Presented by Awadh Althwab School of Engineering and Advanced Technology, Massey University

1. The Scope and Development of Disaster E-health
Awadh Althwab and Tony Norris
School of Engineering and Advanced Technology
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2. Recent Disasters
• The 2004 Indian Ocean tsunami when 288,000 people died in a dozen countries
• The 2005 Hurricane Katrina, in the USA responsible for over 1,800 causalities
• The devastating 2010 Haiti earthquake that slew more than 300,000 people
• The 2014 super typhoon in Philippines that resulted in more than 5000 deaths
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3. The Problem
How do we deliver healthcare following a natural disaster?
• Trauma
• Serious injuries
• Confusion
• Triage
• Disrupted services
• Loss of health records
• Loss of access to medication
• Long-term medical conditions
Two approaches
• Disaster management
• Disaster medicine
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4. Disaster Management
“Disaster management refers to the protocols, procedures, and decisions needed to protect
populations and organizations from the consequences of natural or man-made disasters”
Four phases
• Mitigation, preparedness, response, and recovery
Disaster decision making
• High stress levels
• Limited time to make decisions
• Situation is continuously evolving
• Situation awareness and communication
• Incomplete or excess data
• Lives and infrastructure are at stake
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5. Disaster Medicine
“Disaster medicine is the area of clinical specialisation that deals with the provision of healthcare to
disaster survivors and responders and the planning of medically related disaster preparation, planning,
response, and delivery”
• Protocols for dealing with clinical events in disasters
• Competencies for clinical personnel in emergencies
• Training of clinicians, nurses, paramedics etc for delivery of care in disasters
• Development of disaster healthcare plans
• Deals mostly with immediate and short-term consequences of disasters
• Strong clinical focus
• Very limited use of e-health technologies
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6. E-Health
“E-health is the application of information management, systems, and technology to the planning and
delivery of, and wide access to, high-quality and cost-effective healthcare”
Existing applications
Emerging applications
Electronic health record (EHR)
Big data (BG)
Telehealth (TH)
Cloud computing (CC)
Mobile health (MH)
Internet of Things (IoT)
Decision support (DS)
Social networking (SN)
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7. Disaster E-Health (DEH)
Disaster Medicine
Disaster Management
Disaster E-Health
E-Health
But what does Disaster E-Health look like? What is its scope?
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8. Scoping DEH: Research Questions
•
How can DEH be integrated with mainstream approaches to disaster management?
•
How can DEH be integrated with mainstream approaches to disaster medicine?
•
What are the limitations of DEH?
•
How should e-health applications be embedded in disaster preparation plans?
•
How do we improve the e-health awareness and skills of emergency managers and clinicians?
•
What e-health competencies should disaster management personnel have?
•
How do we train disaster medicine clinicians to select e-health techniques when appropriate?
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9. Scoping DEH: Answering the Questions
Build a
Build a
knowledge
knowledge
base of core
base of core
concepts and
concepts and
current
current
practices
practices
Identify key
Identify key
concepts
concepts
including
including
prevalent
prevalent
e-health
e-health
technologies
technologies
Construct
Construct
scenarios of
scenarios of
e-health
e-health
technology use
technology use
in the disaster
in the disaster
life cycle
life cycle
Generate
Generate
rigorous criteria
rigorous criteria
for evaluating
for evaluating
scenarios
scenarios
Goal
Identify how best to use e-health technologies in the different phases of a disaster to minimise the
healthcare impact on survivors as well as reveal interactions between the different actors
Approach
At each stage carry out a Delphi aggregating consensus using a consultative panel of experts
Scenarios
Scenarios reveal the most effective applications, the needs of the actors, their interactions, and the
range and sequencing of events that improve care delivery
Criteria
Increased responsiveness, quality of care, automated data collection and entry, integrated workflow,
resilience, flexibility, cost, ease of use
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10. Scoping DEH: Example Scenarios
Mitigation
Back-up systems are critical aspects of risk identification and reduction mitigation. If primary care or hospital
systems become inoperative during a disaster then an emergency EHR system, and the protocols for its
operation, will facilitate access to essential patient medication.
Preparedness
Teleconferencing can play a vital role in preparing emergency responders and citizens via disaster
simulations, distance presentations, and courses that educate and maintain awareness and keep everyone
up to date with protocols and technology.
Response
The cloud will offer a repository for many data sources central to effective disaster responses. Even basic
demographic data are critical to healthcare delivery. When local infrastructure is damaged, the ability to
access a cloud access point provides a valuable measure of resilience.
Recovery
When there are no clinical needs for patients to stay in hospital they can go home and wear sensors or have
their residence converted into a smart home using RFID devices to track movements or locate objects.
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11. Scoping DEH: Pre-event Phases
Cycle Phase
Applications
Mitigation
•
•
•
•
•
•
•
•
Health risk identification, sharing of plans via teleconferencing (TH)
Disaster medicine education of clinicians, e.g. computer-based competencies (TH)
Development of public health messages using mobile technologies (MH)
International sharing of epidemiological data (EHR & CC)
Availability of EHRs in the cloud (EHR & CC)
International exchange of disaster healthcare response experience (CC)
On-line availability of big data analysis to help reduce the spread of diseases (BG)
National (and global) scheme for wearable computers that transmit health data (IoT)
Preparedness
•
•
•
•
•
•
•
Development of plans for evacuation, and in situ or hospital treatment (DS)
Cross-country plans for accessing electronic health records (EHR)
Provision of computer-based care protocols and pathways (DS)
Mobile healthcare apps for victims, volunteers, and professional responders (MH)
Context-aware simulation exercises and training programmes (TH, MH & SN)
Use of big data to characterize injury patterns seen as result of disasters (BG)
Use of big data to specify cultural, ethnic, religious and linguistic issues (BG)
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12. Scoping DEH: Post-event Phases
Cycle Phase
Applications
• Remote triage of injured patients before arrival at hospital, e.g. tablet PC (TH)
• Mobile networks to support healthcare responses - e.g. blood donations (MH)
• Automated health advice based on context (MH)
Response
• Telemonitoring of patients via wearable sensors (IoT)
• Deployment of medical teams to crisis areas identified by sensors (IoT)
• Better decision making with real-time visual data - e.g. Google Glass (IoT)
• Cloud computing to facilitate access to medical information from anywhere (CC)
• Victim identification via Google person finder (SN)
• Crowd sourcing of situations for rapid response (SN)
• Mobile communication between clinicians and recovery managers (MH)
• Teleconferencing support for patients with mental stress (TH)
• Mobile contacts for health situation awareness - e.g. food and water supplies (MH)
Recovery
• Help injured patients to recover from home - e.g. wearable sensors (IoT)
• Web sites to support crisis patients and their carers (SN)
• (G)mail groups for mobilising healthcare support when and where needed (SN)
• Organised crowd sourcing to deploy scarce health resources (SN)
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13. Developing DEH: From Feasibility to Practice
Moving to Good Practice
•Develop e-health technology competencies for different roles of responders and survivors
•Develop standard protocols for employing e-health
•Determine how competencies and protocols fit into disaster management/medicine practice
•Determine how technologies, competencies, protocols fit into disaster planning
•Recognise and understand awareness and training needs
•Develop change management processes
Goal
Embed e-health technologies into disaster management and medicine to provide disaster
responders and survivors with the skills and tools to deliver effective and appropriate healthcare
Definition of Disaster E-health
The application of information and communication technologies (ICTs) in a disaster situation to restore
and sustain the health of individuals and communities at pre-disaster levels
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14. Scope and Development of Disaster E-health
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