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  • Safe, seamless, secure: digital health strategy from Down-under

    There’s no doubt about Australia’s vision for its eHealth: safe, seamless and secure: evolving health and care to meet the country’s modern needs. Produced by the Australian Digital Health Agency  (ADHA), Australia's National Digital Health strategy up to 2022 has seven strategic priorities to support the option for every citizen to have their own “My Health Record”:

    • Health information available whenever and wherever it is needed
    • Health information that can be exchanged securely
    • High-quality data with a commonly understood meaning that can be used with confidence
    • Better availability and access to prescriptions and medicines information
    • eHealth-enabled models of care that improve accessibility, quality, safety and efficiency
    • A workforce confidently using eHealth technologies to deliver health and healthcare
    • A thriving eHealth industry delivering world-class innovation
    • Safe, seamless and secure: evolving health and health care to meet the needs of modern Australia.

    It sets out six Critical Success Factors (CSF) too:

    • Trust and security assurance
    • Commitment, cooperation and collaboration across all governments to leverage existing assets and capabilities to avoid duplication and speed up benefits realisation
    • Establishing legislative, regulatory and policy frameworks
    • Strong consumer and clinician engagement and governance
    • Effective governance and leadership
    • Learning from others.

    A core concept’s that eHealth’s information is the “bedrock of high quality healthcare.” Its five patient benefits are significant and compelling:

    • Avoided hospital admissions
    • Fewer adverse drug events
    • Reduced test duplication
    • Better care coordination for people with chronic and complex conditions
    • Better informed treatment decisions.

    The strategy builds on considerable eHealth progress. About 20% of the population have a “My Health Record.” An estimated 98% will have one in 2018. Many already access their health information from My Health Record using mobile apps.

    It will help to overcome the challenge of disjointed and hard to navigate care for people with chronic conditions. Developing new models of care are being constructed on their EHRs.

    A National Cancer Screening Register will create a single view for Australians participating in cervical and bowel cancer screening. It will integrate with GP clinical information systems to help GPs to identify patients’ screening eligibility and history to support real-time clinical decision-making.

    Recognition of the risk of uncoordinated eHealth investment may not meet a common set of standards shows the strategies realism. A combination of agreed priorities underpinned by standards is a signal to the market about the role of priorities of eHealth vendors.

    Enabling the exchange of high-quality data between healthcare providers and the systems is a core goal, so semantic interoperability (IOp) is a high priority. It includes co-ordination between people, organisations and systems. The goal is to preserve data’s meaning when it’s shared between people and systems and one context to another, so information is used and interpreted in the same way.

    The Global Open Data Index produced by Open Knowledge International (OKFN) recently ranked Australia number one in the world for its open data policies that create an IOp environment and using data assets as a national resource.

    There are many lessons for Africa’s eHealth. One is the way that eHealth strategies can build on one before and its implementation and lessons.


  • Cyber-threats keep evolving

    Cyber-criminals have sent millions of fraudulent emails as crude, random attacks, hoping to trick people to reveal their personal or financial information. As organisations and people worked out how not to respond, cyber-criminals began switching to bespoke targeted attacks. These use advance reconnaissance, research and testing, using use specialised knowledge and details about targets to try by-pass defences and penetrate organisations’ networks. They’re more lucrative than random cyber-attacks.

    Trend Micro, a global cyber-security firm, has published a white paper available through Health IT SecurityNavigating the evolving threat landscape with a more complete approach to network security deals with:





    • How targeted attacks change network security landscapes
    • Responding to increasingly complex threats
    • A cross-generational approach to network security
    • Security fuelled by market-leading global threat intelligence
    • Detection techniques comprising a smart network defence
    • Integration with other security solutions
    • Seamless threat intelligence sharing
    • Centralised visibility and control.

    Its findings from 264 organisations are alarming:


    • 80% had experienced a network-based attack or exploit
    • 90% had active command and control activity on their network
    • 65% had been infected by zero-day or unknown malware
    • 17% were being actively breached.

    Zero-day vulnerability is an important concept in cyber-security. It’s an undisclosed software vulnerability that cyber-criminals and other hackers can exploit to disrupt computer programs, data, additional computers and networks.

