Program Proposal: Public Health Information System with Alytus, Vilnius, and Utena Public Health Centers & Information Technology Training Project

Table of ContentsDetailed Proposal for Public Health Information System with Alytus, Vilnius, and Utena Public Health Centers & Information Technology Training Project...............................................................1Table of Contents.................................................................................................................................1Part I. Project Overview:......................................................................................................................2

A. Purpose........................................................................................................................................2B. Background..................................................................................................................................2C. Current Problems & Their Negative Effects:..............................................................................2D. Project Solutions (Referenced to Numbers Above):...................................................................3E. Brief Project Description.............................................................................................................4F. Short-term Goals & Immediate Results.......................................................................................4G. Long-term Goals..........................................................................................................................5

Part II. Audience & Project Participants:.............................................................................................6A. Overview....................................................................................................................................6B. Participants with Responsibilities:..............................................................................................6C. Other Participants/Beneficiaries..................................................................................................7

Part III. Overview of Project Steps:.....................................................................................................9Part III. Overview of Project Steps:.....................................................................................................9

Phase 1: Preparation (9.2000 to 12.2000):.......................................................................................9Phase 2: Development of the PHIS & Training (1.2001 to 8.2001):...............................................9Phase 3: Implementation & Results (1.2001 to 12.2002):.............................................................11

Part IV. Results..................................................................................................................................11Part V. Budget & Timetable:..............................................................................................................12Attachment 1: Public Health Information System Structure..............................................................15

1. Statistical Data:...........................................................................................................................152. Regulatory Information:.............................................................................................................153. Publications:...............................................................................................................................154. Information Technology Training Courses:...............................................................................165. Regional Information, News & Events:.....................................................................................166. Questions & Answers:................................................................................................................16

Attachment 2: Training ScheduleAttachment 3: Flow of Public Health Information in the PHIS...17Attachment 3: Flow of Public Health Information in the PHIS........................................................18References..........................................................................................................................................19

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Part I. Project Overview:

A. PurposeThe purpose of this project is to develop the capacity of staff in the Public Health Centers of Alytus, Vilnius, Utena counties to use information technologies, such as the Internet and Geographic Information Systems, to improve public health programming and increase information access to the public. The first part of this will be accomplished through the development and deployment of a Public Health Information System (PHIS) to store, analyze, and distribute vital information to county-level and affiliate public health centers. A PHIS is not a single system or software, it is a framework for storing both statistical and text information in an organized format for ready distribution via the Internet, CD-ROM and other means. The idea of a PHIS is fundamental principle for collecting and analyzing public health data and strongly recommended by the World Health Organization (World Health Organization 2000). The second part of this project is a detailed information technology training program for the 10 county-level public health centers in Lithuania on topics including: databases (MS Access), spreadsheets (MS Excel), statistics (Systat), public health data management/analysis (EpiInfo 2000), web site design (MS FrontPage), and geographic information systems (GIS) (ArcView). We believe this combination of a PHIS and training will make a valuable contribution to improving the efficiency and the effectively of programming, while also increasing information exchange and dissemination among public health centers and other groups.

B. BackgroundOur experience with Vilnius Public Health Center has shown us that there are several needs in public health throughout much of Lithuania and compatible with information technology solutions. These problems can be broadly classified as information availability, information analysis, and information exchange/collaboration. The projects initiated at Vilnius Public Health Center have had an impact in these areas and show the potential for increasing these types of projects to a broader geographic region. Vilnius Public Health Center web site’s entry page alone has received more than 500 unique visits in the two-month period since the hit counter has been installed (~1300 page views). Additionally, our training provided to several public health centers was well received and many participants commented that more was needed. Below the issues of information availability, information analysis, and information exchange/collaboration, their negative effects on public health management, and our proposed solutions are described in detail.

Note:Vilnius Public Health Center’s web site can be viewed at http://www.is.lt/vilniaus_vsc/ and the State Public Health Center’s web site at http://www.vvsc.uni.cc/. Demonstrations of certain technologies discussed in this proposal can be seen at http://www.waterscape.org/phis/.

C. Current Problems & Their Negative Effects:1. Information Technology Capability of Public Health Workers. Given the vast amounts of

data that public health centers must collect, analyze, and distribute, there is a strong need for public health staff to be adept in computer usage. It is impossible to calculate even basic statistics on a city of 580,000 such as Vilnius without such capability. In particular, knowledge of spreadsheets, statistical programs, and database usage is necessary.

