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  • An eBook sets out six steps for clinical mHealth

    Clinical teams have increasing mHealth opportunities. mHealth strategies should provide the bases for decisions to use them. An eBook by Spectralink, a communications provider, available from Health IT Security, sets out six steps. The goal’s to invest in clinical smartphones for healthcare professionals to communicate, collaborate and co-ordinate patient care across wide arrays of teams and team members. 

    Six Steps to Developing a Successful Clinical Smartphone Strategy combines generic strategic concets, such as vision, with technical components. The six steps are:

    Define an overall vision for mHealth technology initiativesUnderstand information flows, application and technology requirementsEvaluate enterprise-class smartphone solutionsAssess ICT infrastructure and requirements, including Wi-FiImplement a proof of concept and pilot programmeAddress operational issues, including training and support requirements. 

    Creating successful clinical mHealth strategies need measured, forward-thinking. Improving patient care and outcomes, and accounting for future technology advancements  must be the focus. It should include people, processes and technology to maximise organisation’s benefits.

    The eBook extends from strategy to mHealth investment. Acfee would include a step for business cases to generate and compare options to identify and estimate:

    Strategic fitSocio- economic impact, including optionsManagement capacity to deliver and realise net benefitsFinance and affordabilityCommercial themes, such as contractual options.

    Completing this would be before and after step 5. Step 6 should also address benefits realisation issues. These lay foundations for M&E as step 7. 

    Africa’s health systems assign a high priority to mHealth. The eBook provides a process that they can adopt and ehance.

  • ADB eHealth guidance says look at the forest and the trees

    Managing and investing in eHealth’s seen as similar to forest management. Both are complex ecosystems. A Peter Drury blog from the Standards and Interoperability Lab – Asia (SIL-Asia) emphasises the large number of dynamically, interacting elements that where. Each element in the system may not know about the behaviour of the whole system. 

    Five-year strategic visions and plans help. The WHO/ITU National eHealth Strategy Toolkit provides guidance for these, but they’re not enough. Managing a complex sets of real-time elements is a greater challenge. It’s the core of Guidance for Investing in Digital Health, an Asian Development Bank initiative. 

     It’s based on how stakeholders engage, or don’t engage, with current systems, and how well, or not, they’re supported by management, technical, and workforce foundations. Investment appraisals and decisions spring from these,

    Instead of a five-year cycle, eHealth policy-makers should:

    Monitor progressAdapt to emerging challenges and opportunitiesManage expectations and investment. 

    The ADB’s Digital Health Impact Framework User Manual, linked to the Guidance, provides a methodology for these activities. It too is iterative, and addresses short and long-term requirements. 

    Pressure for quick wins doesn’t help. To counter this, the Asia eHealth Information Network (AeHIN) and SIL-Asia support work on Digital Health Governance Architecture and the Mind the GAPS programme covering governance, architecture, programme management, standards and Interoperability.

    While these are Asian initiatives, Africa can begin to adopt them. Using components that fit each countrys’ health systems is the way to start. It’ll set them on a trajectory of proven good practices.

  • Medical imaging’s the big gainer from AI and ML

    AI’s not new. It emerged in the 1960s. A blog from PLOS Speaking of Medicine says advertising hyperbole has led to scepticism and misunderstanding of what’s possible with machine learning (ML) and what’s not with. The blog sets about providing an accessible, scientifically and technologically accurate portrayal of ML’s current state in clinical translation.

    Medical imaging workflows are seen as benefiting most in the short-term. ML algorithms automatically processing two or three-dimensional scans to identify clinical signs of conditions, such as tumours and lesions, and determining likely diagnoses have been published. Some are progressing through regulatory steps toward the market. 

    Many use deep learning. It’s a form of ML based on layered representations of variables, ML’s neural networks. It’s benefited ophthalmology. A major UK eye hospital has used deep learning to deal with a clinically-heterogeneous set of three dimensional optical Coherence Tomography (CT) scans. Referral recommendations reached or exceeded experts’ decisions.

