Health Informatics and Surveillance Response Paper

Health Informatics and Surveillance Response Paper

Health Informatics and Surveillance Response Paper

1 day ago

Maia Junco

RE: Discussion – Week 8

Health Informatics and Surveillance

Dr. Srikanta Banerjee

Maia Junco


Consider the benefits of tele-health for data gathering as well as its impact on public health disease surveillance.

Telehealth is a great communication tool that has transformed the way we check on people’s health (Lombardo and Buckeridge, 2007). Tele-health started developing at the beginning of the 21st century at the same speed as communication technology has progressed. Anytime we record and transmit health information such as blood pressure, oxygen, weight, or symptoms through a device such as a telephone or a wearable, we are making it easier for health authorities to assess health issues in the fastest way possible (Lombardo). These advances in information communication have transformed how medical attention and treatment are given and treatment, it has also dramatically improved data accessibility and efficiency for surveillance and research purposes. produced a great amount of data for surveillance and research purpose. The nurse-hotline, phone triage, personal emergency devices, mobile health apps, and wearable devices are examples of means of telehealth ( Panesar, 2019; Lombardo and Buckeridge, 2007)

Until 2020, Telehealth has been slowly implemented to medical and health care settings. According to Panesar (2019) In 2016, only 15% of businesses reported using telehealth. In the last decade, several companies have been innovating in this field by creating new devices, which has resulted in the excessive production of data for health care providers. If we learn to use this data in a more efficient way it could improve care. Patients produce data through imaging, mobile health apps, and telehealth remote services (Panesar, 2019). This type of communication is especially important today with the ongoing pandemic because it provides us with the data needed to conduct effective surveillance and research.

Select two strategies and/or technological tools that could be used to improve telehealth systems.

My first strategy to improve telehealth is to simplify important health devices and increase access to these devices by providing subsidies for them, specifically for low income and minority populations. My second strategy is to improve data security. A tool that can be used to enhance data security in telehealth is blockchain technology. .

Justify your selections and explain how they would improve telehealth systems. Briefly describe any potential difficulty in adopting the strategy or tool.

The simplification and accessibility of devices and apps are possible strategies that can improve data monitoring and accumulation for surveillance. If more individuals have access and use an application that monitors measurements such as blood pressure, the number of miles walked, or heart activity; then surveillance will become more efficient and direct by monitoring the data transmitted by a device. Unfortunately, most individuals that have access to these devices and applications are wealthy and technology savvy people.

Data is generated by several transactions that people execute through smartphones, mobile apps, smartwatches, and computers. In an ideal world the individual should have complete control of the data, however, contrary to claims that companies often make, personal data is commonly breached and taken advantage of, this happens in all industries. Blockchain technology is a combination of different pre-existing technologies that creates an immutable, public archive that is verifiable by anyone, which helps create trust, accountability, and transparency (Panesar, 2019). Popularized by the cryptocurrency bitcoin, blockchain technology is a decentralized system that has the potential to revolutionize data input, access, privacy, and trust. However, it is yet to be implemented in mainstream healthcare (Bhattacharya et al., 2020; Panesar, 2019).

Limitations of the two strategies

In order to make accessible, simple, and effective communication devices, big manufacturers such as Samsung and Apple would have to collaborate with governmental and nonprofit health organizations. Simple and cheap ideas such as free text services for pregnant women and new moms that distribute information in different languages about prenatal care and beyond (CNN, 2017) could be created to reach out to low-income minorities and help improve their health.

Blockchain technologies have fewer limitations than advantages. However, if this technology, is used without regulation or adequate security and privacy measures it can potentially be dangerous. It has also caused concerns about cost and interoperability (Bhattacharya et al., 2020). If it is properly implemented and updated constantly, using digitally encrypted signatures to access data, this advanced technology could become the most secure and efficient way to transmit health data.


Bhattacharya, S., Singh, A., & Hossain, M. M. (2019). Strengthening public health surveillance through blockchain technology. AIMS public health, 6(3), 326–333. 

Feder Ostrov B.(2016, July 5) Lower-income Americans getting ‘digital health,’ too.Retrieved 01/21/2021from Lombardo J. & Buckeridge D. L. ,(2007) Disease Surveillance: A Public Health Informatics Approach.John Wiley & Sons, Inc.

