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HANDI – A Handy App for Public Health

Categories: Disease Investigation, General, Response

2 phones lying on table

By Melissa McClung, MSPH
Denver Public Health

The next person in line hands me their driver’s license.  I scan it with a device docked with my iPod touch, ask some questions, print a barcoded sticker, and direct them to where they need to go.  Are we at the airport?  Car rental?  Sports venue?  None of the above!  We are at a mass vaccination clinic administering flu shots during a hospital employee flu campaign.  This handy tool is appropriately named HANDI (Hand-held Automated Notification for Drugs and Immunizations); it’s a mobile app being developed by Denver Public Health (DPH).  HANDI helps health care workers collect data to register individuals, monitor contraindications (reasons to withhold a treatment) and track immunizations and treatment plans administered during mass intervention events.  Using commonly available mobile devices (e.g., iPhone, iPod touch), HANDI is a prime example of how we can use mobile technology in public health and emergency preparedness.

After years of emergency response planning and experience with mass H1N1 vaccination clinics, DPH wanted to improve the process.  A mobile application such as HANDI, adaptable to a variety of clinic formats and environments, significantly reduces the time needed to serve the population and considerably enhances our ability to monitor these efforts to protect the public’s health.  From our prior experience, patient registration and data entry were time consuming steps.  A mobile application addresses both issues by using scanning technology to capture standardized patient data and inputting it directly into a database or registry.  Rapid electronic data storage allows for real-time data analysis (e.g., number of people served, demographic characteristics, risk factors and geo-locatable information).
The main goal of HANDI is to support efficient public health immunization and treatment activities through rapid collection and transfer of standardized data.  During a mass intervention, event specific information is defined using the HANDIMan (event manager), and downloaded onto the device.  Three different workflows or “stations” may be combined or separated based on personnel and patient throughput during the intervention process:

HANDI at Flu Vaccination Clinic

Station 1 – REGISTRATION:  the healthcare worker scans each patient’s driver’s license using an innovative “sled” that couples with the mobile device and reads the magnetic stripe or 2-D barcode.  Additional data can be entered manually if required (e.g., phone number, race, and health insurance information).  Using a mobile printer, a barcoded label with the patient’s unique identifier is printed and given to the patient for presentation at the other stations.

Station 2 – INTERVIEW/CONTRAINDICATION: the patient’s barcode label is scanned, and the patient is asked health questions relevant to the intervention (e.g., is the patient allergic to eggs?).  Patient responses are recorded by the healthcare worker on the device.

Station 3 – DOCUMENTATION: the patient’s barcode label is scanned and intervention specific data (e.g., manufacturer, lot number) are recorded, the dosage and site are determined if applicable, and the vaccine or drug is given.  A card with vaccine or drug information is provided to the patient.

After the station-specific workflow is completed, data are saved on the device and transferred to the application server either in real-time or when a connection is established.  The server bundles the data from each station and the complete patient record is securely transferred to a designated database or registry (e.g., state immunization registry).

Melissa from DPH swiping card into phone

HANDI was first tested during the Colorado State University meningococcal vaccination campaign in November, 2010.  DPH partnered with the Larimer County Department of Public Health and Environment and shadowed 42 patients.  The average time from when the patient signed consent to when the injection was complete was just 5 minutes.  HANDI users reported that data entry was easy, straightforward, intuitive, and fast.  HANDI was next deployed at the Denver Health mandatory hospital employee flu campaign conducted during Fall of 2011.  HANDI was used during five flu clinics to vaccinate 242 employees.  The average time from when the employee signed consent to when the injection was complete was about 4 minutes.  HANDI users strongly agreed that HANDI is a good way to enter data and would use HANDI again to collect data.

Although vaccination times were comparable to times without the use of HANDI; the real time savings was with data entry.  Prior to HANDI, each patient’s data had to be manually entered into a database or software application, sometimes more than once.  This process was resource intensive, time consuming, error prone and often did not get done.  HANDI significantly improves the process by reducing the amount of data entered and storing standardized data electronically.  Using HL7 messaging, data were available for transfer to state immunization registries in near real-time instead of months afterward.

Next Steps

Although HANDI was first developed for mass immunization events, we have efforts underway to expand its use.  HANDI is being modified to include an expanded public health data model to accommodate a wide range of public health services beyond just immunization and other preventative treatments.  Health care reform will require public health to play a significantly different role.  Public health teams will include outreach workers who collect information to support community-based interventions to improve health.  Using mobile technology, such as HANDI, increases our ability to more accurately record activities happening in the community.  These data may be linked to other data sources (e.g., electronic health records) for a more comprehensive view of the continuum of care.