    Radiologic diagnoses are another ML beneficiary. An algorithm detected 14 clinically important pathologies from frontal-view chest radiographs. They included:

    PneumoniaPleural effusionPulmonary masses and nodules.

    ML’s performance matched practicing radiologists. Another 

    There’s several other clinical activities where ML can benefit healthcare. They include: 

    Triage and preventionClustering for discovery of disease sub-typesAnomaly detection to reduce medication errorsAugmented doctors.

    The blog’s an advance report. Its final version’ll be in PLOS Medicine at the end of December. It’s a valuable guide for Africa’s health systems’ eHealth strategies. An initial step’s to lay down data foundations.

  • Medopad aims for doctors’ and patients’ information to reach beyond healthcare

    Based in London, the Medopad mission’s to build solutions that provide the right information to patients and doctors when patients are beyond healthcare settings. It says this’s 95% of the time. 

    Activities that its data support includes:

    Better medical diagnosesEnhanced treatmentsExpanded professional knowledgeEmpowered publicFaster and better collaboration of medical teams.

    It claims its services are used by the “world’s leading healthcare providers.” 

    Medopad’s examples include four major London Hospitals: 

    Royal Free LondonGuy’s and St Thomas’Bart’s Chelsea and WestminsterHospital Corporation of America (HCA) a private healthcare provider.

    Its data range includes: 

    Medication trackingBlood glucose monitoringSP O2 logsWalk testsWeight measurementSymptom logsAfter care videosSupport groups.

    These are for four main conditions:

    Rare diseasesMetabolic diseasesCardiovascularCancers.

    Health insurers use Medopad to reward policyholders for healthy behaviour. Benefits include increased retention, lower risk and bespoke policies.

    Pharma’s a development project. Three goal are to use Medopad’s real-time data to develop more effective drugs, accelerate medication trials and to close the gap between suppliers and hospital.

    How long will it be for Medopad to be used across Africa? Does its emphasis on tertiary hospitals and rich countries’ health insurance mean that Africa’ll be towards the bottom of its priorities?

  • A study designs a model to manage eHealth evaluation

    eHealth evaluation isn’t a common activity. A study in the Journal of Medical Internet Research, says the importance of evidence hasn’t been discussed as rigorously as the diverse research approaches and evaluation frameworks have been discussed.

    From this position, the team’s objective was to elucidate how evidence of eHealth effectiveness and efficiency can be generated through evaluation. It developed a model to help. Evidence in eHealth Evaluation comprises:

     

    It aims to show how evidence can be generated by evaluating certain aspects at each intervention phase. Assessing distinct aspects during distinct phases is a novel concept discussed in this study and requires further analysis.

    It’s consistent with Digital Health Impact Framework (DHIF) designed for the Asian Development Bank (ADB) and Standards and Interoperability Lab Asia (SIL-Asia). It also has some differences. DHIF. For example, DHIF includes optimism bias and risk exposure, and emphasises the different impacts, especially benefits, across a range of stakeholder types.

    The study implies an inconsistency between literary eHealth evaluation concepts and practices. It

    found that eHealth evaluation isn’t common in design and pretesting phases. Acfee’s view’s that it isn’t common before these, at the strategic and business case decisions stages that seek preferred options that commissions designs. It’s also rarely used at eHealth procurement stages. 

    It seems feasible to stretch Evidence in eHealth Evaluation model to include eHealth components on a wider timescale. Adding extra components within its timeline seems possible too. It is a conceptual model in its preliminary stages, so still being developed. It’s not a prescription, but a way to show a reliable progression of evidence in eHealth intervention. Africa’s health systems could build from it too.

  • Babylon’s AI is embedded in Rwanda’s primary care, and other countries

    Succeeding with UHC depends on extra healthcare resources. It depends on efficient and effective use of resources too. eHealth’s part of the solution. 