Panesar A. (2019).Machine Learning and AI for Healthcare

Coventry, UKISBN-13 (pbk): 978-1-4842-3798-4

.org/10.1007/978-1-4842-3799-14 days ago

William Payne

RE: Discussion – Week 8


Telehealth is the application of information technology and/or of telecommunication to health-related practices (HRSA, 2021). It involves a variety of communication technologies, user interfaces, and media of transmission (Miller, 2007; Laureate Education Inc, 2011). It can take the form of any of five modalities of delivery, including (CCHP, n.d.): 1) remote communication, 2) live video, 3) mobile health, 4) remote patient-monitoring, and 5) store-and-forward.

As the prefix tele– would suggest (Random House, n.d.), a central motif of telehealth is the enablement of health-related services/activities across a great distance. Health Informatics and Surveillance Response Paper

Telehealth, broadly speaking, can improve public health surveillance.

Telehealth’s more narrow application to medicine (i.e., telemedicine) can improve or enhance medical/clinical performance but likely can never fully replace it. After all, telemedicine does has a few limitations or drawbacks that are unique to it.


Telemedicine shall likely never completely replace collocated clinical interaction, owing to some drawbacks inherent to it. Perhaps most basically, its use or interface is not suitable for certain kinds of patients, who may fundamentally dislike the idea of telehealth, disapprove of its use or interface, or otherwise consciously resist its uptake (Sanders, 2012).

More commonly though, a lack of face-to-face interaction arguably always imposes at least some non-trivial limitation(s) on the medical provider’s ability to thoroughly examine or otherwise assess the patient, creating some heightened concern for patient safety and for provider liability (Cascella, n.d.). This concern manifests most prominently in the online prescribing of medications (Cascella, n.d.; Myers & Turvey, 2013). Controversy surrounding the practice is perhaps most evidenced by the passage of the Ryan Haight Online Pharmacy Consumer Protection Act, under federal law (US Congress, 2008). Even in my own state of Texas, an intriguing court case arose between the Dallas-based Teladoc (the nation’s first and now-largest provider of telemedicine nationwide) and the state’s Texas Medical Board (in which Teladoc majorly prevailed) (TX 3rd CoA, 2014; Walters, 2016; Goodman, 2016). The practice still remains controversial, though (Myers & Turvey, 2013), and further guidelines or regulations are likely to come.

01. Post a brief description of the two strategies and/or technological tools you selected.

Medical Improvements:

Despite these inherent limitations, telemedicine shows considerable promise in increasing the efficiency and accessibility of medical care and indeed has been surprisingly slow in its uptake and expansion (Miller, 2007). We should continue to expand, evaluate, and ultimately improve it. The most apparent room for improvement can be seen at the technical level and at the administrative/regulatory level.

At the technical level, current guidelines exist to enhance telemedicine in six key areas: 1) network security, 2) confi­den­tiality, 3) quality improve­ment, 4) training, 5) informed consent, 5) record-mainte­nance, and 6) technical support (WSNA, 2018). In addition, improvements to data-sharing and data access could increase it clinical efficiency (Taylor et al., 2015). Finally, continuing to expand broadband internet access would help to maximize telemedicine’s impact by reaching more marginalized, medically underserved populations (HVH, 2017). Health Informatics and Surveillance Response Paper

At the administrative/regulatory level, the governments should include telemedicine in all payment/reimbursement models (including expanding the coverage thereof by MedicAid and especially by MediCare) so as to more closely align the medical care system’s reimbursement model with the exercise of telemedicine and should ease regulations on licensing, malpractice, and on geographic areas (HVH, 2017; Paul, 2006) so as to better facilitate inter-state telemedicine.

Surveillance Improvements:

In addition to telemedicine’s ability to improve clinical practice, telehealth, more broadly, can be used to enhance public health surveillance.

Teletriage is of especial use in syndromic surveillance, for two major reasons. First, it precedes clinic visits and is available to the patient immediately without appointment and so offers especially timely data (Lombardo & Buckeridge, 2007). Second, telephone triage calls are more numerous than clinic visits, even amongst people who have access to both, and so may even be a more sensitive indicator than electronic medical records (Lombardo & Buckeridge, 2007).

