R Samyuktha and Dr Aasawari Nalgundwar explore the various applications of Health IT in predicting and preventing epidemics and how an environment of health IT preparedness gave an advantage to certain countries in the current battle against COVID-19
“If history is our guide, we can assume that the battle between the intellect and will of the human species and the extraordinary adaptability of microbes will be never-ending.” [1]
This was quoted by Dr Anthony S. Fauci in his paper on emerging infectious diseases back in 2005.
It’s 2020, and we can safely confirm that we are yet to win the battle and that there is still a long way to go.
On the 100th anniversary of the Spanish Flu i.e. 2018, WHO released a publication on managing and preventing epidemics for WHO’s World representatives across the countries as a manual on prevention and response in case of an epidemic with emphasis on the age-old adage, “Prevention is not only better than cure, but also cheaper”. Out of the 15 different infectious diseases outlined in the publication, the greatest threat to the world was an influenza pandemic. In a little more than 1 year, the world has found itself in the midst of this threat despite the prevention and response strategies set down by WHO and other national health organisations.
This indicates the fact that just having a set of guidelines to follow “if and when” an epidemic occurs is not enough. There is a need to anticipate, predict and be prepared to contain an outbreak before it becomes an epidemic or worse a pandemic. This is where health IT can play a vital role. In this article, we would be exploring the various applications of health IT in predicting and preventing epidemics and how an environment of health IT preparedness gave an advantage to certain countries in the current battle against COVID-19.
Proposed use of health IT interventions to prevent epidemics
Following adequate research on emerging technologies and their applicability in prevention of epidemics, the following five areas were identified along with their proposed usage.
Public Health Information Network
Public Health Informatics (PHI) is the systematic application of information, computer science and technology in areas of public health, including surveillance, prevention, preparedness and health promotion.
Public Health Information Network can serve as a facilitator for setting up regional level electronic surveillance programmes to get real time updates on potential epidemic infections in regions under surveillance.[2]
Big Data analytics in the prevention and monitoring of epidemics
Big data analytics is the complex process of examining large and varied data sets, or big data, to uncover information and make informed decisions.
With the wide cell phone data coverage available globally, it is possible to track the movement of the spread of infection among people and this information can be analysed to predict the possible paths potential infectious diseases can take and thus put in measures to control the spread and contain it to prevent the epidemic from occurring.[3]
Artificial intelligence (AI) to prevent epidemics
AI is the process of empowering machines to make decisions real time from the information fed to it.
AI based programmes in conjunction with Natural Language Processing can be used to monitor news outlets and healthcare reports in multiple languages and flag potential outbreaks or high priority diseases at the earliest to prevent it from becoming an epidemic.[5]
Remote sensing technology
One of the causes for epidemic outbreaks is environmental changes. The ability of infectious diseases to thrive depends on changes in the Earth’s environment such as the climate, precipitation and vegetation of an area. Hence monitoring environmental changes using remote sensing technology is a possible preventive measure
The use of remote sensing technology aids specialists in predicting the outbreak of some of the most common and deadly infectious diseases today such as Ebola, West Nile virus and Rift Valley Fever. Through orbiting satellites, data is collected daily to monitor environmental changes. That information is then passed on to public health agencies around the world who use to predict and track the potential disease outbreaks and prevent epidemics from occurring.[6]
Updating Electronic Health Records (EHRs) to reflect travel history
Since travel and tourism is a major driver of epidemics, health experts have called for the travel history of patients to be updated in the EHRs along with the records of their vitals in hospitals and healthcare institutions. This enables public health officials to manage an outbreak effectively by isolating infected individuals and treating them before the transmission starts.[4]
Health IT preparedness is the solution
The countries that were affected the most during the SARS epidemic in 2002 were Asian countries and this experience had them better prepared in term of digitisation and health IT infrastructure upgrade in their healthcare institutions to handle the current COVID-19 pandemic and keep the infection largely under control and have been carrying on with their everyday lives.
To drive home this point, insights have been gathered and represented in this article from healthcare experts in Singapore, South Korea, Malaysia, Thailand and Japan.
Singapore – Tan Tock Seng Hospital’s Health IT solutions
Real Time Location System
The visitors, staff and medical equipment in the hospital were tracked by using Radio Frequency Identification Tags in real time and this made resource allocation easier when outbreaks occurred.
Command and Control Centre
The hospital had developed the command and control centre post SARS outbreak and this could sense, think and respond to optimise patient flow, care delivery and resource allocation.
In-house diagnostics kit development
The hospital also developed and had their own supply of diagnostic kits (Fortitude 2.0) in place to quickly test patients and control the outbreak.
South Korea – Seoul National University Bundang Hospital’s Health IT Solutions
Rapid Response System
Since 2013, South Korea’s SNUBH hospital had set up a Rapid Response System in place to handle disease outbreaks. The system allows for complete contactless monitoring of patients admitted with symptoms thus reducing the risk of hospital infections and spread.