2. Information Accessibility to the Public, Businesses, and other groups. Important information vital to public health centers, primary health care providers, businesses, universities, and the sick is difficult or costly to obtain in many parts of Lithuania. Simple publications on healthy living, regulations applicable to many businesses, polyclinic contact information, and other important information should be made available. The importance of this

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is well documented, for instance in recent reports from the Regional Environmental Center for Eastern Europe and elsewhere (Hallo 1997; Regional Environmental Center for Central and Eastern Europe 1999).

3. Analytical Ability of Public Health Institutions. No system to interpret or exchange information about morbidity and mortality, a major diagnostic in public health planning currently exists. The raw data for these indicators is diligently collected by primary health care providers, however, there is not a system to relay this information back to public health centers and, more importantly, no system to analyze it. In the most fundamental way, if public health centers do not know where and from what people get sick programming to prevent these diseases is much less effective (Rushton and Armstrong 1997). Additionally, it is very important to identify epidemics and other fast-occurring outbreaks and system needs to be in place in order to accomplish this.

4. Information Exchange, Data Standardization, & Collaboration Among Public Health Institutions. Information exchange among these public health centers is limited and could be enhanced by: cataloging reports, laws, and fact sheets on the Internet and CD-ROM for exchange; forming listservs; and providing training to increase Internet usage. Higher-level cooperation is needed to reduce overlap in web site content from various public health centers. There should be basic data standards in the reporting and analysis of morbidity and mortality data, i.e. diseases rates in one region should be readily comparable to another. Similarly, there are data discontinuity problems in agencies related to public health, such as drinking water quality. Collection of such data should also be standardized to an extent to permit ready transfer from water companies to public health centers and comparison among cities.

D. Project Solutions (Referenced to Numbers Above):The following solutions are proposed in our project to address the aforementioned problems. 1. Train public health workers. Clearly there is a need to train public health workers in

information technology. The demands of public health in Lithuania require public health staff to be adept at various technologies such as spreadsheets, databases, and the Internet. Increasing their abilities will allow them to more efficiently perform their duties and improve the quality. Our program includes training in some of the latest technologies, such as EpiInfo 2000 that is used in 117 countries, and shows how these technologies can be applied to their fields of work.

2. Develop a Public Health Information System (PHIS) to centrally store, manage, and disseminate information. Public Health Centers need access to a variety of information including: regulations, fact sheets, current public health research, environmental conditions and, most importantly, data on morbidity/mortality in Lithuania. We recommend designing a system to store and centrally manage this data, making the information available to public health centers and other groups through the Internet and CD-ROM. The PHIS will utilize a variety of technologies including web sites, databases, and geographic information systems. We believe that the needs of each of the three public health centers and their affiliates are similar. Designing one system to address these needs will reduce overlap and increase the impact of one program in one region by making the results more shareable to other regions. It would also help to promote standardization in programming, analysis, and reporting if centers and other public health institutions adopted EpiInfo.

3. Design functions into the PHIS to help analyze this data. The PHIS will also be more than just a warehouse of information, but will also incorporate tools for analysis. Public health data to be included in the PHIS will likely be stored in EpiInfo 2000, which uses MS Access databases. EpiInfo 2000 has many tools available for epidemiological studies helpful to pubic health centers (Dean and Arner 2000). These activities need to be coordinated above the county-level and we believe our project will be the first step in coordinating these data storage and analysis activities on the national level, recognizing that databases and web sites should be coordinated on a national level to reduce overlap across different centers.

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4. Provide a forum for information exchange. The PHIS can also serve as a forum for information exchange, particularly if we take advantage of certain technologies such as discussion forums, listservs, and on-line postings that can allow groups to collaborate on-line. We could also use the PHIS to provide dial-up e-mail access to affiliate public health centers and rapidly make available alerts pertaining to public health, such as water quality advisories. Many countries comparable to Lithuania in terms of economic development have very successfully used these technologies. The PHIS will be an important step toward data standardization by allowing three county-level public health centers and their affiliate centers to congruently collect and report basic health data. Lastly, we propose to build a small water quality database for Vilniaus Vandenys to demonstrate how information transfer can take place among institutions related to public health. This database will be distributed to other water companies if found successful (it is a requirement of Lithuanian law that water companies report water quality measurements to public health centers).