    An effective response, Trend Micro says, has to be “smart, optimized and connected.” Part of this is sophisticated cyber-security tools that operate alongside existing platforms and applications. Rigorous integration and interoperability ensures a stronger defence. These other technologies include:


    • Security Information and Event Management (SIEM)
    • Vulnerability assessment and management
    • Application security
    • Next-generation firewalls
    • Breach detection
    • Visibility and enforcement of Transport Layer Security (SSL), derived from Secure Sockets Layer and including encryption
    • Software-defined networking and the cloud
    • Network Packet Brokers (NPB) that optimise incident analyses by enabling ICT and security services to acquire situational awareness and security intelligence about intrusion and extrusion incidents, enabling faster incident responses
    • Incident response automation.

    Africa’s health systems should consider enhanced cyber-security as part of their eHealth strategies. It’s affordability can measured against the estimated costs of cyber-security breaches.




  • eVisits create more visits

    Long before eHealth, the 18th century Scottish poet and farmer, Robert Burns, alerted us to the risks of projects having a mind of their own. His poem to a Mouse, a field mouse to be precise, gave us a permanent truth that "The best laid schemes o' mice an' men / Gang aft agley.” Since then, management and academic gurus have encapsulated it in more prosaic theories.

    Another human condition inspired by his field mouse was “I backward cast my e'e, On prospects drear!” A big advantage of retrospective evaluations is identifying unintended consequences. These can be extra benefits or extra costs. At an extreme, they can make a problem worse, such as Black Swan events, Nassim Nicholas Taleb’s concept, or unmitigated large-scale risks. Robert King Merton, a US sociologist awarded the National Medal of Science, promoted the concept. It’s important for eHealth strategists, planners and developers know if and when they’ve created any. Then, they need to fix any that are adverse, not rationalise them.

    A study published by Social Science Research Network (SSRN) found two unintended consequences arising from eVisits, a secure messaging service  between patients and providers. Generic goals are to improve healthcare quality and increase providers’ capacity. The team from Wisconsin University and Wharton School at Pennsylvania University found that eVisits create about 6% extra office visits by patients to their doctors. It also found mixed results on phone visits and patients’ health.

    The increased demand reduced capacity. It redeployed time allocated to phone visits, and 15% fewer new patients were accepted by doctors each month following their eVisits implementation. These results are from almost 100,000 patients over five years from 2008 to 2013, a period that includes eVisits’ rollout and diffusion.

    Taken together, the two findings may be good value for the 6% who may be accessing healthcare they need, but they might have delayed or foregone. It’s not good for the 15% who may have given up on healthcare they need.

    The adverse effect was more pronounced for healthcare organisations already at or near capacity. These seem like high priorities for eVisits’ potential. The study also reveals the difference between eHealth’s potential and its probable net benefits. Rarely, if ever, does eHealth operate at its full potential. A probable performance below this can create viable net benefits. Falling well short creates negative results.

    Africa’s health systems can test these unintended scenarios using effective business case methodologies. Risk adjustments that convert an ostensibly attractive project into a negative can reveal the scope for unintended consequences to come into play. It provides decision-takers an opportunity to deal with them prior to the event.  While another of Burns’ lines was sceptical about estimating. He thought “Foresight may be vain.”


    Maybe, but it’s better to model and test an unwelcome future than stumble into it.


  • eHealthAFRO 2017 is interactive

    "Great things in business are never done by one person. They’re done by a team of people," said Steve Jobs. eHealth fits this perspective.

    eHealth's a high-risk endeavor, so collaboration’s an essential part of success. It’s at the heart of eHealthAFRO 2017. eHA2017 changes the conference game by making participants part of eHealth planning & decision making for Africa.

    Interactive sharing and eHealth wisdom track through all sessions. The core theme’s “eHealth for UHC”. UHC can’t be achieved without eHealth, and the eHealth it needs is sophisticated.

    eHealthAFRO isn’t like conventional conferences. Each keynote - the only conventional part of the programme - concludes with an interactive roundtable discussion, where each table of delegates debate what they heard from the keynote and agree one recommendation for priority action.

    There’s an eHealth Use-case Bazaar too, with a wide range of eHealth solutions to review. Use cases provide the latest value of eHealth projects.

