Implementing a new health management information system in Uganda.
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This paper reports on research investigating the health management information system (HMIS) implementation process in Uganda, utilizing the diffusion of innovation and dynamic equilibrium organizational change models. Neither perspective guided the HMIS development process. Instead, technological issues, rather than wider organizational issues, dominated the planned change. The need to consider the organizational context when changing information systems arises because the process is more complex than some practitioners have realized, when attempting to understand the causes of information management problems and developing HMIS in low-income countries. In particular, information system developers had not acknowledged that they were promoting an informational approach to management when they promoted a change from a centralized reporting system to a HMIS supporting use of information at the level of collection. Strategies to facilitate this approach were not advocated. Organizational theory can contribute to the diffusion of innovation framework. It has yielded an integration of Rogers's diffusion of innovation framework and Leavitt's concept of organizational forces in equilibrium. The diffusion framework describes the process, but the organizational model has given the context and reason for aspects of the process. The diffusion model does not predict what needs to change within the organization when a particular innovation is introduced, or how much. The addition of the organizational model has helped. These frameworks can facilitate the introduction of future information management innovations and allow practitioners to perceive their introduction as a staged process needing to be managed. Implications for practice are identified. (+info)
LASIK complications and the Internet: is the public being misled?
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BACKGROUND: LASIK (Laser in Situ Keratomileusis) is a very popular combined surgical and laser procedure, which is used to correct myopia (shortsightedness) and hyperopia (farsightedness). There is concern that the public is being misled regarding the safety of the procedure. OBJECTIVES: To assess the quality and quantity of the information on complications on LASIK Web sites. METHOD: Serial analysis and evaluation of the authorship, content, and technical quality of the information on the complications of LASIK on 21 Web sites. RESULTS: Of the 21 LASIK Web sites visited, 17 were commercial. Of the 21 Web sites, 5 (24%) had no information on complications. Of the 16 sites that had information on complications the author of the information was clearly identified in 5 (31%), the content was only referenced in 2 (12.5%), and evidence of the information having been updated was only seen in 2 (12.5%). The quantity of information is generally minimal and the information itself is generally difficult to understand and locate. CONCLUSION: The quality and quantity of the information on the Web on the complications of LASIK are poor. More work is required to encourage clear, accurate, up-to-date, clearly authored, and well-referenced, balanced ophthalmic information. (+info)
Using geographic information systems to assess risk for elevated blood lead levels in children.
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OBJECTIVES: Targeted screening for childhood lead poisoning depends on assessment of risk factors including housing age. Using a geographic information system (GIS), we aim to determine high-risk regions in Charleston County, South Carolina, to assist public health officials in developing targeted lead-screening. METHODS: Properties built before 1978 were geocoded (assigned latitude and longitude coordinates) from tax assessor data. Addresses of Charleston County children who have been screened for lead poisoning were also geocoded. Locations of all housing, lead poisoning cases, and negative screens were created as separate map layers. Prevalence ratios of lead poisoning cases were calculated, as were relative risks for each category of housing. RESULTS: Maps of Charleston County were produced showing the location of old housing, where screening took place, and where cases were found. One thousand forty-four cases were identified. Twenty percent of children living in pre-1950 homes had elevated blood lead levels (EBLL). Children living in pre-1950 housing were 3.9 times more likely to have an EBLL than children living in post-1977 housing. There was no difference in risk of living in a 1950-1977 home vs. a post-1977 home. A large number of cases were also found in an area of newer houses, but near a potential point source. Eighty-two percent of all screens were from children in post-1977 homes. CONCLUSIONS: Children living in pre-1950 housing were at higher risk for lead poisoning. GIS is useful in identifying areas of risk and unexpected clustering from potential point sources and may be useful for public health officials in developing targeted screening programs. (+info)
Draft framework for evaluating syndromic surveillance systems.
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Interest in public health surveillance to detect outbreaks from terrorism is driving the exploration of nontraditional data sources and development of new performance priorities for surveillance systems. A draft framework for evaluating syndromic surveillance systems will help researchers and public health practitioners working on nontraditional surveillance to review their work in a systematic way and communicate their efforts. The framework will also guide public health practitioners in their efforts to compare and contrast aspects of syndromic surveillance systems and decide whether and how to develop and maintain such systems. In addition, a common framework will allow the identification and prioritization of research and evaluation needs. The evaluation framework is comprised of five components: a thorough description of the system (e.g., purpose, stakeholders, how the system works); system performance experience (e.g., usefulness, acceptability to stakeholders, generalizability to other settings, operating stability, costs); capacity for outbreak detection (e.g., flexibility to adapt to changing risks and data inputs, sensitivity to detect outbreaks, predictive value of system alarms for true outbreaks, timeliness of detection); assessment of data quality (e.g., representativeness of the population covered by the system, completeness of data capture, reliability of data captured over time); and conclusions and recommendations. The draft framework is intended to evolve into guidance to support public health practice for terrorism preparedness and outbreak detection. (+info)
Statutory basis for public health reporting beyond specific diseases.