E. Brief Project DescriptionThis project is scheduled to begin as soon as possible with training and the development of the PHIS lasting until August 2001. Although the major of the work will be completed by this time, goals have been set through December 2002. The three county-level public health centers of Alytus, Vilnius, and Utena, along with their affiliate centers will be the major participants in this project. The public, universities, businesses, and other government institutions will also gain substantially from this project as described in Part II of this proposal.

The centerpiece of the project will be a Public Health Information System (PHIS) to serve the needs of the three public health centers (Flay 2000). Attachment 1 shows the variety of information to be housed in the PHIS and Attachment 3 shows a diagram of the data organization and flow. There will be approximately 6 types of data stored here including: statistical data, regulatory information, publications, information technology training tutorials, news and events, and questions and answers section. The data will be accessed through three means, including the Internet, CD-ROM, and printed publications. We hope that the former two will be the most frequently used; although we realize that certain affiliate centers and other groups will not have access to the Internet or CD-ROM. We will provide ways for these centers to access the material through printer publications or by accessing the CD-ROM at the regional centers. We also plan to make this project well-known to mass media such as television, radio, and newspapers to facilitate outreach to the public and other groups. Attachment 1 also lists the purpose of each section of the PHIS. Training will also be an invaluable part of this project and training details can be found in Part III of this proposal.

F. Short-term Goals & Immediate Results Train 45 regional public health center staff in EpiInfo 2000, MS Access, MS Excel, web design,

geographic information systems, and statistics. (Training will be provided to affiliate public health centers and other groups, as space and funding are available).

Develop a PHIS to store statistical public health data and text information. Design features to analyze this data using GIS to create maps.

Create a web interface to access this data and text information, such as disease rates or first aid fact sheets, via the Internet. Package this information on CD-ROM and disseminate it to 50 public health institutions in Lithuania at 6-month intervals.

Represent 3 county-level public health centers and their affiliates on the Internet in an integrated fashion.

Provide dial-up e-mail access to affiliate public health centers via the PHIS. We could also host web sites for other public health institutions.

Form working relationships with two to three newspapers in the project region to print PHIS information.

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Demonstrate the PHIS to an open audience at university conferences, municipalities, or other places and promote the project.

Build an MS Access database for Vilniaus Vandenys to store water quality data, transmit it via MS Excel to Vilnius Public Health Center, and post it on the Internet.

Set goals of 250 unique web site visits per month in the first 6 months of the web site activity and 500 per month thereafter.

G. Long-term GoalsThe latest report of the World Health Organization echoes the importance of many of our ideas (World Health Organization 2000). We firmly believe that our project will be a major step in reaching the following goals: Increased education of the public, businesses, and other groups in the areas of health and the

environment. Increased information technology capability of public health workers. Facilitated regulation compliance and improved government-business communication in public

health. Increased ability of public health centers to identify trends in public health and focus

programming. Established national data standards in the areas of morbidity and mortality data collection,

analysis, and reporting. If EpiInfo is successful we will distribute the developed database format freely to other regional public health centers, state institutions, and primary healthcare providers who can use the program.

If the water quality database is effective, we will also distribute it to other water companies to facilitate the transfer of data among water companies and public health centers.

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Part II. Audience & Project Participants:

A. OverviewAlytus, Vilnius, and Utena County-level Public Health Centers and their affiliate public health centers will be directly involved in the development of this project. This project will largely focus on developing the capacity of these centers to serve the public health information needs of diverse groups who will be the major beneficiaries of this project. Other beneficiaries are primary health care providers, schools/universities, businesses, mass media, the ill, and the general public. Each group has varied interests in public health, ranging from regulatory compliance information to current information on healthy living and disease prevention.

The responsibilities of the participants helping to develop this project are listed below. In general, two individuals at Vilnius Public Health Center will be responsible for the majority of the work and project coordination. Staff at each of the other public health centers will have periodic (probably monthly) contributions to make. Affiliate pubic health centers and primary health care providers will also contribute and receive in return information periodically, but less so than the public health centers.

Note: Training will also be provided to regional and affiliate public health centers outside this region.

B. Participants with Responsibilities:General Project Coordinators (at Vilnius Public Health Center)Vilnius Public Health Center will coordinate this project through the three individuals listed below. The main server used to house the Public Health Information System (PHIS) will be located here with a satellite link to the Internet. Vilnius Public Health Center will continue to manage and administer this server after the project is completed. Information Technology Manager (IT Manager): The IT Manager will design and develop the

PHIS. This will include design of the EpiInfo 2000/MS Access database(s) used to store the data, the Geographic Information Systems (GIS) to view it, and the web site/CD-ROMs used to distribute it. The IT Manager will design the general PHIS web site and web pages for county-level public health centers. Details are listed in the budget & timetable. Randolph Flay could potentially fulfill this role.

