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  • Articles (2,257)
  • EHRs can be more efficient, with better quality

    Better efficiency and quality are two main eHealth benefit groups. They don’t stand alone. Benefits in one group can lead to benefits in the other. Imprivata  emphasises two lessons in its white paper, available from EHR Intelligence.  Saving time, improving care Two lessons to remember when integrating a new EHR sees efficiency gains liberating resources for better quality. 

    Its proposition’s that clinicians can waste 13 seconds waiting unnecessarily with the time they log into EHRs. Aggregating these across all clinicians’ logins can create a valuable chunk of their time, about 13,000 hours a week for a typical hospital. On this scale, clinicians’’ time, can be redeployed to improving health care quality. This simple arithmetic looks appealing, but it’s consistent with an EHR challenge of redeploying each clinician’s small time savings and efficiency gains. It’s an essential, but not an easy activity. 

    Three important findings from a study by American EHR illustrate the difficulties:

    42% of professionals who found it difficult to improve efficiency with EHRs72% found it difficult to decrease workload with EHRs54% said EHRs increased total operating costs.

    These confirm the need for eHealth to be highly usable. It’s a prerequisite for benefit realisation. 

    Imprivata suggests early types of EHRs incorporate these constraints. Modern versions can overcome them, and more benefits will result. It points Africa’s health systems to the need to test the efficiency and performance of EHRs that they’re considering in their procurements. Better EHRs offer better benefits. It looks encouraging for Africa’s healthcare.

  • Some employees can be a cyber-security threat

    Uncomfortable as it may be, Imperva says employees are the greatest cyber-security risk. They may be careless, become compromised or have malicious intent, and their trusted access to data can expose organisations. 

    An Imperva blog proposes the action needed to minimise the risk.7 Steps to Protect Your Data From Insider Threats are: 

    Discover and classify sensitive dataMonitor all user access to dataDefine and enforce organisational policiesLeverage advances in artificial intelligence detectUse interactive analytics tools to investigate security incidentsQuarantine risky usersGenerate reports to document security events.

    These aren’t proposed as absolute solutions. Imperva offers them as a guide to help detect and contain insider threats. Perhaps the most modern feature’s using machine learning to uncover unknown threats. It can sift through massive amounts of detailed data access logs so security teams can establish behavioural baselines of users’ access to data and rapidly identify changes, inappropriate or abusive data access. Drilling down’s more manageable. 

    The seven steps provide a framework for Africa’s eHealth cyber-security. Applying them needs resources, especially skilled people to manage and operate the process.

  • US ONC mission: to IOp and beyond!

    Buzz Lightyear, a Toy Story celebrity and star, saw his environment extending “To infinity, and beyond.” The US Office of the National Coordinator (ONC) sees interoperability (IOp) having an equivalent horizon. In an interview with EHRIntelligence, Genevieve Morris, ONC’s Principal Deputy National Coordinator, says the emergence of new technology and data sets means that IOP extends beyond a conventional EHR-to-EHR connectivity, which is becoming  an IOp  foundation.

    Extending IOp into genomic data and all other data needed for precision medicine’s ONC;s goal. They’re different data sets to mainstream healthcare data in EHRs. Learning health systems comprise totally integrated healthcare environments where IOp takes on a new and expanded meaning. This is a concept embedded in the ONCs’ updated healthcare IOp roadmap reported by eHNA. 

    While IOp and beyond may seem like a leap into the unknown, ONC’s approach’s pragmatic and incremental. It includes underlying standards and technical components needed for medical device integration and patient-generated health data. 

    Provenance’s an example. It identifies people and devices that create data elements and specifies when and where. This meets healthcare providers’ needs to know who and where data comes from as part of clinical data exchanged between EHRs.

    Africa’s IOp strategies and initiatives need to stretch out into these extra territories. It’s a continuous commitment to skills, resources and finance. EHRs are a start, not an end.

