18.9.1992, EcoInforma ’92, Bayreuth: Workshop “Environmental Health Information Systems”

2^nd International Congress and Exhibition on Environmental Information & Communication (Eco-Informa ’92), 14-18 Sep 1992, University of Bayreuth.

Session #29 (Workshop) Environmental Health Information Systems; Room: H10. Chair: R. Fehr [92-14]; Program:

• 10:30 Fehr, R. (IDIS, Bielefeld, D), Overview of Issues on Environmental Health Information Systems [92-4]
• 11:00 Brand, H., T. Lenz (Gesundheitsamt Minden. D), Information Systems for the Public Health Services – What Do They Need?
• 11:30 Stern, R.M. (WHO Europe, Bilthoven, NL), Geographical Information Systems for Environment and Health in Europe
• 12:00 Fehr, R., A.-B. Kobusch, E. Kohn-Schulze (IDIS. Bielefeld. D), An Index System Facilitating the Integrated Usage of Environmental Health Information Sources [92-5]

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Overview of Issues on Environmental Health Information Systems

R.Fehr, Institute of Social Medicine (IDIS), Westerfeldstr.35-37, W-4800 Bielefeld, (Textfassung) Eco-Informa, 18.9.92, (Diskette E, File Ecoinf4.txt) [92-4]

The renowned Institute of Medicine of the US Academy of Sciences in its recent volume: The Future of P[ublic] H[ealth], defined the mission of PH as follows: assessment, policy development, assurance. Among the more important sub-disciplines of PH is E[nvironmental] H[ealth], which

• is based on environmental epidemiology and toxicology
• investigates the impact of the physical environment on human health and
• deals with environment-related health hazards, risk assessment, preventive measures, and their evaluation.

The practice of EH, e.g. in local health departments, covers assessment, enforcement, planning, reporting, consulting, health education, etc. Correspondigly, an easy access to detailed, reliable, and current information is needed on a large scale. EH information needs may be structured into broad categories such as:

• current status of an area (monitoring of exposures, health outcomes, confounders, etc.)
• scientific knowledge on causal relationships etc.
• legal regulations of EH hazards
• resources (institutions, experts, information materials).

To provide this easy access to EH information, appropriate information systems are being called for in programmatic documents such as: European Charta for Environment and Health, Health for All 2000 by WHO Europe, Healthy People 2000 by P[ublic] H[ealth] S[ervice], US-DHHS, Healthy Communities 2000 by A[merican] P[ublic] H[ealth] A[ssociation]. In these documents as well as in other contexts, the term “information system” may legitimately be interpreted in different ways, i.e. either in the sense of technical systems, espec. electronic database systems, or in the sense of complex systems, e.g. cooperative networks which take advantage of but go beyond merely technical information systems.

EH information sources obviously include print materials as well as electronic databases. As for electronic databases, there now is a vast and diverse supply of systems; about 500 or more different systems are now publicly available. Among the electronic systems are (i) inquiry systems which, from the user perspective, allow for retrieval only, (ii) storage and analysis systems, incl. GIS, (iii) communication systems, e.g. mailbox systems.

This paper focuses on inquiry systems only. Electronic inquiry systems are either portable, i.e. systems on diskettes or on CD-ROM, or online systems, accessible at hosts. Confronted with the number and diversity of existing systems, it is essential for the user to know about typological and quality characteristics. Inquiry systems may conveniently be characterized in several ways:

• certain basic types of databases can be distinguished
• the information can be arranged according to various “axes” of access
• a set of 6 classification criteria and of 6 quality criteria has been developed.

The basic types of databases are; bibliographic, directory, factual, full text, and statistical. In particular for factual databases, the usual axis of access is by noxious agents (espec. chemicals), although the other access ways are also often needed. The 6 proposed classification criteria are: 1. availability (public / restricted), 2. way of access (portable / online), 3. topic area (EH in general / chemicals…), 4. time-space relationship (general knowledge / local situation), 5. target group (level of expertise), 6. language.

The 6 proposed quality criteria are: 1. data quality (validity, assured espec. by peer review procedures), 2. timeliness (absence of significant lag-time), 3. breadth of information (example of factual database on chemicals: number of chemicals covered), 4. depth of information (same example: number of categories, and completeness of information in these categories), 5. user friendliness (e.g. choice between command mode and menu-driven handling), 6. cost-benefit ratio.