Organizer: The Organizer will coordinate the overall project and work closely with the IT Manager. The major role is to see that information is smoothly and timely passed from the participant public health centers and state institutions to the IT Manager. After the bulk of the development is completed it is expected that the Organizer will take over the duties of the IT Manager. The Organizer will be an individual of Vilnius Public Health Center. Details are listed in the budget & timetable. Vaidas Kukarėnas could potential fill this role. (Certain duties of the Organizer will likely include the information technology specialists at Vilnius Public Health Center, e.g. installation of the server).

Trainer: The Trainer will provide the training of MS FrontPage, MS Excel, MS Access, statistics, ArcView/ArcExplorer, and EpiInfo. The Trainer will also convert the course materials to appropriate forms for placement in the PHIS for retrieval via the Internet and CD-ROM. Details are listed in the budget & timetable. Randolph Flay could potentially fulfill this role.

Alytus Public Health Center, Vilnius Public Health Center, and Utena Public Health CenterEach county-level public health center should have a computer with an Internet connection and MS FrontPage to maintain their web site. Each center must also be willing to participate in training.

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Each of the three county-level public health centers should provide the following to the IT Manager: A GIS map of the city and county, likely obtainable from the municipality's planning

department. Streets and city districts should be defined elements in the map. (ArcView shapefiles or ArcInfo exchange formats *.e00 are sufficient). Dates for submission of this are defined in the budget and timetable.

Monthly drinking water quality data and air quality data as available. Most cities and towns monitor drinking water quality and this information should be relayed to the public.

Market control data that is locally managed, e.g. food industry. Regular submissions of their publications such as first aid, tips for healthy living, etc. (We will

accept documents in a variety of formats such as MS Word, Adobe PDF, MS PowerPoint, etc.). A timetable for submissions should be determined.

County-level public health centers should identify the following individuals: Organizational Specialist: Will be located in each county-level public health center and will be

regular employees of the public health center. They will serve as the point of contact, coordinate the information transfer from the Technical Specialist to the IT Manager, and help to the promote the project (e.g. advertise training courses).

Technical Specialist: Will be responsible for updating certain portions of the regions PHIS web site pertaining to the region and coordinating the transfer of the GIS, publications, and other data to the IT Manager.

By participating in this project, county-level public health centers benefit from: having a web presence; receiving CD-ROMs with publications/laws, public health data, and EpiInfo databases/maps that they can use to store and analyze their own data; and training. We also hope to increase reporting of public health topics in newspapers.

Affiliate Public Health Centers in Each CountyAffiliate public health centers should identify a contact point to coordinate the project. As available, they should provide drinking water quality data, air quality data, and other socio-economic data locally managed and pertinent to public health. They should be willing to participate in training and develop a local network with municipal government and the media to help relay information. This will facilitate the penetration of information to the public. By participating in this project, affiliate public health centers benefit from: having a web presence; receiving CD-ROMs with publications/laws, public health data, and EpiInfo databases/maps that they can use to store and analyze their own data; and training. They will also receive a dial-up e-mail connection to the Internet through the PHIS.

C. Other Participants/BeneficiariesPrimary Health Care Providers will have access to the PHIS publications and data via the Internet and CD-ROM (a certain number of CD-ROMs will be provided free with additional copies provided at cost). Universities will have access to the PHIS publications and data via the Internet and CD-ROM (a certain number of CD-ROMs will be provided free with additional copies provided at cost). We will also promote the use of our data by universities. A perfect example of collaboration would be universities analyzing public health, environmental, and socio-economic data provided by the PHIS.Business will be able to review most public health regulations that pertain to their business via the Internet and post questions to public health staff in areas that pertain to their business. "Questions & Answers" will be indexed and searchable.Public/Ill will have access to the PHIS via the Internet. We will also develop links with mass media such as radio and newspapers to relay the information of the PHIS to a broader audience that does not have access to the Internet. Tips on first aid or suggestions for coping with a particular disease are a sampling of the information we will present.

