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 & “Healthy Executive Seminars;

Leadership
Individuals & Leadership ID,
Training & Advocacy
Populations ”
PhD; Masters Informatics;
Human Capital Non-degree Certificate Programs
_________________________
(eHealth Workforce Capacity) Clinician/Public Health Champions
___________AMIA 10x10____________
Health Informatics Building Blocks
(HIBBs) - Knowledge & Skills Offerings
State of Information/
National Readiness Assessment
Telecommunications Infrastructure
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’.
 Terms: HICT
• Human Factors
– Cognition, change resistance, behavior, learning
• Information
– Knowledge, meaning, semantics
• Communication
– Speaking & listening for understanding
• 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)
 A warm Thank You to
AMIA GPP Committee members
Steering:
• 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 Program
• 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