    Babylon Health uses AI to improve access to primary care. It’s planning to expand into chronic care. In England, it’s restricted geographically to London.  Regulations seem to prevent Babylon’s AI from providing diagnoses. Instead, it provides health information.  This could change as hard evidence becomes available.

    A review, reported in Digital Health, says Babylon’s AI claims lack convincing evidence. Babylon Health doesn’t agree. A report claims its AI beat human doctors’ average score of 72% in a range of 64% to 94%. Babylon scored 81% in a Royal College of General Practitioners (RCGP) exam using a representative sample of questions from the final assessment for GPs in training. The results have not been peer-reviewed.

    In Rwanda, it’s called Babyl. It uses AI to provide:

    Consultations with doctors and nursesLab testsPrescriptionsReferrals.

    It’s a core UHC component for the country. Where access isn’t feasible with conventional healthcare, Babyl seems crucial in meeting health and healthcare needs.

    Babylon’s AI uses machine learning created by a team of research scientists, engineers, doctors and epidemiologists. They have access to large data volumes from the medical community. Learning’s continuous through feedback from Babylon’s experts.

    It comprises: 

    A knowledge graphA user graphAn inference engineNatural Language Processing (NLP). 

    It seems like a solution for all Africa. On its own, it may not be enough. Increasing referrals may need investment in extra healthcare capacity.

  • Nigeria uses mHealth to improve blood donations

    Blood shortages are common in many health systems. An initiative in Nigeria uses mHealth to create a community of voluntary blood donors, and connects hospitals with blood banks, and blood banks with donors. Life Bank, a Lagos start-up also provides a discovery platform on for hospitals to order blood

     LifeBank delivers requested blood in less than 45 minutes, in a WHO Blood Transfusion Safety compliant cold chain. An article in Disrupt Africa says it’ll add other medical products such as oxygen, vaccines and rare drugs to its services.

    Its founder, Giwa-Tubosun, began a non-profit service to encourage people to donate blood. She then moved on to address supply shortages and poor logistics. Two main goals are: 

    Increasing access to bloodReducing the number of Nigerian women who die from birth complications. 

    LifeBank’s resources include: 

    AIBlockchainCold chainmHealthMotorbikes.

    These combine to provide information about blood availability and avoid health workers’ wasted time and frustration seeking blood products. They also minimise ineffective blood transports that result in bacteria proliferation and consequences of health complications.

     Supporters include:

    Co-Creation Hub (CcHub) in 2016 that raised pre-seed fundingEchoVC Partners, a venture capitalistParticipation in Merck’s Lagos-based satellite accelerator this yearSelection for MIT Solv2018 that added grants and access to other resources.

    Its impact is considerable. To date, LifeBank’s delivered some 11,000 products for over 400 hospitals. Over 6,300 people are registered as voluntary blood donors, with over 20% donating blood in the last two years. The result: over 2,100 lives saved.

    A challenge is convincing blood bank partners to use LifeBank. As this is  overcome, it’s it easy to envisage LifeBank eventually operating across Africa.

  • AeHIN sets up its Community of Interoperable Labs (COIL)

    Six countries’ health systems have formed the Asia eHealth Information Network (AeHIN) Community of Interoperable Labs (COIL). The Standards and Interoperability Lab-Asia (SIL-Asia) is guiding the initiative. Viet Nam, Malaysia, Thailand, Philippines, Indonesia, and Taiwan commitment to interoperable health systems at the 6th Asia eHealth Information Network (AeHIN) General Meeting and Conference on Interoperability for Universal Healthcare Coverage (UHC).

     

    A blog by SIL-Asia says the Regional Interoperability Workshop organised by the AeHIN at the the Global Health Research Forum in August 2015 was the genesis. SIL-Asia was set up as a regional health interoperability lab to meet the needs of Asian countries for a facility to benchmark emerging digital health technologies in the market. The benchmarking criteria are common international standards for interoperability or systems to exchange usable data and information.

