Learning From Haiti: Health IT and Disasters

Posted by AnneryanHeatwole on May 04, 2010

In the days following the devastating earthquake in Haiti in early January 2010, aid workers arrived on the island to offer medical and technical support. With the capital, Port-au-Prince, suffering the brunt of the destruction, transporting supplies and people over destroyed roads proved difficult. Communications technologies, in an immediate post-disaster environment, are critical for aid workers to coordinate relief supplies and to deliver post-disaster care.

As a follow-up look at how post-disaster relief efforts have gone in Haiti, GHDonline hosted an online discussion, “Health IT for Disaster Relief and Rebuilding: Lessons from Post-Earthquake Haiti” from April 19 to April 30. The dialogue, consisting of posts on a discussion board, focused on how experts in global health care delivery used ICTs immediately after the earthquake, and what lessons translate to other disasters. GHDonline.org is a web-based collaboration platform that is an offshoot of the Global Health Delivery Project. The posts (a collection of personal experiences, technology descriptions, and projections for the future) brought together experts a wide range of responses. 

Many of the responders had been on the ground in Haiti either prior to or immediately after the earthquake, and as such had first-hand knowledge of what worked and what didn’t during the disaster.  One of the key areas is the need for patient tracking and sensible data collection and sharing.

John Brooks of Médicins Sans Frontières/Doctors Without Borders described some of the problems his organization faced as early responders, saying that gathering patient post-op data and patient history was difficult due to the frequent transfers of patients and the lack of a centralized electronic database. As part of his post he described the situation doctors faced after the earthquake:

There are no intersectional standards for post-op data 
collection, nor is there any EMR system in place for multi-site access to 
patient treatment history. When a patient is transferred within MSF or to 
an external center, the resume of hospitalization or care is written by 
hand on paper.

Clay Heaton responded by recounting his experiences and the tools he built to accommodate the situation:

I built a Ruby on Rails EMR for the HHI field hospital in Fond Parisien in under a week while sitting on site in the pharmacy there. 

It runs on a donated computer and has both web and iPhone interfaces. It is used to track pharmacy data, warehouse supplies, patient medical records, medication history, separated children, patient families, volunteers and their skills and travel schedules, and other information relevant to the aforementioned items. 

Staff on site can wander the tent rows with iPhones and access up-to-date patient histories at each tent. They've also used the iPhones to manage warehouse distributions of goods (wash buckets, soap, etc.). The iPhone interface is built on jQTouch and launches from the iPhone interface just like a normal app, mimicking native app interfaces. 

We're currently at > 4500 records of patient medical events (surgery, physical therapy, medication, transfers, discharge readiness, physical therapy, prosthetics, etc...) for over 600 patients, nearly 5000 records of drugs removed from the pharmacy for over 500 different medications, over 400 different types of warehouse supplies, and tracking of nearly 650 volunteer staff.

While this post highlights the ways quickly developed technology can have a positive impact in post-disaster areas, many of the conversations looked to the future to see how technology could make gathering and sharing data easier in the future. Hamish Fraser drew on his personal experiences to look to what might make systems run more smoothly in the future. He wrote:

When I was in Haiti last week I spent a lot of time talking to people about what they need and how we could better use information. One consistent message was that the surgeons needed to be able to document the diagnosis and procedure performed so that they or more often someone else could provide follow-up care. This also applies to physical therapists providing rehabilitation care who need to know what happened and what was done. So I think that there should be someone who can coordinate and document care as part of the early teams. That would bring immediate benefits in terms of tracking supply requirements and patient load, and then longer term benefits for individual patient care. Use of standard paper forms matched to an electronic system (with both web and cell phone form options) would allow redundancy. At first maybe you just have a ring binder with case forms and then that starts to get entered into the EMR as staff and connectivity allow. These paper forms could be photographed or scanned for back-up copies and maybe uploaded of shipped out to a more stable location on CD for offsite data entry. I think we are looking for consistency of data and redundancy of technologies and data management strategies.

Further discussion brought up questions about the consequences of trying to incorporate technology that is neither suited to the area or applicable to the situation. Some of the discussants looked at finding ways to reduce doctor/aid workers’ workloads, while others focused on finding workable systems. An honest look at problems in pre-earthquake and post-earthquake technology came from Kurt Jean-Charles:

As an Haitian IT practitioner my concern related to (Health) IT initiatives, before the earthquake, was about data usage at every level of decision making and sustainability (both in a cultural and technological point-of-view) of our efforts in an environment with limited access to technology and weak public capacity (leadership). (that's a serious challenge but some of us still think we can win this battle although we do not always agree on the best path to take). 

After the earthquake, there is more than ever an opportunity (and risks to go wrong) to show value in IT and to strengthen local capacities by providing efficient tools that can make sense in our environment and for me it means some challenge in transferring ownership (tools and processes) to locals.

Jean-Charles’s frank discussion of opportunities and limitations prompted others to lay out designs for future uses of ICTs in post-disaster areas. One theme that came up repeatedly was the importance of a system that could be used by many different types of phones, and that didn’t require lots of special technology. Since natural disasters can take out electricity or cell towers, acknowledging limitations was a key theme. Myles Clough responded to Heaton’s words with a look toward the future:

To expand Clay's system to one usable by everyone who responds to a disaster requires all the responders to have an iPhone (and presumably an App or two). This won't happen. I think it is reasonable to expect that virtually all responders will have a mobile phone of some sort but nothing pre-coordinated and no expensive purchases. Looking down the road on this we are hoping to develop a global trauma data collection system which is usable in all the LMICs. The disaster database is (in our view) an urgent special case; if the community can develop a system which is robust enough to work in that situation we think that an expanded version with an fuller dataset could work all over the world. So we, at any rate, would like to see a system that the average overworked emergency doctor or orthopaedic resident in sub-Saharan Africa could and would use.

Om Goeckermann approached the conversation with some optimism, writing:

It is common lately for me to hear that its 'too difficult' for the relief community to come up with interoperable reporting mechanisms. 
Now is the perfect time as technology advances quickly into this space, development will leapfrog current mechanisms and a common frame of reference can only enable more meaningful data uses.
Even an attempt to codify will give others something to aim at, or start from.

These kind of discussions are important – taking lessons from disasters and using them to create better systems will result in saving time, money, and lives during the next event. The direct aftermath of a disaster isn’t the best time to try to develop new ICT or mobile programs; sharing knowledge about what happened in the past can lead to more creative and effective tools that make crisis response and management better in the future. 

Anne-Ryan Heatwole is a writer for MobileActive.org.  Follow her on twitter at @arheatwole.

Photo courtesy AIDG

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