ISCRAM 2017 Workshops

Disaster Healthcare and Disaster e-Health - Workshop

Disaster Healthcare and Disaster e-Health - Workshop
Sunday, May 21, 2017

Workshop Chairs and Co-Chairs


Dave Parry
dave.parry@aut.ac.nz
Corresponding Co-Chair
Associate Professor and Head of the Department of Computer Science, Director AURA Lab
AUT University of Technology, Auckland, New Zealand

Richard Scott
ntc.ehealthconsulting@gmail.com
Co-Chair
CEO, NT Consulting – Global e-Health Inc., Calgary, Alberta, Canada
Professor, University of KwaZulu-Natal, Durban, South Africa
Adjunct Professor, University of Calgary, Calgary, Alberta, Canada

Facilitators / Contributors

Learning Outcomes

By the end of the workshop you will be able to:

  • Understand the spectrum of e-Health activities.
  • Appreciate the potential contributions of e-Health to the entire Disaster Management Cycle and to Disaster Medicine.
  • Contribute to providing recommendations for a DeH roadmap and priority DeH research areas.
  • Recognise the skills needed to successfully apply e-Health to disaster settings.
  • Engage in further opportunities to advance use e-Health in immediate, medium, and long-term response to disasters.

Brief Background

A number of international initiatives have been promulgated in recent years in regards to reacting to Disasters (from preparedness and response, through recovery and mitigation, to rehabilitation and prevention). These include:

Neither the Hyogo Framework nor the Sendai Framework acknowledge or promote the use, or contribution, of e-Health in their approaches (see Chart of the Sendai Framework for Disaster Risk Reduction 2015-2030 below). Members of DeCOI (Disaster e-Health Community of Interest) and others believe this is a significant oversight and missed opportunity.

Disaster management and disaster medicine are well-established disciplines for responding to natural disasters and providing healthcare for affected individuals, respectively. Disaster management (DMAN) is a methodical discipline to respond to and mitigate the effects of major disasters, whether they arise from natural events, human error, conflict, or epidemics. In such events there are invariably human casualties who need rapid treatment for trauma, and the specialised field of disaster medicine (DMED) has evolved for this purpose.

‘e-Health’ itself has been defined by the WHO as simply “… the use of Information and Communications Technologies (ICT) for health” [link]. e-Health spans a wide range of services and systems that remain at the periphery of mainstream health and healthcare. For example, e-Health is used in developed, developing, and least developed countries to: deliver primary healthcare services to rural and remote communities, provide clinical decision support, allow consumer and practitioner education and maintenance of skills, as well as more esoteric uses such as telesurgery and health related robotics, plus newer areas of application including m-Health, and leverage of big data and social media. It has even been identified as key to supporting universal health coverage (UHC) globally [link].

It has been said that “There is no aspect of health or healthcare that has not been, is not being, or will not be impacted by e-Health.” e-Health has certainly been used in disasters, but primarily through immediate military and humanitarian response, without consideration of other potential uses throughout the disaster management cycle (DMC). However, DMAN practitioners and DMED clinicians are seldom trained to be aware of the existence or potential of e-Health applications, let alone to acquire competency in their use, or participate in innovative exploration and research of new applications. Given the above, DeCOI wishes to contribute to growth of the new field of ‘Disaster e-Health’ by:

  • Promoting and supporting awareness, availability, and use of e-Health,
  • Identifying research and technology gaps in the understanding of e-Health’s potential roles,
  • Providing recommendations for research priority areas, and
  • Contributing to knowledge and application of e-Health solutions before, during, and after disasters.

Through the sharing of knowledge, experience, and innovative thoughts of participants, this workshop will contribute to these goals.

Agenda Sunday, May 21, 2017 — Room 0F05

Sunday 21 May 2017
08:00-09:00 Registration
09:00-09:15 Welcome, introductions, and previous experience scan
Dave Parry
09:15-09:30

Presentation 1
The Spectrum of ‘e-Health’ – It’s Relationship to Disaster e-Health Richard Scott

09:30-09:45
09:30-10:00

Presentation 2 The Role of e-Health in Disasters: A Road Map for Education, Training and Integration in Disaster Medicine Tony Norris, Dave Parry, Jose J. Gonzalez, Richard E. Scott, Julie Dugdale, Deepak Khazanchi

Presentation 3 Pinpointing What Is Wrong With Cross-Agency Collaboration in Disaster Healthcare Reem Abbas, Tony Norris, Dave Parry

10:00-10:30
10:30-11:00 Break
11:00-11:30

Presentation 4
Health Resilience in Rural India
Santiago Martinez, Martin Gerdes, Gareth Loudon, C. Santhosh Kumar, Jose J. Gonzalez, A. Anand Kumar, KV Beena, Sanjeev Vasudevan, K. I. Ramachandran

Presentation 5 Disaster e-Health Framework for Community Resilience Jose J. Gonzalez, Santiago Martinez, Ahmed Aboughonim, Tony Norris, Dave Parry

Presentation 6 “Never let a crisis go to waste” – e-Health after the Christchurch Earthquake Dave Parry

11:30-12:00
12:00-12:30
12:30-14:00 Lunch
14:00-14:15 Review and open discussion period
Professor David Parry
14:15-14:30

Practice Exercise 1
Facilitator: Professor Richard Scott
Plenary Discussion Lead: Professor Jose J. Gonzalez
Question A: Of what use could e-Health be in Disasters?

