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  • mHealth economics and finance are separate and integrated

    As mHealth continues to expand, especially from narrowly focused wearables to sophisticated clinical data and Artificial Intelligence (AI), robust economic and financial profiles are more important.

    Underlying sequences and profiles over time reveal information than can help to modify existing mHealth services and plan investments. A team from Acfee , the Johns Hopkins Bloomberg School of Public Health (JHU) and Johns Hopkins University Global mHealth Initiative has constructed a stage-based process for integrating economic and financial evaluations into business cases and M&E.

    Published this month in Cost Effectiveness and Resource Allocation (CERA), “Defining a staged-based process for economic and financial evaluations of mHealth programs” describes how eeconomic evaluations generate evidence about value for money achieved by a project. Financial evaluations provide evidence on the financing required to initiate, sustain and expand programmes and assess their affordability. Integrated economic and financial evaluation has several advantages. It:

    • Demonstrates how mHealth can be implemented concurrently across lifecycle
    • Helps to manage progressions across stages of maturity
    • Improves the rigour of evidence, optimise allocations of scarce and finite resources
    • Facilitates programme planning, implementation, efficiency, effectiveness and sustainability.

    Economic and financial data have some common features. It’s a theme important for Amnesty LeFevre from JHU, She says “There are so few high quality evaluations of digital health solutions, let alone ones that rigorously explore costs and consequences, particularly across sub-populations and geographic areas and consider the financial implications of sustaining and scaling up. Our article aims to promote evidence-based decision-making and encourage decision-makers to rely on a wider range of analyses to inform their decision on optimal resource uses.” It needs six stages:

    1.     Defining programme strategies and links with strategic outcomes

    2.     Effectiveness assessments

    3.     Full or partial economic evaluation

    4.     Sub-group analyses

    5.     Estimating resource requirements for expansion

    6.     Affordability assessment and identifying sustainable financing models.

    It recommends analysts:

    •  Prioritise activities within these stages based on programmes’ links with health outcomes
    • Align these with mHealth solutions’ broader stages of maturity and evaluation
    • Incorporate into M&E activities and match outputs to stakeholders’ evidence needs
    • Fit to time points of initiations and secure available evaluation resources for each stage.

    Acfee’s Sean Broomhead and a report author said “mHealth is a crucial and expanding part of Africa’s health systems. It’s vital we can show it’s worth it, affordable and sustainable. This rigorous methodology has an essential part to play in mHealth’s future.” Adopting the combined methodology will help to improve mHealth’s role in health systems.

  • Cyber-security has a smarter step up

    Chasing cyber-threats is a wearisome endeavour. A US healthcare provider’s relying on analytics to deal with some of the drudgery and anxiety. RWJBarnabas Health has twelve hospitals and some 250 clinics. A report in Fierce Healthcare says it’s halfway through a four year cyber-security upgrade that uses data analytics and network visualisation tools to track who’s accessing patient data and which devices are connected to the network. The aims are to detect and report threats and provide its system with more latitude to integrate mobile devices and step up mHealth.

    It’ll also improve the ICT department’s productivity to conduct manual network scans to identify new devices as they were connected. Now, it uses software to track devices in real-time and deploys monitoring tools to track the movement of patient data.

    It may be a benchmark for Africa’s health systems’ cyber-security trajectory. Balancing data sharing and network accessibility with privacy and security’s a challenging prospect with limited numbers cyber-security staff. Using analytics can be part of the solution. 

    The US healthcare systems are enduring sustained, and possibly increasing cyber-attacks. A recent report from Protenus Breach Barometer says almost three times more patient records were accessed in March compared with February and January combined. About a third of March’s 39 breaches were linked to hacking. Nearly 85% targeted hospital providers. These risks could increase as healthcare adopts more Internet of Things (IoT) initiatives and there reliance on networked devices.

  • Vodacom Siyakha launches mHealth for expecting mothers

    Siyakha means ‘we are building’ in isiZulu. It’s also a platform used by Vodacom South Africa, and offers prepaid customers free access to a range of zero-rated sites, including:

    • Vodacom insurance products
    • Free health content from the TV series Hello Doctor
    • Vodacom’s infotainment platform Video Play
    • Educational portals and careers and jobs websites.

