Info-Aids and Success Stories
The Public Health Informatics Fellowship Program (PHIFP) fellows are CDC data detectives. These professionals use their expertise to help investigate and implement solutions to address data management needs in public health. They work in CDC programs but also support other federal, state, local, or global health agencies and provide support to requesting agencies through Info-Aids—short-term informatics assistance projects to help meet urgent public health needs. The following are a few examples of Info-Aids provided by CDC’s PHIFP fellows.
- September 2017 HIV Investigation in West Virginia
- August 2017 Acute Watery Diarrhea Surveillance
- February 2017 Indiana State HIV Prevention Metrics
- February 2017 The Electronic Medical Record (EMR) Implementation Experience in Kenya
- January 2017 RATS (Reporting Architecture and Tracking System)
- November 2016 Creating Sustainable Health Information Systems Certification Frameworks: A Kenya Example
- November 2016 Improved Compliance Reporting Systems
- October 2016 Feasibility Assessment of Online Data Management Solutions to Assess Risk Factors for Suicide Among US Marines
- October 2016 Kenya-FELTP Management Information System
- June 2016 How Efficient Are Your Weapons in the Fight Against Zika?
HIV Investigation in West Virginia, Prototype Tool for Managing Case and Contact Information. Undetermined Risk Factors for HIV Infection—West Virginia
PHIFP Fellow: Amarnath Babu, MD, MPH
Info-Aid Requestor: West Virginia Bureau for Public Health
Between January and July 2017, the state of West Virginia saw an increased number of new HIV cases.
The new cases were mainly men who have sex with men, and few among them had a history of injection drug use. The West Virginia (WV) Bureau for Public Health requested an Epi-Aid (a rapid, short-term epidemiological technical assistance from CDC) to evaluate the extent of HIV diagnoses in the region, identify the risk groups involved, and determine the availability of HIV prevention measures. The Epi-Aid team then requested an Info-Aid which would review information systems in the WV Bureau for Public Health, identify the data being collected, and import them into a tool to manage case and contact data for analysis.
Babu analyzed eight data collection information systems within the WV Bureau for Public Health. He used agile software development principles to determine how to consolidate data from all the systems. Agile software development is an approach that allows systems solutions to evolve as a result of collaboration between cross-functional teams (the Epi-Aid team) and their customers (the WV Bureau for Public Health). In his analysis, Babu identified data elements in six out of eight of the systems that needed to be collected into a single tool to assist the Epi-Aid team with their investigation. He used Microsoft Access (software that was readily available, easy to use, and quick to develop and deploy solutions) to create a database to store, manage, and analyze case and contact information. The database established an electronic process which generated a weekly snapshot report in one hour, significantly faster than the two-day manual process. This report helped WV Bureau for Public Health staff prioritize field visits and contacts to pursue during the investigation. Hands-on training was provided to help staff maintain the tool after the investigation.
The database that Babu developed can be easily adapted for other HIV-related purposes. For example, it can be modified for web-based platforms to enable faster data import from other systems, including data entry directly from field investigations. Additionally, components can be added or removed to customize the tool for specific investigations or other uses.
Acute Watery Diarrhea Surveillance—Establishing Systems for Emergency Operations in Ethiopia
PHIFP Fellow: Kenneth Blaylock, MPH
Info-Aid Requestor: Ethiopia Ministry of Health
Acute watery diarrhea has been prevalent in the Somali region of Ethiopia, with 40,000 cases reported over the past three years. It is caused by a variety of pathogens spread by the fecal-oral route through contaminated food or water caused by poor sanitation. The Ethiopian Ministry of Health requested Info-Aid assistance to streamline disease tracking and mitigation activities related to this illness in its newly-established Emergency Operations Center (EOC).
Prior to the Info-Aid, each county investigating acute watery diarrhea gathered data in its own way. Additionally, data collection was manual; counties submitted data to the EOC via phone calls or text messages. This created a lack of data sharing necessary to efficiently mitigate the spread of acute watery diarrhea in Ethiopia. Blaylock’s role for this Info-Aid was to establish an efficient flow of data from the counties to the EOC. He evaluated the EOC’s existing tools and resources—technology (Wi-Fi and electricity), adequately trained personnel, and software—to determine how they could be used for the investigation. Blaylock found that MS Excel and QGIS (an open source geographic information system) were familiar to the EOC staff, and would be the best software to house raw data from the counties as well as to generate databases and outbreak maps for EOC staff. He provided leadership and training to EOC staff on managing the types of information in the databases and the relationship between the data to provide meaningful reports for EOC staff, helping them advise in-country leadership on the status of outbreak investigations.