  • India’s patient and personal information data's been hacked

    Wide-ranging, Interoperable (IOp) eHealth depends on effective, secure Unique Patient Identifiers (UPI). India’s extending Aadhaar, its national identity number, as the UPI for healthcare. The Tribune has a report saying it’s been hacked. Rs 500, 10 minutes, and you have access to billion Aadhaar details refers to the Unique Identification Authority of India (UIDAI), responsible for Aadhaar, claim in November that Aadhaar data for over a billion people’s fully safe and secure and there has been no data leak or breach.

    A Tribune employee paid Rs500, about US$8, for a service offered by anonymous sellers to provide unrestricted access to details for Aadhaar numbers. Contact was made over WhatsApp, and took ten minutes to complete. Data provided included a login ID and password for access to any Aadhaar number in the portal and access the data that individuals have submitted, including name, address, postal code, photo, phone number and email address. Another Rs300, almost US$5, bought software that can facilitate Aadhaar card printing by entering an Aadhaar number of any individual.

    The Tribune says IDAI officials in Chandigarh were shocked at the revelations. It’s classified as a major national security breach. It seems the breach was some six months ago. Anonymous groups were created on WhatsApp. They targeted over three unemployed Village-Level Enterprise (VLE) operators hired by the Ministry of Electronics and Information Technology (ME&IT) under the Common Service Centres Scheme (CSCS). 

    CSCS operators produced Aadhaar cards. They lost their jobs when the service was restricted to post offices and designated banks to avoid security breaches. Initial illegal Aadhaar access was used to print and sell Aadhaar cards to low income villagers. Cyber-criminals have expanded the service.

    There are several lessons for Africa’s planned UPIs. Cyber-security should never be seen as safe. It required constant vigilance. Changes in personnel and providers always need corresponding changes in access rights and monitoring. These should be part of a rigorous cyber-security strategy.

  • Taiwan’s eHealth success has important lessons

    Health and healthcare challenges for Taiwan are being addressed with eHealth. Success with ageing populations and advanced eHealth has lessons for other countries. These were elicited with a qualitative methodology in 90-minute semi-structured interviews with 38 stakeholders, including focus groups. Published in the Journal for Medical Internet research (JMIR), their views are:

    eHealth can enable seamless patient careClinical benefits include flexibility in time managementLeaders’ visions, authority, and management skills might influence health care innovation successBoth internal and external organisational governance are relevant for implementing eHealth innovation in health care.

    A common thread across these is that eHealth helps healthcare teams to work smarter, not harder. This sits on Taiwan’s history of advanced medical and technological innovation. This’s an important aspect to reflect in assessing Taiwan’s lessons for Africa’s health systems. 

    Identified lessons include:

    Telehealth is essential, and how it’s used can make a differencePersonal information security must be addressed before designing eHealth care systemsWhen benefits can outweigh security concerns, these systems may become as popular as online banking and shoppingSecuring personal medical data should not be seen as an insurmountable problem that prevents telecare’s adoption and developmentElectronic data can be easily integrated with an existing HIS and can ultimately contribute to by decreasing financial burdensSystematic and integrated patient records can be developed to offer better health services, decrease diagnostic errors and ensure quality and cost-effective benefitseHealth’s a crucial tool for connecting people, not replacing themeHealth can help to bridge gaps in isolation between older and younger generations and rural and urban societiesClinicians were concerned about biometric data accuracy while they say they can collect more accurate data than hospitalsCost of adapting eHealth might initially pose challenges because of growth, but upgrading and renewal costs become more cost-effective in the long termUltimately, eHealth systems’ benefits will outweigh any potential problems in the long term. 

    These are encouraging insights for Africa’s eHealth. Affordability for Taiwan’s health systems may not be as challenging as Africa’s.

  • Oracle has a supply chain system for healthcare

    Effective logistics are essential for efficient and effective healthcare. Oracle aims to provide this by transforming healthcare’s supply chains. Its white paper from Fierce Markets set out the steps: 

    Better automation and analyticsTighter integration between all stakeholders, including end users, supply chain, distributors, suppliers and Group Purchasing Organisations(GPO)Increased emphasis on sound inventory management and demand planning. 

    Care and Cost Drive Healthcare Supply Chain Revolution says these can overcome four core challenges:

    Master data management, such as item pricing and trackingManual processes and multiple hand-offs between stakeholdersLegacy technologyA reactive instead of proactive approach.