     

    COIL is a community of Asian countries committed to establishing their own interoperability labs (IOL). These will focus on digital health interoperability and facilitate national health data and information exchange to support evidence-based healthcare.

     

    It’s a knowledge sharing community too. Each country is expected to share their lab technologies, artifacts and documents with one another to promote inter-country co-operation on standards and interoperability.

     

    Other countries can join COIL too. Teaming with SIL-Asia is the way in.

     

    SIL-Asia and COIL are models that can benefit Africa’s health systems and their eHealth initiatives. Which entities will provide the sustainable finance needed.  

  • Zanzibar’s eHealth aims to connect its 24 hospitals

    Zanzibar, a semi-autonomous Tanzian region in the Indian Ocean, has successfully installed a national ICT programme. It’s the backbone of social services digitisation. A report in IPP Media says it’ll provide broadband to its citizens across the archipelago and connect all 24 hospitals in region. 

    The government has set up a data centre to house medical information. It supports the eHealth objective of improving delivery of a range of social services.

    It also provides a platform to develop eHealth programmes to:

    Share patient informationRemote interpretation of test resultsRemote diagnosis.

    The plan’s to use the expanded connectivity to improve healthcare and social services quality. There’s a more sophisticated objective too. It’s to stimulate economic growth by unlocking entrepreneurial potential. This can create exponential eHealth investment trajectory that all Africa’s health systems could replicate.

  • Expect more cyber-attacks on healthcare

    The next cyber-attack never seems far away, and healthcare may be in criminals’ sights. A UK conference organised by The Guardian, a newspaper, and supported by technology company DXC, has some dark, ominous warnings for the UK’s NHS. They apply to healthcare everywhere.

    The report says some NHS employees expect another cyber-attack similar to WannaCry. In 2017, it caused widespread disruption to hospitals and GP surgeries. Not enough has changed to seek to avoid it.

    Poor leadership, budgetary constraints, deficient ICT systems and a lack of qualified staff combine to make the NHS vulnerable. A member of parliament and chair of the UK parliament’s public accounts committee commented that these limitations are exacerbated by:

    No particular benefit for patients from good eHealtheHealth isn’t a big enough issueIt’s not an instant winMany NHS staff don’t trust their IT systems.

    Lack of clarity on patients’ benefits is another theme that needs attention. It reveals inappropriate eHealth investment.

    A report on the WannaCry incident by the National Audit Office (NAO) found that the attack could have been prevented by basic ICT practices. Cyber-security was weak too. An NHS Digital cyber-security assessment of 88 England’s NHS trusts, about 37%, before WannaCry found none passed. NHS Digital has no power to require action. Consequently, the NHS remained vulnerable.

    These commentaries and findings provide a vital checklist for all health systems’ cyber-security and eHealth investment activities and goals. Waiting for the next attack without preparation’s a high risk approach.

  • Rome Business School has a short course on using the Digital Health Investment Framework

    eHealth finance and economics are core components of the  Masters in eHealth and Telemedicine Management at Rome Business School. The module includes an assignment on using outputs for the Digital Health Investment Framework (DHIF), an Asian Development Bank initiative.

    An important theme in DHIF is equipping users with the skills and knowledge to begin using it to support eHealth investment decisions. Building on this, the School now has a short course of five sessions on DHIF, all available online.

    The first course starts in February 2019. Participants can Enrol now.

    The course objectives are:

    Identify the architecture, characteristics and the roles of a DHIF modelUnderstand the concepts and methodology using illustrative DHIF modelsApply DHIF to real-life projectsReview DHIF illustrative models.

