Web App Innovations

The following post is a response to the article below:


Web App Helps Visualize Farm Bill Spending

The Center for a Livable Future at the Johns Hopkins Bloomberg School of Public Health has launched the Farm Bill Budget Visualizer, an innovative web-based application that allows visual analysis of Farm Bill spending since the 2008 Farm Bill. As debate surrounding the 2012 Farm Bill becomes more urgent, the Budget Visualizer facilitates understanding of how the provisions and budgets within the farm bill tie into the nation’s public health, environmental sustainability, and other priority concerns.

Every four or five years, the federal Farm Bill specifies policies that have profound positive and negative impacts on public health from numerous angles—through food assistance and nutrition education, efforts to improve access to fruits and vegetables, commodity programs that indirectly impact environmental quality, and conservation programs that impact soil and water quality, for example.

The Budget Visualizer uses “treemap” technology, a method of displaying spending data as nested rectangles, which allows users to “see” the proportion of federal funding received by Farm Bill programs. The application, developed in partnership with the Hive Group, is intended as an educational aid for the general public, advocacy groups, and policymakers who wish to better understand the relationships among public health and other priorities, and federal spending in the Farm Bill.

With the application, users may filter by and view specific expenditure categories such as public health, fruit and vegetable access, sustainable agriculture, commodity grain production, or industrial food animal production. Users may also view data regarding actual and estimated spending in the years 2009, 2010, 2011 and 2012. The Visualizer and accompanying materials are available at http://www.jhsph.edu/clf/programs/visualizer/.

Using data uncovered by researchers at the Center for a Livable Future, the Visualizer ties together budgetary information otherwise only available from scattered sources, enabling new analyses. Roni Neff, PhD, CLF’s research and policy director, says, “Transparency is a key theme and objective of our work; we’ve not only provided our audiences with access to details of the Farm Bill budget, but also provided a new way to understand this complex piece of legislation.”

The Visualizer was inspired by food system advocate, Marjorie Roswell, who created a prototype in the lead-up to the 2008 farm bill.

The article is interesting because of the potential opportunities it opens for future innovations in the field.  Imagine a webapp that tracts the number of homeless individuals within a region to allow greater access to services!  If that appears controversial (since it requires a mechanism of tagging), imagine a web app that provides utilization of shelters every day.  This is then accessible by homeless individuals via their social workers or physicians who can tell them their best bet for a nights rest away from the streets.  

I believe that the future of IT integration is bright with small yet innovative web apps that make a huge difference in a domestic and international setting.

Keys to Success - Coordination

During the past few months I have had the privilege to work with Tara Vecchione, Anna Diller, and Matthew Scally on the budget formulation process for the Global Health Bureau at USAID.  The process is if anything complicated and relies on a strong coordination of stakeholders coming together for the common good.

The same principles apply to the field of IT, especially in the homeless health context.  Here is an excerpt of the most recent email I received from the US Department of Housing and Urban Development:

Updated Guidance on the Homelessness Pulse Project

The U.S. Department of Housing and Urban Development’s Pulse Project collects quarterly data on homelessness from Continuums of Care nationwide.  The attached guidance:

·         Reviews the objectives of the Pulse project,

·         Describes recent revisions to the Pulse reporting requirements,

·         Provides definitions of key concepts, and

·         Answers frequently asked questions.

The guidance is designed to help HMIS administrators and vendors program accurate Pulse reports in their systems.  HUD is currently developing programming specifications for the Pulse project, which will be released in early 2012. 

If you have any questions about the Pulse project or want to learn more about participating in the project, please send an email toAHAR@abtassoc.com.

Here's what I found so impressive about the email from a coordination standpoint (and we're not even talking about the actual guidance document)

1)  Each guidance document takes the time to review the objectives.  How many times have we been at board meetings or management meetings when someone asks "why are we doing this again?"  Presenting guidance in this format brings everyone back to the same page to have a productive meeting

2)  Recent revisions and key concepts are highlighted.  This allows everyone to follow on all the changes made to the project.  A small step toward establishing corporate memory independent of people.

3)  The contact information for any further questions was provided.  Having points of contact for different elements in the project are absolutely crucial in order to pass information in the right order and to have action administered by the right people.

All in all, the coordination of the project is greatly helped by a common understanding of objectives and rebuilding buy-in with stakeholders at each point of contact.

Reflections on Homeless Health - Class Presentations

Today, I had the privilege to listen to the presentations of my peers.  It was very informative to observe the acquire/store/analyse/distribute/measure being used in a variety of fields and topics.  This blog post summarizes my key takeaways on how to modify the Homeless Management Information System based on the thoughts of my colleagues.

