Having worked in various IT (Information Technology) departments and roles over the years, I’ve become accustomed to the point of view that IT workers are “just” overhead. In many organizations, they are considered a cost of doing business. Often the attitude is summed up in a statement like this: “We’ve got to have email, but I’ll be darned if I know what those people do all day!”
Sometimes, it is even worse and the IT department is just seen as an obstacle to work around. As the Wall Street Journal writes: “often it’s just easier to accomplish certain tasks using consumer technology than using the sometimes clunky office technology our company gives us”.
Then there are the poorly supported in-house applications that the IT department tends to throw together. If the organization is large enough, they’ll have a dedicated support team, but, again, this is seen as a cost of doing business instead of something that adds value.
I think part of this can be understood because much of what a savvy technology worker does is completely behind the scenes. If it is done well, the end-user sees the product of the work, but not the hours put into it. The end-user has no means of understanding the work performed.
I encountered just this sort of thinking in a conversation with my brother the other night. In May, he’ll take his boards and become a certified pharmacist. In the past, he’s worked as a lab tech at the Genome Sequencing Center at Washington University in St Louis, so he is no stranger to the value that a good IT department can add to any organization, but he was still under the impression that IT had a “neutral” economic effect.
In an attempt to illustrate just what kind of difference IT has made in the past and can make in the future, I used an example almost any American our age is familiar with: Pa Ingall’s house.
Enamored with the idea of owning his own land (and being somewhat of a loner), Pa headed west and worked and struggled to build a farm and house for his family. He worked long hours, but, at the end of the day, the best house he could build for his family still lacked some amenities like indoor plumbing and electricity that even the poorest modern day American home-owner would consider necessities today. The technology was simply not available (e.g. electricity) or was completely infeasible (e.g. indoor plumbing for prairie homes). Obviously, the creation and spread of technology has helped create a healthier and more efficient home for the modern American.
The Open Source efforts that IntraHealth’s Informatics team are pursuing could offer the same scale of benefits for health care in developing countries. As you can see from the photo to the right, many of these countries still use nineteenth century methods for organizing information about their health care workers. When there is a regional epidemic, the official in charge will have to rely on his memory or go sort through stacks of paper-based records to find the right people to send to the area.
The paper-based system lacks good reporting tools, as well. Manually compiling a list of areas with worker shortages is going to be a time-consuming, error-prone task. iHRIS puts good reporting tools at your fingertips. Reports can be created in seconds, rather than hours or days.
If iHRIS is successful to any degree, we will have a real chance of dramatically improving the health care in these countries by helping the health care workers get better access to training and by ensuring that they are deployed where they are most needed.
This, from something as mundane as providing better access to personnel records.
For someone who has been involved in IT for a few years, the chance to have this kind of impact can be intoxicating!
Posted by
Mark Hershberger on 10/29/2007 • Tags: Africa, Data Collection, Decision-Making, Digital Divide, HRIS, Information Systems, Open Source
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Well, the best answer is “not much.” As I work on an HRIS implementation in Kigali, Rwanda, this week, I have been giving the need for accurate, continuously maintained data a lot of thought. Many developing countries have embraced decentralization—the shift of decision-making authority from the central level to the regional or local level. While decentralization has many good points, it presents challenges for collecting country-wide data. Imagine a situation where every region and district used a different method for collecting and sharing data on health workers! While separate methods of data collection might work well locally, lack of consistency across the country makes collection of data for use at the government level challenging at best.
We all know databases rely on consistency of information to generate reports. To get consistent data, regional and local health managers must have a way of submitting standardized data to the central level that does not add an excessive additional burden. More importantly, local health leaders must see the benefit of providing data to the central government—access to country-wide aggregate information, increased services from the Ministry of Health or easier maintenance of their own health worker records.
Ensuring a local level commitment to share data is only half the challenge. Western culture is data oriented—we love charts, graphs and numbers. Because current data is often lacking, many health leaders in developing countries have, by necessity, learned to rely on intuitive decision making. Add this to an increasingly rapid shift from paper based systems to databases and the process can be overwhelming.
