# Presentation: 089281

## ICE on Injury Statistics Meeting

**ICE on Injury Statistics**** Meeting**
**Camino Real Sumiya**
**Cuernavaca**
**Mexico**
**June 1 - 2, 2005**

** ****I  Getting Started:Needed is IT Sustainability and an**
**Awareness of IT Elsewhere**
**~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~**
**II Benefits of e-Surveillance and an Integrated PAS**

- Ron Hébert, Chairman
- ronh@herontech.com

## Getting Started on the Route to IT Success Sustainability of Health Informatics Systems

***ICE on Injury Statistics ICE on Injury Statistics****** ***

**ICE on Injury Statistics Meeting**
**(International Collaborative Effort on Injury Statistics)****  **
** ****DATA must be gathered leading to**
****
******INFORMATION**
****** ****KNOWLEDGE**
****** ****UNDERSTANDING**
****** ****WISDOM**
****** ****VISION (Joanna Wiebe, Canada****)**

## Getting Started on the Route to IT Success Sustainability of Health Informatics Systems

***ICE on Injury Statistics ICE on Injury Statistics****** ***

**ICE on Injury Statistics Meeting**
**How To Gather Injury Data**
**(on a Timely and Accurate Basis)**
**MANUALLY**
**(The historical method)**
**or**
**in**** E-FORMAT**
** ****[direct to computer as in Jamaica]**
**(emerging E-Surveillance)**

## Getting Started on the Route to IT Success Sustainability of Health Informatics Systems

***ICE on Injury Statistics ICE on Injury Statistics****** ***

**ICE on Injury Statistics Meeting**
_**Introduction**_
** **
**“****I have stressed repeatedly, here in the *****Pan American Health Organization***** (PAHO), that information is a critical resource for our work. Our technical cooperation must be based on good information about those areas in which we will cooperate with our Member States.”**
**“****Competent management of the services requires that there be *****efficient and effective information systems.”***
**Dr. George A. O. Alleyne**
**Director**
**Pan American Health Organization**
***Setting Up Healthcare Services*****	****  Pan American Health Organization**
***Information Systems*****	****	****  World Health Organization, JULY 1999**

## E-Surveillance and the Integrated PAS  

**Advantages of an Integrated Surveillance/PAS System*:**
_**Brief background:**_
**It is estimated that 12% of the global burden of disease is due to injuries (1998)**
**In 1998 injuries caused 5.8 million deaths in 15 - 44 year olds.**
**	****Road traffic injuries moving from 9th (1990) to 3rd (2020) leading cause of death.**
**Accordingly, it is imperative that communities monitor injury trends: *****data to action*****.**
**Most functioning national injury morbidity surveillance systems are in developed countries.**
**“****Jamaica is one of a few developing countries with an ER-based Injury Morbidity S System.”**
**“****This system may be considered a success, having grown to a national** system.”**
**How did Jamaica achieve ‘success’ to become a ‘model’ for other countries?**
***    ****Main source: Injury Control and Safety Promotion (Vol. 9 No 4), Dec 2002**
****  ****A ‘national’ system may be defined as one that represents more than 20% of hospital beds.**

***“******The JISS/PAS*** could be a model for other developing and developed countries”  (CDC 2003)

## Getting Started on the Route to IT Success Sustainability of Health Informatics Systems

**There are many *****‘fundamental’***** reasons for success/failure:**
**Starting with success, the country:**
******	****Has the capacity to pay for the IT solution (without a WB loan) within 2% of budget.**
******	****Has a clear written ‘realistic’ definition as to its *****starting***** needs, and future plans.**
******	****Has taken the time to look closely at ‘successes’ in other **_***developing***_*** *****countries.**
******	****Has a ‘cheerleader’ to follow through on the implementation: overcome challenges**
******	****Monitors the progress and success at every step of the way to the end objective. **
******	****Has a very strong commitment at the highest political and MOH levels.**

## Why have most countries not yet computerized their national health sector? - Getting started.

**Why no National Integrated e-Surveillance/PAS installs?***
****** ****	****Backgrounder: An example is Canada (the USA is much the same)****.**
****** ****	****Incompatible IT environments in EACH hospital (700), of each province (10).**
******	****	****The provinces cannot/will not agree on patient data sharing.**
******	****	****There are no national or provincial data standards.**
******	****	****Canada in 2004 has finally *****announced***** National E-Surveillance (USD$100M).**
*** Except Jamaica**
**“****The JISS/PAS is, to the best of my knowledge, the first, and probably still the only, fully computerized, wide-area networked national surveillance system in the western hemisphere.” (Yvette Holder, CDC)**
**(JISS/PAS = Jamaica Injury Surveillance System/Patient Administration System)**