    Whichever eHealth role you have, eHealthAFRO’s not to be missed. Get your tickets here.

    #eHA2017 #AreYouReady?

  • Better personal cyber-security with these tips

    It’s important that Africa’s health workers are cyber-security conscious. Good practices in their personal cyber-security, such as protecting their identity from theft, can help to improve their cyber-security practices at work.

    Using social media provides opportunities for cyber-criminals to steal personal identities. An article in the UK’s Guardian newspaper offers some tips. Holly Brockwell, a freelance technology journalist and editor of Gadgette, an online magazine offers five tips to minimise the risks. These are essential when some companies use weak security protocols.

    1.     Don’t play social media games because a notorious information security hole is the secret question and answer checks that offer weak security, with answers often in the public domain on social network sites, so often used to access open people’s accounts and can be accidentally provided by playing social network games

    2.     Don’t take dodgy online quizzes, they can ask for information that can provide access to personal accounts, so check trustworthiness by reviewing URLs, internet addresses, that quizzes came from, and if it’s not a recognised, reputable name, don’t do it, but, malicious sites can disguise their addresses, so it may best not to do any quizzes.

    3.     Don’t accept friend requests from strangers, because it provides them with access to historic and future status updates, so set security settings and all previous posts to friends only

    4.     Delete old posts every day

    5.     Use a password manager to help have unique passwords for personal accounts

    6.     Turn on two-factor authentication, such as having a unique passcode sent to a mobile phone, but mobile’s can be hacked to steal codes, so consider an authenticator app such as Google Authenticator, reviewed by Make Tech Easier

    7.     Don’t be anxious about applying effective cyber-security measures.



  • DG for Health Precious Matsoso to open eHealthAFRO 2017

    Ms Malebona Precious Matsoso will open eHealthAFRO 2017. She is passionate about eHealth's transformative potential and believes that achieving "UHC depends on effective, patient-centred eHealth". We are thrilled to confirm that she has accepted our invitation to open the conference with a personal address and perspective on eHealth in South Africa.


    Ms Matsoso is no stranger to eHealth, information systems and their role in transforming health and healthcare. She has led South Africa’s eHealth strategy and its current review. The overarching objectives that place eHealth in a core role to support Universal Health Coverage (UHC) are challenging to achieve. Her leadership is essential in securing these for the long term. Her vision sets the context for the provinces and local health services for their eHealth endeavours.



    Ms Matsoso drives the Ministerial Advisory Committee (MAC) that I have the honour of serving on, alongside ten South African eHealth leaders. She recognises that eHeath is essential to achieve better health for all and is leading the MAC to ensure that South Africa's eHealth will support health transformation, helping sustain the health of South Africans in line with international good practice.


    The conference theme “eHealth for UHC” emphasises UHC’s dependence on effective, patient-centred eHealth. Ms Matsoso sets the direction and a realistic timescales for successful eHealth.


    Ms Matsoso was appointed Director General of the National Department of Health (NDOH) by the President of South Africa on 08 June 2010. She serves under the Minister of Health, Dr Aaron Motsoaledi. 

    She holds a degree in Pharmacy, a Postgraduate Diploma in Health Management from the University of Cape Town, and a Masters degree in Law and Ethics (LLM) from the University of Dundee. Her career has included posts as Head of Medicines Control Council (MCC), member of the National Research Ethics Council of South Africa, and the Director of the Essential Drugs and Traditional Medicines Programme for the South African Health Department. She was a Director in Public Health Innovation and Intellectual Property (PHI) in the office of the Director General, of the World Health Organisation (WHO) serving as WHO Secretariat on Public Health, Innovation and Intellectual Property. She served as the Chair of the Executive Board at World Health Organization from 2015 to 2016.


    Ms Matsoso has a bold vision for health transformation and we look forward to her comments when she opens eHealthAFRO 2017.

    Get your tickets here.

    #eHA2017 #AreYouReady?




  • Africa’s broadband needs to be faster

    Speed’s a bit of obsession in cyber world. Mahatma Ghandi said “There is more to life than increasing its speed.” It might not appeal to a young African trying to download a video. Health workers trying to reach remote communities with valuable health information may not be happy with plodding broadband either.