    Vodacom Siyakha has an mHealth service for pregnant mothers too.  Mum and Baby builds on Siyakha’s health service to offer maternal support to pregnant mothers. It provides educational articles videos and health information containing stage-based pregnancy information and advice. An article in IT News Africa says Mum and Bay also provides free health information and videos for childhood development too, extending across children’s first five years. Expecting mothers receive three weekly SMS’s to keep them undated on the progress of their pregnancies. These videos and SMS’s cover a range of health topics including:

    • Sexual and reproductive health
    • Breastfeeding
    • Immunisation
    • Early childhood development
    • Mother and child bonding
    • Nutrition
    • HIV/AIDS.

    A publication at My News Room, says Mum and Baby’s available in several languages, making it more accessible. The solution targets expectant mothers who lack easy access to healthcare facilities, It can be used by family caregivers too, who’ll be empowered with information and tools to use in their daily work setting.

    Vodacom customers can access Mum and Baby by dialing *111*88#, a prepaid number, or visiting the Siyakha mobi site.

  • mHealth good practices can reduce avoidable readmissions

    Many people don’t like the prospect of being admitted to hospital. It’s tolerable when it’s unavoidable. Being readmitted when it’s avoidable’s not a pleasant step, both for patients and their families and friends. A report from Mobile Smith, an app platform provider, says about 70% of the US’s hospital readmissions are avoidable. It’s hard to find equivalent numbers for Africa’s health systems.

    How Mobile Apps Can Reduce Preventable Readmissions sets out efficient app strategies that lead to quick impact on reducing avoidable readmissions. They’re:

    •  Effective discharge communication to minimise poor communication with patients and families members at discharge, a main reason for readmissions arising from confusion about follow-up care and prescribed medications
    •  Better discharge procedures that include education, communications with patients and families, support after discharge and fewer unresolved medical issues needing action after discharge, all of which result in lower readmission and improved patient outcomes
    • Use an app for post-discharge with interactive functions that includes promoting self-reliance, empowering patients to take charge of their health, connections to EHRs’ messages, managing appointments, access to educational articles and storing documents and notes
    •  Improving prescription adherence, including knowledge of the purposes of their medications and interactions, to improve health outcomes by tracking medication doses and intervals receiving medication reminders and recording reactions.

    There are six good practices:

    •  Research, know and understand target patient groups
    • Start simple and iterate often
    • Polish user interfaces and experiences
    • Keep apps fresh
    • Establish secure data exchanges
    • Embrace analytics to track utilisation and understand positives and negatives.

    These are valuable requirements for all mHealth initiatives. Africa’s developers and users can benefit by adopting them.

  • Sierra Leone sets up a National eHealth Coordination Hub

    Succeeding with eHealth’s complexities across national health systems invariably needs a core organisation. Sierra Leone’s Ministry of Health and Sanitation has set up its National eHealth Coordination Hub to co-ordinate and regulate eHealth. It’ll also support eHealth expansion across the country’s health system. The Ministry of Information and Communications is a leading part of the initiative too.

    A report in Awoko says support’s provided by UNICEF as part of a US$2 million project financed by the United States Agency for International Development (USAID) to strengthen Sierra Leone’s eHealth Management Information System in Sierra Leone. It’s part of the US Government’s commitment to strengthen health systems and services after Ebola. Laurie Meininger, Deputy Chief of Mission, said the Awoko that “Sierra Leone is taking a step in the right direction, recognizing the growing importance of health coordination for the future health and sustainable development goals in Sierra Leone.”

    The Hub has three main goals I supporting the government’s eHealth ambitions. They’re:

    • Co-ordination
    • Regulation
    • Improve alignment of data with national health system goals.

    Acfee’s regulations database has extending across 64 eHealth regulation topics shows Africa’s health systems trailing those on other continents. Catching up’s a big task that needs resources for regulation risk assessments, regulation decisions and compliance reviews. Selecting and implementing relevant and appropriate priorities are essential to expanding eHealth regulations.

    It’s an important achievement. For Africa’s health systems, affordable, sustainable eHealth decisions are tough to take. Creating the Hub provides Sierra Leone with a constructive way to take them. 

  • MapmyIndia and VISIT launch mHealth for Inida’s Swastha Bharat

    As mHealth moves towards more sophisticated services, collaboration between suppliers creates opportunities to move ahead. A report on India’s Outlook  news scroll says MapmyIndia, a digital map, GPS and tracking service, and VISIT Internet Services, provider of a range of getvisit apps are working together to support the government’s Swastha Bharat, a video and radio health magazine available through 30 regional kendras, types of charitable trusts. Doordarshan and All India Radio are the broadcasters. 