To even further improve Telehealth’s contribution to public health syndromic surveillance efforts, I have two suggestions (the first pertaining mostly to the United States). Health Informatics and Surveillance Response Paper

1. Create a nationwide, general-purpose telephone triage (TT) system.

Despite TT’s exceptional timeliness and sensitivity, for syndromic surveillance in the United States, TT data seems to me underutilized, owing indeed to being curiously underdeveloped in the first place. To date, the United States government has no nationwide, universally available, general-purpose TT hotline (Lombardo & Buckeridge, 2007). Of course, TT hotlines does exist, but only in a patchwork way, amongst separate private entities (e.g., medical care-provider organizations, HMOs, etc.) or in a subject-specific way (e.g., for domestic violence, etc.) (FYSB, n.d.). This poses a problem for surveillance, because each institution shall inevitably have some selection bias in who is included amongst the data. For example, the Department of Veterans Affairs (VA) medical system has a TT system and even uses it for biosurveillance, but its patient population is only 9% female (Lucero-Obusan et al., 2017).

By contrast, the United Kingdom (UK) has a nationwide, general-purpose TT system, called NHS 111 (Harcourt et al., 2016) (which has replaced the NHS Direct system described in our textbook) (Lombardo & Buckeridge, 2007). NHS 111 is proving tremendously useful in the UK, both for triaging patients and for syndromic surveillance in the UK (Harcourt et al., 2016).

So, the United States should first implement a nationwide, general-purpose TT system, analogous to NHS 111 but, of course, larger in scope. The system could, first and foremost, help direct many confused, symptom-experiencing Americans to appropriate medical care, but, beyond that, would serve as a useful data stream for syndromic surveillance nationwide. In order to maximize surveillance performance, the TT system should have a few characteristics, however. First, the TT system should be in operation always – 24 hours per day, 365 days per year. This insulates the system against signal-distortions caused by time-of-day effects, day-of-week effects, holiday effects, inclement weather, etc. (Lombardo & Buckeridge, 2007). Also, the system should collect demographic data and geographic data (Lombardo & Buckeridge, 2007), since the population size and geographic range of the United States are both exceptionally large. Finally, like the Ontario Telehealth System (Rolland et al, 2006), the United States TT system should ensure that decision-making rules are uniform amongst all of the call centers and should use a central database structure (Rolland et al, 2006). This would ensure that the triage algorithms are the same nationwide and therefore that the data is compatible and comparable across the country (Rolland et al, 2006). Health Informatics and Surveillance Response Paper

2. Have historic/baseline data available.

If the surveillance goal is not merely to quantify some health indicator but, quite beyond that, to detect an outbreak (i.e., a sudden increase above the norm) afoot, then the surveillance practice is very much an exercise in detecting a signal within noise. To do this, knowing the normal/baseline levels for the indicator is sine qua non, because knowing the number of syndromes at any given time is unhelpful in identifying an outbreak if the surveillants have no established basis for comparison. Health Informatics and Surveillance Response Paper

For that reason, any surveillance system needs background data. In deciding to launch some new surveillance system, surveillants should consider this need seriously.

For example, when the UK chose to replace NHS Direct (NHS-D) with NHS 111, two changes gave rise to some uncertainty regarding data validity. First, NHS 111 uses different Clinical Decision Support Software (CDSS) algorithms that did NHS-D, possibly resulting in significant levels of differing, non-comparable diagnosis data between the two systems (Harcourt et al., 2016). Second, NHS 111, at launch, did not have any baseline data. Instead, NHS’s surveillants chose to have NHS 111 rely on NHS-D’s baseline data. Although I can understand the convenience or practicality underlying this choice, the possibility for significant difference in baseline data between the two systems would, for me, have been too great a cause for concern. Instead, I would have recommended a baseline/training period for NHS 111 to generate its own, internally consistent baseline data. This would have made longer the process of developing and then rolling out NHS 111, but, to my mind, confidence in the data and its ability to offer credible assurance is more important than swiftness in the starting up of a new surveillance system. Health Informatics and Surveillance Response Paper

02. Justify your selections and explain how they would improve telehealth systems.
(see previous).

03. Briefly describe any potential difficulty in adopting the strategy or tool.

1. Creating a nationwide TT system.

Although I am sincere in my recommendation of the development of a nationwide, general-purpose TT hotline in the United States, the idea, practically speaking, is fanciful. The United States has a much larger population than Ontario or the UK, and so the hotline would be much more expensive to operate than either the Ontario Telehealth System or NHS 111. Although I do think that the idea is probably feasible, the nevertheless steep cost involved would likely be insufficiently politically palatable to win acceptance.