For me, this is where Pam McQuide’s stakeholder leadership group model becomes so important. Stakeholders united in a common purpose and pursuing a shared benefit can agree on appropriate, effective ways to evolve well-entrenched methods of data collection. Having seen the success of the stakeholder model time and time again, even I find myself here in Rwanda still fighting the siren song of the perfect system to focus on what is most important— local stakeholder leadership and the data itself.
Posted by
Vanessa Spann on 10/24/2007 • Tags: Data Collection, Data Quality, Decision-Making, ICT4d, Information Systems, Leadership
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When we design information systems, particularly working with stakeholders who have had difficulties accessing data in the past, it can be very tempting to collect every piece of data we can think of, just because we now have a tool that can capture and store the data. But we have to resist such temptations, or we’ll end up with systems that are too bloated to maintain and unwieldy amounts of data that are impossible to analyze meaningfully.
We’ve all seen forms that ask for so much information it’s exhausting to even think about filling them out. What incentives do we have to complete such forms, or to not rush through them as quickly as possible? The data entry person who fires up a bloated information system has the exact same reaction. When faced with a seemingly endless number of fields to complete, she might be tempted to skip some or fake data if all fields are required. She typically doesn’t know what is critical to the analyst. So bad data goes in, and bad analysis comes out. The system runs the risk of being abandoned, either by the people trying to maintain it or the people trying to get information out of it — or by everyone.
It’s better, when first designing the system, to ask “why” about each data field that is proposed. Why is it necessary to collect this? What report will require that data item to be complete? How will you use this piece of data to make better decisions? That’s why we typically ask stakeholders to come up with their most critical policy and management questions that they have been unable to answer because they couldn’t access the pertinent data. This process narrows the types of data that the system needs to collect to only the most critical pieces of information and helps us avoid “data smog” that can actually keep analysts from making good data-driven decisions.
Even with this process, it’s difficult to control the kid-in-a-candy-store mentality. Sitting down with stakeholders and brainstorming requirements for a new module often results in calls for everything but the kitchen sink. Just because we can collect a lot of data doesn’t mean we should.
I think it’s better to take a minimalist approach, especially when first introducing an information system to an organization that hasn’t used one before. Real-world use of the system will reveal which critical pieces of data may still be missing, and those fields can be added in a later version, or by the organization with a customized need. It is better, I think, to risk the system being too small than being too large.
What do you think? How much data is too much?
Posted by
Shannon Turlington on 10/22/2007 • Tags: Data Quality, Decision-Making, Design, Information Systems
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I had the great fortune to go hear Edward Tufte talk the other day. If you are unfamiliar, Tufte is a Yale professor who is a master at analytical design. He’s written (and self-published) four books on better information display and has even pioneered some new ideas in the field. Though there was a lot to learn in a one day course I will need to think and study much of it some more to start applying those ideas to our work here at IntraHealth. The obvious areas for Tufte’s lessons to work their way in are: interface design in our applications, reporting tools for iHRIS and other apps, our work on data-driven decision making, and the simple presentations we all have to make from time to time.
On presentations, Tufte has always had a lot to say (in the negative) about PowerPoint, and though sometimes humorous he did make it clear that often the bad design that PowerPoint forces on users is used in the dissemination (or more likely not) of very important, and life-saving information. Those are definitely not the times to not be using slow revealed bullet points!
One thing Tufte talked about that I personally want to think about more is the idea that the principle of design is the same as analytical thinking. One must show comparison and causality in design just as they would when simply thinking about the problem. A good chart is one that compares findings with a norm, or another similar scenario and then gives the cause. Yes, all in one chart. Tufte’s books are full of good examples from Galileo to a good newspaper sports page. When considering the amount of information millions of people acquire from the tables of the sports page everyday, it is not so daunting a task to show a similar amount of data to someone who needs to make a decision about the health care in their country. There is no such thing as clutter, there is only bad design.