Appreciation for the importance of m-health in a domestic setting.
After a few presentations on m-health, is clear that the importance of this realm is critical to global health.  Another observation I had was its under-utilization in the domestic realm as well.  Do we not share the same issues in patient adherence in Canada and the United States?  Do we not have greater access to the technology in question? (SMS texing, google voice, etc)


Applying this to HMIS
Imagine a Homeless Management Information System in a completely different construct.
1) A Homeless patient meets with social worker weekly or monthly.
2) During this encounter, the social worker asks the patient about their current medical update.  This does not have to be anything more than compliance to medications.
3) The social worker enters the patient compliance information into the system
4) The primary care physician receives a text during the next interview with the patient to address the issue with compliance.

Utilizing sms technology in this context, providers, social workers, with real-time reminders on what to ask their patients during their encounter.  This appears to be far underutilized and I am curious on how a model could be built around this idea.

Quality Measurement: The ANALYZE in HMIS.

ANALYZE

 The Housing Inventory Count (HIC)

The Housing Inventory Count collects information about all of the beds and units in each Continuum of Care homeless system, categorized by five Program Types.

1. Emergency Shelter: Total number of emergency shelter beds and units that are designated to serve people who are homeless and are recognized as part of the formal homeless system.
2. Transitional Housing: Total number of transitional housing beds and units designated to serve people who are homeless and are recognized as part of the formal homeless system.
3. HPRP Homeless Assistance (new for 2010): Total number of HPRP Homeless Assistance beds and units occupied on the night the annual inventory.
4. Safe Haven: Total number of Safe Haven beds and units that satisfy HUD’s standards, as identified in the 2009 NOFA.
5. Permanent Supportive Housing: Total number of permanent supportive housing beds and units.

The Housing Inventory Count also includes information about unmet need.

Point-in-Time Homeless Persons Count (PIT)

The Point-in-Time Count provides a count of sheltered and unsheltered homeless persons from either the last biennial count or a more recent annual count. Counts are based on:

1. Number of persons in households without children;
2. Number of persons in households with at least one adult and one child; and
3. Number of persons in households with only children. This includes only persons age 17 or under, including unaccompanied children, adolescent parents and their children, adolescent siblings, or other household configurations composed only of children.

Counts are further broken down into subpopulation categories including counts of persons who are chronically homeless, persons with severe mental illness, chronic substance abusers, veterans, persons with HIV/AIDS, victims of domestic violence and unaccompanied children.

Source:  The US Department of Housing and Urban Development.

Understanding the Homeless Management Information System

In order to gain a deeper appreciation for the Homeless Management Information System (HMIS) in Baltimore, I've managed to join their listserve in the past week.  This has given me access to a lot of information regarding their membership, and their strategy from an acquire store, analyze, distribute, measure perspective.

From a demographic standpoint, some of the information is downright shocking.  For example, of the 6000+ homeless individuals last counted, more than 1038 are in fact children.

Here are a few points which I believe have been integral to the HMIS functioning across 30+ separate agencies.

1)  Standardization:  The Baltimore County Universal Intake Form provides one set of questions that all agencies utilize to input new clients into the system.  This is then shared across a central database and is accessible to all other agencies in the network

2)  Information sharing protocol:  There are currently no barriers to sharing information.  Agencies are not protective over their information and recognize that the more that is shared with clients, the better the impact of the HMIS

3)  Participatory communication:  External tools such as the HMIS website and the listerve serve as portals for stakeholders such as agencies and potentially interested parties (such as myself) to appreciate the strength of the HMIS.  This in turn allows for the expansion to neighboring agencies but also serves to keep existing stakeholders involved in continually evolving HMIS.

Breaking News! More developments on e-kasih!

The e-kasih topic appears to be far more dynamic than I assumed.  It appears that the Village Development and Security Committee as well as the Women and Family Development Ministry have begun to realize its potential value for integrating IT with the needs of the population.

I believe that the Ministry's support for e-kasih is absolutely essential for this project to move forward.  as the article below comments, there have already been 50,000 applicants registered.  Imagine the abilities of NGOs and international aid relief organizations if e-kasih was adopted on a global scale!

October 10, 2011 17:29 PM

Grassroot Leaders To Be Appointed To Help Register Poor Under E- Kasih

KUCHING, Oct 10 (Bernama) -- Grassroot leaders of the Village Development and Security Committee (JKKK) will be appointed as "rakan kerja" to assist the state Welfare Department to register poor families under the E-Kasih system, Sarawak Welfare, Women and Family Development Minister Datuk Fatimah Abdullah said Monday.

