Campus Health-Aid: A Health Information System
Description of a health information system for students living on campus, at the University of Northern Iowa.
John Van Hemert
The Current System
The current system for managing health information on campus is paper-based. It is formally called Health Aide and has its own small staff. The Department of Residence works closely with Health Aide to provide on-campus residents with basic first aid support.
Description
The Health Aide system is based on paper forms, completed by Resident Assistants on campus. There is a full-time coordinator, who is responsible for overseeing the training of Resident Assistants, distribution of Health Aide supplies and reporting of the use of those supplies.
There is one Health Aide Kit for every on-campus House (a community of 30-50 residents). That kit is managed by the House’s Resident Assistant, who is trained to use everything in the kit. Residents are to seek a Resident Assistant whenever first aid is needed.
The kits contain the following items:
- Advil
- Alcohol Pads
- Antibiotic ointment
- Antiseptic Towelettes
- Bandaids (small)
- Bandaids (large)
- Calamine Lotion (Hall Coordinator’s Kit)
- Decongestant
- Elastic bandage
- Gauze pads (2x2)
- Gauze pads (2x3)
- Gauze wrap (3" roller gauze)
- Ice Pack
- Medicine cup
- Paper sack
- Pepto Bismol
- Plastic bags
- Rubber gloves
- Safety pins
- Scissors
- Tape
- Thermometers
- Throat lozenges/cough drop
- Triangle Bandage
- Tweezers
- Tylenol (acetaminophen)
The report required for every use of Health Aide supplies contains the Resident Assistant’s name, the patient’s name, the reason for the report and a list of the supplies used:
Process
When a resident needs first aid attention, the Resident Assistant uses his Health Aide Training and the supplies in his Health Aide kit to tend to the resident. The Resident Assistant also proceeds with further action if needed. In every case, the Resident Assistant must complete the Report Form and deliver it to the Resident Assistant on his staff that acts as the Health Aide Representative. The Health Aide Representative collects Report Forms and regularly delivers batches of forms to the Health Aide Coordinator. The Health Aide Representative collects from the Health Aide Coordinator those supplies which his staff needs restocked and delivers them accordingly. The Health Aide Coordinator manually records the data from the forms and submits the information to a reporting agency, which then supplies the information to the Health Aide Program’s funding source for budgeting.
There is a diagram of the process here.
Limitations
The bottleneck in this system is the paper-based Health Aide Report Form. It hampers the process in two main areas:
Labor
The information is manually entered twice: first by the Resident Assistant, and then by the Health Aide Coordinator.
Downtime
The system is batch-like because data sits idle in the possession of the Health Aide Representative until two criteria are satisfied: 1) the number of forms in her possession justifies the time and effort to manually deliver them to the Health Aide Coordinator, and 2) she has enough time to manually deliver them to the Health Aide Coordinator. Weeks can pass by before both of these requirements are met.
A Solution System
A new system that addresses the limitations of the current Health Aide system must decrease or eliminate the downtime and labor associated with the paper Report Form in the current system.
Description
The solution system should be paperless and automated. It should be identical to the current system, except for the transfer of information from the Resident Assistant to the Health Aide Coordinator.
Process
As with the current system, when a resident needs first aid attention, the Resident Assistant uses his Health Aide Training and the supplies in his Health Aide kit to tend to the resident. The Resident Assistant also proceeds with further action if needed. Here is where the solution system differs from the current one: In every case, the Resident Assistant must complete an electronic Report Form by accessing a secure server on the University intranet. The server contains a database that stores a real-time inventory of the Health Aide supplies in every kit. The Health Aide Representative regularly accesses a view of the database, showing her the inventory of her staff’s Health Aide supply. The system alerts the Health Aide Representative whenever there is an item below a certain quantity in her staff’s inventory. This eliminates the subjective criteria for justifying a trip to restock her inventory, and uses an objective and practical criterion. When instructed by the system, the Health Aide Representative collects from the Health Aide Coordinator those supplies which his staff needs restocked and delivers them accordingly.
The Health Aide Coordinator accesses the server database in the same manner for University-wide inventory management. The system automates the process where the Health Aide Coordinator submits the inventory and supply usage information to a reporting agency, which then supplies the information to the Health Aide Program’s funding source for budgeting.
See the solution process diagram here.
See the solution web architecture diagram here.
Tools
In addition to more accurate and timely inventory management, the solution system can facilitate first-aid-epidemiology on a University-wide scale. Each Report Form contains information for its case:
- Resident Assistant name
- Hall
- Student (Patient) name
- Date
- Problem (The health event)
- Supplies used/ Action taken
- Comments/Observations
- Referrals/Additional parties involved
Using this information, epidemiological studies can be performed easily and accurately. For instance, trends and infection patterns in certain illnesses can be tracked. Correlations between different factors in Health Aide and the student population can be inspected. With the right software to process the solution system’s data, literally any relationship (location, building age, student type, season, etc. versus illness/injury) can be investigated with the click of a button. The system could, therefore, help predict the need for Health Aide attention on campus, and thus, improve the Health Aide program’s service to students.
A good tool would be WINPEPI.
Ethics
In healthcare or first aid, it is considered unethical to provide anything but the “standard of care,” meaning the best, normal processes for attention to patients. The same is true for an information system like the solution system for the University’s Health Aide Program. The system is not based on widgets, numbers, dollars, etc, but is based on illness, injury and vulnerability. The resident students trust the University to provide the standard of first aid, and therefore, any information system facilitating that first aid must also follow the state of the art in efficiency AND quality.
Further, the users of the system must posses high integrity, because they will be forced to make important ethical decisions regarding the distribution of medicine and supplies, access to confidential information as well as many other unforeseen questions. In order to facilitate good medical/health informatics ethics, the solution system should follow some important guidelines for security.
Security
Automation and digitization are not without certain issues, when applied to a health information system.
Privacy
Privacy is the need for a person to control their own personal health information. In this case, a resident should be assured that any information regarding his health is known only to who he willingly gives that information; the Health Aide program on campus. No other entity should have access to the information. The solution system must use encryption protocols for data transmission to ensure privacy.
Availability
The solution provides real-time data for users concerned with both inventory and analysis.
Accountability
In order to ensure that users are responsible for their access to the database, the solution system uses usernames and passwords that allow only Resident Assistants and the Health Aide Coordinator access. Each user is assigned a unique username and their activity is logged. Also, with the solution system, there is no risk of losing or exposing to third parties the Report Forms.
Perimeter Definition
The system must control the boundaries of trusted access to information. Physically, the server must be located in a locked room. Backup facilities must also be physically secure. Logically, the system must allow only encrypted data communication behind the front-end login page. The epidemiology tools must also be within the trusted access perimeter.
Role-Limited Access
Users of the solution system must only have access to information that is essential to their tasks. This is an area of improvement form the current system, because with the current system, Report Forms are possessed by three different individuals at different points in time (the Resident Assistant, the Health Aide Representative and the Health Aide Coordinator.) With the solution system, the report goes directly from the responding Resident Assistant to the Health Aide Coordinator.