So can you download HANDI from the App Store?  Well, not exactly.  While we tried to make the HANDI app as simple as possible, the server components (e.g., HANDIMan, database, data engine) are more complex due to data management, security and messaging.  Every organization’s unique network security requirements also impact a HANDI installation.  However, we are happy to share our experience and lessons learned, and stay tuned as we continue to develop HANDI into an accessible universal tool.

Can you think of a use for HANDI in your health department or practice? Have questions about the app? Leave us a comment.

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this blog is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. February 2, 2012 at 3:58 pm ET  -   Ashley

    As a college student I am interning and working with the Idaho Immunization coalition and believe that this is a giant step forward in improving immunization rates. I hope that through collaboration and improvements this will also help aid in improving childhood immunizations rates.

    Link to this comment

  2. February 3, 2012 at 7:36 am ET  -   Dalpay

    How do you keep the reader from becoming a Fomite? Is it stored in a UV sterilization unit when not in use?

    Link to this comment

  3. February 3, 2012 at 8:57 am ET  -   jami krugman

    we love your idea and would like to implement something like this in our community immunization clinic keep us up to date

    Link to this comment

  4. February 4, 2012 at 1:34 am ET  -   sibauk bieb

    not everyone would have driver’s license that can be scanned. in this case it would be difficult to improve data acquisition and management, particularly in developing country situations. however the potential for this application use in developing country public health situations is good. are there any plans to trial this application in a developing country situation, say in a vaccine preventable disease situation?

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  5. February 4, 2012 at 9:19 am ET  -   PJ Geraghty

    We are looking for something exactly like this to simplify organ donor registrations across the country. I would be grateful if someone could contact me via email to discuss this further.

    Link to this comment

  6. February 5, 2012 at 11:36 pm ET  -   Ral Marti

    The mass proliferation of mobile handheld devices linked to greater information highways and databases has allowed the convergence of technology access.

    This is a great step forward and is a potential groundbreaking technology, not only in immunization space, across medical and crisis management applications. I would like to seem more articles such as this.

    R Marti

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  7. February 6, 2012 at 9:00 am ET  -   colloidal silver

    Legislation requires that the EPA be notified if chemical spillage occurs, and the system works via a sliding scale. The more toxic a chemical, the less is required to spill before notification is required.

    Link to this comment

  8. February 7, 2012 at 5:28 pm ET  -   Tom Michels

    I think this is a great idea. I could see where this kind of technology, or a version of it, could be used in every day life in the clinic. As far as the units being a fomite, I would thing in the grand scale of pandemics, this would be the least of our worries.

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  9. February 9, 2012 at 1:14 am ET  -   Kathy Griffin

    The steps taken by technology on a daily basis is simply amazing. With such mobile apps, it will be real easy for both common citizens as well as medical attendants. The process is quick and does not waste much time.

    Link to this comment

  10. February 14, 2012 at 1:25 pm ET  -   Michael kelley

    i would be interested in using the application for a POD exercise. Is there a contact person for the project?

    Link to this comment

  11. February 23, 2012 at 12:55 am ET  -   May reynante

    Kids do not have drivers license, how is it use for kids?

    Link to this comment

  12. March 12, 2012 at 11:58 am ET  -   Melissa McClung

    AUTHOR COMMENT: HANDI does allow manual free text entry so that people without licenses can be entered. Also, there is a feature that allows children to be added under their caregiver’s record so that the data do not have to be reentered and the parent/child relationship is captured.

    Link to this comment

  13. March 14, 2012 at 10:35 am ET  -   Jennifer B

    What are the security measures on this application?

    Link to this comment

  14. March 15, 2012 at 11:56 pm ET  -   Drew W.

    I think that this technology should be used to its maximum potential and will enhance public health.

    Link to this comment

  15. March 16, 2012 at 7:25 am ET  -   Susan Thomas

    This is a great development! Data entry is always a place for heavy error in Public Health and I feel that this will eliminate some of the human mistakes that often come with carelessness. I also have questions regarding the use of this technology in underdeveloped nations as well as what other forms of identification you can use to scan.

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  16. April 10, 2012 at 1:54 pm ET  -   Melissa McClung

    As a local public health department, we do not have plans to test HANDI in underdeveloped nations at this point.

    With respect to what forms of identification can be scanned, 3-track magnetic stripes and 1-D and 2-D barcodes can be scanned by the scanner or “sled”, but a parsing routine must be developed for each specific stripe or barcode in order to process the text string into usable data. We intend to enhance HANDI to scan employee badges for the next flu vaccine campaign.

    All of HANDI’s data are encrypted using AES 256. Both the device and the app are password protected, and data are transferred using secure network environments. Mobile device management software is installed on each device to provide the capability of wiping the device if it were to become lost or stolen.

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