    It’s an mHealth service for people living in smart cities and, those with populations between 50,000 and 99.999, the tier-2 towns and villages. They’ll be able to access health services such as emergency ambulance services, finding nearby hospitals, clinics, labs and pharmacies, and a way to consult doctors and specialists by chatting, phoning and video.

    The new app’s powered by mapping technologies and AI-enabled telemedicine platform, respectively. VISIT developed the live chat service. It’s backed by India's top doctors who regularly review the information provided to users. It includes health recommendations about the most chatted issues, adjusted for users’ demographic data and past history. The aim’s to help them avoid health concerns. The chat assistant also provides updates on local epidemics and any preventive steps that users need to take. 

    It’s an mHealth initiative that Africa’s health systems could adopt for their towns and cities. From experiences in these locations, it may prove beneficial for some remote areas.

  • CDC backs automated cause-of-death reporting app

    Every death tells a story. Taken together, they provide valuable insights about the deceased and the population around them. These details are crucial for the Center for Disease Control and Prevention (CDC). The longer it takes for them to access Cause of Death (COD) details, the less valuable the data becomes for surveillance and responses. Health Data Management has a report saying to address this challenge, the state of New Hampshire has launched a mobile app, eCOD, for doctors to use to submit prompt COD reports to CDC.

    eCOD’s an original solution. Its developers are excited about its benefits. “Historically, this has been a pen and paper process that takes a long time and keeps valuable data from the CDC they could use to track disease and make public health decisions,” Stephen Wurtz, New Hampshire’s state registrar and director of the Division of Vital Records Administration said in an article in MobiHealthNews. “With eCOD, physicians or the medical examiner, wherever they may be, can immediately report and certify the death and get that information to the CDC.”

    This real-time death data could transform public health surveillance and disease prevention. “From a surveillance standpoint, a state might have an obligation to the CDC to share data once a month or whatever, but with the enhancement of eCOD, we can currently disseminate information twice per day,” said Wurtz. “That’s unheard of. We’re talking hours. Other states are talking days and weeks.”

    The app makes it easier to collect and report information to formulate complete prompt COD profiles It also enables CDC to raise follow-on questions, all of which can be quickly collected and disseminated to improve public health surveillance and response. This is mainly due to the ability to update vital statistics twice a day instead of monthly.

    For complicated or combined death cases that need coroner’s office certifications, eCOD can speed up documentation before cases are completed. “They don’t have to make a complete report and have it certified before they can start centralizing the data and helping state and other government agencies,” Wurtz said.

    The app took a year to complete. Financed by the CDC’s National Center for Health Statistics and developed by CNSI an IT company. Pilots are underway to develop a national model for mobile COD reporting and certification.

    eCOD uses Validation and Interactive Edit Web Service (VIEWS), CDC’s death certificate audit programme, to ensure all information is accurate and understandable.  It’s a format that every person who needs to access the information can already interpret.

    African countries that face disease outbreaks can benefit from this simple disease surveillance system. It can ensure  that authorities and agencies have near real time data on outbreaks and help to save lives. 

  • Will cyber-criminals go for medical devices next?

    Nothing on ICT landscape’s off limits for cyber-criminals. Attacking medical devices could be their next target. In the Rise of the Machines:  The Dyn Attack Was Just a Practice Run, the US Institute for Critical Infrastructure Technology (ICIT), a cyber-security think tank, says the Mirai Internet of Things (IoT) botnet has inspired more Distributed Denial of Service ( DDoS) botnet innovation. Its value’s enhanced by the lack of good practice cyber-security at design stages in the Internet and IoT devices. This harsh reality’s an opportunity for Africa’s eHealth to prepare for rigorous evaluations of IoT projects.

    Krebs on Security, a cyber-security news and investigation service, says  IOT’s botnet source code was responsible for the DDoS attack against it. A conclusion drawn from the incident by Kerbs is

    that the Internet will soon be flooded with threats and attacks from many new botnets powered by insecure routers, Internet protocol (IP) cameras, digital video cameras that can send and receive data with a computer network and the Internet, and used for surveillance, digital video recorders and other networked devices that are easy to hack. 