14:30-15:00
15:00-15:30
15:30-16:00 Break
16:00-16:30

Practice Exercise 2
Facilitator: Professor Tony Norris
Plenary Discussion Lead: Professor David Parry
Knowing some answers to ‘Question A’...
Question B: What might a Road-Map for DeH and DeH Research look like?

16:30-17:00
17:00-17:15
17:15-17:30 Wrap-up and Evaluation

Practice Exercises

Practice Exercise 1

Question A: Of what use could e-Health be in Disasters?

  • ‘World Café’ Breakout groups: 14:15 - 14:55

    Break into 4 Groups, identify one rapporteur for each group (rapporteur remains with that group throughout, but can contribute their own ideas on other domains during the open Plenary Discussion).

    Each group to consider ONE domain of e-Health

    • Telehealth
    • Health Informatics
    • e-Learning (TEET)
    • ‘Other’

    Take 10 min to collectively brainstorm how services / tools within the domain could be used for any phase of the disaster management cycle (DMC).

    Write down (legibly !!) the service or tool, and what phase(s) of the DMC it could be used in. If for a specific disaster type(s) only, then write after (Fire; Earthquake; Chemical; as appropriate).

    Move clockwise to the next group, and repeat for the new domain.

  • Plenary report: 15:00 – 15:20 – Rapporteurs will briefly outline the ideas that came to mind for each domain.
  • Plenary discussion: 15:20 - 15:30 – Open discussion to identify additional thoughts.

Practice Exercise 2

Knowing some answers to ‘Question A’...

Question B: What might a Road-Map for DeH and DeH Research look like?

  • ‘World Café’ Breakout groups: 16:00 - 16:40

    Break into 4 Groups, identify one rapporteur for each group (rapporteur remains with that group throughout, but can contribute their own ideas on other domains during the open Plenary Discussion).

    Each group to consider ONE domain of e-Health

    • Primary research topics (prioritise - ‘best bang for the buck’ or ‘urgent’ topics at top of list)
    • Potential research groups and organisations
    • e-Learning (Technology Enabled / Enhanced Training; TEET)
    • ‘Other’

    Take 10 min to collectively brainstorm around the topic.

    Write down (legibly !!) the ideas that come forward.

    Move clockwise to the next group, and repeat for the new topic.

  • Plenary report: 16:40 – 17:00 – Rapporteurs will briefly outline the ideas that came to mind for each topic.

  • Plenary discussion: 17:00 - 17:15 – Open discussion to identify additional thoughts; to prioritise research topics into a DeH Research Agenda; and to develop a chronological pathway for development of the field of Disaster e-Health to act as a Road-Map for moving forward.

Chart of the Sendai Framework for Disaster Risk Reduction

Abstracts

Presentation 1
The Spectrum of ‘e-Health’ – It’s Relationship to Disaster e-Health

Richard E Scott (NT Consulting – Global e-Health Inc., Canada; University of Calgary, Canada; University of KwaZulu-Natal, South Africa)

e-Health (“the use of Information and Communications Technologies (ICT) for health”, WHO 2005) has been in use for 60-70 years or more, even in response to disasters (typically through the military). In contrast, the field of Disaster e-Health – investigation of the application of e-Health to natural and anthropogenic disasters – is in its infancy.

Despite growing and global application of e-health there remains much confusion about what exactly 'it' is, and of what 'it' is comprised. Web ‘research’ simply adds to this confusion. To introduce a new field – Disaster e-Health – it is essential that potential proponents (Workshop participants) first thoroughly understand the breadth of e-Health. This understanding can then be aligned with both the needs of stakeholders (from the victims and first responders, through national and international humanitarian organisations, to local, regional, and national governments), and with the different phases of the Disaster Management Cycle, to find appropriate solutions. This understanding will, in turn, inform and increase the depth of understanding of Disaster e-Health.

Based on recent work with Médecins Sans Frontières (March 2017), this presentation will provide a brief but structured review of e-health and introduce a tool by which participants can identify e-Health solutions for Disaster associated problems.

Presentation 2
The Role of e-Health in Disasters: A Road Map for Education, Training and Integration in Disaster Medicine

Tony Norris (SCMS, AUT University, New Zealand)
Dave Parry (SCMS, AUT University, New Zealand)
Jose J. Gonzalez (CIEM, University of Agder, Norway)
Richard E Scott (CHS/FM, University of Calgary, NT Consulting – Global e-Health Inc., and University of Calgary, Canada, and University of KwaZulu-Natal, South Africa)
Julie Dugdale (University of Alpes, France, and University of Agder, Norway)
Deepak Khazanchi (CIST, University of Nebraska, Omaha)

This paper describes the origins and progress of an international project to advance disaster e-health (DeH) - the application of e-health technologies to enhance the delivery of healthcare in disasters. The study to date has focused on two major themes; the role of DeH in healthcare and facilitating inter-agency communication in disaster situations, and the fundamental need to promote awareness of DeH in the education of disaster managers and health professionals. The paper deals mainly with continuing research on the second of these themes, surveying the current provision of disaster medicine education, the design considerations for a DeH programme for health professionals, the key curriculum topics, and the optimal delivery mode.