There is another difficulty in applying the TT system. Although exceptionally timely and sensitive, TT data suffer from poor specificity. Because the nurse is triaging (rather than diagnosing) and is classifying by syndrome and severity (rather than by disease), the data’s specificity suffers (Lombardo & Buckeridge, 2007). However, in some cases, the individual call data can be linked to any subsequent, individual clinical data on a patient-by-patient basis, including to ICD-9 codes (Lombardo & Buckeridge, 2007). This would ameliorate the poor specificity, but, again, would likely require additional cost, making the prospect seem even less initially inviting.

2. Having historic/baseline data available.

As mentioned previously, the most obvious challenge in generating background/baseline data for a surveillance system is the inclusion of a baseline/training period. This makes the system take longer to become operational, but, in my judgment, is generally still the preferable choice.

I do note that, in chapter 10, the textbook discusses the various ways of generating background data (e.g., authentic vs. simulated, various models, etc.) and their respective strengths and weaknesses (Lombardo & Buckeridge, 2007), but that discussion seems a bit too complex and much too far ahead in the coursework to elaborate on here


Cascella, L. M. (n.d.). Risk perspectives in telehealth: Online prescribing. MedPro Group.

Center for Connected Health Policy [CCHP]. (n.d.). About telehealth.

Goodman, M. (2016, November). How the north Texas telemedicine revolution began. D Magazine.

Harcourt, S. E., Morbey, R. A., Loveridge, P., Carrilho, L., Baynham, D., Povey, E., … Elliot, A. J. (2016). Developing and validating a new national remote health advice syndromic surveillance system in England. Journal of Public Health, 39(1), 184–192. 

Healthcare Value Hub [HVH]. (2017, November). Telemedicine: Decreasing barriers and increasing access to healthcare. Healthcare Value Hub.

Laureate Education, Inc. (Executive Producer). (2011). Introduction to health informatics and surveillance: Telehealth.

Lombardo, J. S., & Buckeridge, D. L. (2007). Disease surveillance: A public health informatics approach. John Wiley & Sons.

Lucero-Obusan, C., Winston, C. A., Schirmer, P. L., Oda, G., & Holodniy, M. (2017). Enhanced influenza surveillance using telephone triage and electronic syndromic surveillance in the department of veterans affairs – 2011-2015. Public Health Reports, 132(1_suppl), 16S–22S. 

Miller, E. A. (2007). Solving the disjuncture between research and practice: Telehealth trends in the 21st century. Health Policy, 82(2), 133–141. 

Myers, K., & Turvey, C. (2013). Telemental health: clinical, technical, and administrative foundations for evidence-based practice (1st ed.). Elsevier.

2 days ago

Nyoka Rogers

RE: Discussion – Week 8

Post a brief description of the two strategies and/or technological tools you selected.

Tele-health enables a clinical process to be conducted remotely, thus combining the power of health telecommunication and information technology to improve the efficiency and quality if heath care (Buckeridge & Lombardo, 2007). Telehealth is also sometimes called telemedicine. Telehealth is the use of electronic information and telecommunication technologies to provider care when you and the doctor aren’t in the same place at the same time (What is Telehealth). The first strategy would be the use of telenursing/telephone triage. Telenursing or telephone triage is a subset of tele-health in which the focus is on nursing practice via telecommunications (usually the telephone) (Buckeridge & Lombardo, 2007). Telenursing/telephone triage is being used in many ways for the benefit of health care. Research shows that telenursing/telephone triage has help with the control of health care costs, decreased the number of emergency care visits, and it has also met the demands of patients that need around the clock health care. The tool I selected would be the use of the Royal College of General Practitioners sentinel surveillance system. The particular surveillance system is one of the main modes of communicable disease surveillance in England and Wales.

Justify your selections and explain how they would improve tele-health systems.

The use of telenursing/telephone triage has so many known benefits that improves the tele-health system. Research shows that nurses have come to recognize that the quality of telehealth services parallels that of in person visitation. Telenursing helps improve the efficiency of nurses who deliver services to those from rural areas. Telenursing allows for the improvement of a patient’s health condition by the continuous monitoring which can not be afforded if the patient has to come into the office daily. I personally think that telenursing helps increase the amounts of people being seen for medical problems due to people feeling more comfortable with being in an environment that they are familiar with as to coming into a doctor’s office. The Royal College of General Practitioners surveillance system can improve the telehealth system by helping to keep track of the illnesses and diseases that may not be present at hospitals. The Royal College of General Practitioners surveillance can also help with keeping track of illnesses that laboratory specimens are not routinely taken. Health Informatics and Surveillance Response Paper

Briefly describe any potential difficulty in adopting the strategy or tool.