    ICIT provides a comprehensive and detailed analysis of the new threat. Stakeholders have been driven to recognise and accept the design security weakness and the prevalence of vulnerabilities inherent in IoT devices. Its report includes:

    •  A concise overview of the basic Internet structure, including key players and protocols of the International Organization for Standardization (ISO) Open Systems Interconnection (OSI) and Transmission Control Protocol/Internet Protocol (TCP/IP), used to govern computer systems’ connections to the Internet
    • DDoS anatomy,  including details on constructing botnets, conventional  botnets compared to IoT botnets and launching a DDoS attacks
    • An overview of the Mirai Incidents, including KrebsonSecurity, OVH cloud and  Internet Service Provider (ISP), Dyn, Liberia, Finland, the US Trump and Clinton presidential campaigns, WikiLeaks and Russian banks
    • Evolution of IoT malware, including profiles Linux.Darlloz, a worm, Aidra, QBot and Qakbot, BASHLITE, Lizkebab, Torlus, gafgyt and Mirai
    • A discussion on the sectors at greatest risk including healthcare
    • Recommendations and remediation to combat these threats.

    The ICIT report is essential reading for Africa’s health systems. It can help to prepare cyber-security plans for their forthcoming IoT initiatives.

  • Cyber-crime’s rampant rise needs Africa’s health systems to respond

    The growing use of technology and connection to the Internet increases susceptibility cyber-crime.  Sub-Saharan Africa’s ranked third highest exposure to cyber-crime globally. South Africa has the highest connectivity relative to other African countries, making it a hotspot for cyber-crime. It’s not too surprising it’s ranked first in Africa

    As South Africa’s eHealth blossoms, cyber-criminals have a growing interest in South Africa . Its health systems are not immune to cyber-attacks. Phishing’s the most common form of attack. It’s when cyber-criminals send an apparently legitimate email to entice recipients to respond by providing sensitive information like passwords to accounts and systems, usernames, personal data and other details that can be used mainly for fraud, but also enable ransomware downloads to extort money. It’s an unsophisticated cyber-attack, often successful and frequently used. Avoiding it needs constant vigilance, awareness and trained users.


    An article in the Cover says breaches in healthcare  outweigh all other industries and services. Its data collection, storage and sharing  of confidential patient information makes healthcare perfect targets for cyber-crimminals. If its leaked, it can potentially result in liability claims and grave reputational damage. As healthcare professionals become more reliant on eHealth and its, EHRs and technology, it opens cyber-security windows wider.


    In South Africa, cyber-crime has an economic impact on the nation. It costs an estimated R5.8 billion a year. It’s mainly attributed to risks of system failures and additional costs of restoring systems once hacked. The consequences includes loss of productivity and revenue. Adressing it needs strict legislation, regulation and policies to  help minimise risks and threats. But they’re not enough.


    Healthcare workers need to be more aware of risks and risky behaviours. This needs training and education on avoiding breaches and phishing attacks. They also need to be vigilent with their equipment and materials and adopt best practices.


    Even this is not enough. In a world increasingly driven by technology, having appropriate, effective and far reaching digital cover is imperative. It’s impossible to eliminate cyber-crime’s risks, so rigorous technological solutions are needed to minimise it.  Health systems and organisations have to implement and sustain the most effective holistic cyber-cover that build in modern techniques such as layering defences. Many cyber-attacks breach perimeter defences but don’t reach organisations’data. These are warning signs that need addressing and stopping. A sigh of relief isn’t cyber-security.

  • eHealth SME start-ups aren’t booming yet

    As a relatively new and constantly changing industry, eHealth can expect the role of Small to Medium-sized Enterprises (SME) to provide a significant contribution. Africa’s eHealth success could depend on them. An EU survey of over 300 European eHealth SMEs by eHealth Hub produced some surprises that highlight issues for Africa’s eHealth.

    About 39% of eHealth SMEs are in pre-revenue stages. Some 43% have revenues below €100,000. Taken together, that’s 82% in early development stages.

    These point to an EU market that’s still maturing. While this may be the state of the SMEs, their solutions may be further ahead. Pascal Lardier, executive director at Health 2.0 says demonstration apps for Health 2.0 Europe have shown a consistent maturity over several years. His conclusion’s that the supply side is maturing faster than demand by consumers and healthcare.

    He’s also surprised that most SMEs, almost an even split for a total of about two thirds, work on B2B or B2B2C solutions:

    The EU differs from the US where the bulk of investment’s for B2C solutions. In the EU, it’s about 8%. It may be that the EU’s investment flow may be greater if B2C initiatives were stronger, with Europeans spending more as health consumers?