    A general savings estimate, claimed as conservative is 3% to 5% of supply costs. These are achieved by enhanced strategic sourcing that can weed out supply chain redundancies. Actual savings depend on the levels of efficiency that healthcare providers have already achieved. Further gains may be from better re-order quantities and minimum and maximum ordering and stockholding levels. IoT solutions can help too.

    Oracle’s solution relies on a cloud service. For Africa’s health systems, it could be a big step forward. Better spending on drugs and medicines and avoiding counterfeits are high-value objectives. Improving their costs and availability has a direct impact on healthcare quality and efficiency. The Supply Chain Management System from Management Sciences for Health ( MSH) and operating across much of sub-Saharan Africa has insights in the impact.

  • Verizon sees a bright IoT future, but…

    eHealth strategies should have a prime place for IoT.  It’s role’s expanding, but there are still several challenges that need addressing. A report from Verizon Enterprise set these out. State of the Market: Internet of Things 2017 Making way for the enterprise says IoT’s taking hold in almost every industry. An example’s where pharmaceutical companies use them to track and trace medicines from production to patients. eHNA has another example. 

    What can Africa’s health systems expect from them? Verizon’s findings across economies are

    73% of executives are either researching or currently deploying IoT for the most important assets and processes 84% increase in IoT connections by manufacturers41% increase in transport and distribution industries40% increase in energy and utilities sectors19% increase in smart cities and communitiesIoT increases operational efficiencyImproved supply chain managementIt delivers unparalleled experiences to partners and customers.

    The big but’s that adoption’s slower than expected. Over 50% of executives say the reasons are a lack of:

    Industry-wide IoT standardsSecurityInteroperabilityAffordability.

    Both perspectives need to be included in eHealth strategies. Some of the inhibitors may be beyond health system’s direct control. Where they are, links to these initiatives need setting in place to monitor developments as part of investment plans.  One feature to keep on focus’s the changing supply side. Verizon says there are predictions of continuous market consolidation as larger providers acquire start-up and specialist IoT firms. 

  • Two bugs, Meltdown and Spectre, render your devices vulnerable

    An alarming start to eHealth’s New Year’s a claim by The Register that there are two bugs in chips used in the vast majority of computers and smart phones. It’s important for Africa’s eHealth vulnerability. It says severe design flaw in Intel microprocessors allows sensitive data, such as passwords and crypto-keys, to be stolen from memory.

    It seems that Intel's CPUs could allow applications, malware, and JavaScript running in web browsers to access confidential information in private, hidden memory areas. These zones often contain files cached from disk, a view onto the machine's entire physical memory. Intel's flaw’s called Meltdown. 

    Arm and AMD processors are affected too, but Meltdown doesn’t affect AMD processors. AMD says there its chips risk are near-zero. Arm has produced a list of its affected cores, typically in smartphones, tablets and other handheld devices. It links to a set of workaround patches for Linux systems. 

    Chips in desktop PCs, laptops, phones, fondleslabs and backend servers don’t completely walk back every step they take when they've taken a wrong path of code. Consequently, data remnants they shouldn't have been allowed to fetch remain in their temporary caches and can be accessed later. 

    Spectre allows apps to extract information from other processes running on the same system. It can be used by code to extract information from its own process too. AMD says its processors are practically immune to Variant 2 Spectre attacks. As for Variant 1, microcode updates or recompiled software’s needed. Google’s confident that ARM-powered Android devices running the latest security updates are protected due to measures already in place to thwart exploitation attempts, especially access to high-precision timers needed in attacks. The Register lists security patches, mitigations and updates for Google's products, including Chrome and ChromeOS. 

    It remains to be seen if the proposed fixes, patches and updates fix the vulnerabilities. It leaves Africa’s eHealth with a big headache in their current limbo.

  • eHealth's 'good to great' formula for 2018

    Amit Ahlawat in his book, “Seven Ways to Sustained Happiness”, says, “New doors open up; we stop looking back, enjoy the present and start planning and prioritising for the future in an optimal and optimistic manner." Similarly, as the doors of 2018 have swung open, eHealth must look forward, carrying with it the wins and lessons from 2017 to plan for an optimistic future. So, what does this future look like?  More importantly, what are Africa’s  eHealth priorities in 2018?