We, at IntraHealth, are designing all the time. From software applications such as iHRIS, to paper-based public health systems, its all design. As Clay Shirky recently wrote “users are experts in their own lives” therefore “Design is humility.” Something we should always keep in mind.
Posted by
David Mason on 10/19/2007 • Tags: Data Quality, Decision-Making, Design, Development, Documentation
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Kenyan born Samwel Wakibi is a Human Resource Information Systems Advisor for IntraHealth. With over 18 years of experience in IT, social research, data management and project monitoring and evaluation, Mr Wakibi helps to develop, implement and strengthen HRIS databases in the field.
As an HRIS advisor Mr. Wakibi works to initiate and facilitate these processes and is a firm believer in the participatory process undertaken by IntraHealth and the Capacity Project. “The strength of HRIS is in the development and implementation process. These are the points at which data quality ingredients of accuracy, completeness and timeliness can be inculcated. Participatory approach, adopted in all IntraHealth and Capacity Project system development, is crucial as it generates ownership, empowers database owners, builds capacity and opens communication channels between users and also developers,” said Mr. Wakibi. “Health care, just like any other service, is dependent on the person delivering the services. HRIS provides information about the number of health workers, their work stations and their skills. This information can be used to deploy and allocate tasks to health workers according to the needs in the health sector as guided by the burden of diseases and injury trends experienced over time.”
Mr. Wakibi has helped to implement programs most recently in Uganda, Southern Sudan, Lesotho and Kenya.
In Uganda, a registry database has been developed and fully implemented. iHRIS Qualify for the Uganda Nurses and Midwives Council (UNMC) is now fully operational and data entry is current. Reports have been designed and developed based on identified management and policy questions gathered from the system owners at the UNMC and in the health sector. Presently, similar modules for the other professional councils in Uganda are being completed. Training on data use for decision making has also been conducted to expand the scope of managers in the health sector on evidence-based decision making and policy formulation.
Southern Sudan is emerging from 25 years of civil war that destroyed the infrastructure and institutions both private and governmental. The demand was so great for an HRIS system to provide answers and information, guide decision making, policy formulation, development and sound implementation of HR strategic plans that a quick fix step solution was preferred. After the stakeholder leadership group was formed, Mr. Wakibi conducted a needs assessment and developed a Microsoft Access-based “step” solution to provide answers as better alternatives are being sought. Data are currently being collected from training schools and states. Data collection and entry should be completed in November 2007.
Most recently in Lesotho, Mr. Wakibi conducted a needs assessment and developed an HR database. Similar to iHRIS Manage, the Microsoft Access-based system is designed to track staff movement, attrition and monthly payments made to employees. In addition, it will provide staff statistics for budgeting purposes, monthly under/overpayments to staff and staff complements that will trigger a recruitment process where there are shortages due to transfers, promotion and attrition. It is estimated that by the end of October 2007, a complete and clean dataset for all employees of the Ministry of Health and Social Welfare will be ready and available to managers for decision making. Reports are to be designed and developed in November 2007. Other system developments under way include an iHRIS Qualify for the Nursing Council.
In Kenya, a stakeholder leadership group has been formed, a needs assessment undertaken and required equipment has been acquired. The development of iHRIS Manage is under way.
In all these developments, staff members from the client government ministry or council are fully involved in order to build capacity to develop and enhance the database and production of tailored reports from the databases.
Mr. Wakibi is committed to helping implement systems that can build human capacity and wants to make certain those systems are effective and that health professionals feel confident using and developing HRIS independently.
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Luke, HR Information Systems (HRIS) senior developer, and myself, Geographic Information System (GIS) manager, visited the “Free and Open Source Software for Geospatial” (FOSS4G) conference in Victoria, Canada this last week. We wanted to get a better handle on how HRIS and GIS could interact within an open-source context. We walked away with some major conclusions and ideas on how to further develop GIS capabilities within and beyond HRIS. But as HRIS is built on the premise of open-source, this conference also gave us an opportunity to participate and learn from an organized community of geospatial software users which has been making progress in furthering the open-source ideal.