As a result of Blaylock’s efforts, the timeline for the EOC’s data management process was reduced from one full day to a matter of hours. He helped the EOC establish an efficient, uninterrupted data flow so the incident manager could obtain case counts, charts, and maps from the data. A team effort was successful in modifying procedures to accommodate a newly formed EOC, as well as providing training and resources for a longer-term sustainable solution.
Indiana State HIV Prevention Metrics—Requirements Gathering, Analysis, and Design for a Dashboard Prototype Development
PHIFP Fellow: Kamran Ahmed MD, MS and Blanche Temate, PhD
Info-Aid Requestor: Indiana State Department of Health
In 2015, Indiana faced one of the largest HIV outbreaks among intravenous drug users in Scott County. The Indiana State Department of Health (ISDH) responded to this outbreak, but faced major challenges in documenting, monitoring, and reporting during the response. ISDH needed consolidated data related to surveillance, testing, contact tracing, medical care, and prevention activities to manage this public health response and its aftermath. Because of the silo nature of HIV programs, each HIV dataset is managed separately and tailored to the relevant needs of each HIV program area. ISDH initiated early efforts to integrate thousands of data points from disparate data sources and better track and report HIV prevention metrics statewide. However, this integration process was managed manually at the state level. An ISDH staff person was responsible for matching individual records from the data sources to ensure it wasn’t duplicated or incorrect. Since only the person in charge of integrating the datasets had a complete picture, this manual process made the resulting dataset susceptible to inconsistent and redundant data. Realizing these challenges, ISDH requested Info-Aid assistance to assess its existing data linking process and develop an electronic dashboard prototype for HIV monitoring and prevention metrics reporting.
Ahmed and Temate assessed ISDH’s datasets and conducted an environmental scan of HIV reporting needs, work flows, and business processes, as well as information on operations, processes, and attributes of data systems. Next, they focused on the requirement’s gathering process for HIV reporting needs. Finally, Ahmed and Temate developed a dashboard content inventory tool to gather HIV reporting needs and dashboard operational requirements from stakeholders. Once all the stakeholders agreed on the dashboard requirements, Ahmed and Temate created a final dashboard prototype that linked data from three different sources. The Info-Aid allowed ISDH to reduce the time it takes to extract and link data from several of its systems from two weeks to half a day.
Also, as a result of this Info-Aid, ISDH is developing an information technology infrastructure to allow for easier linkage between systems at the state level.
This Info-Aid highlighted the importance of involving public health informaticians in creating a health information system infrastructure at an early stage. Informaticians have an important role in understanding the value and best use of data integration as a crucial part of improving the health of their populations. The results of this effort offer other states an opportunity to apply these lessons to improve future public health informatics initiatives.
The Electronic Medical Record (EMR) Implementation Experience in Kenya
PHIFP Fellows: Lisa Murie, MSc and Loretta Amadi, MS
Info-Aid Requestor: CDC Kenya
In 2012, CDC Kenya, with the Ministry of Health (MoH) and other partners, started a large-scale, national roll out of electronic medical records (EMR) to support patient management in HIV/AIDS and TB programs. To date, EMRs have been implemented in over 650 health facilities owned by the MoH, faith-based and other non-governmental organizations, and others throughout the country. CDC Kenya requested an Info-Aid to capture and preserve the institutional knowledge gained from EMR implementation thus far, including lessons learned and promising practices. The goal of this Info-Aid was to help define the best way to transition health facilities from the EMR pre-implementation phase, where there’s no EMR implemented, to the last phase, where there is a sustainable, meaningful use of EMRs to provide improved quality of care for HIV/AIDS and TB patients.