    A survey of global broadband speeds by Cable.co.uk show’s Africa’s lagging behind the rest of the world. Average download speed for 189 countries was 7.37mps. The average for 39 African countries was 1.91mps, about 26% of the global speed. At 8.83mps, Kenya’s the only African country above the global average. It’s below the global average plus one standard deviation. Seychelles, second in Africa’s rankings operates at 5.84, putting Kenya well ahead.

    Another eleven countries are above the 39-country average. They’re Morocco, South Africa, TunisiaMadagascar, Nigeria, Zimbabwe, Zambia, Liberia, Uganda, Rwanda and Cape Verde. There speeds range from 4.38mps down to 2.00 mps. Four countries. Kenya, Seychelles,  Morocco and South Africa have broadband speeds above Africa’s average plus one standard deviation.

    Cable.co.uk analysed data collected by research group M-Lab, a partnership between four organisations New America's Open Technology Institute, Google Open Source Research and Princeton University's PlanetLab. Africa’s overall position in the global ranking is in the chart.


    Catching up’s a huge task. For Africa’s eHealth, two goals might be enough. First, creep up to the global average, which’ll probably increase. Next, creep up to Kenya’s speed. It’ll help achieve another of Ghandi’s philosphies that It is health that is real wealth.” 

  • India steps up certification training for medical device makers

    High quality medical devices are imperatives for healthcare. It may become more important as Africa’s health systems adopt more Internet of Things (IoT) initiatives. India’s first state-of-the-art medical devices manufacturing park in Visakhapatnam, the Andhra Pradesh MedTech Zone (AMTZ), organised a two-day industry training programme on quality certification. The aim’s to shorten the time and cost of achieving globally recognised quality certification for India’s medical device makers.

    A report in eHealth Magazine says the course was organised by Quality Council of India(QCI)  National Accreditation Board for Certification Bodies (NABCB) and Association of Indian Medical Device Industry. (AIMED). Medical device manufacturers, medical professionals and industry stakeholders were participants.

    There’s a need to fill the regulatory space in quality certification for India’s medical devices in the country.  The main themes included:

    ·       Interpretations and understanding of Conformité Européene (CE),  the European Commission (EC) the  labrynthine guidelines and regulations and product marking

    ·       Industry Indian Certification for Medical Devices (ICMED) certification 9000 and 13485

    ·       New Medical Device Rules 2017

    This could be a template for equivalent events for Africa’s device makers and users. As IoT expands, devices will have to keep up. Regulations and training are a vital ways to achieve it.

  • Bitpaymer’s offspring disrupts hospitals

    A variant of Bitpaymer ransomware’s been breaching hospital’s ICT. It’s been in Scotland’s Lanarkshire Trust, previously breached earlier this year by WannaCry, reported on eHNA. Some operations were cancelled, GPs’ work disrupted and patients asked to attend Accident and Emergency only if their needs were essential. ZDNet has a report saying systems were taken offline. Perpetrators say they’ve gathered "private sensitive data."

    Unlike most hacks that prefer to be covert, ransomware makes contact with users to ask for a ransom in return for a decryption key. The ransom request was very high, some 50 bitcoins, about £168,000, US$218,000. Failure to pay may result in the cyber-crooks sharing data they’ve acquired.

    ZDNet has short ransomware guide. Ransomware: An executive guide to one of the biggest menaces on the web. Other guides are Remove All Threats has a guide on removing Bitpaymer. Protect PC Health has a guide too. Both are for PCs.

  • webDHIS data experts for South Africa at eHealthAFRO 2017 pre-conference seminar

    A new seminar will help to develop data management experts for South Africa’s National Department of Health (NDoH) and provinces to expand use of the webDHIS and its data to support the best possible health strengthening decisions. The seminar is part of the extensive eHealthAFRO 2017 pre-conference programme.

    Health Information Systems Program – South Africa (HISP-SA) data specialists and NDoH partners, led by Chief Director Ms. Thulile Zondi and her team from the Health Information Research and M&E (HIRME) cluster will facilitate the five-day seminar. It is designed to give participants an understanding of data management principles and hot to get the most out of the webDHIS.

    Find out more about pre-conference seminars on the eHealthAFRO website. Tickets are available through the conference website or from Quicket. Don’t miss your opportunity to a part of this landmark event for the eHealth community in Southern Africa.