Obstacles barring the more widespread use of such systems by PH practitioners include: lack of knowledge about what is available; lack of equipment; system design factors; user qualification, training needs; finance. To overcome these problems and to take full advantage of existing resources, some kind of strategic EH information planning is needed. Today, information workstations can access a multitude of portable and online information sources to meet specific wants and needs while operating at relatively low cost levels.

In the state of North Rhine-Westphalia in Germany, it is planned to provide standardized information workstations to all 54 county health departments in order to enable them to take full advantage of information resources on EH issues. With 10 of the health departments, a pilot phase has just been completed. This will be described in more detail in my second paper today.

With more and more people having access to a growing set of information sources, it becomes increasingly important to reflect on the pros and cons of alternate approaches such as: print sources vs. electronic sources; portable vs. online sources; factual vs. bibliographic databases. Time does not allow to go into details at this point, but the result of our own evaluations is that, considering the complexity of most EH issues, no single system can meet all the needs. Integrated usage of several systems seems to be the way to go. In this situation, there is a marked demand for orientation, support, “guidance”, training, etc. Here I see a real challenge for Environmental health information centers on international, national, and regional levels to meet these demands.

The IDIS institute has functioned as a mixture of regional and national information center for quite some time now. So in concluding, I give an overview of EH information management from the perspective of IDIS. We distinguish 3 functional levels, from basic, i.e. access improvement, over intermediate, i.e. provision of additional supply, to advanced, i.e. more direct contribution to health promotion.

• For level 1, the concept is: classification, selection of appropriate materials, and making these materials accessible to users. Specifically, this means running a library, archives, an “electronic library”, and a documentation of relevant institutions and their respective materials.
• For level 2, the concept is production of additional materials (print and electronic) in order to fill certain gaps. The IDIS produces the only German-language bibliographic database SOMED on social medicine and environmental health issues; the Noxious Agents Information System NIS to be described in the other paper, and several print materials.
• For level 3, the challenge is to support health promotion and a healthy policy, espec. in the state of NRW. Current activities include EH reporting, EH statistics, and EH planning involvement, espec. in the context of Health and Environmental Impact Assessments.

I hope that this paper succeeded in giving an overview, albeit incomplete, of important issues on environmental health information systems and management aspects. If you ask me about my bottom line opinion, I would like to suggest that adequate employment of EH databases and information systems (by state and local health departments) is likely to lead to a significant increase in competence and efficiency for EH problem-solving and decision-making – but also: that there is a long way to go until a smooth and efficient path can be offered to all parties concerned with EH. It is my hope and expectation that this session here today will contribute to identifying this path of successful EH information management.

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An Index System Facilitating the Integrated Usage of Environmental Health Information Sources

R.Fehr, A.-B.Kobusch, E.Kohn-Schulze, Institute of Social Medicine (IDIS), Westerfeldstr.35-37, W-4800 Bielefeld, (Textfassung) Eco-Informa, 18.9.92, (Diskette E, File Ecoinf3.txt) [92-5]

Background: State and local health departments in Germany are experiencing an increasing need for environmental health (EH) information. The Ministry of Health of North Rhine-Westphalia charged the IDIS Institute with the task of developing an information system to meet these needs. IDIS has developed an integrated electronic information system which combines features of a factual database with those of an index system.

Information workstations: For the purposes of a pilot study, information workstations have been established in a number of selected local health departments.

NIS: These workstations are equipped with the Noxious Agents Information System (NIS) and provide access to portable and online EH information sources. Development of NIS was based on an extensive review of currently available systems and an analysis of the EH information needs of the Public Health Service. The menu-driven system consists of several modules (factual, index, bibliographic, and glossary) and tries to satisfy the needs of advanced as well as of occasional users.

NIS-FAKT – NIS-BIB – NIS-GLOSS – NIS-INDEX. NIS facilitates access to eight different information sources, which consist of three print sources (series) and five factual databases. Two of the databases (ECDIN, HSDB) are accessible online at the host DIMDI in Cologne; the other three (CESARS, CHEMINFO, HSFS) are contained in the portable CCINFOdisc system of the Canadian Center for Occupational Health and Safety in Hamilton, Ontario.

Print sources – Portable databases – Online databases. Pilot phase, evaluation: The first part of the 3-year pilot phase is currently being completed, and preliminary results of an ongoing evaluation are now available.