    2017 left us with a whirlwind of eHealth innovation, some big wins and some great lessons. Over the past few days, every noteworthy eHealth blogger, author and fund have written about their insights for 2018. As a young voice in this industry, I’d like to share my eHealth predictions for the year ahead. 

    My infatuation with analytics leads me to my first prediction; 2017’s curiosity with BDdata will result in greater investment in analysing data and making it more useful in 2018. eHNA’s published several articles over the last two years around the need for predictive analytics and the applications of Machine Learning (ML) in Africa’s healthcare. Micromarket Monitor predicts a Compound Annual Growth Rate (CAGR) of over 28% in predictive analytics investment in the Middle East and Africa by 2019.  Growth will be driven by the high penetration of new technologies in eHealth, rapidly increasing eHealth start-ups in Africa and the deluge of data they generate.

    Next, the rise in mHealth applications will swing more users towards Bring Your Own Devices (BYOD). While  it’s been a hot topic in 2017, Africa’s eHealth seems unconvinced by it. An eHNA article reported that over 90% of healthcare workers own a smart device. Barring security concerns, mHealth’s growing use in clinical decision support and healthcare delivery will propel government and organisations towards developing BYOD strategies. 

    Unsuspectingly, gamification may grab lots of attention this year. As healthcare moves away from a reactive to a proactive response, gamification may provide a large helping-hand in behaviour modification and awareness. It’s already created a sensation with Pokemon Go. Research suggests it improves physical and mental health.

    There’ll be many more predictions and events for Africa’s eHealth in 2018. The success of these will be underpinned by prioritising and investing in:

    Developing eHealth leadershipChange managementRisk managementCyber-security. 

    eHealth needs a unique type of leader with the right eHealth perspective, insight and skills to identify and maximise Africa’s eHealth opportunities. Without this, opportunities may not be seized. Acfee feels strongly about this and has put together a number of resources to develop eHealth leaders and champions.

    Change management’s vital for eHealth transformation. It helps stakeholders understand, commit to, accept and embrace the changes that eHealth brings with it. Prosci reports that projects with excellent change management are six times more likely to meet their objectives than projects with poor change management.

    Lastly, no endeavour is without risk. England’s WannaCry crisis and spambot Onliner are proof that eHealth and innovation will attract a fair amount of risk. 2017’s frenzy around cyber-security has taught us some valuable lessons. Lessons that need to carried into this year and strongly embedded into risk management protocols. For preparedness is no luxury, but a cost to eHealth’s progression and efforts.

    I look upon 2018 with great zeal and zest for the infinite opportunities that lie ahead. 2017 has shown that Africa has a promising eHealth future ahead of us, and the contributions you make as innovators, collaborators and visionaries can only strengthen it. I wish you all a prosperous new year and hope that you will remain in our readership as we unfold 2018’s innovations and breakthroughs.

  • How eHealth will support healthier Africans in 2018

    Contemplating my New Year's resolutions recently, I thought about Africa's eHealth journey over the last decade. It's moved from a largely disputed, nebulous term, to a fledgling industry with remarkable potential to transform our African health landscape. While eHealth is better understood now and showing some progress, the potential has not been translated into tangible African health benefits at scale.

    Numerous key issues need to be addressed. They constitute the contents page of many new National eHealth Strategies. An issue that is frequently underestimated though, is how to create better ways for the numerous eHealth stakeholder types to participate constructively. To be effective, this engagement needs to extend across a wide value chain, along timescales beyond most strategic plans. Only then, can it secure eHealth's role in achieving Healthy Africans.

    Improving engagement, building capacity and developing eHealth leaders is essential and why we created the African Centre for eHealth Excellence (Acfee). Our growing list of initiatives are starting to move this forward, such as the eHealth Network for Africa (eHNA) blog, the eHealthAFRO regional events, the African eHealth Forum including Acfee's Advisory Board of eminent African health advisers and the Acfee Awards for Outstanding eHealth Leadership. All these contribute to Acfee's work to collect data about Africa’s eHealth initiatives, engage African stakeholders, build capacity, develop eHealth's leaders and support countries’ national eHealth strategies.