    HISP-SA develops and implements health information systems. Its vision is to do this sustainably to empower healthcare participants and improve the efficiency of health services, in partnership with ministries of health. HISP-SA is supporting webDHIS rollout across South Africa.

    The webDHIS is the South African deployment of the web-based District Health Information System 2 (DHIS2). NDoH first adopted the DHIS in early 2000. The primary objective of DHIS is to generate, analyze and disseminate health information. This facilitates effective policy development, formulate and implement health programmes, direct and budget health resources effectively, and monitor and evaluate healthcare in South Africa.

  • Is machine learning the new buzzword for healthcare?

    By now, it’s old news that big data will transform healthcare. Electronic health records and health information systems have arrived, data flows, and there’s a lot of it. However, all this data, is only useful when it has been analyzed, interpreted and acted on. So will it be algorithms that perform this analysis that will really transform healthcare?

    Access to lab results via a mobile app, has helped clinicians diagnose and treat patients faster. Imagine how much more useful these results would be if they also showed the patient’s risk for cardiovascular disease or renal failure, based on the last several years of the patient’s lab reports. This is where machine learning might help physicians to make better decisions at point of patient care.

    Machine learning is an area of artificial intelligence (AI) that is starting to attract interest in healthcare. It is a set of algorithms that help a system to automatically learn and predict outcomes, after continuous exposure to variable datasets. The value of machine learning in healthcare is its ability to process huge amounts of clinical information, beyond that of human capability, and then reliably convert analysis of that data into clinical insights. This will help physicians plan better and ultimately lead to better outcomes, lower costs of care and increased patient satisfaction.

    Machine learning is already making headlines in healthcare. Google has developed a machine learning algorithm to help identify cancerous tumors on mammograms. Stanford is using a machine learning algorithm to identify skin cancer. A JAMA article, last year, reported the results of a deep machine-learning algorithm that was able to diagnose diabetic retinopathy in retinal images. Others, like Philips, are transforming TB screening, using machine learning algorithms that can offer an objective opinion to improve efficiency, reliability, and accuracy.

    Machine learning puts a new arrow in the quiver of clinical decision-making.

  • Discover Africa’s plethora of eHealth opportunities at eHealthAFRO 2017 Use-case Bazaar

    Industry stakeholders are realising the opportunity for eHealth to help expand access to healthcare resources, improve patient outcomes, and increase efficiency of healthcare services. The eHealth space in Africa is experiencing an explosion of new ideas and technologies, which the eHealthAFRO 2017 conference will showcase. It takes place at Emperors Palace from 2-4 October 2017.

    Afternoon use-case bazaars on Tuesday and Wednesday will allow conference participants to explore 48 new ideas and technologies. These sessions will feature compelling eHealth solutions and implementations. The use-case bazaar themes extend from the conference theme: eHealth for Universal Health Care (eH4UHC) and includes mobile apps and devices, eHealth systems and architecture, and eHealth use-cases demonstrating on-the-ground successes.

    Participating organizations include HISP-SA, UCT's CIDER, Jembi Health Systems, SANAC's Focus for Impact project, the AitaHealth assisted community outreach project, HPCSA’s new eLogbook for interns and many more.

    See the expanding list on the eHealthAFRO website. Don’t miss this opportunity to engage with industry leaders, share your ideas and keep abreast of eHealth developments in Southern Africa.

    If you or your organization have an interesting eHealth solution or project, let it be shown where Africa meets for eHealth. There are still a few open slots for organizations that would like the opportunity to showcase their eHealth idea or technology. For more on this opportunity, contact the eHealthAFRO organizing committee here.

  • EU’s BigData@Heart aims to improve heart disease treatments

    A report on Cardiovascular Disease (CVD) published by Springer says CVD prevalence in sub-Saharan Africa’s increasing. Limited access to prevention and continuing care are seen as constraints to improvements. The EU’s BigData@Heart project may contribute to the development of treatments for heart disease patients. It has lessons for Africa’s health systems.

    It’s a large-scale, five-year, €19 million project. Its aim’s to use data and advanced analytics to develop a translational research platform of phenotypical resolution to improve patient outcomes and reduce societal burdens of atrial fibrillation (AF), heart failure (HF) and acute coronary syndrome (ACS). Data sources include real-world evidence, best-practices in drug development and personalised medicines.