What we saw was a young and passionate movement not-so-subtly showcasing their dedication for open-source as a tool by which to challenge corporate, or closed-source, IT monopolies in the geospatial domain. Just like the domination of (preinstalled) corporate Windows operating system over the free and viable Linux alternative—for no reason other then “familiarity”—so is the purchase of ESRI products, the leading closed-source geospatial analysis software system, taken for granted in the geospatial realm. Sold for a hefty price and with annual update/support contracts, ESRI dominates, over the free, open-source GIS software available. Why is this? Is open-source GIS less viable then its big, corporate version?
FOSS4G challenged corporate geospatial IT by providing a different vision. As Damian Conway, PERL- enthusiast and keynote speaker emphasized: “Open Source software development and support is based on a model of collaborative interaction that is entirely different form the competitive world of commercial software. It’s not a business, it’s a culture”. A culture? In the geospatial world, this culture of open-source expresses itself, according to Paul Ramsey, Director of Refractions Research, through four largely independent development “tribes”: “within each tribe, developers cross-pollinate very heavily, contribute to multiple projects, and have high awareness of ongoing developments.”
The tribes are identified by some of their totem pole (apt Canadian analogy for the symbol that focuses their unity) software solutions. First there is the “C” tribe, including geospatial software such as MapServer, GRASS, PostGIS, QGIS. Then there is the Java tribe, building geospatial solutions from a java platform with products like GeoTools, uDig, Geoserver. Then there is .Net tribe, consisting of developers working on Worldwind, SharpMap and other software. Finally, a loose category of developers are part of the Web tribe, including various toolkits and webservices providing browser based spatial services. So when there are tribes, where is the tribal warfare (don’t tribes always do that?)? And, to extent the analogy, how does the neocolonial corporate ESRI system relate to them? Capitalist oppression and exploitation of the hobbying, tribal geeks?
One would assume that the existence of four developer community tribes in the geospatial open-source world would automatically assume a hefty competition for resources, if not all-out tribal warfare. This in fact does not seem to be the case at all. I tried myself to ask one of the tribal member to compare his Java based webmapping server with the C++ version. He smiled at me and pretty much explained that there is little difference, and what more, that in fact they would operate with pretty much any other software solution outside of their tribal clans. Reason? The interoperability principle. That, and perhaps the fact that all tribal members are united through the ambition of statehood.
What makes open-source so different from a corporate system like ESRI is its fundamental interest in building software according to universal standards. This in contrast to the strategic interest of any closed, corporate system to somehow make users reliant on their system alone. Interoperability refers to the achievement of exchange of communication and data through common standards across software platforms and databases. In the geospatial world, the Open Geospatial Consortium has been working hard to achieve these standards, and the fruits of this labor is the lack of any ethnic warfare between the open-source tribes roaming around in geoland.
Interoperability is also about synthesis, or the emergence of a larger whole out of components by allowing for free flow of information, interactivity. In the words of David Schell, CEO and Chairman of the Open Geospatial Consortium: “Interoperabiltiy seems to be about the integration of information. What it is really about is the coordination of organizational behavior.” Or, in other words, interoperability is created by organizations working together to more efficiently achieve goals.
The lessons for HRIS, Capacity building, and international development at large might be obvious: open architecture is important if not crucial because it provides free access to a diversity of information, motivates integration the coordination of organizational behavior. It is possible to develop lasting technology solutions in real-time, facilitating a common picture of reality for different organizations that all have different views of the situation collectively. Open-source is about creating community through diversity. It is the essence of democratic behavior itself. Because there is no ownership, open-source maximizes the willingness of partners to share data, ideas, and innovations, and it allows software to move beyond building stove pipes, or vendor specific solutions, and address requirements built to a standard.
Posted by
Danny de Vries on 10/17/2007 • Tags: Capacity Building, FOSS, FOSS4G, GIS, HRIS, Information Systems, Open Source, Sustainability, Technology
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