    Acfee's 2018 plans include new contributions on strategy, leadership and curricula, guides on cyber-security, governance, regulation and impact, a much anticipated eHNA v5 release, and other technology assets that will provide our network of African eHealth experts with better tools to advance African eHealth. The successful eHA2017 in Johannesburg will continue annually. Additionally, eHA2018 will launch an East African event, in partnership with the East African Science and Technology Commission (EASTECO).

    Many hands make Acfee's work possible. Thank you for being part of this journey, whether you work with us, challenge us, or simply participate in an Acfee initiative. Together, 2018 will be the best Acfee chapter yet, for eHealth and for Healthy Africans.

  • What were the top ICT stories in 2017?

    Now 2017’s history, the significant ICT themes can be seen. A retrospective by Health IT Analytics found the top ten from its posts. They’re Big Data, Fast Healthcare Interoperability Resources ( FHIR) and machine learning are included. They’re:

    Top 10 Challenges of Big Data Analytics in HealthcareTop 4 Machine Learning Use Cases for Healthcare ProvidersWhat is the Role of Natural Language Processing in Healthcare?Judy Faulkner: Epic is Changing the Big Data, Interoperability GameHow Healthcare can Prep for Artificial Intelligence, Machine LearningExploring the Use of Blockchain for EHRs, Healthcare Big DataHow Big Data Analytics Companies Support Value-Based HealthcareBasics to Know About the Role of FHIR in InteroperabilityData Mining, Big Data Analytics in Healthcare: what’s the Difference?Turning Healthcare Big Data into Actionable Clinical Intelligence. 

    It’s a valuable checklist for Africa’s health informatics and ICT professionals for there personal development plans. eHealth leaders can use it too to ensure their eHealth strategies either include initiatives for the top ten, or lay down the investigative and business case processes for future plans. 

  • BYOD needs to sit on a strategy

    With mHealth, comes Bring Your Own Device (BYOD). It can be haphazard, random and uncontrolled, and can stretch across all eHealth. It’s best to avoid these high-risk scenarios. A white paper from MobileIron, an enterprise mobility service provider, describes an approach. The Ultimate Guide to BYOD deals with:

    Building a programmeRolling it outSustaining its security and performance.

    The overarching strategy’s using BYOD to drive transformation in a mobile enterprise. It fits Africa’s eHealth. MobileIron’s sequence of three BYOD maturity steps are:

    Prepare the organisationSet a risk tolerance level and impact for a BYOD programmeEngage stakeholders early to define programme goalsSurvey and communicate with employeesIdentify mobile and ICT capabilitiesUpgrade ICT infrastructure to support BYODInclude eight Components of a successful BYOD strategy:> Trust, the strategic core> Device choice> Liability> Internal marketing> App design and governance> User experience and privacy> Economics and financeSoft launch BYOD programmesDeploy programmes and training services.

    From this maturity stage, the desired result’s satisfactory cruising. It leads onto a culture of user independence comprising: 

    Self-registration of new devices, monitoring and managing current devices and retiring redundant devicesSelf-remediating hardware, software, application and compliance issues using explicit notifications and resolution instructionsContinuous productivity, efficiency and cyber-security compliance.

    From this second stage of maturity, the third’s:

    Incrementally add more devices, systems and appsEnsure safe and effective device retirementMeasure and demonstrate BYOD valueTake the measures needed to achieve mobile transformation. 

    These offer Africa’s eHealth a way to a sound BYOD strategy. It carries a financial cost. So does unfettered freedom.

  • Gamification and eHealth join on the Baltic Sea

    For eHealth enthusiasts making their plans for March 2018, how does a cruise on the Baltic sound? You can take in an international eHealth event while you’re there.

    Not to be outdone by the 22nd ISfTeH conference, a superb event I attended in Casablanca, Morocco in November 2017, the 23rd ISfTeH event’ll be held on a cruise ship travelling between Helsinki, Finland and Stockholm, Sweden.

