Informatics Metrics and Measures for a Smart Public Health Systems Approach: Information Science Perspective

Trading-off privacy and utility: the Washington State experience assessing the performance of a public health digital exposure notification system for coronavirus disease 2019

OBJECTIVE

Digital exposure notifications (DEN) systems were an emergency response to the coronavirus disease 2019 (COVID-19) pandemic, harnessing smartphone-based technology to enhance conventional pandemic response strategies such as contact tracing. We identify and describe performance measurement constructs relevant to the implementation of DEN tools: (1) reach (number of users enrolled in the intervention); (2) engagement (utilization of the intervention); and (3) effectiveness in preventing transmissions of COVID-19 (impact of the intervention). We also describe WA State's experience utilizing these constructs to design data-driven evaluation approaches.

METHODS

We conducted an environmental scan of DEN documentation and relevant publications. Participation in multidisciplinary collaborative environments facilitated shared learning. Compilation of available data sources and their relevance to implementation and operation workflows were synthesized to develop implementation evaluation constructs.

RESULTS

We identified 8 useful performance indicators within reach, engagement, and effectiveness constructs.

DISCUSSION

We use implementation science to frame the evaluation of DEN tools by linking the theoretical constructs with the metrics available in the underlying disparate, deidentified, and aggregate data infrastructure. Our challenges in developing meaningful metrics include limited data science competencies in public health, validation of analytic methodologies in the complex and evolving pandemic environment, and the lack of integration with the public health infrastructure.

CONCLUSION

Continued collaboration and multidisciplinary consensus activities can improve the utility of DEN tools for future public health emergencies.

Clustering and spatial heterogeneity of bovine tuberculosis at the livestock/wildlife interface areas in Namwala District of Zambia

BACKGROUND AND AIM

Bovine tuberculosis (bTB) remains a major public health issue in Zambia and has been exacerbated by human immunodeficiency virus prevalence and consumption of unpasteurized milk in the Southern Province of the country. The prevalence of bTB has been established to be linked to Kafue Lechwe, which act as reservoir hosts and share grazing fields with domestic cattle. No studies have so far used geographic information system (GIS) to investigate the relationship between the reservoir hosts (Kafue Lechwe) and domestic animals. This study, therefore, aimed to apply GIS to investigate the spatial distribution of bTB in Namwala District of the Southern Province of the country.

MATERIALS AND METHODS

To investigate the spatial distribution of bTB, geographical positioning system (GPS) coordinates representing 96 cattle herds across 20 independent villages were captured alongside risk factor data. The 96 herds were based on abattoir reports of condemned carcasses and a trace back. Positive herds were confirmed by cross-reference to purified protein derivative tests conducted by the District Veterinary Office. The GPS coordinates were transferred into ArcView 3.2 and laid on the map of Namwala District alongside physical features, including national parks, game management areas, and flood plains. Questionnaires were administered across 96 independent households to assess risk factors of bTB transmission.

RESULTS

The results revealed a "clustered" spatial distribution of the disease in cattle in Namwala District of Zambia, particularly significant in the eastern interface areas of the district (p=0.006 using Moran's I). Abattoir to production area trace back revealed a herd-level prevalence of 36.4% (95% CI=26.7-46.3%) among cattle herds in Namwala District, whereas individual animal prevalence ranged from 0% to 14% (95% CI=2.4-26.2%). Further, GPS data indicated that the majority of the positive herds were located at the livestock/wildlife interface area. Contacts with wildlife, coupled with sharing grazing, and watering points were found to be significant risk factors for bTB transmission.

CONCLUSION

This study demonstrated the presence of bTB in cattle and associated spatial risk factors. In particular, bTB was observed to be a function of animal location within the livestock/wildlife interface area. GIS is thus an applicable and important tool in studying disease distribution.

Development and Implementation of Electronic Disease Early Warning Systems for Optimal Disease Surveillance and Response during Humanitarian Crisis and Ebola Outbreak in Yemen, Somalia, Liberia and Pakistan

OBJECTIVE

To share lessons learned with experience in concept development of electronic disease early warning system (eDEWS) as a standardized informatic tool for optimal disease surveillance for early warning and response Network (EWARN) during humanitarian crisis.

METHODS

We did literature search, review and analysis to document system attributes of existing electronic tools being used for disease surveillance, early warning and health management information system (HMIS). We generated baseline information and conducted multiple planning sessions with stakeholders for EWARN system requirement elicitation and validation to inform concept development of standardized electronic tool.

RESULTS

We identified 98 electronic health projects, classified 22 projects under 'Disease and epidemic outbreak surveillance' theme, whereas only four electronic tools met our selection criteria and were reported to be implemented in humanitarian settings complimentary to EWARN. Baseline information was obtained to guide work on requirement gathering and analysis process, and development of concept for a standardized electronic tool for EWARN.

DISCUSSION

The eDEWS was enhanced with an objective to develop standardize electronic tools and data collection procedures to monitor diseases and health events for alert detection in global humanitarian settings. The enhanced system could be harnessed as a powerful tool by outbreak response teams in getting vital epidemiological information for appropriate and timely response during emergencies.

CONCLUSION

eDEWS experiences in Yemen, Somalia, Liberia and Pakistan offers an opportunity to learn and apply lessons to improve future health informatics initiatives or adapt eDEWS as a feasible standardized approach to enhance EWARN implementation during humanitarian crisis, and potential integration into routine surveillance systems.

Artificial Intelligence in Public Health and Epidemiology

Objectives:  To introduce and summarize current research in the field of Public Health and Epidemiology Informatics.

Methods:  The 2017 literature concerning public health and epidemiology informatics was searched in PubMed and Web of Science, and the returned references were reviewed by the two section editors to select 14 candidate best papers. These papers were then peer-reviewed by external reviewers to provide the editorial team with an enlightened vision to select the best papers.

Results:  Among the 843 references retrieved from PubMed and Web of Science, two were finally selected as best papers. The first one analyzes the relationship between the disease, social/mass media, and public emotions to understand public overreaction (leading to a noticeable reduction of social and economic activities) in the context of a nation-wide outbreak of Middle East Respiratory Syndrome (MERS) in Korea in 2015. The second paper concerns a new methodology to de-identify patient notes in electronic health records based on artificial neural networks that outperformed existing methods.

Conclusions:  Surveillance is still a productive topic in public health informatics but other very important topics in Public Health are appearing. For example, the use of artificial intelligence approaches is increasing.

A Web-Based Tool for Automatic Data Collection, Curation, and Visualization of Complex Healthcare Survey Studies including Social Network Analysis

There is a great concern nowadays regarding alcohol consumption and drug abuse, especially in young people. Analyzing the social environment where these adolescents are immersed, as well as a series of measures determining the alcohol abuse risk or personal situation and perception using a number of questionnaires like AUDIT, FAS, KIDSCREEN, and others, it is possible to gain insight into the current situation of a given individual regarding his/her consumption behavior. But this analysis, in order to be achieved, requires the use of tools that can ease the process of questionnaire creation, data gathering, curation and representation, and later analysis and visualization to the user. This research presents the design and construction of a web-based platform able to facilitate each of the mentioned processes by integrating the different phases into an intuitive system with a graphical user interface that hides the complexity underlying each of the questionnaires and techniques used and presenting the results in a flexible and visual way, avoiding any manual handling of data during the process. Advantages of this approach are shown and compared to the previous situation where some of the tasks were accomplished by time consuming and error prone manipulations of data.