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Other Public Health Institutions (State Insurance Fund, Health Information Center, Registrars of Disease, etc.) if the EpiInfo platform is successful, we will distribute it to other agencies for use in the storage, analysis, and exchange of public health data.Other State Institutions will be able to obtain CD-ROMs (at cost) and access the Internet portions of the project. We believe that information exchange between government agencies is very important, an example being the flow of information among the Ministry of Health, the Ministry of Environment, the Statistical Department, and others.

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Part III. Overview of Project Steps:Details here closely follow those listed in the budget and timetable. These steps have been generally grouped into three phases: preparation, development and training, and implementation.

Phase 1: Preparation (9.2000 to 12.2000):Objective: Prepare for the development stage and carryout some surveying to tune the project to needs of public health centers.Steps: 1. The first stage will be to inventory each county-level public health center and affiliates to

determine their information technology capabilities, training needs, and interests with respect to this project. This information will then be used to plan the overall PHIS structure, the web sites, and the training courses. This is already underway to assist in the authoring of this proposal.

2. The training seminars on Microsoft Access, Microsoft Excel, Microsoft FrontPage, Systat (statistics), EpiInfo 2000, and ArcView/ArcExplorer (GIS) will to be planned.

3. A structure for the “back-end” of the PHIS (MS Access/EpiInfo databases, GIS maps, and document library) along with the “front-end” (web site and CD-ROM layout) should be designed. This will include obtaining input from several parties that deal with public health data.

4. The server and Internet connection should be installed.5. Information from county-level public health centers, such a GIS map of their county, will be

requested and should be provided.6. As an example of data exchange, we will also develop a database to store drinking water quality

data for Vilniaus Vandenys. Lengthy discussions took place between Randolph Flay and Vilniaus Vandenys during the summer of 2000 about this project. There is a need for a database to record measurements and rely them to Vilnius Public Health Center. Vilniaus Vandenys was very interested in designing an MS Access database that can easily export data to MS Excel for conversion to web pages and transmission to Vilnius Public Health Center. Additionally, this database will be distributed to other water companies if found successful.

Phase 2: Development of the PHIS & Training (1.2001 to 8.2001):Objective: Develop the PHIS and train public health workers in its usage. Steps: 1. Develop the PHIS “back-end,” create the EpiInfo 2000/MS Access databases to store and

analyze the data. This database will be distributed to all institutions that find it useful. In this way, data can be readily transferred to and from the PHIS to regional public health institutions and universities. It is of vital importance that Lithuania standardize its morbidity and mortality data collection procedures. PHIS Details: Technologies Employed by the PHIS Server and Clients. In the event that

a county-level public health center or affiliate does not have access to the Internet nor CD-ROM, we will employ other methods of information dissemination, possibly including: other magnetic media, print materials, or providing computer access in another location.

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PHIS Details: Structure of the PHIS. See Attachment 1 for the structure of the PHIS and

specifics on the type of information to be included.2. Obtain GIS maps of each county and format them for use in EpiInfo 2000, allowing for the

creation of maps of morbidity, mortality, and environmental and socio-economic conditions.3. Build the “front-end” of the PHIS, create the web site and the HTML interface to the CD-ROM.

Organize the digital library of publications/laws and create a searchable index.4. Devise procedures for transferring data from State institutions and other sources to the PHIS (an

example would be transferring morbidity data from the State Insurance Fund to the PHIS). This may involve distributing EpiInfo to these institutions.

5. Carry out the training seminars. These training seminars will be carried out in at least three locations, such as Klaipeda, Kaunas, and Vilnius. First preference will be given to county-level public health centers, followed by affiliate public health centers and primary health care providers. These training courses will build off previous experience and input from our one-week seminar in Vilnius in June 2000. Additional, follow-up support pertaining to PHIS may also be provided. See Attachment 2 for the training seminar outline.

Phase 3: Implementation & Results (1.2001 to 12.2002):Objective: To ensure the greatest impact from project activities and continuously update the content of the PHIS.Steps: 1. Maintain the PHIS data and web site interface bi-weekly.2. Disseminate CD-ROMs of the PHIS content every 6 months beginning on 7/2001.3. Produce a detailed report on disease rates and mortality in Vilnius as a demonstration of the

PHIS.4. Demonstrate the PHIS at four or more conferences at universities or other places.5. Regional public health centers should submit, at regular intervals, publications and statistical

data to the PHIS.6. The Organizer should involve media outlets, such as newspapers. If informed and demonstrated

the system, newspapers will likely report information to a broader audience on matters pertaining to public health and make good use of the PHIS.