    Learning outcomes are:

    Understand and develop investment goals of health, healthcare, and digital health strategiesDefine different stakeholders’ types, user requirements and required functionalityHow to develop DHIF architecture and contentIdentify appropriate network requirements, and data and capacity dependencies from other eHealth investmentsDevelop personal skills in stakeholder engagement, human capacity building in using the DHIF and change management skills

    Contents are:

    Introduction to DHIFIntroduction to eHealth costs and benefitsIntroduction to decision makingPutting it into practice, using participants own DHIF models.

    Two organisations, Società per la Salute Digitale e la Telemedicina (SIT) and Acfee are patrons of the School's Masters in eHealth and Telemedicine Management. The DHIF short course is linked to its eHealth finance and economics module.

    The DHIF course is appropriate for Acfee’s eHealth Investment Model for Africa (eHIMA), reported in eHNA. It will enable participants from Africa’s health systems to achieve a fast start up.

  • A telemedicine toolkit from Novartis Foundation supported by CWCDH

    As telemedicine moves further into the mHealth environment, it can become more widespread. To help its expansion, Novartis Foundation, with the Commonwealth Centre for Digital Health (CWCDH) as a messanger, has have compiled a telemedicine toolkit.

    It covers a wide range:

    High-level overviewInteractive implementation guide Business continuity planCommunicationFact sheetFever overview, protocol and role play templates Postpartum haemorrhage overview and protocolReferencesRollout templateWhat to look out for.

    There are two videos:

    Ghana Telmed Toolkit Video 1Ghana Telmed Toolkit Video 2.

    Ghana Health Service and Ministry of Health are core collaborators. Ghana telemedicine has more background information.

    Two objectives for the toolkit are:

    Increased healthcare access for people in low- and middle-income countriesLeverage eHealth best practiced and benefits.

    It sees telemedicine as vital to connect Community Health Workers (CHW) to medical specialists in 24-hour tele-consultation centres. Doctors, nurses and midwives in the centres mentor, coach and advise CHWs in managing emergency cases that are beyond their capabilities. Ghana’s experience shows that telemedicine’s strengthened healthcare capacity can result in:

    Over half of tele-consultations can be solved directly by phone, so mHealth has a core roleHospital referrals can reduce by 31%Empowered CHWsBetter healthcare qualityReduced travel times and costs for patients.

    Developed in Africa, the telemedicine toolkit can help African countries' health systems expand towards a shared, successful model. This can lay a platform for sharing and developing the required eHealth regulation.

  • AI, blockchain, cold chain and motorbikes improve blood donations and save lives in Nigeria

    Blood shortages are common in many health systems. An initiative in Nigeria uses mHealth to create a community of voluntary blood donors, and connects hospitals with blood banks, and blood banks with donors. Life Bank, a Lagos start-up also provides a discovery platform on for hospitals to order blood

    LifeBank delivers requested blood in less than 45 minutes, in a WHO Blood Transfusion Safety compliant cold chain. An article in Disrupt Africa says it’ll add other medical products such as oxygen, vaccines and rare drugs to its services.

    Its founder, Giwa-Tubosun, began a non-profit service to encourage people to donate blood. She then moved on to address supply shortages and poor logistics. Two main goals are:

    Increasing access to bloodReducing the number of Nigerian women who die from birth complications.

    LifeBank’s resources include:

    AIBlockchainCold chainmHealthMotorbikes.

    These combine to provide information about blood availability and avoid health workers’ wasted time and frustration seeking blood products. They also minimise ineffective blood transports that result in bacteria proliferation and consequences of health complications.

    Supporters include:

    Co-Creation Hub (CcHub) in 2016 that raised pre-seed fundingEchoVC Partners, a venture capitalistParticipation in Merck’s Lagos-based satellite accelerator this yearSelection for MIT Solv2018 that added grants and access to other resources.

    Its impact is considerable. To date, LifeBank’s delivered some 11,000 products for over 400 hospitals. Over 6,300 people are registered as voluntary blood donors, with over 20% donating blood in the last two years. The result: over 2,100 lives saved.

