1. Tell us about how and why you got into research.
Well, my research interest started in early 90s when I joined the Ministry of Health, Kenya, as a Systems Analyst/Programmer—after completing my undergraduate degree program with a BSc in Statistics and computer science. Immediately I was deployed to help enhance the national inpatient and outpatient systems that were used to capture data from >5,000 governmental and non-governmental health facilities (hospitals, health centers and dispensaries) across the country. While on these projects, I got interested in research on how to strengthen the of continuity of care processes across the healthcare continuum. Although we implemented several interventions, our efforts were limited by the dearth of technology diffusion in the care system. However, this saw my debut in publishing—we published “Sigei C., Kimani J., Olola C.H.O. et al. Health Information Systems in Kenya. HIS report 1992-1996, MoH-Kenya; 1996.”
In the mid-90s, I was fortunate to go back to graduate school to pursue further education in computer studies, after which I was re-deployed to the Kenya National HIV/AIDS Control Program (NASCOP)—to lead efforts in HIV/AIDS surveillance at 24 sentinel surveillance sites in the country. This was the time when HIV/AIDS was causing immense havoc throughout the world. This accorded me numerous opportunities to venture into HIV/AIDS surveillance research, from which we published several papers e.g., “Okeyo T.M., Baltazar G., Mutemi R., Olola C.H.O. et al. HIV/AIDS Situation in Kenya. NASCOP; 1999.” The rest is history.
After my masters program (MS[IS]) from the University of Leeds, UK, I then moved to the Kenya Medical Research Institute [KEMRI]/Wellcome Trust Research Laboratories (WTRL) to help coordinate malaria research in African children with severe malaria (in 5 countries in Africa)—through the Severe Malaria in African Children (SMAC) clinical network—a US National Institutes of Health (NIH) funded project through a 5-year grant held by Michigan State University, the affiliation of the Principal Investor.
2. Tell us some more about your involvement in the malaria research project in Africa.
SMAC is a multi-center clinical network that is conducting malaria research in 5 countries in Africa: Kenya, Malawi, The Gambia, Ghana, and Gabon. We worked with severely ill children who were mostly comatose with malaria. The main problems were lack of access to immediate and quality care, inadequate diagnostic and data collection tools, and feeble technical capacities to meaningfully combat the ravaging malaria epidemic in Africa. The consortium involved malaria experts from the 5 countries and many others from the US, UK, and WHO. I was attached to the network’s statistical core at the Harvard School of Public Health. By the time of my departure from KEMRI/WTRLs, over 50,000 patients had been enrolled in the several malaria research studies (most of which were randomized controlled trials). We published and continue to publish many original malaria research papers out of the datasets. Some of these datasets are now publicly available (upon request) at the Harvard Dataverse databank: https://dataverse.harvard.edu/dataverse/kwtrp--for other interested researchers to use. It is during my work with SMAC that I got interested in Biomedical Informatics—which saw my departing KEMRI/WTRL to pursue my PhD (Biomedical Informatics – Public Health emphasis) at the University of Utah in 2005.
3. How did you wind up at the International Academies of Emergency Dispatch (IAED)?
During my 2nd year (in 2006) into my PhD program at the University of Utah, my wife saw a very short job advertisement item on bioinformatics, in the classified section of the university newspaper—and she encouraged me to apply for it. I applied and eventually secured the job, as a Data Analyst.
4. How does your 28 years of academic and clinical research experience in health informatics relate to your current role at the IAED?
My PhD (Biomedical Informatics) at the university of Utah was on the enhancement of continuity of care (CoC) using an American Standard for Testing & Materials’ (ASTM) Continuity of Care Record (CCR) Standard. Basically, informatics is the science of how to use data, information, and knowledge to improve the delivery of care—hence improve health of humans. Now, Public health informatics (my PhD emphasis) is the application of this science in the (public) populations—a domain where prehospital care (emergency dispatch) fits in.
5. Please describe the evolution of research at the IAED.
It was a two-person department for some years--Dr Clawson and me. When I started with the IAED in 2006, Dr Clawson was looking for someone to establish a full-fledged research division—to help move research to the next level—specifically to generate more cogent evidence to support the validation and evolution of the dispatch protocols. Before then, just a few research papers (mostly authored by Dr Clawson) had been published in peer-reviewed journals. In late 2007, we started to get part-time help from Greg Scott (who was still full-time with the Consultants/implementation team) and was still on the road a lot. Amelia Clawson & Brett Patterson helped review most of the work before we submitted to publication. We then started, in 2014/2015, to devolve research to external collaborators i.e., with agencies, universities/colleges, communities etc.
The initial start was challenging but, with Doc’s wealth of prehospital care experience, I knew I was in great hands. Although, I had close to 15 years of public health research experience, emergency dispatch was a whole foreign domain to me—I had never heard of dispatch.
At the outset, we faced 2 major challenges:
(1) How do we get our research proposals reviewed and approved? We had no institutional Review (Board (IRB), sometimes known as an Ethics Board.
(2) Where do we publish our research papers? Most peer-reviewed journals did not understand our dispatch work.
One of the very first studies was on diabetes, titled “Ability of a diabetic problems protocol to predict patient severity indicators determined by on-scene EMS crews. We had to submit our research proposal to 6 IRBs in the Salt Lake region! Eventually we secured approval. Data collection was another obstacle—clinical notes were on paper and had to be manually entered into a database. Despite these challenges, from this single project we managed to publish 3 original research papers in respected peer-reviewed journals.
After that, I proposed to Dr Clawson that we register an IRB with the Department of Human Services (DHS) in 2007. So, we gathered the required content and completed the paperwork., Hence the IAED IRB was born—in 2007 and automatously operates under the chairmanship of Mr. Jerry Overton and a team of 10 other professionals.
