Global Health Informatics

Principles of eHealth and mHealth to Improve Quality of Care

by Leo Anthony, Celi, Fraser, Nikore, Osorio, Paik

ISBN: 9780262338127 | Copyright 2017

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Contents (pg. v)
Preface (pg. ix)
I GLOBAL HEALTH LANDSCAPE (pg. 1)
1 The Global Burden of Disease (pg. 3)
Take-Home Messages (pg. 3)
Introduction (pg. 3)
Background (pg. 4)
Metrics for Measuring the Global Burden of Disease (pg. 6)
The State of Global Health (pg. 6)
Transitions in the Global Burden of Disease (pg. 15)
Conclusions and Recommendations (pg. 17)
Questions for Discussion (pg. 17)
References (pg. 18)
2 Case Study: Challenges in Providing Universal Health Coverage in Kenya (pg. 23)
Take-Home Messages (pg. 23)
Introduction (pg. 23)
Background (pg. 24)
Policy Implementation and Monitoring (pg. 26)
Physical Infrastructure (pg. 28)
Human Capacity (pg. 35)
The Way Forward (pg. 36)
Questions for Discussion (pg. 38)
References (pg. 38)
3 Health Systems in Lowand Middle-Income Countries (pg. 41)
Take-Home Messages (pg. 41)
What Is the Goal? (pg. 42)
How Are Health Systems Financed and Managed? (pg. 43)
How Do We Measure Health System Performance? (pg. 44)
Conclusion (pg. 45)
Questions for Discussion (pg. 45)
References (pg. 46)
4 Culture of Quality and Safety: A Prerequisite for Any Informatics Intervention (pg. 49)
Take-Home Messages (pg. 49)
Introduction (pg. 49)
Defining a Culture of Quality and Safety (pg. 50)
Past Successes and Potential Solutions (pg. 52)
Conclusions (pg. 53)
Questions for Discussion (pg. 54)
References (pg. 54)
5 Modern Epidemiology and Global Health in the Era of Information Systems and mHealth (pg. 61)
Take-Home Messages (pg. 61)
Study Design (pg. 63)
Sources of Bias and Study Error (pg. 65)
Design Issues for eHealth and mHealth (pg. 66)
Questions for Discussion (pg. 67)
References (pg. 67)
6 Global Health and Social Theory (pg. 69)
Take-Home Messages (pg. 69)
Introduction (pg. 69)
Robert Merton’s Theory of Unanticipated Consequences (pg. 70)
Structural Violence (pg. 71)
Conclusion (pg. 72)
Questions for Discussion (pg. 73)
References (pg. 73)
II INTRODUCTION TO HEALTH INFORMATION TECHNOLOGY (pg. 75)
7 What Are Health Informatics, eHealth, and mHealth? (pg. 77)
Take-Home Messages (pg. 77)
Introduction (pg. 77)
Defining eHealth, Global Health Informatics, and mHealth (pg. 78)
What Is the Current Status of eHealth? (pg. 79)
What Challenges Does eHealth Face? (pg. 82)
What Is the Technology Used in eHealth? (pg. 83)
Conclusion (pg. 86)
Questions for Discussion (pg. 86)
Appendix A (pg. 86)
Appendix B (pg. 87)
References (pg. 87)
8 Understanding Local Policy and the National eHealth Strategy (pg. 91)
Take-Home Messages (pg. 91)
Summary (pg. 91)
Introduction (pg. 91)
Challenges with Implementing eHealth (pg. 92)
State of eHealth in Asia (pg. 92)
Why Are National-Scale eHealth Systems Difficult to Implement? (pg. 93)
Enterprise Architecture (pg. 95)
Monitoring and Evaluation (pg. 97)
Conclusion (pg. 97)
Questions for Discussion (pg. 97)
9 Databases and Registries (pg. 101)
Take-Home Messages (pg. 101)
Introduction (pg. 101)
What Is a Database? (pg. 102)
Types (pg. 102)
Applications in Health (pg. 104)
Electronic Health Records (pg. 105)
Registries (pg. 106)
SQL Overview (pg. 107)
Select Statement (pg. 109)
Future of Databases (pg. 110)
NoSQL (pg. 110)
NewSQL (pg. 112)
Selection Criteria for Choosing Database Types (pg. 112)
Open-Source Database Options (pg. 112)
Conclusion (pg. 114)
Questions for Discussion (pg. 114)
References (pg. 114)
10 Electronic Health Records (pg. 117)
Take-Home Messages (pg. 117)
Introduction (pg. 118)
Evolution of EHRs in Global eHealth: A Brief History (pg. 118)
Core Principles and Functionality (pg. 121)
Wider EHR Perspectives (pg. 126)
Lessons Learned and Case Studies (pg. 128)
Conclusion (pg. 131)
Questions for Discussion (pg. 132)
References (pg. 133)
11 Communication Networks and Global Health (pg. 137)
Take-Home Messages (pg. 137)
Internet (pg. 138)
Mobile Cellular Network (pg. 142)
Questions for Discussion (pg. 145)
References (pg. 146)
12 Health Information Standards and Interoperability (pg. 149)
Take-Home Message (pg. 149)
Introduction (pg. 149)
eHealth, Information Standards, and Interoperability (pg. 149)
