managing public health information

Managing Information in Public Health7th Public Health Conference, Concorde Hotel, Shah Alam

Assoc. Prof. Dr. Jamalludin Ab Rahman B.Med.Sc., MD, MPH

Department of Community Medicine

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10 Achievements – The last decade1. Reductions in Child Mortality – reduction in infectious disease, now 41% death

among neonates due to birth related infections

2. Vaccine-Preventable Diseases – increased coverage

3. Access to Safe Water and Sanitation – reduced water related diseases

4. Malaria Prevention and Control – bed net, indoor spray increased, global malarial death reduced 21%

5. Prevention and Control of HIV/AIDS - new infection reduced (3.1M to 2.6M)

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10 Achievements – The last decade…

6. Tuberculosis Control – largely by DOTS, reduced but slow confounded by HIV

7. Control of Neglected Tropical Diseases - dracunculiasis (Guinea worm disease), onchocerciasis (river blindness) in the Americas, and lymphatic filariasis

8. Tobacco Control - WHO Framework Convention on Tobacco Control (WHO FCTC) & MPOWER

9. Increased Awareness and Response for Improving Global Road Safety – death declined in several European countries

10. Improved Preparedness and Response to Global Health Threats - International Health Regulations,

Ten great public health achievements--worldwide, 2001-2010. (2011). MMWR Morb Mortal Wkly Rep, 60(24), 814-818.

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What’s that report tells us?o Apart from those 10 great achievements,

o We need data to come out with such (information) report

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We need a lot of informationo Evidence based policy

o We already have a lot of data – a lot of returns, reports

o Are these data captured properly?

o Are these data analysed properly?

o Are these data interpreted into good info?

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So, what will be covered?1. In the first place, what is information?

2. What is information in public health?

3. What is information management?

4. Strategies to manage information in public health

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in·for·ma·tiono Knowledge that you get about someone or

something.

o Facts or details about a subject.

"Information." Merriam-Webster.com. Merriam-Webster, n.d. Web. 9 Oct. 2013. <http://www.merriam-webster.com/dictionary/information>.

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Data, information & knowledge

R G Y

Red is the favourite colour

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Why manage information?o Too many data

o Unstructured, ‘unformatted’, redundant data

o But many man-hours already used to collect those data

o Less time & expertise for analysis (or can they be analysed?)

o We should automate

o Data Information Knowledge/Policy/Decision

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What is IM?o It’s the same as the basic functions of

‘Management’ – Planning, Organising, Leading/Command/Direct & Controlling/Monitoring

o It manages ‘Information’

o How? Use the technology – information technology = computer technology

o Manage (process) information (preferably) using computer technology to support decision making

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Management functions

PlanningOrganisi

ng

LeadingControlli

ng

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Information management functions• Determine what are the

main outcomes of this exercise

• Identify our capability & resources (people, financial)

• Identify specific tasks

• Organise the resources esp. the people and tasks

• Who does what• Identify organisations

involved

• Getting it done• Motivate

• Monitor and evaluate the progress against plans

Planning Organising

LeadingControlling

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The strategy Information

PeopleTechnology

• Most important step!!• Determine the information required• Determine data to collect• Identify must have from good to have• No perfect complete system• Determine standard to

follow• Determine network and

storage infrastructure• Always think of backup &

recovery system• Acceptance by users• Simple & attractive

interface• Delicate migration from

old practice• Security

• Form the committed working committee

• Convince stake holders• Identify the ‘champions’• Reward & motivation• Proper & continuous users

training• Feedback to users & stake

holders

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THE INFORMATION

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Information vs. data (source)

R G Y

The information

that we want

The data to be

collected

The data to be

structured & analysed

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Public health information/data

NCDCDC

PHC

Health Enforcement

OccupationalHealth

EnvironmentalHealth

Nutritional Health

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How to structure?o No one single answer!!

o Back to the principles, mission & vision

o Determine what we want from public health

o What is our previous performance

o Learn from the past - Ten great public health achievements-worldwide, 2001-2010

o What is our direction

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Source of data (examples – list is not exhaustive)

Internal – within ministry• Surveillance

• Return/reports

• Survey

• Registry

External – outside ministry• Private

• Universities

• Meteorological

• Veterinary

• Police

• Registration department

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Data types1. Personal (demographic) information – clients (public,

organisation), providers, users

2. Socioeconomic

3. Geographic (spatial)

4. Hazard & exposure (risk factors) data – occupational, environmental, lifestyle

5. (Personal) Health data

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Data collection plano Data dictionary/code book (definitions & working definitions)

o Variable attributes (level of measurements, alphabet or numeric, number of characters, date/time format)

o Identify missing value

o Range & logic check

o Coding scheme

o Document properly from start – consider document control officer

o Create & follow SOP (differentiate SOP from red tapes)

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Data standardso IDC10

o SNOMED

o DICOM

o HL7

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Data quality controlo Important!!

o Check & ensure validity & consistency

o Unique identifier, range checks, missing values, merge, cross validation check etc.

o SOP

o Document

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Caution!o Do not collect data which are not (ready) to be

analysed

o It is OK if not perfect

o Few data but valid is better than a lot of wrongly collected data

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Consider data miningo Secondary analysis of large (available) database

o Challenging – not standard data, temporal change, missing value, invalid entries

o May not worth the effort

o If you don’t try, you don’t know

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THE PEOPLE

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The stake holderso Provider vs. users

o Users can be the public or the policy makers

o Develop good internal development team

o Engage the technical experts

o Identify motivated users

o Identify mediators (link between technocrats & users)

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Identify (& honour) the championo The backbone in any IT related activities/projects

o Idea may come from top manager, but the motivated mediators make the plan a success

o Continuity

o Ensure reward & promotion

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THE TECHNOLOGY

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The ‘informatics’o Software vs. hardware vs. peopleware

o Guiding principles – the process

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The peoplewareo System owner

o System users – internal & external

o System designer

o System builder

o System analyst

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Optionso Buy from the shelf & customize, or

o Build from square one

o Train staff, or

o Outsource expertise

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Integration (data linkage)o The headache

o Connecting all domains (depending on structure)

o Important to have common (standard) variables

o Good relational database experts (must have internal experts)

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IS architectureo Always complicated

o Always personalised

o Relationship between hardware & software

o Struggle between users & providers

o The need of a good mediator (understand both lingo)

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Summary – the steps1. Establish a good working committee (working, not sleeping)

2. Identify your information need (need, not want)

3. List data required to generate the information

4. Define all the data

5. Identify relationship between data (relational db)

6. Engage solution provider

7. Ensure effective communication (document well)

8. Follow Gantt chart religiously

9. Pre-test, modify, pre-test (compare with agreed outcome i.e. the info)