Murie and Amadi co-led this Info-Aid. They used a modified version of the CDC Framework for Program Evaluation, which is designed to help public health professionals summarize and organize program evaluation activities. They engaged with stakeholders to evaluate the EMR implementation process, conducted a data analysis of the systems, and sought feedback from stakeholders to determine lessons learned and best practices. They categorized the lessons learned into five main themes: governance, leadership, and policy; infrastructure needs; standards and guidelines; workforce and training; and funding. For each of these themes, Lisa and Loretta outlined promising practices to help future end users embrace EMR implementation. For example, for the theme of standards and guidelines, which are essential in carrying out the process of EMR implementation, the Info-Aid identified that a phased approach for development works best, which would then support benchmarking activities, performance testing, and cost evaluation that could make the implementation process more efficient. CDC Kenya can employ the promising practices recommended by the fellows to create EMR implementation guidelines, which can be shared widely and adopted by other organizations implementing EMRs within similar, low resource settings.
Murie’s and Amadi’s evaluation of CDC Kenya’s EMR implementation efforts allows staff to consider how EMRs extend the knowledge of the health care provider and, therefore, improves the quality of care.
RATS (Reporting Architecture and Tracking System) for the Seoul Virus Outbreak
Fellow: Linda Roesch, MPH
Info-Aid Requestor: Viral Special Pathogens Branch (VSPB), National Center for Emerging and Zoonotic Infectious Diseases
In early 2017, VSPB provided assistance to health officials in several states to investigate an outbreak of Seoul virus infection. Seoul virus is a type of hantavirus that is carried and spread by rodents and, in some cases, can cause severe illness in humans. People can become infected through bites or contact with urine, droppings, or saliva from infected rodents.
During this outbreak, 17 people in seven states were infected by pet rats. VSPB assisted state health departments with data collection activities to better understand how the virus entered the pet trade and to prevent transmission to other rats or people. The branch requested an Info-Aid to create a surveillance database to merge information from different systems used by each state involved in the outbreak and to minimize manual data entry and reporting processes.
To help VSPB, Roesch developed FacilityID—a unique identifier for each facility reporting data during the outbreak investigation. FacilityID linked disparate data coming from various systems used by the states to report test results for rats and people linked to ratteries with confirmed infections. It minimized manual data identification and entry processes, which helped better integrate the data. Roesch leveraged Power Query for Excel and Power Pivot for Excel—reporting tools that VSPB could already access—to create a database that would help epidemiologists analyze the outbreak data.
The new database structure and data reporting process that Roesch created greatly reduced the amount of time epidemiologists spent collecting data and developing reports during the investigation. It streamlined data integration and led to expedited disease tracking and mitigation. Though initially created for the Seoul outbreak investigation, VSPB can customize the system for future outbreak investigations.
Creating Sustainable Health Information Systems Certification Frameworks: A Kenya Example
Fellow: Wycliffe Odongo, MSC
Info-Aid Requestor: CDC Kenya Office, Center for Global Health
Many new health information systems (HIS) are rapidly emerging in the Kenyan healthcare landscape with varying degrees of success in implementation, adoption, and integration. This has resulted in disparate systems that are not able to share accurate and timely data, which creates inefficient business processes. Kenya’s Ministry of Health and other healthcare stakeholders worked on a comprehensive HIS regulatory framework to integrate the systems. The CDC Kenya Office requested an Info-Aid to review the HIS regulatory framework and provide recommendations on how to improve and implement it.
Odongo compared the Kenyan HIS regulatory framework to existing frameworks and identified gaps that impeded successful adoption and implementation. He then worked with stakeholders to revise the framework to facilitate better systems control, efficiency, and timely information exchange, which would result in standardized and integrated HIS. HIS integration was critical since the information contained within these systems needed to be accessible to all stakeholders and enable them to make decisions at all levels of the healthcare system throughout the country.
Kenya’s Ministry of Health fully owned and adopted the revised HIS framework. The impact of this work resulted in stakeholders being able to facilitate data-driven decisions at all levels of the healthcare system throughout the country. An additional impact of this Info-Aid was the HIS development process, which created opportunities for better collaboration among a large number of stakeholders with different health information needs.