The only potential difficulty I can see with adopting the telenursing strategy as much as the United Kingdom does compared to the United States would sharing the health information. The United Kingdom has a universal health care system. The United States would have difficulty consolidating all of the health information received due to having more than one system where all of the data from patients are collected. The United States has the potential to mimic the Royal College of General Practitioners surveillance system to monitor chronic illness, but difficulty in reaching, servicing, and surveilling as many as the United Kingdom through this particular surveillance system.


Lombardo, J. S., & Buckeridge, D. L. (2007). Disease surveillance: A public health informatics

approach. Hoboken, NJ: Wiley-Interscience

What is telehealth? (n.d.). Retrieved January 21, 2021, from 

2 days ago

Dominique Morgan
RE: Discussion – Week 8
Brief description of the two strategies and/or technological tools you selected
Telehealth is a way to provide healthcare using telecommunications and information technologies no matter location or time (Laureate Education, 2011). One strategy for telehealth systems improvement is to create standard data collection and reporting protocols to ensure the quality and efficiency of the information that is collected, reported, and used. The second strategy for telehealth systems improvement is enhancing the user experience by encouraging more users to participate and utilize telehealth systems. There are benefits in telehealth to gather data to impact public health surveillance.
Justify and explain how your selections would improve telehealth systems
Having standard data collection and reporting procedures is necessary when striving to provide accurate and useful data derived from telehealth activities. Standardization creates room for consistent outcomes and improvements in the quality of care and data collected (Wolters Kluwer, 2017). To ensure quality and efficiency, telehealth systems should be used in conjunction with other traditional surveillance systems and their data sources like labs, pharmacy data, and more (Lombardo & Buckeridge, 2007). For example on an individual level, a user taking their blood pressure with an at-home monitor (a form of remote monitoring) that records the readings for their physician, but the provider also using the patients pharmacy data in verifying if they are taking their blood pressure medication in addition to monitoring it; the results would be consistent with one another. Consistency in results create a check and balance system creating more assurance in data interpretation, analysis, and dissemination.
Engaging users in telehealth systems like teleconsultations, e-health technologies, and remote monitoring allows for care and education that is not bound by location or time (Laureate Education, 2011). Tele-health can reach those living in areas where it is hard to access medical care, public health services, or health education services (Rasi et al., 2021). Studies have found that overall, patients and other telehealth service users think it is valuable to get information and get in touch with providers and other health professionals immediately (Karisalmi et al., 2019). Users also find that telehealth services are an excellent way to get peer support and ask sensitive questions (Karisalmi et al., 2019). Patients report feeling safe, secure, and in control when using telehealth services (Karisalmi et al., 2019). Encouraging users with examples like those above of the benefits of using telehealth, telemedicine, e-health, teleconsultation, remote monitoring, and more will allow for increased usage and make way for new telehealth services.
Briefly describe any potential difficulty in adopting the strategy or tool
A potential difficulty in adopting these strategies is the telehealth systems being too general when providing education or guidance to users. There is a balance between standardization and overshadowing personalization. It may be difficult for every user to get what they need from the system. It may also be difficult for the designers to create systems that can be integrated into various public health and health care institutions. Another potential difficulty is ensuring that patients and users receiver the same quality of care, whether via telehealth or traditional means. Although providers strive for the same degree of quality, it will take extra work to ensure the same quality level is present in telehealth systems.
Karisalmi, N., Kaipio, J., & Kujala, S. (2019). Encouraging the use of eHealth services: A survey of patients’ experiences. Studies in Health Technology & Informatics, 257, 206–211. 
Laureate Education. (2011). Introduction to health informatics and surveillance: Telehealth [Video file]. Baltimore, MD: Author.
Lombardo, J.S. & Buckeridge, D.L. (2007). Disease surveillance: A public health informatics approach. John Wiley & Sons, Inc Publications.
Rasi, P., Lindberg, J., & Airola, E. (2021). Older service users’ experiences of learning to use eHealth applications in sparsely populated healthcare settings in Northern Sweden and Finland. Educational Gerontology, 47(1), 25–35. 
Wolerts Kluwer. (2017). How does standardizing care affect quality? 

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