Where to publish was the next challenge. In 2012, I proposed to Dr Clawson that we needed a registered peer-reviewed journal. I had some prior experience with this process as well. To accomplish this, we needed an ISSN (International Standard Serial Number), which is akin to the ISBN for books. We applied for it, and soon after The Annals of Emergency Dispatch & Response (AEDR) became a reality j; debut AEDR volume v1.1 was published in 2013—with me as the first Editor-in-Chief. We have had 3 editors (Chris Olola, Isabel Gardett, & Greg Scott) since then and I’m now an editor emeritus—still helping with reviews and administration of the journal.
6. While your background is clinical, do you also contribute to police and fire research?
My background is Public Health. So early on with the IAED, fire and police were even more foreign than medical. The thing that got me up to speed in all the 3 disciplines was the Principles of EMD book, taking the IAED certification courses, and lots of discussions with our subject matter experts (Dr Clawson, Greg Scott, and many other dispatch professionals in our organizational network). I did and still do a lot of online learning as well. The IAED subject matter experts for fire and police really helped us begin researching these disciplines. The pioneers were Eric Perry and Jay Dornseif. Then Dave Warner and Chris Knight took over after Eric left, and we’ve since completed multiple published works together—which are being cited by several researchers world over.
Also, the Emergency Communication Nurse System (ECNS) was another new area of research. I had no idea at the start what it was all about! With the help of Dr. Conrad Fivaz, we were able to publish several original research studies on the ECNS.
7. Briefly explain how the center came about and how it can be used.
The Data Center is one of the greatest assets that the Academy has! Back in 2011 we started collecting data from a few users of the ProQA™ software. But since we were using a file transfer protocol (FTP) process, data transfer into our IAED server was relatively slow and could only occur by request. We needed more data, faster, to do comprehensive multi-site studies. In early 2015, Greg Scott and I started brainstorming ways to collect data more efficiently, with less effort for both the IAED and our users. We felt there was a solution out there that could benefit both the IAED and its protocol users. One day we floated the idea to Doc (Dr. Clawson), and he liked it. He gave us approval to proceed and work out a framework for it. Bruce Tenney, Software Developer Manager for Priority Dispatch Corp. was given the mammoth task of making it a reality. Bruce didn’t let us down—he came up with an App (“fusion”) that would seamlessly extract and transmit data to the Academy’s server—from where we would easily access the data and use for research. By early 2018 we were receiving data from just a few agencies. The rest is history! We cannot thank the agencies enough for their continued support in sharing their ProQA™ data (medical, fire and police) via the data center service.
The data center is an asset that serves not only all our 3 organizations (PDC, IAED, PSI), and participating agencies but, the public as well—through access to several rich, useful, and sophisticated data analytics dashboards. We have a publicly accessible deidentified and aggregated benchmarking analytics reports dashboards and private agency-specific analytics reports dashboards. Joining the data center is simple—lots of useful is available at these two sites: https://www.emergencydispatch.org/the-science/data-center\ and https://www.aedrjournal.org/analytics-dashboard-home\. We would like more agencies to come on board and partake of these beneficial analytics, as they support us to help advocate for evidence-based dispatch practice.
8. Describe a study that piqued your interest and why.
One study that stands out as having been less successful was a follow up study which was meant to be an expansion of a study we published in the STROKE journal entitled “Predictive Ability of an Emergency Medical Dispatch Stroke Diagnostic Tool in Identifying Hospital-Confirmed Strokes.” The study published study was based on Salt Lake County data maintained by National EMS Information System (NEMSIS) network and the Utah Department of Health (UDoH). Although the findings were very compelling (with very high sensitivity in predicting strokes), we had wanted to replicate the study using national data. After several fruitless attempts to recruit agencies, we were quickly hit with the reality that the kind of interoperable infrastructure we had in the Salt Lake County—with NEMSIS and UDoH—did not ubiquitously exist across the nation. I guess it was a long shot! And where the infrastructure existed, we encountered prohibiting resistance with legal teams at several states—data sharing outside the state was basically prohibited, even if deidentified to expunge personal protected information. Sadly, after several applications (some even up to the State Attorney General’s office), we gave up and the study never materialized.
9. Give us some tips on creating a research social network.
Learning is a continuous process. It means connected to professionals of diverse backgrounds e.g., informatics, public health, healthcare, information systems, clinical, research, emergency dispatch, et cetera. LinkedIn is one platform where I get research ideas and continued education. It has a plethora of very enlightening presentations on public health, technology, dispatch, informatics—and healthcare and research, in general.
Another platform that I find very useful is ResearchGate. It’s a platform where you network with your peer scientists and researchers, share papers, ask, and answer questions, and find collaborators in your research field.
10. Finally, what is your advice to people who would like to conduct research but don’t quite know where to start.
As I always say, everyone, literally everyone does research. The only issue is that some do not know that they’re already doing it. A good example is everyone (at some point) encounters a problem. A problem needs a solution. And so, one must do an investigation for a solution. Research is basically the systematic application of deliberate methods to investigate a problem and potentially find a solution to it. Reach out to people already in the field for advice and mentorship. A good first step is writing a case study (usually a brief 1500 words max of a unique or interesting case you’ve encountered in your area of work), and/or doing a research poster and presenting at a conference. We’ve published several papers not only in AEDR, but in external journals as well.
Please feel very free to contact me for any advice along these lines. Our research team and will be more than delighted to hold your hands. Evidenced-based dispatch practice is core to our profession. Let’s move dispatch research and profession to the next level—together!