    The theme for the conference is "Health communities facing cyber transformation". The event’s a collaboration between the Finnish Society of Telemedicine and eHealth and the International Society for Telemedicine and eHealth.

    ISfTeH has become known for innovative collaborations. The 2018 event will include eHealth2018 Game Jam organised by Games for Health Finland. Game Jam brings together healthcare professionals and game makers to create new ideas and ways to use eHealth technology and promote eHealth using gamification. The challenge’s to create a new solution in under 29 hours. Game jamming is a constant learning process for beginners and pros alike, inviting all skills to participate, whether you’re a programmer, designer or story teller. 

    Conference topics also include:

    Citizens as partners: disrupting healthcareCyber era in leadership and educationBenchmarking nationwide eHealth communitiesBeating Cancer with the help of cyber communityTackling acute crisis in local and distant environmentsCollaborating innovationsMy solutions: eHealth around the world.

    So whether it’s the Baltic Sea or the eHealth experts you’re most keen to see, the 23rd ISfTeH Conference sounds attractive. I hope to see you there.

  • Is eHealth mature enough for healthcare?

    Two opposing views of eHealth could be optimism and cynicism. An article in Fierce Healthcare identifies a view in between. It sees eHealth as a maturing endeavour that’s in an adolescent stage. While it’s a view of US eHealth, if it’s right, it has implications for Africa’s eHealth strategies too/

    It starts from a position where basic ICT infrastructure’s in place, such as EHRs, analytics and population health tools. This has created lots of data, but healthcare organisations don’t seem to know what to do with it. They’re entering a phase of trying to pull it together into a cohesive unit. Doctors are taking a core role in this, such as the Integrated Health Model Initiative (IHMI) reported on eHNA. 

    EHRs aren’t as communicative as they could be, and doctors don’t like the extra time they have to commit to eHealth’s demands. This extends to data entry too.

    Wearables can be full of potential for better health and healthcare. Unresolved challenges include designing effective service models and creating appropriate reimbursement arrangements. Reimbursement for telehealth remains elusive too, which doesn’t augur well for rising investment trajectories. It’s especially disappointing when over half of healthcare executives plan to expand their current programmes based on improved patient satisfaction and healthcare coordination achievements. 

    Recent huge global cyber-attacks, WannaCry  and Petya/NotPetya. revealed healthcare’s vulnerabilities. WannaCry breached several hospital systems in the UK’s NHS. For many weeks after the attack, the US Department of Health and Human Services was dealing with it’s operational aftermath for two multi-state health systems.

    Petya: 

    Damaged a US-based drug companyForced a West Virginia hospital to replace its entire computer systemCost Nuance some US$68 million by shutting down it’s medical transcription services.

    Repairs weren’t confined to technical cyber-security matters. They had to address a severe lack of ICT security talent too. 

    In this setting, US eHealth investment’s up. For Africa, it’s eHealth strategies need recognise and deal with both the challenges and opportunities. A wide range of resources need deploying to drive through eHealth’s complexities that extend beyond ICT. 

  • New telehealth code of practice's out

    As their mutual cycles evolve, telehealth’s developments lead onto updated codes of practice. Telehealth Global has released the 2018/19 International Code of Practice for Telehealth Services, updated be the Telehealth Quality Group (TQG). Its perspective’s consumer and service users, and deals with: 

    Remote consultationsActivity monitoringTelecare and social alarms (PRS)Vital signs monitoringmHealthVirtual coachingIncorporates ISO/TS 13131: Health Informatics – Quality Planning Guidelines for Telehealth Services.

    Interoperability (IOp) and cyber-security are given more emphasis. Enhancing telehealth’s IOp  can improve its fitness for purpose. Consistent data between hubs and remote centres, and people’s devices in their homes is the goal. It’s seen as offering greater choice. 

    Better cyber-security’s needed to ensure more trust. It means effective cyber-security needs reaffirming, leading on to action to strengthen defences.

    Demonstrating telehealth’s performance is important too. More openness means that performance measures and achievements are required to be honestly and openly displayed on service websites. These can lead to greater accountability. 