    A challenge is convincing blood bank partners to use LifeBank. As this is  overcome, it’s it easy to envisage LifeBank eventually operating across Africa.

  • A manual for Africa to use Asia's Digital Health Impact Framework

    Following the completion of the Digital Health Impact Framework (DHIF), an Asian Development Bank project, Acfee is completing its version for Africa. It draws directly from DHIF, and emphasises ways that Africa’s health systems can start simply and use it as a platform for increasing sophistication in appraising planned eHealth investment.

    The prototype, eHealth Investment Model Africa (eHIMA), mirrors the development track of DHIF’s forerunners that include the eHealth Impact model and the Five Case Model for business cases.  Both methodologies were less sophisticated in their original formats, and have been enhanced to meet increasing needs of decision takers. eHIMA is at the equivalent entry point for African health systems.

    eHIMA combines socio-economic , financial and accounting concepts to estimate eHealth projects’ Value for Money (VFM) and affordability over time.  These are dealt with in DHIF’s ten steps:

    Identify timescalesIdentify stakeholdersIdentify benefitsIdentify resources neededEstimate socio-economic benefits' monetary valuesEstimate socio-economic costsAdjust for sensitivity, optimism and riskCalculate net benefits, the Socio-Economic Returns (SERs)Estimate financial costs and affordabilityRefine and iterate SERs and affordability to find an optimal link

    eHIMA will guide Africa’s users in selecting which steps are the most important to being modelling and appraising for decision-takers’

    A  report on eHNA describes DHIF in more detail. It was presented to the Asia eHealth Information Network (AeHIN) conference in Sri Lanka in October.

    Acfee’s overall aim is to help Africa’s eHealth decision-takers and analysts in dealing effectively with increasingly complex eHealth investment scenarios and options. Good, affordable eHealth strategies are the starting point.  eHIMA will be available in January 2019. eHNA will post updates on progress.

  • Heidelberg University launches an eHealth policy course.

    Three entities have combined to create a five-day residential course on eHealth policy at Heidelberg University. The other two are evaplan, a University Hospital Heidelberg consultancy, and the Institute for Global Health.

    Developing national digital health policy: Laying the Foundations is designed for health planners and policy advisers. It will help them to explain eHealth’s national requirements for success. A specific emphasis is on low and middle income countries. It aims to help participants to:

    Understand how well-crafted eHealth strategies support smart investment Use available toolkits to design and improve country’s eHealth policiesStrengthen participants’ eHealth adviser roles Support decision making for interoperable eHealth and avoid further fragmentation Understand organisational and behavioural changes needed to maximise eHealth benefits.

    The curriculum for the first four days includes: 

    Health Strategies and eHealth strategies in developing countriesDeveloping eHealth strategiesPlanning for interoperabilityManagement and behavioural change. 

    The dates are 4 to 8 February 2019 at the university’s Internationales Wissenschaftsforum Heidelberg (IWH), Germany. The final day includes a guided tour of Heidelberg and time for mentoring and networking. Presenters are Peter Drury and Michael Stahl, The course is in English. Applications close on 15 November 2018.

  • Commonwealth Centre for Digital Health and ECH Alliance to launch their joint action plan

    Working and sharing with eHealth agencies offers mutual benefits. At the Digital Heath Week 2018 in Sri Lanka, the Commonwealth Centre for Digital Health (CWCDH) and the European Connected Health Alliance (ECH Alliance) met and agreed their joint action plan. It was originally envisaged in the partnership agreement announced in May 2018.

    The full action plan will be announced shortly. It will include:

    On 20 November 2018, launch of an ecosystem in Malta, both a European and a Commonwealth countryUganda’s ecosystem will be a nexus for collaboration across East Africa for CWCDH. HealthOrganisation of a Commonwealth Digital Health Skills Summit early in 2019 to connect existing skills programmes with the needs of many Commonwealth countriesLaunch of ecosystems in Sri Lanka and Uganda in early 2019. 