Part IV. ResultsThe Ministry of Health’s mission statement reads: “shall analyse the needs of activity of improving health status of the population, its health status and related prognosis, the resources of health care, the accessibility, acceptability and suitability of health care and shall plan the activity of improving the health status of the population on the state level.” We believe that our project helps fulfill this and many other goals as stated in the Lithuanian Health Program (Grabauskas, Degutiene et al. 1997). Systems of information technology and training in information technology are vital in preparing Lithuania to meet the challenges of public health in the coming years. Our project as proposed is an important step forward in meeting those challenges.

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Part V. Budget & Timetable:

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Step Title Type DescriptionResponsible Party

Estimated Time Burden (hours)

Labor Costs (litas)

Purchase Costs (litas) Begin Date End Date

Labor Each regional public health center must be inventoried for computer availability, Internet access, and computer-use knowledge. Coordinators in each regional public health center should be identified. Organizer 5 125 01-Aug-00 01-Aug-00

Labor Provide requested information (3 county PHCs * 5 hours). County PHCs 15 375 01-Sep-00 15-Sep-00

Labor Provide requested information (10 affiliate PHCs * 5 hours). Affiliate PHCs 50 1250 01-Sep-00 15-Sep-00

LaborTime to plan the Web design, MS Excel, MS Access, EpiInfo, GIS training seminars. Trainer 80 2000 01-Aug-00 31-Oct-00

Cost Cost of overhead slide preparation. Trainer 0 600 01-Aug-00 31-Oct-00Cost Purchase and/or printing of books, training

materials for seminar participants. Trainer 0 1200 01-Aug-00 31-Oct-00Labor

Study EpiInfo 2000 to plan most effective PHIS structure. IT Manager 80 * 01-Jul-00 01-Sep-00

Labor

Vilnius PHC and IT Manager propose structure, submit to regional centers for input, and revise.

IT Manager & Organizer 80 2000 01-Aug-00 31-Oct-00

Labor

Design data request for GIS maps, drinking water quality data, air quality data, etc. Plan a scheme for future transmission of data. Specifics on data formats need to be set. Organizer 10 250 01-Sep-00 15-Sep-00

Labor Provide data (3 regions * 25 hours) Regions 75 1875 01-Oct-00 30-Nov-00

Cost Server Organizer 0 16000 01-Sep-00 31-Dec-00Cost ArcView GIS Software (for maps) Organizer 0 6000 01-Sep-00 31-Dec-00

Cost Satellite Internet Connection (installation) Organizer 0 12000 01-Sep-00 31-Dec-00Cost Satellite Internet Service (12-months) Organizer * 01-Sep-00 31-Dec-00

LaborSet up dial-up e-mail access for affiliate PHCs Organizer 20 500 01-Sep-00 31-Dec-00

Labor Install server and Internet Access Organizer 80 2000 15-Sep-00 15-Nov-00

6

Develop water quality database for Vilniaus Vandenys Labor

Build a database to store water quality data at Vilniaus Vandenys to enable rapid relay of information to Vilnius Public Health Center and posting on the Internet. IT Manager 40 1000 01-Oct-00 31-Dec-00

7

Hardware & Installation of Clients Cost 2 copies FrontPage (for Alytus & Utena) County PHCs 0 1000 01-Sep-00 01-Sep-00

Hardware & Installation of Server

5

3

Plan/design data structure of PHIS

Plan training seminars for all public health centers

Phase 1: Preparation (9.2000 to 12.2000)

2

Inventory county-level and affiliate public health centers

1

Obtain data from regions

4

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Step Title Type DescriptionResponsible Party

Estimated Time Burden (hours)

Labor Costs (litas)

Purchase Costs (litas) Begin Date End Date

LaborDesign main web site and web sites for regional PHCs IT Manager 120 3000 01-Jan-01 31-Mar-01

Labor Database of morbidity, environmental data IT Manager 240 6000 01-Jan-01 31-Mar-01Labor GIS interface to the databases (for maps) IT Manager 120 3000 01-Jan-01 31-Mar-01Labor Web server configuration and maintenance IT Manager 20 500 01-Jan-01 30-Jun-01

2

Obtain data from State institutions (e.g. Health Information Center)

Labor

Data to be analyzed in conjunction with the morbidity/mortality data should be obtained, such as air quality, water quality, demographic, social, economic, and other indicators. Design a scheme for regular transmission of data. Organizer 120 3000 01-Jan-01 30-Apr-01