    83% of SMEs surveyed stated they were currently looking for funding. Their investors’ most important criterion remains commercial traction. About 37% of these start-ups also said they’d already raised a round of external capital, with 38% of that subset having raised over €1 million. Indicating that raising investment money without revenues is viable.

    Finding the right investors needs a combination of the right idea with the right plan to turn it into a successful business, Pascal Lardier’s advice’s to adopt an old “Ask for money and you'll get advice, ask for advice and you'll get money." Will this work for Africa’s eHealth SMEs?

  • Smart dashboards are essential for eHealth benefits

    Realising benefits depends extensively on maximising the number of users. It also depends on them using the data effectively. This, in turn depends on meeting their requirements. There are two main parts to this, the information they need and having in a format, style and presentation that they can use for faster decision taking.

    Tableau, a dashboard supplier, has a white paper saying there are four main ways to use data to improve healthcare:

    • Using analytics for better  population health management
    • Using real-time analytics to increase productivity
    • Aggregating and blending data to reveal and fix supply chain inefficiencies
    • Automating ad hoc visual analysis for better revenue cycle management.

    Providing more data doesn’t always help. The first step’s to simplify data that’s already available. It might easier said than done. In a hospital organisation, there can be a thousand or more health workers. Common themes for simplification include: 

    • Use data visualisation so users can quickly automate processes rapidly
    • Enable users to visualise and assimilate data the way their minds work
    • Helps users see and understand their healthcare data no matter how big it is, or how many systems it is stored in
    • Connect quickly to any data, analyse it and share insights to reveal opportunities to benefit patients, health workers and healthcare organisations.

    As Africa’s eHealth expands, it’s vital that these concepts are in place too. Maximising eHealth’s benefits depend on it. 

  • Cyber-criminals target hospitals in 2017

    As cyber-criminals step up their malevolent activities, health systems aspire to match them. Estimates from the Herjavec Group show that healthcare’s global spending on cyber-security is set to exceed US$65 billion by 2021. But, the real problem isn’t how much healthcare organisations spend, it’s how much they aren’t spending, says an article in HealthcareITNews.

    Herjavec Group’s report says cyber-attacks will become more damaging before they can be challenged. Matt Anthony, Herjavec Group’s vice president of incident response says healthcare organisations’ cyber-security’s set for a rocky year. “In 2017 healthcare providers are the bull’s-eye for hackers.”

    Bitcoin is helping cyber-criminals in their endeavours. It encourages them to pursue ransomware attacks. “Bitcoin is the engine for cybercriminality, and as long as there is an anonymous way for criminals to get paid, it’s not going to get better anytime soon,” says Anthony. “It’s a winning combination for organized crime

    Connected devices, Internet of Things (IoT), the cloud, EHRs and eHealth systems in general are not always built with cyber-security as their priority. This makes healthcare attractive to hackers.

    Hospitals also have little choice but to pay up after ransomware attacks to retrieve their patients personal data. They’re not usually prepared, underfunded, bogged down by legacy systems and really need the data cyber-criminals have encrypted. This makes them soft targets.

    “Hospitals will pay, they’ll pay fast and they’ll pay what it takes to get data back,” Anthony said. “We ask people not to pay but sometimes there’s no alternative in healthcare.”

    Access management tools and practices are slowly starting to improve, with healthcare organisations increasing the priority of cyber-security. There’s still plenty to do. Africa’s health systems implementing eHealth can learn from these experiences and ensure their systems and staff accord a priority to cyber- security measures from the onset.

  • mHealth to test male fertility

    Infertility’s an important health challenge. Globally about 15%, 48.5 million, couples are affected by infertility. A study shows that underlying fertility issues are often associated with sperm abnormalities. A unique view on male infertility around the globe says that social stigma and lack of access to testing meant that many men never pursue diagnosis evaluation.

    Researchers at Harvard Medical School and Brigham and Women’s Hospital in Massachusetts  have developed an mHealth device that can accurately diagnose mens fertility by testing sperm counts. The innovative smartphone app and device pairing is fast, highly accurate and affordable.  It could become as prevalent for male fertility tests as the at-home pregnancy test is for women.

    A device for semen analysis and rapid infertility diagnostics attaches to a smartphone to count sperm numbers and measure motility, the markers for infertility. Fortune publications has reported that the combination can accurately measure sperm concentration and linear and curvilinear velocities using a small volume, less than 35 ?l, of unwashed, unprocessed semen samples. Using the solution requires drawing semen samples into disposable microchips plugged into the side of  phones’ attachments, similar to a USB. In less than five seconds, analysed results are displayed on the screen.