    Four outputs are:

    ·         New universal, computable, definitions of diseases and outcomes relevant for patients, clinicians, industry and regulators

    ·         Informatics platforms linking, visualising and harmonising data sources, completeness and structures

    ·         Data science techniques to develop new definitions of disease, identify new phenotypes, and construct personalised predictive models

    ·         Guidelines that allow for cross-border use of big data sources acknowledging ethical and legal constraints and data security.

    It can have considerable value for Africa. The continents health systems and cardiologists could move their CVD services ahead in the wake of BigData@Heart’s progress. 

  • England’s NHS spending on a digital academy

    Developing eHealth leaders is an essential component of successful eHealth. NHS England has announced it’s creating the NHS Digital Academy. Its goal’s to train and develop informatics capabilities for Chief Information Officers (CIO) and Chief Clinical Information Officers (CCIO). The one year programme’ll provide specialist ICT training and development support to 300 senior clinicians and health managers.

    It implements the recommendation in a report from the National Advisory Group on Health  Information Technology  in England, lead by its chair, Prof Robert Wachter, chair of University of California, San Francisco  Department of Medicine. The report identified a shortage of CCIO and CIO professionals who can advance eHealth transformation. Harnessing the Power of Health Information Technology to Improve Care in England proposed spending of £42m, about US$55m, €46m, to strengthen and expand CCIOs’ capacity, especially in informatics, and health ICT professionals. It’s about 1% of the England’s £4.2b eHealth plan. It’s about 0.04% of NHS England’s total spending.

    NHS Digital Academy will have three main partners in the initiative, Imperial College London, the University of Edinburgh and Harvard Medical School. Part of the programme’s remit’s to support the development of vibrant professional societies for clinician and non-clinician informaticians, informatics researchers, programme evaluators and system optimisers. It’ll be mainly online, with some residential events.

    eHealth success needs many other leaders across the whole reach of programmes. It seems that their development needs are not part of this initiative. NHS England already has its Leadership Academy.

    Can Africa’s health systems start a journey towards this? Several Universities across Africa already provide health informatics degrees. Several Africans attend the Master’s in e-Health Management course at Rome Business School, supported by Acfee, which also provides Future eHealth Leaders events, including pre-conference workshops at this year’s eHealthAFRO 2017. While modest compared to NHS England’s initiatives, these combine into a start-point for eHealth leadership capacity.

  • Missouri HC estimates HIE savings

    Limited knowledge of eHealth benefits relative to eHealth costs is long-standing deficiency. There are several partial estimates that offer some light on the subject, but partial means incomplete. A report from InterSystems, a health ICT supplier, Measuring ROI: Missouri Health Connection quantifies the benefits of an HIE doesn’t include a Return on Investment (ROI), as its title suggests. It’s an estimate of cost savings at Missouri Health Connection (MHC), relying mainly external cost estimates rather than estimates from MHC’s own costs.

    ROI’s a ratio of benefits to costs. There’s several ways to compile data needed to use the generic formula. Providing estimates of one part of the formula can be informative, but cannot be an ROI.

    Donaldson Brown, an engineer, invented ROI in 1914 when he was Assistant Treasurer at the Du Pont Powder Company, a multi-activity firm. It was the ratio of net earnings to the costs of operations. The methodology’s still used, and when applied to internal initiatives to improve performance, it’s a ratio of total benefits to total the costs of investment. Both costs and benefits can include extra cash and redeployed existing resources both over time.

    ED savings comprised 83% of the total estimated savings of almost US$12.9m. Clinical savings in the ED were 80% of the total, operational savings 20%. Total savings for all five categories were:

    Estimated Savings

    US$m

    %

    ED visits and costs

    10.7

    83%

    OP medication errors

    0.3

    2%

    IP medication errors

    0.2

    1%

    Preventable readmissions

    0.8

    6%

    Preventable litigation

    0.8

    7%

    Total

    12.9

    100%

    One MHC site using HIE has reduced ED blood specimens by 18%. It compares to studies claiming 56% fewer laboratory tests and a 36% drop in radiology examinations.