The system has a dedicated team in place and facilitates real time communication between patients and doctors using 55-inch monitors.
Thailand – Samitivej and BNH Group of Hospitals’ Health IT Solutions
Digital health tools for patients
Tytocare, a healthcare solutions provider developed digital health tools that were given to patients for use at their homes to check their conditions and vitals and communicate the same to doctors at the hospital via teleconference calls.
Malaysia – University Malaya Medical Centre’s Health IT Solutions
Integrated Information System in hospital
Integrated information system helped in managing supplies, organising HR personnel, maintaining surveillance of the disease, optimising care and ensuring that information is delivered effectively.
Japan – Kyoto University Hospital’s Health IT Solutions.
Contactless ICU units
Series of digital measures were taken after SARS outbreak to keep the ICU units as contact less as possible. They were as follows:
Analog Voice channel, Analog hands free phone and Ubiquitous IP Camera (Dynamic VLAN to give specific IP address)
Remote control pump for controlling the ICU parameters remotely developed by the hospital in association with TERUMO.[7]
Health IT interventions in India post COVID-19
Although India had its share of healthcare issues, nothing had brought healthcare to the forefront of national discussion like the current COVID-19 pandemic has done. Some advancements made in the health IT space post COVID-19 outbreak are:
Regulation of telemedicine practice
As of March 25, 2020, following an amendment to Indian Medical Council Regulations (2002), consultations through telemedicine is permissible in India and this has led to the development of several telemedicine platforms such as esanjeevaniopd.in developed by Centre for Development of Advanced Computing and has made remote healthcare accessible to patients during the pandemic and also reduced the burden on our health infrastructure.
National Digital Health Mission
With an aim to digitise healthcare, the Government of India launched the National Digital Health Mission on August 15, 2020 – right in the middle of the COVID-19 pandemic.
The emphasis here is to develop a health IT ecosystem that leverages standardised, interoperable health information data in order to improve the quality and delivery of healthcare as well as to aid the nation in the fight against epidemics and pandemics in the foreseeable future.
The mission has called for the development of Health Facility Registry – a repository for healthcare facilities across the nation and Electronic Medical Records – a digital record of patients’ treatment details in a healthcare facility.[8]
The development of such centrally hosted repositories containing healthcare information can play a crucial role in information exchange and surveillance when an epidemic outbreak occurs and thereby aid public health officials to contain the spread and prevent future epidemics.
In conclusion, the current COVID-19 has exposed severe shortcomings in our preparedness for pandemics. When SARS outbreak happened in 2002, the major brunt of the epidemic was borne by Asian countries such as China, Singapore, Taiwan, South Korea and Japan.
From this experience the health care officials and the governmental agencies underwent rapid transformations in terms of digitisation and health IT preparedness and this preparedness aided them in their fight again COVID-19.
The article recommends countries such as India that are now bearing the major brunt of COVID-19 pandemic to make the best use of this crisis as an opportunity to turn around their healthcare delivery models and set up a health IT ecosystem to gain an upper hand in the continuing battle against epidemics.
(The article has been authored by R Samyuktha, PGDM Healthcare 2019-21 batch, SP Mandali’s Welingkar Institute of Management Development and Research (WeSchool) and co-authored by Dr Aasawari Nalgundwar, Assistant Professor – Healthcare, WeSchool)
References
[1] Fauci, A. S., Touchette, N. A., & Folkers, G. K. (2005). Emerging infectious diseases: a 10-year perspective from the National Institute of Allergy and Infectious Diseases. Emerging infectious diseases, 11(4), 519–525. https://doi.org/10.3201/eid1104.041167
[2] Aziz, H. A. (2017). A review of the role of public health informatics in healthcare. Journal of Taibah University Medical Sciences, 12(1), 78–81. https://doi.org/10.1016/j.jtumed.2016.08.011
[3] Madhav, N. (2017, August 6). InformationWeek, serving the information needs of the Business Technology Community. InformationWeek.
[4] Jason, C. (2020, March 6). Researchers Recommend Travel History to be Implemented into EHR. EHRIntelligence. https://ehrintelligence.com/news/researchers-recommend-travel-history-to-be-implemented-into-ehr++
[5] Heaven, W. D. (2020, March 12). AI could help with the next pandemic—but not with this one. MIT Technology Review. https://www.technologyreview.com/2020/03/12/905352/ai-could-help-with-the-next-pandemicbut-not-with-this-one/
[6] EurekAlert! Science News Service from AAAS. (2007, November 6). EurekAlert!
[7] HIMSS APAC Digital Dialogue Series 2020.
[8] National Digital Health Mission. (n.d.). National Health Portal India. Retrieved October 21, 2020, from https://www.nhp.gov.in/national-digital-health-mission-(ndhm)_pg
Nice article with important and nice ideas, thanks for sharing.