    Recently, the mHealth device was tested in comparison to lab equipment. Results in the journal Science Translational Medicine show 350 semen samples of both infertile and fertile men were analysed and found to be 98% accurate in identifying abnormal sperm samples. The device could also help to test sperm count of men who recently underwent a vasectomy to determine if the procedure was successful.

    The team’s currently performing additional tests to gain approval by the US Food and Drug Administration (FDA). An article on ehealth news says the device will cost about US$50 when it’s ready to go to market.

  • There’s an mHealth generation gap

    Technology adoption’s becoming shorter. Larry D Rosen said technologies that used to take dozens of years to become mainstream now achieve it in three to five years. Radio took 38 years to reach an audience of 50 million. Television took 13 years. Personal computers took 16 years. The Internet took a mere five years. Within these changes, different generations use technologies in different ways. Their questions, choices and web navigations aren’t the same. 

    Research in the Journal of Medical Internet Research (JMIR) aimed to learn more in the context of chronic conditions, an increasing challenge for people and healthcare systems. Smartphones and health apps are promising tools to change health-related behaviours and manage chronic conditions, but they may have different roles across generations. The study explored:

    •  The extent of smartphone and health app use
    • Socio-demographic, medical and behavioural correlations of smartphone and health app use
    • Associations of app uses and characteristics with actual health behaviours.

    A survey of 4,144 Germans aged 35 and older identified socio-demographics, presence of chronic conditions, health behaviours, quality of life, health literacy and the use of the Internet, smartphones and health apps.

    About 61% of the sample were smartphone users. Younger users undertook more Internet research net, were more likely to work full-time, have a university degree, engage more in physical activity, ate low fat diets and have a higher health-related quality of life and literacy.

    Almost 21% of smartphone users also used health apps. They were younger, less likely to be native German speakers, undertook more research on the Internet, more likely to report chronic conditions, engaged more in physical activity, ate low fat diets and were more health literate than people who used only smartphones.

    The profile of their health apps was:

    ·       Planning                            51%

    ·       Smoking cessation           44%

    ·       Healthy diets                     39%

    ·       Weight loss                        23%

    ·       Reminders                         36%

    ·       Prompting motivation        34%

    ·       Providing information         34%.

    There were significant associations between planning, health behaviour and physical activity. Equivalent links were found between feedback or monitoring and physical activity, and between feedback or monitoring and adherence to doctors’ advice.

    Two overall findings emerged. One’s that there were many smartphone and health app users. The other’s that a substantial proportion of the population was not engaged. The difference is attributed to age, socio-economics, health literacy and health disparities in mHealth use. A recommendation’s that health app developers and researchers should include the needs of older people, people with low health literacy and chronic conditions in their innovative endeavours. As Africa’s population increases and the demographics slowly change, this will be important to maximise the benefits.

  • eHealth for consultations can reduce hospital waiting times

    It’s inevitable that appointments with hospital specialists have waiting times. eHealth that provides online consultations can reduce them. A report in the New England Journal of Medicine (NEJM) Catalyst says NYC Health + Hospitals, an integrated healthcare system of hospitals, neighbourhood health centres, long-term care, nursing homes, and home care, has built an eConsult services that improves access to specialty care and reduces patients’ waiting times.

    It offers fast review of clinic referrals for specialists to provide clinical guidance to some referring providers. The initial pilot found 30% of referrals were either appropriate for management by the referring provider or needed extra work before patients were seen by specialists. Transforming these clinical and working practices has three lessons that Africa’s health systems can consider for their eHealth strategies and plans: 

    1.     Learn the unique needs and limitations of health systems’ referral processes so eConsult’s aligned specific needs

    2.     Specialty clinics must prepare for an appropriate eConsult workflow by designating a specialist reviewer who can triage each referral and allocate resources for patient communications and scheduling

    3.     Specialty providers must collaborate on the best care plan each patient and set clear expectations on communications and shared management. 

    The greatest waiting time reduction was a pilot clinics third next available appointments dropping from 37 days to eight days in the first six months, about an 80% improvement. Achieving an equivalent for Africa’s health systems can improve productivity and liberate some of their overstretched healthcare resources for redeployment to other patients, and minimise costly journeys for patients and save them time.