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Statutory authority for public health surveillance is necessarily broad as previously uncharacterized diseases are regularly discovered. This article provides specific information about general disease reporting provisions in each state. The intent of these reporting laws and the Health Insurance Portability and Accountability Act Privacy Rule is to support this critical disease surveillance function for the benefit of the entire population. (+info)
Syndromic surveillance using minimum transfer of identifiable data: the example of the National Bioterrorism Syndromic Surveillance Demonstration Program.
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Several health plans and other organizations are collaborating with the Centers for Disease Control and Prevention to develop a syndromic surveillance system with national coverage that includes more than 20 million people. A principal design feature of this system is reliance on daily reporting of counts of individuals with syndromes of interest in specified geographic regions rather than reporting of individual encounter-level information. On request from public health agencies, health plans and telephone triage services provide additional information regarding individuals who are part of apparent clusters of illness. This reporting framework has several advantages, including less sharing of protected health information, less risk that confidential information will be distributed inappropriately, the prospect of better public acceptance, greater acceptance by health plans, and less effort and cost for both health plans and public health agencies. If successful, this system will allow any organization with appropriate data to contribute vital information to public health syndromic surveillance systems while preserving individuals' privacy to the greatest extent possible. (+info)
A systems overview of the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE II).
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The Electronic Surveillance System for the Early Notification of Community-Based Epidemics, or ESSENCE II, uses syndromic and nontraditional health information to provide very early warning of abnormal health conditions in the National Capital Area (NCA). ESSENCE II is being developed for the Department of Defense Global Emerging Infections System and is the only known system to combine both military and civilian health care information for daily outbreak surveillance. The National Capital Area has a complicated, multijurisdictional structure that makes data sharing and integrated regional surveillance challenging. However, the strong military presence in all jurisdictions facilitates the collection of health care information across the region. ESSENCE II integrates clinical and nonclinical human behavior indicators as a means of identifying the abnormality as close to the time of onset of symptoms as possible. Clinical data sets include emergency room syndromes, private practice billing codes grouped into syndromes, and veterinary syndromes. Nonclinical data include absenteeism, nurse hotline calls, prescription medications, and over-the-counter self-medications. Correctly using information marked by varying degrees of uncertainty is one of the more challenging aspects of this program. The data (without personal identifiers) are captured in an electronic format, encrypted, archived, and processed at a secure facility. Aggregated information is then provided to users on secure Web sites. When completed, the system will provide automated capture, archiving, processing, and notification of abnormalities to epidemiologists and analysts. Outbreak detection methods currently include temporal and spatial variations of odds ratios, autoregressive modeling, cumulative summation, matched filter, and scan statistics. Integration of nonuniform data is needed to increase sensitivity and thus enable the earliest notification possible. The performance of various detection techniques was compared using results obtained from the ESSENCE II system. (+info)
Use of ambulance dispatch data as an early warning system for communitywide influenzalike illness, New York City.
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In 1998, the New York City Department of Health and the Mayor's Office of Emergency Management began monitoring the volume of ambulance dispatch calls as a surveillance tool for biologic terrorism. We adapted statistical techniques designed to measure excess influenza mortality and applied them to outbreak detection using ambulance dispatch data. Since 1999, we have been performing serial daily regressions to determine the alarm threshold for the current day. In this article, we evaluate this approach by simulating a series of 2,200 daily regressions. In the influenza detection implementation of this model, there were 71 (3.2%) alarms at the 99% level. Of these alarms, 64 (90%) occurred shortly before or during a period of peak influenza in each of six influenza seasons. In the bioterrorism detection implementation of this methodology, after accounting for current influenza activity, there were 24 (1.1%) alarms at the 99% level. Two occurred during a large snowstorm, 1 is unexplained, and 21 occurred shortly before or during a period of peak influenza activity in each of six influenza seasons. Our findings suggest that this surveillance system is sensitive to communitywide respiratory outbreaks with relatively few false alarms. More work needs to be done to evaluate the sensitivity of this approach for detecting nonrespiratory illness and more localized outbreaks. (+info)