    These will comprise the beginnings of the Commonwealth Connected Health Alliance. Its aim will be exemplars for ecosystems across the Commonwealth. 

    Prof Dissanayake’s chair of CWCDH. He said “We decided to work together because we share the same mission and values and by joining forces we hoped we could deliver faster and do more better.” He is satisfied that considerable progress has been achieved in just a few months. The plan now’s to build on the value of the partnership with ECH Alliance and move forward with constructive activities as part of the commitment to work jointly with.

    COO of CWCDH, Anoop Singh said the partnership’s main goal’s to deliver real benefits, not to try to do everything. Bringing together eHealth stakeholders and collaborators from Europe, the Commonwealth and beyond will contribute to meeting numerous needs and opportunities.

    ECHAlliance chair Brian O’Connor is convinced that the collaboration will bring mutual benefits to everyone involved. His view’s based on discussions with people from over 40 Commonwealth countries. He sees their progress, innovations, determination and passion as a vital ingredient for future success.

    CWCDH will hold an event during the World Health Assembly (WHA) in Geneva in May 2019. The goal’s to obtain the commitment of Commonwealth governments to CWCDH’s planned activities. 

    Nineteen countries are Commonwealth members. If the benefits spill into the rest of Africa, the partnership will have proven its worth.

     

  • How far into the future should eHealth strategies look?

    By definition, eHealth strategies are about investing in the future. They’re also about taking existing eHealth investments forward, either by switching, enhancing and rolling out further. In 2006, Rosabeth Kanter identified several lesson for innovation strategies. They included an “innovation pyramid” where:

    Not every innovation idea has to be a blockbusterSufficient numbers of small or incremental innovations can lead to big gainsBig bets at the top that get most of the investmentA portfolio of promising midrange ideas in test stageA broad base of early stage ideas or incremental innovations.

    The last one’s relevant for a perspective set out in an eBook from Oracle. Technology Takes Healthcare to Next Level proposes strategies for disruptive technologies of:

    AIBlockchainChatbotsIoT. 

    Each one offers promise for healthcare. Combined, Oracle sees the sum of the parts as greater than the whole. Combining blockchain and IoT allows frictionless data exchange. AI and machine learning put data in motion with minimal human intervention. AI tools can study blockchain’s large volumes of data to find patterns that need responses

    For Africa’s health systems, investment in ICT foundations and patients’ clinical and demographic data’s needed to. The strategic challenge is to choose between sequential investment and progress in an innovation pyramid where these four technologies start their journey. While leaving the disruptive technologies into the future, it can defer the costs. It will also defer the benefits.

     

  • EHR’s financial benefits may be elusive

    Acfee’s stance on EHRs is that they’re an investment in health and healthcare, not an initiative to increase healthcare organisations’ income. The Acfee eHealth Impact Database contains over 60 evaluations. A common theme is that the extra cash needed for eHealth exceeds its cash savings. Healthcare quality and productivity are the main sources of benefits. The affordability planning and management lessons are clear for Africa’s health systems.

    It seems that US healthcare may see it differently. An article in Modern Healthcare says hospitals and health systems each spent millions and sometimes billions of dollars on EHRs. Examples are: 

    Trinity Health reported a US$107.8 million asset impairment charge in 2018 to switch to a single version of Epic EHR and revenue cycle management software over four years and undisclosed costsMayo Clinic spent US$1.5 billion on Epic HERPartners HealthCare spent $1.2 billion on an Epic HERScripps Health reporting weakened financial results when started an EHR conversion budgeted at US$300 million over ten years, with estimated operating costs of US$360.5 million, 20% more than the non-recurring costsBanner’s US$45 million project contributed to a US$92 million hit to university delivery operations 2017 when it spent US$24.3 million on EHR conversion.