    Los Angeles County Department of Health Services provides acute and rehabilitative services with 19 integrated health centres. Fierce Healthcare has reported that its eConsult service achieved similar benefits. About 25% of patients resolve their health issues without visiting specialists.

  • eHealth could avoid and improve prescribed drugs

    As a concept, eHealth that can improve people’s health as much as a drug can, but without the same cost and side-effects, is good. Andreessen Horowitz, a venture firm, says it’ll work. It predicts digital drugs, will become medicine’s third phase, the successor to chemical and protein drugs we have now, but without the cost of bringing them to market. In the US, digital therapeutics don’t usually need Food and Drug Administration (FDA) approval, especially where they promote low-risk lifestyle or dietary changes.

    It’s part of eTherapies, or digital therapeutics. There are two types, medication augmentation and medication replacement. The report says several peer-reviewed studies show that the outcomes are better than drugs alone. About a dozen start-ups are working on it. The apps are different from wellness apps, such as activity monitors, smart scales and sleep trackers. However, eTherapies can include tracking sensors, coaching material and cognitive behavioural therapy.

    A distinguishing feature’s that eTherapies have big ambitions. An example’s Virta Health, based in San Francisco. It aims to reverse diabetes without drugs or surgery using online coaching to encourage people to adhere to a special diet high in fats and low on carbohydrates. Research in 2011 found that “Normalisation of both beta cell function and hepatic insulin sensitivity in type 2 diabetes was achieved by dietary energy restriction alone.”  It took about eight weeks.

    Propeller Health works with GlaxoSmithKline (GSK) to combine GSK’s asthma medications with sensors that patients attach to their inhalers to monitor when they’re used. Patients using the app’s feedback use the medication less often. 

    For Africa, these nascent initiatives are worth watching. It’s too early for the continents health systems to include them in their eHealth plans. As soon as they’re up to scale, Africa can take them.

  • AskNuma’s Nigeria’s latest eHealth service

    Personal health’s a big step forward from one size fits all. It’s also challenging to achieve and sustain, which is where eHealth, and especially its mHealth component fits.

    Nigerian digital health company Numa Health has launch AskNuma, an mHealth personal health assistant. It provides patients with high quality health information and creates a network for healthcare vendors.

    An article in BIZTECH AFRICA says the platform has revolutionised healthcare delivery in the country. Its Artificial Intelligence (AI) healthcare system hosts a wide database of health information which users can access in real-time. The services also serve as a personal health record, allowing users to manage their health wherever they go.

    AskNuma provides users with diagnoses based on the results of their interactions with the platform and connects them with nearby health facilities using  the diagnoses to find them. To access AskNuma, users can visit www.asknuma.com.

    Co-founder, Dr. Obisanya identified the lack of information and poor supporting healthcare infrastructure as leading to poor health in Nigeria. “In maternal health, over 2,300 children under five and 145 women of childbearing age die daily in Nigeria and according to UN figures, Nigeria contributes to over 10% of the maternal mortality figures globally. These figures highlight the wider issues and challenges in the Nigerian healthcare system and exist due to fragmentation in the healthcare system, a lack of information regarding healthcare options and a lack of basic medical records.”

    Co-founder, Anthony Ajose added, “Numa directly addresses these gaps in healthcare provision by leveraging existing healthcare resources with novel technology, increasing access to healthcare for patients and caregivers. Our personal automated health assistant is accessible via AskNuma.com, patients can manage minor conditions while securely and confidentially connecting to verified healthcare professionals and services when needed for further treatment locally.”

    The Numa platform aims to give patients control of their health, and provide a space where healthcare professionals can offer high quality services to their patients. It can be a catalyst for Africa’s health systems by encouraging healthcare organisations to be more responsive to their population’s needs.

  • Microsoft fixes a Word bug and vulnerability

    A bug in all Word versions is called a zero-day vulnerability. Proofpoint, a cyber-security firm, reports that researchers found documents exploited in a large email campaign, mainly in Australia, distributing the Dridex banking Trojan. It’s a type of malware that uses macros from Word to specialise in spying on computer users to steal bank credentials. It’s also known as Bugat and Cridex. Microsoft’s now fixed it with a patch. 

    A zero day vulnerability’s a hole in software that’s unknown to the vendor. It’s exploited by cyber-criminals before the vendor’s aware, and subsequently fixes it. The cyber-crime’s called a zero day attack.