Labor Preparations between seminars Trainer 72 1800

Labor

Web design, MS Excel, MS Access, EPI INFO, GIS. 15 days of seminars in 3 different locations Trainer 360 9000 01-Apr-01 15-Jun-01

LaborDesign and print a brochure to inform about project Organizer 20 500 01-Feb-01 31-Mar-01

Cost Print 200 copies of a brochure Organizer 0 800 31-Mar-01 31-Mar-01

5

Train future IT Manager Labor

The IT Manager will train a future IT Manager to continue the project IT Manager 80 2000 01-Apr-01 30-Jun-01

6

Additional Training Labor

Additional Training to Regional Public Health Centers or Public Health Institutions Trainer 01-Jul-01 15-Aug-01

Build the PHIS

1

Phase 2: Development of the PHIS & Training (1.2001 to 8.2001)

Perform training

3

4

Notice to municipal governments, universities, & PHCs about project

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Step Title Type DescriptionResponsible Party

Estimated Time Burden (hours)

Labor Costs (litas)

Purchase Costs (litas) Begin Date End Date

1Data analyses

LaborFull Report on morbidity/mortality in city and rural areas of regions. IT Manager 80 2000 01-May-01 31-Jul-01

Labor

County Public Health Centers should submit or organize the direct submission of environmental data from their region and publications. (5 hours/month*18 months* 3 centers) County PHCs 270 6750 01-Jan-01 30-Dec-02

Labor

County Public Health Centers should submit or organize the direct submission of environmental data from their region and publications. (5 hours/month*18 months* 10 centers) Affiliate PHCs 900 22500 01-Jan-01 30-Dec-02

3

Maintain web site, manage data

Labor

The Organizer will continue to manage the web site and coordinate the data transmission. (10 hours per month * 18 months = 180 hours) Organizer 180 4500 01-Jan-01 31-Dec-02

Labor

This is scheduled to occur 4 times at 6 month intervals. Data included will be the morbidity/mortality database and a viewable GIS system.

IT Manager & Organizer 80 * 30-Jun-01 31-Dec-02

Cost CD-ROMs (50*4)=200 count * 8 litas IT Manager 1600 30-Jun-01 31-Dec-02

5

System demonstration in each region

Labor

In each of the 4 centers the possibilities for accessing the system will be demonstrated (Internet, CD-ROM, diskette, printed forms). 4 two-day seminars Trainer 64 1600 01-Feb-01 30-Aug-01

6

General Support

Labor

Vilnius must agree to provide minimal technical support to regions for 2-years. Responsibility will be transferred to Organizer after a set time period (5 hours per months * 24 months). Organizer 120 * 08-Jan-01 31-Dec-02

7

University Conference Advertisement Labor

Attend 2-4 conferences to talk about the project IT Manager 40 * 01-Jan-01 30-Jun-01

8

Media Involvement

Labor

Develop working relationships with 2-3 newspapers in the project area to print basic information from the PHIS. Demonstrate the system. Organizer 40 * 30-Jun-01 30-Oct-01

Total Costs 77525 39200

Grand Total Litas

NotesPHC = Public Health Center* = the individual or group will absorb cost

116725

Write CD-ROMs for data transfer to regions and other groups

4

Phase 3: Implementation, Results & Continual Work (1.2001 to 12.2002)

Regular Data Submissions

2

Attachment 1: Public Health Information System Structure

1. Statistical Data: (For Vilnius, Alytus, and Utena regions). In order for public health officials to perform their job well and develop appropriate programming, they need accurate information about the state of public health, in particular they need access to accurate morbidity and mortality data. Additionally, environmental and social data, in combination with public health data, are very useful tools for identifying problems and targeting programming to the areas of need. We propose that the IT Manager obtain these data and put them into a format that easy for county-level public health to utilize. This data will be primarily stored in Microsoft Access databases, linked fully or partially to the Internet for download. Geographic Information Systems (GIS) software such as ArcView will be used to create maps of morbidity, mortality, etc. ArcView also has a feature to serve the maps over the Internet called the Internet Map Server Extension. For areas with limited Internet access, these databases could be periodically sent on CD-ROM. We also hope to establish a location in Vilnius where public health center staff could perform their own, more detailed analyses. Training in GIS, Microsoft Access, and statistical techniques can be provided at request.

