MOPH was led by Karen Gordon-Boyle, MD, DrPH, deputy chief medical officer, and included Christiper Squires, acting head of the MIS Unit, and Thameshwar Merai, software development coordinator. CDC CRO was represented by Gyndawattie Blake, an HMIS/IT analyst.
The group traveled to CDC headquarters in Atlanta to participate in five days of intense I-LEAD activities. The end goals were to gain knowledge and insights into e-health development activities in the US and to engage in a strategic planning simulation to address and prioritize Guyana’s health information systems (HIS) needs. These goals are achieved by promoting effective e-health governance and leadership at the national level, the development of a skilled informatics workforce, and the meaningful design, development, implementation, and evaluation of health information systems.
The most recent visit started with a session on Health Information Systems in PEPFAR. Members of DGHT’s HIDMSB/Health Information Systems Team (HIST) presented on topics such as e-health capacity development, informatics project management, a HIS maturity model framework, case-based surveillance, data exchange, and health IT interoperability. That afternoon, presentations included interagency collaboration, human resources for health (by DGHT’s Health Systems and Human Resources Team), geographic information systems in PEPFAR (by HIST), and financing e-health development (by Edward Mensah, MD, University of Chicago). Gordon-Boyle remarked that the most important thing she learned was that, “We have a valuable support system to help us achieve our dream of improving the quality of health service delivery and ultimately improving patient health outcomes.”
Day 2 started with presentations from the Center for Surveillance, Epidemiology and Laboratory Services (CSELS) on Meaningful Use of electronic health records, HIS interoperability, CDC health IT efforts and collaborations, and leveraging clinical decision support. Next, the state health departments of Minnesota, Utah, and Washington discussed the importance of governance and leadership, skilled workforce, and effective health information systems in the development of an informatics-savvy health department. They also discussed how their organizations developed e-health capacity, used e-health to improve population health, and addressed other HIS challenges, including cyber-security. The delegation then traveled to the Georgia Department of Public Health, where they learned about Georgia’s HIV Surveillance infrastructure, including integrated surveillance system.
On Day 3, Ramesh Krishnamurthy, MD, from the World Health Organization (WHO) in Geneva, discussed the WHO E-Health Strategy Toolkit, developing an e-health strategy, and reviewing examples of successes and challenges in developing an e-health strategy. Visitors then enjoyed a lively video conference discussion with the National Center for Health Statics (NCHS) about developing unique patient identifiers, vital registration and the NCHS Data Center. Following a session by Maria Rein of the National Center for HIV, Hepatitis, STDs, and Tuberculosis Prevention on national-level surveillance and lab systems, the delegation learned about the offering of the Public Health Informatics Institute. They finished the day with a discussion of Learning Health Systems by Charles Friedman, MD, University of Michigan.
For Day 4, the group divided into two tracks: one that focused on policy issues, and one that provided didactic and hands-on technical activities. In the policy track, topics included confidentiality and data security law by Andre Verani of HSHRT, and a discussion with Von Nguyen, MD, associate director for policy (acting), on the integration of public health and health care, and implementing healthcare reform in the US. The afternoon sessions provided a panel on clinical decision support from the CDC Clinical Decision Support Workgroup (Maria Michaels (CSELS) and Abigail Viall (NCHHSTP)) and Kensaku Kawamoto, MD, PhD, from the University of Utah; a panel on lab data networks and resources by Michelle Meigs, Reshma Kakkar, and Chris Mangal of the Association of Public Health Laboratories (APHL); and finally a discussion about development and use a master patient index by Joseph Gibson, MPH, PhD, of the Marion County, IN, Department of Public Health.
Visitors in the technical track spent the morning at a site visit to Georgia Tech’s Computing for Good program, hosted by Ellen Zegura, chair of the Computing Science and Systems Division and Santosh Vempala, MD. Other participants included Dhruv Muttaraju, Rosa Arriaga, PhD, and Neha Kumar Arriaga, MD, of Georgia Tech remarked that, “it’s these kind of meetings that strengthen our resolve to do research that actually has impact. “ Upon returning to CDC, they enjoyed a hands-on demonstration of Geographic Information System software by CGH/Health Informatics, Data Management and Statistics Branch (HIDMSB). Then, Jen Antilla of I-Tech/University of Washington led a panel of open source, innovation, and software development. The panel also included Craig Appl, Robert McLaughlin, Greg Rossum, and Casey Iliams-Hauser. Finally, HIDMSB/HIST demonstrated interoperability between Open MRS and DHIS2 (both open source), electronic case reporting, and a data security and confidentiality tool.
On Friday, it was time for the Guyanese delegation to apply the knowledge they gained during the week by going through a simulation in developing an e-health strategy to address key priorities for e-health development. They engaged in several game-based simulations, including refining their previously-developed e-health vision, brainstorming implementation activities, and initial topics and activities for an in-country strategic planning meeting during the week of March 27.
Strong collaboration between the Guyana MOPH, CDC CRO, I-TECH, and CDC headquarters continues as they prepare for the strategic planning meeting in Georgetown. In addition, Guyanese staff have begun to form working relationships with many of the week’s other presenters, setting the stage for future collaborations. For example, the MOPH Permanent Secretary asked Boyle to develop a white paper to present to the Guyanese Parliament for obtaining long-term funding and help with policy development on workforce capacity and information security, and is working with Herman Tolentino, MD, of HIDMSB/HIST and Mensah in this effort.
“It is great to hear that our friends at the Guyana Ministry of Public Health had an incredible and fruitful week here in Atlanta, and I look forward to the opportunity of working with them again in the future.” said Dhruv Muttaraju, Georgia Tech.
This Inside Story by Jan MacGregor