    Dridex works by phishing. It relies on people inadvertently clicking the link and installing the malware. Its success also depends on emails that are superficially convincing. Using documents for phishing has become less frequently, Dridex shows how cyber-criminals can change their approach effortlessly to exploit new opportunities. Proofpoint says Microsoft Word users should install the security updates promptly.

  • There’s lots of projects to improve breast cancer diagnoses

     WHO has a report showing breast cancer as the most common cancer in women, both in developed and under developed countries. The breast cancer mortality rate was estimated at 508,000 in 2011. Although breast cancer is thought to be a disease of the developed world, almost 50% of breast cancer cases and 58% of deaths occur in less developed countries. Incidence rates vary greatly worldwide, from 19.3 per 100,000 women in Eastern Africa to 89.7 per 100,000 in Western Europe. In most developing regions, incidence rates are below 40 per 100,000. Africa has the lowest e rates,  but here, breast cancer incidence rates are increasing.

    An article in FierceBiotech says Philips,  the  Dutch technology company, is partnering with PathAI, a company that develops artificial intelligence (AI) for pathology, to develop solutions that improve the precision and accuracy of routine breast cancer diagnosis. A report by Tissue Pathology says the two companies are developing deep-learning algorithms that will detect and diagnose several diseases, with the first being breast cancer. The outcome’ll be an app that automatically identifies cancerous lesions in breast tissue.

    Tumour analysis is essential to diagnosis, but conducting it manually is time consuming and laborious for pathologists. The app will ease the burden on pathologists.

    Philips’ Illumeo platform uses adaptive intelligence to help radiologists work more efficiently. Its IntelliSite Pathology Solution is an automated digital pathology system that includes a slide scanner, image management system and software tools. Last June, the company bought PathXL, a Northern Ireland company focusing on image analysis and digital pathology.

    There’s plenty of similar research underway. Samsung is another company that’s applying AI to diagnose breast cancer from medical imaging. It uses deep-learning algorithms too to detect breast cancer lesions in ultrasound images.

    Breast Cancer News has reported that researchers from Houston Methodist Hospital have developed software to predict breast cancer risk from patient charts and mammograms. Harvard Health Publications has reported that a Harvard-MIT team has used AI to diagnose breast cancer from slides of lymph node cells.

    These developments are a step into the future of disease diagnosis. How far behind do developing nations lag in implementing these innovations?

  • IOp extends beyond healthcare entities

    Engaging patients, sharing information, analytics and using EHRs for research are examples of modern eHealth. This expansion from the 1990s vision of eHealth means that informatics issues, like Interoperability (IOp) have expanded too. A white paper from IDC Health Insights and sponsored by OpenText sets out a way to respond that can guide Africa’s eHealth approach.

    The Rocky Road to Information Sharing in the Health System says eHealth such as EHRs, operating in healthcare silos, business interests of health systems and health ICT system vendors and regulatory requirements for security have combined to inhibit information sharing complex and costly. The response is to improve IOp to enable better information sharing to help prevent unneeded and costly interventions such as repeat tests and procedures and create evidence-based care plans implemented by networks and in communities.

    Trends and realities of the new eHealth environment include direct messaging that needs IOp standards and protocols and secure data sharing for:

    • Referrals between organisations and clinicians
    • Discharge summaries and test results
    • Care transitions
    • Sending data to public health organisations
    • Information sharing with payers for authorisation of services
    • Secure information sharing between patients and providers. 

    Direct messaging’s still in its infancy. An IDC survey of 179 healthcare organisations showed that paper, phones and faxes are still prevalent:







    Informal, such as phone calls



    Fax machine or fax service



    Scanning directly to recipients



    Standard or secure email



    Portal/system provided by a hospital



    Care/patient transition portal such as Curaspan



    Multiple portals or systems



    EMR or EHR integration



    Health information exchange (HIE)



    Electronic media such as CD/DVD/USB drive



    While direct messaging may be evolving, the consequences poor and incomplete information sharing remain in place. The survey revealed that over the past three years, organisations current methods of sending and receiving patient information resulted in:

    Loss of business               


    Decrease in operational efficiency


    Billing/medical coding errors


    Medical errors                   


    While business cases and their estimated costs and benefits need assessing before adopting direct messaging, the white paper’s clear that healthcare providers have much to gain and little to lose by extending IOp  across their networks and into their communities. It seems like a model for Africa’s eHealth.