Improved Compliance Reporting Systems for Scientific Integrity and Quality Training Program Courses
Fellow: Anais Tanon, PhD
Info-Aid Requestor: Training Unit, Office of the Associate Director for Science (OADS)
The Training Unit in OADS oversees the Scientific Integrity and Quality Training (SIQT) Program. The SIQT Program comprises mandatory training courses for CDC staff involved in scientific activities. The Training Unit monitors course completion data for more than 8,000 CDC employees annually. The group needed a solution to automate the monitoring process and readily review completion requirements for all learners.
Tanon used Structured Query Language (SQL) and Excel to develop a system to integrate raw compliance data from multiple CDC databases, process the data, and produce a compliance report on demand. She used functionality within SharePoint to store the compliance reports, provide an interface for key stakeholders to view the reports, and automate course completion alerts and announcements.
By helping the Training Unit use its existing informatics tools and structure in a new way, Tanon enabled them to significantly reduce the effort associated with monitoring course completion data for the SIQT Program courses.
Feasibility Assessment of Online Data Management Solutions to Assess Risk Factors for Suicide Among US Marines
Fellow: Ester Mungure, MSc
Info-Aid Requestor: National Center for Injury Prevention and Control (NCIPC)
The Medical Officer to the Marine Corps and the US Department of Veterans Affairs (VA), through NCIPC, requested joint Epi-Aid and Info-Aid assistance to develop a data management tool to evaluate the impact of suicide risk among members of the Second Battalion, Seventh Marine Regiment (2/7). They would also use the tool to evaluate possible risk factors for suicide contagion and potential protective factors—factors that, when present in individuals, families, or the community at large, can contribute to improved health and well-being— among the 2/7.
Mungure reviewed the information that the Medical Office of the Marine Corps and the VA needed to collect. She then conducted a feasibility assessment of a tool to capture, manage, and evaluate the required data and provided recommendations that would best fit stakeholder’s needs. The stakeholders accepted her recommendations, and she designed and built an online data capturing tool and proposed a data management system to capture the required information.
Mungure applied a systems thinking approach to create the necessary framework and data management solutions that can also be applied to similar investigations in the future.
Software Requirements Gathering for the Kenya-FELTP Management Information System
Fellow: George Odongo, MPH, BSc
Info-Aid Requestor: Kenya Field Epidemiology and Laboratory Training Program (FELTP), Center for Global Health
The Kenya FELTP provides training opportunities to laboratorians and epidemiologists in the Kenyan public health workforce. Kenya FELTP tracks data related to participant training progress, alumni information, and general descriptive statistics on where participants work. The program requested an Info-Aid to build a system to manage and track student performance and program activities and an online system to ease application and subsequent enrollment management processes. The program also needed a way to link the two systems together.
Odongo collaborated with key Kenya FELTP stakeholders to review their informatics needs. This included gathering user requirements to identify a solution customized specifically for the Kenya FELTP. He developed a systems requirements document that laid the groundwork for constructing an effective information management system to merge performance and activity data and enrollment management processes from different sources to improve how the program is able to manage and track activities.
By using a collaborative requirements gathering approach, Odongo was able to understand, refine, and clarify the Kenya FELTP user requirements very early on the process. The requirements document he created is not only useful for developing and implementing the program’s data management solution, but also for measuring the system’s success down the line.
How Efficient Are Your Weapons in the Fight Against Zika? Do You Know?
Fellow: Manjula Gama Ralalage, MD, MBBS, MSc
Info-Aid Requestor: Vector Control Unit, Puerto Rico Department of Health (PRDH)
As part of CDC’s Zika response in Puerto Rico, the PRDH Vector Control Unit requested an Info-Aid to streamline and interpret the data it received from multiple sources, such as the Women Infants and Children program and vector control service providers, to track Zika prevention services received by pregnant women.
Ralalage built an automated system to merge the disparate data elements and streamlined it to improve the quality of the data. Data collection involved information related to mosquito breeding and Zika education level assessments of pregnant women and their adherence to Zika preventive practices.
The new automated system that Ralalage created not only resolved the difficulties that the PRDH Vector Control Unit faced in managing and formatting data from different sources, but also improved the quality of the information by streamlining existing data collection processes. Since the system was automated, it expedited the process of providing critical information to decision makers in the midst of Zika response activities.
PHIFP fellows are available to help programs develop innovative solutions to meet public health needs. For more information about Info-Aids send an email to email@example.com.