    As Africa expands its telehealth programmes, and the role mHealth plays in them, TQG’s updated code provides a sound foundation to build from. Using the IOp and cyber-security perspectives can direct projects towards better performance for Africans.

     

  • AI’s on the move in healthcare

    Perhaps the biggest display so far of AI potential and enthusiasm was at the Neural Information Processing Systems (NIPS) conference. It’s role in healthcare was a core theme of applied research, as reported in The Economist. 

    Initiatives presented at NIPS 

    Australia’s Maxwell MRI combines MRI and deep learning to improve prostate cancer diagnosesJohannes Kepler University has an AI system to track cell proteins to identify underlying biologyNorth Carolina’s Duke University uses machine learning to use a pocket colposcope to find cervical cancer. 

    Mining EHRs and doctors’ notes to estimate unplanned readmissions is increasing too. Another application’s categorising and understanding children’s allergic reactions. AI algorithms identify the use and distribution of Naloxone, a drug to reverse effects of narcotic drug, treat pain and block the effects of opioids. 

    With AI marching on, it adds to Africa’s eHealth priority challenge. How can it invest simultaneously in mainstream eHealth and AI? There’s no easy answers.

  • NIST updates its cyber-security framework

    Cyber-security measures keep stepping up. The US National Institute of Standards and Technology (NIST) has updated its proposals in its report on the Revised NIST Infrastructure Cybersecurity Framework. eHNA briefly summarised NIST’s first report. 

    Its core comprises four elements: functions, categories, sub-categories and informative references. They stretch across five aspects:

    IdentifyProtectDetectRespondRecovery.

    Four tiers are part of its overall risk management methodology: 

    Tier 1: partial:> Risk management >Integrated risk management programme>External participationTier 2: risk informed:Tier 3: repeatableTier 4: adaptive.

    Each tier has different degrees of rigour in its three common categories of: 

    Risk managementIntegrated risk management programmeExternal participation, 

    Organizations can adopt the framework now. It provides Africa’s eHealth teams with a sound template to work towards.

  • Telehealth reduces risk in chronically ill patients

    As the number of patients with chronic conditions increases, telehealth’s role might become more important to meet their needs. A study in the Journal of Medical Internet Research (JMIR) by a team in Alicante, Spain, evaluated telemedicine’s impact of adopting new care models that provide more home supervision. It found it appears useful to improve targeted disease control and reduce resource use. These are to important findings for Africa’s health systems and their eHealth strategies. 

    Target diseases were one, or more of, diabetes, hypertension, heart failure and Chronic Obstructive Pulmonary Disease (COPD).The study’s objective was to evaluate ValCrònic telemonitoring’s impact on patients with these long-term conditions who are at high risk for hospital readmissions and Emergency Department (ED) visits. It compared before and after effectiveness after a year of primary care monitoring.

    Using the Community Assessment Risk Screening Tool, 521 patients used a tablet to self-report relevant health information. It’s automatically entered into their eHealth record for consultation.

    Compared with the year before ValCrònic, there were significant reductions in: 

    Weight, down from 82 kg before to 80 kgThe proportion of people with high systolic blood pressure,36% to 33%High diastolic blood pressure, 14% to 8%Haemoglobin, 36% to 20%Patients attending primary care emergency services in, 13% to 6%Hospital ED visits, 19% to 13%Hospital admissions due to an emergency,20% to 14%Disease exacerbations, 10% to 8%.

    Taken as a group of measures, an important finding seems to be that they’ve all moved in the same direction. The team’s overall conclusion’ that ValCrònic has positive benefits for high risk patients and healthcare by reducing hospital readmissions and ED visits. It supports equivalent investment by Africa’s health systems.

     

  • Patient ID architecture needs an overhaul

    As eHealth expands its reach across more health and healthcare activities, each health system needs a more reliable Master Patient Index (MPI). Three activities are limited without it: 

    Co-ordination across the healthcare continuum and locatonsAccessing patient informationResolving patient identities across disparate systems and enterprises. 

    These need patient ID architecture needs to switch away from episodic modes. A whitepaper from        

    Verato, a cloud-based platform that matches identities, sets out how. It’s based on three components:

    Agreed business rules and policies for sharing patient dataStandardised EMR access protocols andPatient identity matching. 