***“******The JISS/PAS*** could be a model for other developing and developed countries”  (CDC 2003)

## Why have most countries not yet computerized their national health sector? - Getting started.

**Jamaica has a National Integrated e-Surveillance/PAS !**
****** ****	****No other (known) country in the world has such an integrated health IT system.**
****** ****	****Compatible IT environments in EACH hospital (11), of each Region (4).**
******	****	****The hospitals capture e-Surveillance data (1 - 2 minutes) and send to the JMOH.**
******	****	****The HTC PAS ‘standards’ are the national and provincial data ‘standards’.**
******	****	****Canada (USD$100M) for Surveillance; Jamaica $500 for software, $0 hardware.**
******	****	****Jamaica spends less than 0.5% of its health budget on IT. Canada at 2.5%+.**
******	****	****The HTC PAS/Surveillance cost in Jamaica is 10% per capita the cost of Canada.**
******	****	****Montserrat is live with the HTC PAS; Dominica starts in May/June 2005.**
******	****	****This could soon lead to a Caribbean/PAHO Disease e-Surveillance system.**

***“******The JISS/PAS*** could be a model for other developing and developed countries”  (CDC 2003)

## Why have most countries not yet computerized their national health sector? - Getting started.

**Jamaica has a National Integrated e-Surveillance/PAS !**
**To gather data on VR injuries in the hospital A&E Departments to better understand:**
******	****Who is at risk.****	****	**** ********   Who is perpetrating violence within society**
****** ****	****Where these incidents occur.  ********   What is the cost to the health sector.**
**-------------------------------------------------------------------------------------------------------------------------**
**For data collection purposes, all injuries seen in the A&E are categorized as:**
****** ****	****Unintentional or accidental.****	****  ********  Violence related.**
****** ****	****Attempted suicide****	****	****  ********   Motor vehicle related.**
**-------------------------------------------------------------------------------------------------------------------------**
**Credits for the development of the JISS are attributed to:**
******	****JMOH (Dr. Elizabeth Ward)****	****  ********  CDC, Atlanta, Georgia, USA****	**
****** ****CAREC, Trinidad & Tobago****	****  ********  Heron Technology Corp, Toronto, Canada**

***“******The JISS/PAS*** could be a model for other developing and developed countries”  (CDC 2003)

## Why have most countries not yet computerized their national health sector? - Getting started.

**Jamaica *****has *****a National Integrated e-Surveillance/PAS !**
**01 - ****	****Injuries in Jamaica. Guest Editorial (Yvette Holder)**
**This system may be considered a success as it not only continues **
**to operate up to this time, having grown from a pilot, to a routine **
**national system incorporating 11 tertiary care institutions.**

***“******The JISS/PAS*** could be a model for other developing and developed countries”  (CDC 2003)

## Why have most countries not yet computerized their national health sector? - Getting started.

**RECOGNITIONS for the JA JISS/PAS***
***PAHO***** ****(Pan American Health Organization)**
******	**** ****(Led multi-country week long trip in 2003 to Jamaica; Santiago, Chile 2004)**
***WHO***** (World Health Organization)**
******  ****(Geneva, Switzerland 04; Vienna, Austria 04; Paris, France 04; Liverpool, UK 05)**
***CDC *****(Centers for Disease Control) [2002/2003]**
******  ****(Led study by 26 experts on the JISS/PAS; 8 articles, 57 pages in IC&SP, Vol 9)**
***CSIH***** (Canadian Society for International Health)**
******  ****(Write up in SYNERGY paper on JA Surveillance System - 2001)**
***Resulting from write ups and/or presentations by Dr. Elizabeth Ward, JMOH**

***“******The JISS/PAS*** could be a model for other developing and developed countries”  (CDC 2003)

## Why have most countries not yet computerized their national health sector? - Getting started.

**There are many *****‘fundamental’***** reasons for failures:**
****** ****	****Backgrounder: An example is India ****(plus numerous other countries).**
****** ****	****Economic disparity between countries.**
******	****	****Consultants (mainly from ‘developed’ countries).**
******	****	****‘****Catch-up’ syndrome, and excessive IT ‘complexity’.**
******	****	****Too much focus on ‘technology’ - (state-of-the-art).**
******	****	****Too little focus on ‘business process’- (Canadian gun registry).**
******	****	****Lack of awareness of IT ‘failures’ in other developing countries (Ex:Limpopo).**
******	****	****Suggestions on getting ‘started’, with ‘success’.**
******	****	****How to proceed after achieving a successful ‘start’, to an HIS. **