eHealth Components (pg. 150)
Interoperability (pg. 152)
Level of Interoperability (pg. 153)
Standards (pg. 154)
Why Do We Need Standards? (pg. 154)
Categorizing Different Standards (pg. 156)
Implementing Interoperability and Standards Is Hard (pg. 159)
Thailand Health Information Standards: Current and Future (pg. 160)
Conclusion (pg. 161)
Questions for Discussion (pg. 161)
Recommended Web Links (pg. 161)
References (pg. 162)
13 Data Security for Mobile Health Care (pg. 165)
Take-Home Messages (pg. 165)
The Foundation (pg. 165)
The Security Dimension (pg. 166)
The Mobile Platform (pg. 167)
The Future (pg. 170)
Questions for Discussion (pg. 171)
References (pg. 171)
14 Enterprise Architectures for Digital Health (pg. 173)
Take-Home Messages (pg. 173)
Introduction (pg. 173)
Enterprise Architecture Frameworks (pg. 174)
Enterprise Architecture Standards in Health Care (pg. 176)
Applications of Enterprise Architecture in Global Health (pg. 176)
Interoperability Frameworks and Implementations (pg. 177)
Conclusion (pg. 178)
Questions for Discussion (pg. 178)
Notes (pg. 179)
References (pg. 180)
15 Secondary Data Use (pg. 183)
Take-Home Messages (pg. 183)
Introduction (pg. 183)
Types of Secondary Data (pg. 184)
Secondary Data Use in High-Resource Settings (pg. 185)
Secondary Data Use in Low-Resource Settings (pg. 185)
Further Challenges for Big Data in Lowand Middle-Income Countries (pg. 187)
The Next Step in Secondary Use of Data for Health (pg. 190)
Conclusion (pg. 190)
Questions for Discussion (pg. 191)
References (pg. 191)
III IMPLEMENTING A HEALTH INFORMATICS PROJECT (pg. 195)
16 A Global Health Project Life Cycle (pg. 197)
Take-Home Messages (pg. 197)
Introduction (pg. 197)
Overview of the Project Life Cycle (pg. 198)
Unique Regulatory Barriers (pg. 202)
Conclusion (pg. 202)
Questions for Discussion (pg. 202)
17 Leadership Skills for Global Health Care Innovators (pg. 203)
Take-Home Messages (pg. 203)
Introduction (pg. 203)
Why Is Leadership Development Needed for Innovation in Global Health? (pg. 204)
Leadership Competencies for Health Care (pg. 205)
What Competencies Are Critical for Health Care Leadership? (pg. 206)
Leadership Competencies Especially Needed to Optimize Care in Resource-Poor Settings (pg. 209)
Conclusion (pg. 214)
Questions for Discussion (pg. 215)
References (pg. 215)
18 Building a Global Health Team (pg. 223)
Take-Home Messages (pg. 223)
Introduction (pg. 223)
The Fragmented System (pg. 224)
A New Mantra for Innovation (pg. 225)
Recommendations in Practice (pg. 227)
Conclusion (pg. 229)
Questions for Discussion (pg. 230)
Acknowledgments (pg. 230)
References (pg. 230)
19 The Health Informatics Design Process (pg. 233)
Take-Home Messages (pg. 233)
Introduction (pg. 233)
Essential Recommendations (pg. 234)
Conclusion (pg. 236)
Questions for Discussion (pg. 237)
20 Software Project Management (pg. 239)
Take-Home Messages (pg. 239)
Introduction (pg. 239)
Common Software Project Management Methodologies (pg. 240)
Life of an Example Project (pg. 243)
Project Inception (pg. 244)
Project Approved—Kicking it Off (pg. 244)
Roles and Responsibilities (pg. 245)
Gather Initial Requirements (pg. 246)
Development (pg. 248)
Delivery and Completion (pg. 249)
Project Considerations in LMIC (pg. 251)
Practical Takeaways (pg. 254)
Conclusion (pg. 255)
Questions for Discussion (pg. 256)
Additional Resources (pg. 256)
References (pg. 256)
21 Usability and User Experience (pg. 259)
Take-Home Messages (pg. 259)
Introduction (pg. 259)
Design Thinking (pg. 259)
Audience Identification (pg. 261)
Holistic Design (pg. 262)
User Testing and Evaluation (pg. 264)
User Engagement (pg. 266)
Conclusion (pg. 267)
Questions for Discussion (pg. 267)
22 Privacy and Security: Privacy of Personal eHealth Data in Lowand Middle-Income Countries (pg. 269)
Take-Home Messages (pg. 269)
Introduction (pg. 269)
What Does Privacy Mean and How Does it Link to Security? (pg. 270)
Driving Forces for Examining eHealth Privacy in LMIC (pg. 271)
The State of Privacy Protection in eHealth (pg. 274)
Emerging Challenges in Addressing Privacy (pg. 277)
Conclusion (pg. 277)
Questions for Discussion (pg. 278)
Notes (pg. 278)
References (pg. 278)
23 Financing and Commercialization (pg. 283)
Take-Home Message (pg. 283)
Introduction (pg. 283)