    Significant progress on Interoperability (IOp) for data sharing rules and Health Level Seven (HL7) provide a foundation. What’s needed now's a set of Unique Patient Identifiers (UPI) so data sharing unambiguously refers to each patient. Easy to say, and Verato acknowledges the logistical and politically constraints. 

    Using demographic identifiers, such as names, addresses, birthdates, genders, phone numbers, email addresses and social security numbers, to identify individuals and their EMRs are error-prone when captured at receptions. They change over time too. Between 8 and 12% of people have more than one identity across healthcare organisations. Their medical histories are spread randomly across these different IDs. These duplicates are one of healthcare’s most intractable challenges.

    Current MPIs were created in the late 1990s and broadly deployed over the last ten years. They use probabilistic matching algorithms that compare all demographic attributes to decide if there are enough similarities to make a match. Common changes, such as maiden names, old addresses, second home addresses, misspellings, default entries twins, junior and senior ambiguities, and hyphenated names aren’t detected. 

    Verato’s approach uses pre-populated, pre-mastered and continuously-updated demographic data

    spanning countries’ populations. It referential matching that leverages the pre-mastered database as an answer key to match and link identities. This isn’t enough in eHealth’s changing and expanding world.

    Verato also aims to deal with:

    Adding new ICT by using standard Application Programming Interfaces (API)Automating existing MPI technologies stewardship, discovering missed duplicates and validating identities at registrationSupporting EHR consolidation where connections MPIs can’t reconcile patients’ data in other EHRsSupport HIE. 

    For Africa’s eHealth, these are valuable steps forward. It emphasises the need for better civil registration too, a long-standing challenge.

  • Successful EMR switching lesson from Scotland’s Fife

    Implementing EHRs from scratch is challenging. Switching from one set of EHRs to another is more daunting. NHS Scotland has been developing its latest Patient Management System (PMS) version over several years. Marianne Campbell, eHealth senior programme manager at NHS Fife, a health board in Scotland, has described provided five essential lessons in Connected Care Watch. An overarching requirement’s “Grace under fire … keeping a cool head in times of stress.”

    They five are:

    Early stakeholder engagementFull dress rehearsalClear leadership and delegationStick to the scopeUnderstand priorities.

    An connecting thread running under these is the long timescales needed for success. PMS has been many years in development. Implementing it extends across several too. It’s consistent with finding from Acfee’s eHealth evaluation database 

    Switching needed intensive preparatory efforts lasting over a year. Over 700,000 records were transferred from the existing system to PMS, and change management introduced new processes and procedures across ten acute, mental health and community facilities. More than 3,000 health workers completed the training programme. It also needed teething problems addressing. 

    Fife’s PMS project is part of a broader initiative across Scotland, promoted by the devolved Scottish government. There are 14 regional and eight specialist Sottish Health Boards. Twelve, covering 92% of the population, now use PMS.

    Engagement focused on internal stakeholders, reflecting PMS’s change management requirements affecting almost all health workers. A Fife lesson’s that more engagement was needed, especially regular immersive workshops. These started five months before go live. 

    The full dress rehearsal enables a seamless go live. It revealed troubleshooting actions in a controlled test environment. They were addressed in advance.

    and iron out any kinks before the big day.

    Two leaders dealt with and technology and business in parallel. They weren’t the only ones, Decentralised leadership from each area were empowered to make effective decisions quickly. Two technical teams from of NHS Five and InterSystems worked as a cohesive unit. 

    Sustaining the scope required strict discipline. It had to deal with some robust debates to balance the requirements of services with the go live timeline goal. Being controlled and systematic was the only way to a project of PMS’s scope could succeed. 

    The numerous stakeholders had many competing priorities. Clarity about critical activities was a daily discipline. 

    Success’s attributed to careful planning by many people over a long period. As Ms Campbell points out successful implementation doesn’t preclude issues arising down the track.

    eHNA’s looking forward to her next report on  PMS’s realised benefits compared to the previous system. Lessons from the realisation timescales and activities are as valuable as implementation lessons.