    Modern Healthcare says the promised clinical and financial benefits have been elusive. Some healthcare organisations have suffered financial problems when eHealth has worked against them. In particular, hospitals and health systems have faced financial stress when implementation costs drive up operating costs, a Capex Opex imbalance.

    Doctors and other clinicians have been wary of embracing eHealth too enthusiastically. Concerned that they may feel held back by it and causing clinician burnout.

    A literature review in the Journal of the American Medical Informatics Association said it revealed evidence that “Data entry requirements, inefficiently designed user interfaces, insufficient health information exchange from outside institutions, information overload, and interference with the patient–physician relationship are … factors associated with physician stress.”

    Some explanations are: 

    There’s going to be some disruption when implementing EHRs so budgeting and financial planning, including contingencies helps to avoid financial crisesTo ensure successful EHRs may need extra resources after implementation to mitigate financial risksLooking at EHRs in the long-term, rather than two- or three-year returns, can be helpfulIt’s inevitable that new eHealth, especially large-scale EHRs, will slow patient volume temporarily as providers learning to use them, so are less productivePlan for eHealth complexities that diminish returns from EHRs, including procurement costs, deployment and increases in higher ICT operating costs, higher departmental operating costs and lower productivity and lower employee satisfaction. 

    Africa’s health systems can’t afford these outcomes. Rigorous business cases, an emphasis on health and healthcare benefits and top class eHealth leadership can help to avoid them.

     

  • Rural India uses eHealth with containers

    Shipping containers re-appear in many guises, from roadside cafés to holiday homes. It should come as no surprise that they should have become part of the future of India’s eHealth network.

    A report in The Nation Online says in 2013, Dr. Anurag Agrawal, of the New Delhi-based Institute of Genomics and Integrative Biology (IGIB), saw the possibilities of including shipping containers’ versatility in his work towards a link between genes and lung disease. His plan was to use the movable containers to house and collate health records in rural areas so specialists could analyse the data to identify links between height, weight and predisposition for developing specific lung diseases. The analysis leads on to developing and delivering treatments.

    A container appeared in a village in Uttar Pradesh. Villagers soon had video access to a doctor and could see a paramedic in person. They could also leave blood samples and submit cardiograms.

    This initial success was hindered by IGIB’s link to government. It is one of India’s 39 state-funded Council for Scientific and Industrial Research laboratories, and is limited its scope to expand.

    Then IGIB partnered with the Indian hospital chain Narayana Health (NH) and Hewlett-Packard (HP) to install over 40 eHealth container centres across India. The service includes EMRs, bio-metric patient identification and integrated diagnostic devices. It’s a business model that could be appropriate for Africa’s drive towards UHC.

    India has one doctor for every 11,000 people, well below WHO’s recommended rate of one per 1,000lth. The eHealth container with HP cloud technology offered a dynamic solution. Clinical and administrative data is monitored and medical advice provided remotely.

    Dr Agrawal believes more benefits are available. Telemedicine has improved access to second opinions and international consultation in urban areas. It’s benefits in rural India may be more limited.

  • Robots could be good for your health

    In his book The Rise of the Robots, published by One World, Martin Ford proposes social and economic scenarios for robots that are good for output, but not so good for people. He sees significant upheaval and displacement from employment across a wide range of commercial and industrial activities and across middle and low income families. The drop in income, so spending power, will degrade economies.

    Simultaneously, robots aren’t paid and don’t spend money. He sees this as exacerbating the social and economic impact.

    Healthcare’s the activity that’s different. He sees the robots marching into healthcare that’s already over-stretched as needs and demands continuously outstrip supply. Four roles are crucial:

    Artificial intelligence in medicineHospital and pharmacy roboticsRobots that care for the elderlyUnleashing the power of data. 

    For low and middle income countries and health systems, sustained investment in robots could be part of the solution. They can improve healthcare professionals’ productivity and help to meet demand.

    They should find a place in Africa’s eHealth strategies. Small scale investment will lay out a trajectory for the future.