Defining an Organizational Approach (pg. 284)
The Social Enterprise Model (pg. 284)
Financing (pg. 287)
Commercialization (pg. 291)
Conclusion (pg. 300)
Questions for Discussion (pg. 301)
Reference (pg. 301)
24 Evaluation of Health Information Systems (pg. 303)
Take-Home Messages (pg. 303)
Summary (pg. 304)
Introduction (pg. 304)
Quantitative Evaluations (pg. 306)
Qualitative Evaluations (pg. 310)
Economic Evaluation (pg. 312)
Examples of Key Studies in LMIC (pg. 313)
Data Quality Improvement (pg. 314)
The Learning Health System (pg. 316)
Conclusion and Future Directions (pg. 316)
Questions for Discussion (pg. 318)
Further Reading (pg. 318)
References (pg. 319)
IV DIGITAL HEALTH APPLICATIONS (pg. 323)
25 Mobile-Enhanced Telemedicine: Transcending Barriers to Access and Care with Wireless Communications Technologies (pg. 325)
Take-Home Messages (pg. 325)
Introduction (pg. 325)
What Is Telemedicine? (pg. 326)
History of Telemedicine (pg. 327)
Current Applications in Mobile Telemedicine (pg. 329)
Challenges in Mobile Telemedicine (pg. 331)
Questions for Discussion (pg. 333)
References (pg. 333)
26 Clinical Decision Support (pg. 337)
Take-Home Messages (pg. 337)
Introduction (pg. 337)
Types of Clinical Decision Support (pg. 338)
Key Elements of a Clinical Decision Support Intervention (pg. 342)
Impact of Clinical Decision Support (pg. 343)
Clinical Decision Support and Global Health (pg. 344)
New Directions in Clinical Decision Support (pg. 345)
Conclusion (pg. 347)
Question for Discussion (pg. 347)
References (pg. 347)
27 Pharmacy Systems and Global Health (pg. 351)
Take-Home Messages (pg. 351)
Introduction (pg. 351)
Safer Health Care Delivery Using Pharmacy Systems (pg. 352)
Pharmacy Systems and Public Health (pg. 354)
Other Emerging Solutions to Address Medication Management Complexities (pg. 354)
Global Health Needs and Challenges (pg. 355)
Conclusion (pg. 357)
Questions for Discussion (pg. 357)
References (pg. 357)
28 Medication Adherence (pg. 363)
Take-Home Messages (pg. 363)
Introduction (pg. 363)
Adherence Measurement (pg. 364)
Adherence Barriers (pg. 368)
Technology and Future Directions for Adherence Interventions (pg. 372)
Conclusion (pg. 372)
Questions for Discussion (pg. 373)
References (pg. 373)
29 Mobile Electronic Health Surveys and Data Collection: History and Practical Points to Consider (pg. 385)
Take-Home Message (pg. 385)
Early Days of Mobile Data Collection (pg. 385)
Changing Technologies Overcome Early Limitations (pg. 386)
Key Points for Mobile Data Collection (pg. 387)
Question for Discussion (pg. 388)
Note (pg. 388)
30 Innovations in Health Education: Digital Media and Its Capacity for Front-Line Health Worker Training (pg. 389)
Take-Home Messages (pg. 389)
Questions for Discussion (pg. 393)
References (pg. 393)
31 Medical Devices (pg. 395)
Take-Home Messages (pg. 395)
Introduction (pg. 395)
Traditional Medical Device Development in LMIC (pg. 395)
New Approaches to Medical Device Development (pg. 396)
Challenges in Medical Device Development (pg. 397)
Examples of Success (pg. 398)
Conclusion (pg. 399)
Questions for Discussion (pg. 399)
References (pg. 399)
32 Image Processing in Medical Imaging (pg. 403)
Take-Home Messages (pg. 403)
Introduction (pg. 403)
Imaging Modalities (pg. 405)
Need for Image Processing in Medical Imaging (pg. 407)
Imaging for Global Health Applications (pg. 409)
Tools for Image Processing (pg. 413)
Challenges in Resource-Constrained Settings (pg. 414)
Further Reading (pg. 414)
Conclusion (pg. 416)
Question for Discussion (pg. 416)
References (pg. 416)
33 Public Health and GIS: An Introduction to Mapping (pg. 419)
Take-Home Messages (pg. 419)
Introduction (pg. 419)
Current Applications (pg. 421)
Technology and Methods (pg. 422)
Obstacles and Challenges (pg. 424)
Crowdsourcing and Open-Source Tools (pg. 425)
Conclusion (pg. 427)
Questions for Discussion (pg. 427)
References (pg. 427)
34 Supply-Chain Management (pg. 429)
Take-Home Messages (pg. 429)
Introduction (pg. 429)
Impact of a High-Performing Supply Chain (pg. 430)
Impact of Poor Supply-Chain Management (pg. 432)
Common Challenges (pg. 433)
Impact of Technology on Supply-Chain Management (pg. 440)
Conclusion (pg. 441)
Questions for Discussion (pg. 442)
References (pg. 442)
Contributors (pg. 445)
Index (pg. 449)