***“******The JISS/PAS*** could be a model for other developing and developed countries”  (CDC 2003)

## Why have most countries not yet computerized their national health sector? - Getting started. 

**There are many ‘*****fundamental*****’ reasons for SUCCESS:**
******	****Suggestions on getting ‘started’, with ‘success’.**
******	****	****Focus on ‘affordability’. Implement a ‘sustainable’ IT business solution.**
******	****	****Be wary of ‘consultants’, and don’t abrogate responsibility to others.**
******	****	****Focus on the ‘business process’, and not on ‘state-of-the-art’ technology.**
******	****	****Start simply, and don’t try to proceed too fast with multiple software modules.**
******	****	****Start with the HTC PAS, and achieve an all important ‘success’. Step one!**
******	****	****Ensure ‘success’ by applying for the CCC ‘sovereign’ guarantee.**
******	****	****Once the PAS is fully operational, the ‘Roadmap’ to an HIS is underway. **

***“******The JISS/PAS*** could be a model for other developing and developed countries”  (CDC 2003)

## E-Surveillance and the Integrated PAS  

**Advantages of an *****Integrated *****Surveillance/PAS System:**
**Disease Surveillance activities can be tied to:**
**** ****	****OUTCOMES**
**	****   ******  ****MEDICAL INTERVENTIONS**
*	**	**      ****  ***COMPARATIVE TREATMENTS**
*	**	**            ****  ***DIAGNOSIS DECISIONS**
**	****	****	****        ******  ****LENGTH OF STAY**
*	**	**	**            **** ** ***COSTS**
**	****The ability to cross-reference types of surveillance issues against what actually happened can provide all of the overseers with very important information.**

***“******The JISS/PAS*** could be a model for other developing and developed countries”  (CDC 2003)

## E-Surveillance and the Integrated PAS  

**Advantages of an *****Integrated *****Surveillance/PAS System:**
**“****Since the data were part of the PAS, additional information was available on**
**admitted patients, including the affected body part, surgical procedures performed, length of stay, and outcome of the admission. In addition, the location of the injury and demographic data for inpatients and outpatients could be linked to the JISS data and downloaded for further analysis in other statistical packages.” [p. 223]**
**“****Injury data have been linked to geographical information system (GIS) packages that map the location of injuries. This has been used in conjunction with police homicide data to identify ‘hot spots’ of violence for targeted interventions.” [p. 223]**

***“******The JISS/PAS*** could be a model for other developing and developed countries”  (CDC 2003)

## E-Surveillance and the Integrated PAS  

**Advantages of an *****Integrated *****Surveillance/PAS System:**
**“****The collection of data on violence-related injuries has been cost-effective because no additional hardware or software was required.” [p. 246]**
**“****Use of medical records staff ensured that personnel costs would not increase. Following the implementation of VRISS, the medical records staff reported increased job satisfaction. Evaluation of the system has shown that data collection adds less than two minutes to the registration process and that use of medical records staff to collect the data, minimized any increase in workload for the doctors and nurses associated with the implementation of the system. ” [p. 246]**
**“****The VRISS data have been linked to in-patient hospital data. This linkage has provided information about the burden of disease at KPH.” [p. 246]**

***“******The JISS/PAS*** could be a model for other developing and developed countries”  (CDC 2003)

## E-Surveillance and the Integrated PAS  

**Advantages of an *****Integrated *****Surveillance/PAS System:**
**The road from the PAS/Surveillance suite**
**	****	****to an integrated ****HIS**
**	****	****	****is a LONG road, and**
**	****	****	****	****an EXPENSIVE undertaking, so**
**	****	****	****	****	****	****Start carefully, NOW!**

***“******The JISS/PAS*** could be a model for other developing and developed countries”  (CDC 2003)

## Who is using the

**Who is using the**
**Heron PAS?**
**Canada**
**Jamaica**
**Montserrat**
**Dominica**

**Who is considering the **
**Heron PAS?**
**India, Pakistan, Ghana, Sri Lanka, Bangladesh, *****Colombia*****, Anguilla, Barbados, Ukraine, Antigua & Barbuda, St. Vincent & the Grenadines, St. Kitts/Nevis, and  other countries**

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