  • How can Africa’s eHealth afford AI?

    As AI creates more potential and opportunities for better health and healthcare, it’ll need more investment in ICT. It’s a core theme of an eBook by Azeem Azhar, editor of the weekly blog Exponential View. For Africa’s health systems, it looks like an emerging and major component of their eHealth strategies. 

    Published by Medium, ArtificiaI Intelligence and the Future of Computing sets out his view of the future where machine learning creeps across enterprises and increases the demand for processing capacity significantly. Three main impacts on the ICT supply side, its hardware and software suppliers, practices and opportunities include:

    • Considerable in the computing capacity
    • Flourishing cloud services
    • New chip species.

    These are matched by users’ demand. They’ll need to invest too to pursue their AI goals and benefits. An indication of the scale of the ICT investment step-up’s Azhar’s comparison with Moore’s Law. It’s an average annual 60% improvement of transistor packing or performance every year, a significant expansion. He says the growth AI needs’ll be bigger than Moore’s Law.

    It’s not the only expansion. More algorithms and processing capacity are two. The third’s data, a component requiring Africa to increase its eHealth investment too. These work as a cycle. As processing power increases, more demanding algorithms are possible. These need more data, increasing the demand for more and better processing, leading to more complex algorithms.

    These AI forecasts have considerable implications for Africa’s eHealth. They raise questions like:

    • How can Africa afford AI investment and general eHealth to provide baseline data?
    • How much will it have to invest in human capacity and capability for AI and its algorithms?
    • Within low healthcare budgets, how long will it take?
    • What’s the relative strategic requirement for AI opportunities compared to other eHealth and initiatives such as IoT?

    Simple questions. No easy answers.

  • A microchip can regenerate cells

    A research team at Ohio State University Wexner Centre has set out its’ achievements that will revolutionise regenerative medicine. Using Tissue Nanotransfection (TNT), they can generate any cell type in patients’ own bodies. The technology can repair injured tissue or restore aging tissue’s functions, including organs, blood vessels and nerve cells.

    Injured or compromised organs can be replaced using TNT. The team’s successfully shown that skin can be fertile, and used to grow any cell type for a failing organ. Two organisations collaborated. Dr Chandan Sen led the team from Ohio State’s Center for Regenerative Medicine & Cell Based Therapies and Ohio State’s Nanoscale Science and Engineering Center in the College of Engineering. Its results are in Nature Nanotechnology.

    After studying mice and pigs in these experiments, the team reprogramed skin cells to become vascular cells in badly injured legs that lacked blood flow. Within a week, active blood vessels appeared in the injured leg. By the second week, the injury was saved. Lab tests showed reprogramed skin cells in a live body into nerve cells that were injected into brain-injured mice to help them recover from strokes.

    This breakthrough has huge implications for Africa’s health systems. Nano-technology programmes should find a firm place in their eHealth strategies, or have their own strategies. The benefits for patients, families and communities are considerable. The technologies tractor needs sustained, increasing benefits to secure the achievable sustained benefits.

  • EU’s BigData@Heart aims to improve heart disease treatments

    A report on Cardiovascular Disease (CVD) published by Springer says CVD prevalence in sub-Saharan Africa’s increasing. Limited access to prevention and continuing care are seen as constraints to improvements. The EU’s BigData@Heart project may contribute to the development of treatments for heart disease patients. It has lessons for Africa’s health systems. 

    It’s a large-scale, five-year, €19 million project. Its aim’s to use data and advanced analytics to develop a translational research platform of phenotypical resolution to improve patient outcomes and reduce societal burdens of atrial fibrillation (AF), heart failure (HF) and acute coronary syndrome (ACS). Data sources include real-world evidence, best-practices in drug development and personalised medicines. 

    Four outputs are:

    • New universal, computable, definitions of diseases and outcomes relevant for patients, clinicians, industry and regulators
    • Informatics platforms linking, visualising and harmonising data sources, completeness and structures
    • Data science techniques to develop new definitions of disease, identify new phenotypes, and construct personalised predictive models
    • Guidelines that allow for cross-border use of big data sources acknowledging ethical and legal constraints and data security.

    It can have considerable value for Africa. The continents health systems and cardiologists could move their CVD services ahead in the wake of BigData@Heart’s progress.