Celi G. Leo Anthony

Leo Anthony G. Celi, originally from Manila, Philippines, is an attending physician at Beth Israel Deaconess Medical Center, Boston, an Assistant Professor at Harvard Medical School, and Clinical Research Director of the Laboratory of Computational Physiology at the MIT Institute for Medical Engineering and Science. Leo Anthony Celi and Kenneth Paik codirect Sana at the MIT Institute for Medical Engineering and Science.



Hamish S. Fraser

Hamish S. F. Fraser is Associate Professor of eHealth in the Yorkshire Centre for Health Informatics at the University of Leeds, UK. He was previously the director of Informatics at the Health Care NGO Partners In Health and an Assistant Professor of Medicine at Harvard University. He cofounded the Open source EHR system OpenMRS, now used in more than 60 countries. His research focuses on the evaluation of eHealth systems Worldwide. He is funded from the European Union's Horizon 2020 research and innovation programme under grant agreement No. 661289 Global eHealth.”


Vipan Nikore

Vipan Nikore, a former software engineer, is an internal medicine physician and Medical Director at Trillium Health Partners and an attending physician at Cleveland Clinic in both Cleveland and Toronto. He is a lecturer at the University of Toronto and was a visiting research scientist at the MIT Institute for Medical Engineering and Science


Juan S. Osorio

Juan Sebastián Osorio is a biomedical engineer from Escuela de Inginería de Antioquia and Universidad Corporacion para Estudios en la Salud in Medellin, Colombia. He was named by Technology Review as one of the world’s top innovators under 35 for designing monitors to detect breathing problems in premature infants.


Kenneth Paik

Kenneth Paik is a Research Scientist at the MIT Institute for Medical Engineering, where he teaches courses in global health informatics to improve quality of care and secondary analysis of electronic health records. Leo Anthony Celi and Kenneth Paik codirect Sana at the MIT Institute for Medical Engineering and Science.


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