Presentation 3
Pinpointing What Is Wrong With Cross-Agency Collaboration in Disaster Healthcare

Reem Abbas (SCMS, AUT University, New Zealand)
Tony Norris (SCMS, AUT University, New Zealand)
Dave Parry (SCMS, AUT University, New Zealand)

A disaster is an event in which a hazard has a destructive environmental or ecological impact on such a scale that the effects cannot be managed within local community resources. In such circumstances, the main responders to provide emergency relief are usually emergency management and health personnel. Although these two sectors share the same vision of providing public health services to disaster victims, post-disaster analyses reflect poor communication between these sectors leading to delayed, substandard, and even unavailable healthcare. This paper investigates the barriers to smooth and effective communication between health and emergency management personnel in a disaster with the aim of pinpointing possible points of intervention. The paper presents a critical review of the available literature on the subject and suggests suitable interventions to enhance healthcare delivery through cross-agency collaboration and information exchange.

Presentation 4
Health Resilience in Rural India

Santiago Martinez (University of Agder, Norway)
Martin Gerdes (University of Agder, Norway)
Gareth Loudon (Cardiff Metropolitan University, UK)
C. Santhosh Kumar (Amrita University, India)
Jose J. Gonzalez (University of Agder, Norway)
A. Anand Kumar (Amrita Institute of Medical Sciences, Kochi, India)
K. V. Beena (Amrita Institute of Medical Sciences, Kochi, India)
Sanjeev Vasudevan (Amrita Kripa Charitable Hospital, Wayanad, India)
K. I. Ramachandran (Amrita University, Coimbatore Campus, India)

To improve health resources in rural areas, the World Health Organisation proposes building “greater resilience and self-reliance in communities”. The Ministry of Health and Family Welfare from the Government of India established the National Rural Health Mission “to provide every village in the country with an Accredited Social Health Activist (ASHA)”, totalling 870 000 by July 2013. However, ASHAs lack specific training in e-Health technologies which are crucial for clinical effectiveness and patient outcome. Our ReHsIndia research project will train low technology-literacy health workforce to use health care technology and basic sensing instrumentation in remote and deprived areas in India, and remotely collected data for real-time diagnosis and decision-making, as well as establish a protocol for remotely and professionally assessed clinical intervention integrated in the National Health System. The project outcomes include documentation and comprehension of the current situation and challenges faced in rural villages in India with regards to health and social care, including cultural, infrastructure and literacy factors; establishment of a multidisciplinary research network of international experts in medicine, technology and engineering in the field of health and social care in India.

Presentation 5
Disaster e-Health Framework for Community Resilience

Jose J. Gonzalez (University of Agder)
Santiago Martinez (University of Agder)
Ahmed Aboughonim (University of Agder)
Tony Norris (AUT University, New Zealand)
Dave Parry (AUT University, New Zealand)

Community resilience, the ability of a community to withstand and recover from disasters, has become a key policy issue due to the increasing incidence of man-made and natural tragedies such as terrorism and infrastructure failure, epidemics, floods and earthquakes. To achieve community resilience the life, health and basic values of citizens before, during and following a disaster must be safeguarded. To this effect, the health information technologies that are transforming healthcare must be harnessed. These e-health technologies empower individuals and make communities more self-reliant. They enhance the quality, speed, and safety of care, and their cost-effectiveness improves equity of access, especially for those who are most vulnerable. Further, it is crucial to engage stakeholders: The community at risk, the health providers and emergency services, academia, and government, ensuring that the exchange of different perspectives facilitates collaborative enquiry and social learning. We propose a research framework, EnCORE. The framework's core component is a tool kit that collects socio-economic and demographic data on the community and identifies vulnerable groups. These data identify key themes of community resilience, which suggest recommendations for improvement and generate a numerical resilience score that can be used to measure and monitor progress.

Presentation 6
“Never let a crisis go to waste” – e-Health after the Christchurch Earthquake

Dave Parry (AUT University, New Zealand)

The Christchurch Earthquakes of 2010/1 resulted in the loss of 185 lives, very large-scale infrastructure damage including health infrastructure and population movement. However, these events also stimulated a great deal of activity in the area of eHealth development and new ways of working. Although the city is still being rebuilt, positive effects of these changes are being seen in increased collaboration and innovation in this sector, so much so that this region now has the most advanced eHealth system in New Zealand. This presentation will describe some of these initiatives and their effects as well as reasons why disasters can produce paradoxical benefits for eHealth.