  • Kenya’s mHealth standards set an implementation cycle

    Rigorous implementation standards are set out in Kenya Standards and Guidelines for mHealth Systems. The extensive content in the Ministry of Health report extends from planning to scaling up. The steps are:

    • Planning
    • Landscape analysis
    • Local and national health priorities and needs
    • Target audience analysis
    • Project management

    o   People’s roles, responsibilities, teams, communication and relationships

    o   Systems, from implementation to M&E

    o   Defined policies and procedures for data

    • Partnership development
    • Design, including technology, content, workflow impact and usability, a critical requirement for benefits realisation
    • Technology decisions
    • Creating message content
    • Testing message content
    • Prototype and usability content

    o   Systems launch, including, Beta version process and creating user demand, including incentives and benefits

    • M&E, including needs assessments, monitoring systems and outcomes

    o   mHealth system, including the WHO methodology mHealth Evaluation Reporting and Assessment (mERA)

    o   Compliance with the mHealth standards and guidelines

    • Scaling up activities, including using the WHO model for mHealth Assessment and Planning for Scale (MAPS) and its six steps of groundwork, partnerships, financial health, technology and architecture, operations and M&E.

    Some implementation components are not emphasised explicitly in the standards and guidelines:

    • Business cases, such as the Five Case Model, needed to identify optimal mHealth options for decision takers before mHealth projects begin and setting explicit probable, not potential, socio-economic goals measured by cost benefits or cost effectiveness, and affordability requirements, an essential component of sustainability and setting M&E baselines and performance targets
    • Benefits realisation models that follow on from project management and set baselines for the health benefits included in the standard’s M&E section
    • Applying WHO’s Monitoring and Evaluating Digital Health Interventions A practical guide to conducting research and assessment accessible from eHNA’s Resources
    • Distinguishing between mHealth’s economic and financial components, described in Defining a staged-based process for economic and financial evaluations of mHealth programs, also accessible from eHNA’s Resources.

    These added themes contribute to the standard’s goals of “Well thought-out planning … knowledgeable people … M&E.” It shows how demanding successful mHealth can be.

  • Rothman Index predicts patients’ increasing risks

    It’s often reassuring to hear that hospital patients are in a stable condition.  When they’re deteriorating, it’s not so good. It’s even worse when the deterioration’s a set of marginal steps that are challenging to find, but lead to catastrophic states. This was the motivation for the Rothman Index (RI), a predictive health analytics tool.

    Florence Rothman was diagnosed with aortic stenosis, narrowing of the exit of her heart’s left ventricle. She had a low-risk surgical procedure and seemed to be recovering, then became weaker and started a slow, steady, subtle decline that detected when her condition became critical. Relevant data was recorded in her EHR, but the trends weren’t easy to see, so wasn’t used by the skilled and caring healthcare professionals. She was discharged, and four days later, collapsed and died in the ER.

    Michael and Steven, Florence’s sons, one an engineer, the other a scientist, both skilled in data analysis, were inspired reveal EHRs’ crucial insights to improve healthcare. They created the Rothman Index (RI), a statistically validated patient acuity score across all diseases and conditions. It presents patients’ real time conditions and can be trended and visualised, alerting doctors and nurses of deterioration before it’s critical.

    Pera Health, formerly Rothman Healthcare Corporation until 2012, provides RI. It includes graphical user interfaces so healthcare professionals can visualise trends in health status from patients’ data in their EHRs. Regularly updated health scores are derived from vital signs, nursing assessments and lab results. The model transforms each input into a common representation of univariate risk, enabling heterogeneous data to be summed, solving the data fusion problem. Outputs are continuous measures of patients’ conditions integrated into their EHRs. Trends enable deteriorating and vulnerable patients to be identified, often with less than24 hours warning, and with minimal false alerts.

    The company says RI correlates well with:

    • 24 hour mortality
    • Unplanned transfers to ICUs
    • ICU readmissions
    • Code Blue events to for cardiac or respiratory arrests.
    • Readmissions within 30 days of discharge
    • Lengths of stay.

    RI can be a part of Africa’s EHR programmes to build predictive health analytics into hospitals; routines. It’ll help to maximise their EHRs’ benefits.