Building A New IIS:

Work the World Can Celebrate

By Kristina Crane, STC

If you’re reading this, there’s a good chance you deserve credit for having helped give a gift to the world. Here’s how it happened…

The country of Qatar needed an Immunization Information System, and they needed it fast. The World Cup is coming and that means over a million visitors to a country of fewer than three million residents. The Qatar Ministry of Public Health asked us if we could take their vaccination recordkeeping system — all on paper, stored in binders around the country — and turn it into a world class IIS, with data exchange and vax inventory. Could we do it in 10 months? Possible?

Absolutely. And you’re why. Thanks to all the years of work by public health workers here in the United States, and my colleagues at STC, we have something so good we could take it and give it to the world, starting in Qatar. What we are doing is not reinventing public health information but taking all that we’d learned and reassembling the pieces in the Middle East. It’s like starting telephone service from scratch – you don’t need to put up poles and string wires; you start with cell towers. And that’s what we’re doing with health information.

This past January we had a kickoff event to start the project — hundreds of people, including a sheikh (Dr. Sheikh Mohammed Al Thani, Director of Public Health), all eating gourmet food in Ministry of Public Health convention center. As I sat in that kickoff event in Doha, I thought of all those people who worked in the back offices of health departments, and in our own company, created this marvelous system that we can now share. The world can celebrate this accomplishment… your accomplishment. I wish you’d been with us.

BEYOND THE IIS to DP&E: DETECT, PREVENT & ELIMINATE

The starting point:

Qatar has the highest per-capita income in the world, and the medical infrastructure is first class. (Visiting hospitals in Qatar feels very much like visiting those in the U.S. or Europe.) But, as was the case in the U.S. until recently, the medical records had been kept on paper. (Below are some photos we took. As for the last picture, “defaulters” is the local term for those who are on the vaccine catch-up schedule.)

Not only is our task to create a comprehensive IIS, but we are working with our on-the-ground partners, Ooredoo and Al Sulaiman Health, and U.S.-based partner Sunquest to create the first truly integrated application to detect, prevent and eliminate communicable disease — Sunquest is implementing a surveillance system to DETECT diseases, while we are implementing the immunization intelligence to PREVENT them, and thus, together, we can work to ELIMINATE preventable disease. I’ve come to think of that as DP&E.

Here’s how we envision it and it will look familiar to many of you, except perhaps the abbreviation “MoPH” – that stands for Ministry of Public Health.

So, as I said at the start, this was possible because of all the accumulated labor over many years. We have something that will help the people of Qatar, but that will be part of advancing the world’s health. That means, in this time of so much international commerce and travel, the job of public health in the U.S. will be a little easier.

WORKING IN QATAR

Personal Reflections from Chrissie Gorman, STC

My first trip to Qatar was over 4 years ago.  The biggest shock was flying into Doha which was all desert with this incredibly modern city built up right along the coast.  It is strange to think that 30 years ago there was nearly nothing.  Flying back to Doha earlier this year, it was amazing to see how much the skyline had changed in such a short period. People comment about how Qatar won the 2022 World Cup with zero infrastructure in place, but if there is any country that can pull this off I feel it would be Qatar. It is a fascinating place to work. They want to leapfrog everything – technology, education, architecture, sports….everything. They are constantly at odds with their culture, pushing for a modern westernized world yet maintaining a firm grip on their religion and culture. It is also a melting pot! They have roughly 3 million residents but only 300K are local Qatari citizens, with the remainder being expatriates from every corner of the world.  

Working in Qatar is like working for the UN…people are from everywhere.  I was on a call that included 3 Americans, 1 Jordanian, 1 French, 1 Greek, 2 Indians, 1 Brit, 1 Canadian, 2 Filipinos, 1 Sudanese and 1 Qatari.  The immunization program that we are working with is led by two strong, independent, intelligent women from Sudan and Qatar. They push STC to always do better. They are also very fair, open and honest with us, which I have always appreciated and respected and proved to be our biggest success within this project.

The day-to-day work can be challenging because of the time change (they are 7 hours ahead of me), work week shift (Sunday to Thursday rather than Monday to Friday), varying communication styles. Much of the team is speaking English as their second language.  Our team has found a balance between the polite chitchat and being straight-forward/transparent in our communication and delivering on those.  Through this project, our team has developed a great rapport and we are very fortunate for that.  

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Vax Stats of the Month

Family Household Health: A Better Way to Analyze Immunizations?

by Bill Davenhall, Geomedicine Analyst, STC Health Analytics (Bill_Davenhall@stchome.com)

Counting people is a critical part of present-day governmental funding. Public health programs organize, plan, and implement a host of programs that are largely based on the U.S. Census Bureau’s official population counts, including immunization programs. Today we talk about “population health” but tomorrow we might be talking more about “household health” especially when we discuss immunization of children and adults. Here is why:

Today about 311 million people reside in about 125 million households, of which 81 million are classified as Family Households*, but only 38 million family households contain children under 18. The family household is where desirable immunization practices typically get their start. The Family Household is likely the best analytical “container” in which immunization behaviors can be studied.

The map below identifies the 330 counties (31% of all counties) where 50% or more of all Family Households have children under 18 years of age present — this group represents over 11 million households. Census Bureau studies also estimate that about 69% of all children under 18 years of age are living with two parents, while 23% live with only one, likely another critical factor to understanding immunization practices. Knowing where these households are geographically located is equally important to immunization operations.

That’s why “householding” is an analytical technique that puts the “family” data back together — all the right people in the correct household. Householding allows a more in-depth look at the socio-demographic characteristics and immunization behaviors of the entire household. If you have never conducted analytical “householding” on your immunization registry, perhaps it’s time you gave it a try. It will deliver greater analytical and operational precision and likely become a business imperative in public health’s quest to assure getting desirable lifelong immunization behaviors off to a great start.

Data Sources: US Census Bureau, Scan\US, and STC.

*The US Census Bureau defines a Family Household as a household maintained by a householder who is in a family unit and may include un-related individuals who may also be residing there. The family unit is defined as a group of two or more people (one of whom is the householder) that are related by birth, marriage, or adoption and residing together; all such people (including related subfamily members) are considered as members of one family.