Initially there will be quite a bit of work to design the database, obtain the basic maps of each county for use in GIS, and develop methods for regular transmission of updated public health, environmental, and social data. However, once the basic development phase is complete, importing new data should be a relatively simple process.

a) Public health data1. Morbidity (State Health Information Center)2. Mortality (State Health Information Center)3. Selected diseases, such as cancer, diabetes (Registers)

b) Environmental data1. Drinking water quality (water companies)2. Air quality (Ministry of Environment)3. Sources of air/water pollution (Municipal governments)4. Noise5. Food, market control6. Radiation7. Urban planning (Municipal governments)

c) Social data1. Demographics: population, age distribution2. Lifestyle: smoking, alcohol consumption, etc.3. Socio-economic (Statistical Department)

2. Regulatory Information:This information will be presented on the web site and the full-text of laws and regulations will be presented when possible. Business advice could take the form of fact sheets, or on-line "Questions & Answers" where visitors post their questions and public health center staff answer them. The majority of this data will be accessible via the Internet and can also be copied onto CD-ROM.

a) Laws and Regulationsb) Business Advice

3. Publications: Publications will be full-text reports, fact sheets, and procedural guidelines. Many county-level public health centers and affiliate public health centers have similar needs to produce publications

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to inform the public and businesses. The purpose of this section will be to allow public health centers to store and exchange such publications. The goal is to allow one center that develops a publication on first aid or another topic to be used by other centers. Publications will be accepted in most common file formats such as MS Word, MS PowerPoint, Adobe Portable Document Format, MS Excel, etc. These documents will be indexed and retrievable via the Internet, FTP, and CD-ROM.

a) Reports on disease distributions, research of public health centers and universities in Lithuania, etc.b) Fact sheets on first aid, home treatment, etc.c) Procedural guidelines for businesses such as food preparation, etc.

4. Information Technology Training Courses:Training materials from the courses planned as part of this project will be made available on the Internet for self-training and use by public health centers in further training of their staff. Most of the course materials are in MS PowerPoint, MS Word, or other formats suitable for placement on the Internet and the CD-ROM. Certain practical training courses could also be carried-out through the Internet.

a) MS FrontPage (Web Design)b) MS Excelc) MS Accessd) Systat (Statistics)e) EpiInfo 2000f) ArcView & ArcExplorer (Geographic Information Systems)

5. Regional Information, News & Events: A general monthly news publication will be posted on the Internet and distributed through other means. Each public health center will be responsible for maintaining a portion of the web site consisting of news, events, detailed contact information in the region, regional programming, and other information. These regions will be given direct access to update the web pages. This information will be updated periodically so that the Internet and perhaps a monthly printed publication will be the best means for distribution. We think it is a valuable product of this project that each public health center will have its own small web site and that the information will be coordinated with other centers to reduce the informational overlap. The server will also be a "free" place for the county-level public health centers to host their web site since currently each public health center must pay to host a web site. Forms for adding events and posting news articles to the web site can be designed for frequent changes to by made by authorized public health center staff. This section could also be used for urgent health warnings.

a) Vilniusb) Alytusc) Utena

6. Questions & Answers: Visitors will be able to post questions on the Internet and have them answered by Public Health Center staff.

a) Regulatory compliance questions for businessesb) Healthy living questions for the illc) Etc.

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Attachment 2: Training Schedule

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Attachment 3: Flow of Public Health Information in the PHIS

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ReferencesDean, A. G. and T. G. Arner (2000). Epi Info 2000. Atlanta, Georgia, Centers for Disease Control

and Prevention: 373.Flay, R. B. (2000). The Design of Geographic Information Systems for the Storage and Analysis of

Public Health and Environmental Data. Ecobaltica 2000, St. Petersburg, Russia, St. Petersburg State Technical University.

Grabauskas, V., I. Degutiene, et al. (1997). Lithuanian Health Program. Vilnius, Ministry of Health of the Republic of Lithuania.

Hallo, R. E. (1997). Public Access to Environmental Information. Copenhagen, European Environmental Agency: 1-46.

Regional Environmental Center for Central and Eastern Europe (1999). Access to Information, Public Participation in Decision-Making and Access to Justice in Environment and Health Matters. Third European Ministerial Conference on Environment and Health, London.

Rushton, G. and M. P. Armstrong (1997). Improving Public Health Through Geographical Information Systems: An Instructional Guide to Major Concepts and their Implementation. Iowa City, The University of Iowa: 1-143.

World Health Organization (2000). The World Health Report 2000. Geneva, World Health Organization.

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