She said the department, which had limited resources, needed to go all out to the grassroot level to recruit the longhouse and village headmen and leaders of political parties for the task in collaboration with relevant agencies, including the offices of the state secretary, resident and district offices.

"Why not consolidate all our forces as it is high time for us to work together and appoint these grassroot leaders as rakan kerja," she told reporters after receiving donations of 43 water tanks, worth RM30,000, from Weida Resources Sdn Bhd for her Dalat state constituency, here.

Citing the case of only 400 poor Penan families that had so far registered under E-Kasih despite the community having a population of 10,000 state-wide, she said the current data base was a not a reflection of the real situation on the ground.

She said complaints had been received that those eligible to obtain aid under the poverty eradication programme were not being registered as their data base was not captured while some in the list should not be eligible.

So far 50,000 applicants were listed under E-Kasih in Sarawak under an open registration, she said.

-- BERNAMA

Reponse to ONC/HITECH EHR's Strategy Needs

Question: What areas should the ONC focus on for the development of a nationwide infrastructure to support the growth of HIT? Research the ONC and its various programs.  Provide a strategic plan for carrying out the mission of the program of your choice that is aligned with the bigger ONC mission.  Your plan should address how your program will affect the other programs.  How does your plan affect the caregiver community?  Your strategic plan should also include barriers and how you plan to address the barriers to achieve success.  

1. Encourage on-boarding for diverse small practices who may lack capital (even with the stimulus) to fully implement and transition to an EHR. Leverage their role coordinating high uptake of EHRs to negotiate reduced rates on behalf of private practice physicians, partnerships, and small group practices. Benefits for using a common IT system could come in the form of price subsidies, tax rebates, or ongoing, centrally-funded help desks and support services. This will enable greater diffusion of a standard format of service platforms, and increase uptake by minimizing the cost barrier.  

2. Vendor access could be maximized by coordinating nation-wide CME (continuing medical education) classes featuring demonstrations by multiple IT groups. To incentivize participation the government could assist in educational efforts, increase access and participation, and foster greater understanding of how to demonstrate meaningful use.

3. The federal government can offer a contract for technology companies to bid on. The contract will be for creating a standard EMR system that will be subsidized (possibly paid in full) by the government for those physician practices and hospitals who voluntarily wish to participate, thereby paving the way for a universal EMR system. Recognizing, however, that many hospitals may not wish to join based on the potential to lose clients to larger or higher rated hospitals, HITECH should target large regional hospitals which have the most to gain from a standardized process. Once these hospitals implement a standard system, the added value of their services through EMRs would entice other hospitals to join the roster as well.  

Response drafted by Matthew Scally, Tara Vecchione, Anna Diller, Abhishek Raut.

Submitted to Lawrence Aronhime, discussed with ONC's Alan Traylor Strategic Planning, Carey Business School.

e-kasih

Today's unique IT integration that tackles poverty and health comes from the Government of Malaysia with its unique e-kasih system.  e-kasih is the country's national database of families that have been identified as poverty stricken.  The database has been used by charities to specifically target neighborhoods and groups that require assistance more than other regions.

From an IT integration standpoint, the e-kasih system is a very interesting project for a multitude of reasons

1)  Accessibility:  Its database is accessible by most NGOs and charities making it easy for anyone to provide additional information as needed.  This is interesting because the system has clearly recognized that its value comes from its ability to confer information to external groups rather than just keep it as a Government system only.

2)  Reliability:  As a Government database, it relies on census information which is often conduct after a period of years.  While neighborhood data might still have strong validity, I wonder about the household data themselves.  Given the general economic times of the world, if the last census was undertaken in 2008, one may have missed the effect of the entire recession. There have already been issues and accusations on the reliability of the data and the ability to manipulate this information for a political agenda.

Final comments:  I believe programs such as e-kasih are integral to understanding the larger issues surrounding poverty, development, and healthcare infrastructure.  They key take-away from the e-kasih system is its recognition that its value is only as strong as its ability to provide information to a host of users ranging from local grassroots operations to international relief services.


http://www.futuregov.in/tv/e-government/using-technology-alleviate-poverty/

The new information and communications technologies are among the driving forces of
globalisation. They are bringing people together, and bringing decision makers
unprecedented new tools for development. At the same time, however, the gap between
information ‘haves’ and ‘have-nots’ is widening, and there is a real danger that the world’s
poor  will  be excluded  from  the emerging knowledge-based global  economy.


Kofi Annan, Former Secretary-General of the United Nations