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  • CDC backs automated cause-of-death reporting app

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

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

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

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

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

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

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

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

  • Will cyber-criminals go for medical devices next?

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

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

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

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

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

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

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

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

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


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


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


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


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

  • eHealth SME start-ups aren’t booming yet

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

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

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

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

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

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

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

  • Smart dashboards are essential for eHealth benefits

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

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

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

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

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

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

  • Cyber-criminals target hospitals in 2017

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

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

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

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

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

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

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

  • mHealth to test male fertility

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

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

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

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

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

  • There’s an mHealth generation gap

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

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

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

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

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

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

    The profile of their health apps was:

    ·       Planning                            51%

    ·       Smoking cessation           44%

    ·       Healthy diets                     39%

    ·       Weight loss                        23%

    ·       Reminders                         36%

    ·       Prompting motivation        34%

    ·       Providing information         34%.

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

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

  • eHealth for consultations can reduce hospital waiting times

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

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

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

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

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

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

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

  • eHealth could avoid and improve prescribed drugs

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

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

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

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

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

  • AskNuma’s Nigeria’s latest eHealth service

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

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

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

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

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

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

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

  • Microsoft fixes a Word bug and vulnerability

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

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

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

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

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

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

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

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

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

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

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

  • IOp extends beyond healthcare entities

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

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

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

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

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







    Informal, such as phone calls



    Fax machine or fax service



    Scanning directly to recipients



    Standard or secure email



    Portal/system provided by a hospital



    Care/patient transition portal such as Curaspan



    Multiple portals or systems



    EMR or EHR integration



    Health information exchange (HIE)



    Electronic media such as CD/DVD/USB drive



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

    Loss of business               


    Decrease in operational efficiency


    Billing/medical coding errors


    Medical errors                   


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

  • Is API making HIE obsolete?

    There are several eHNA reports on Health Information Exchange (HIE). One report asked When will HIE take off? Now, a report from Chilmark Research says HIE messaging-based and document-centric models helped healthcare organisations (HCO) coordinate resources and enhance services across networked clinician communities. It concludes that these HIE initiatives have reached their limits. Healthcare practices of assessing and mitigating population risks across distributed clinical care delivery networks needs far richer, diverse information flows that HIE can provide.

    Instead, Application Program Interface (API) offers a solution. It’s a set of commands, functions, protocols and objects that can be used to create software or interact with external systems. It provides developers with standard commands to perform common operations so they don’t have to write code from scratch.

    Chilmark Research’s 2014 report Migration to Clinician Network Management revealed a massive healthcare transformation outpacing the vendor community’s ability to keep up. This gap’s widened since then, partly because most products are tied to a specific approach, and also an obsolete technology stack that doesn’t take advantage of modern development and integration ideas. 

    There are increasing types of data supplying a wider range of applications. Social and behavioural data is being incorporated and provided to points of care and for risk profiling and predictive analytics. Patients reporting data from their wearables and devices are being gradually incorporated into product plans. Most vendors want to make this data available for new computing capabilities such as predictive modelling, machine learning, and cognitive computing.

    The new technical approach advocated by Chilmark’s to leave health data closer to where it’s created, and use API to make it available to diverse applications and users. The concept’s similar to a virtual database. It’s already used outside healthcare, and is a more effective way to supply and consume data. It’s a better way to accomplish development and integration goals too.

    Africa’s eHealth initiatives need to consider how to switch from HIE to API. The pace of change seems so wide and rapid that API may become obsolete before it’s exploited fully.

  • GeneXpert technology to help Nigeria fight TB

    Using modern technology to detect diseases such as Tuberculosis (TB) has helped to reduce it globally. But, much more’s needed.

    For Nigeria, TB’s a major public health concern. WHO’s 2016 TB report says “Unfortunately, case detection in Nigeria is still very low at 16 per cent, while Nigeria is among the six countries accounted for 60 per cent of the new cases in 2015: India, Indonesia, China, Nigeria, Pakistan and South Africa. Nigeria estimates an incidence of 586,000 new cases in 2015 and 180,000 deaths every year. Early and accurate diagnosis is essential for prompt and adequate treatment.”

    To address this challenge, the National Agency for the Control of AIDS (NACA) has donated the GeneXpert test device platform to the St. Kizito Clinic. An article in BIZTECHAFRICA says it includes the installation of the equipment and staff training on GeneXpert technology. The test will substantially improve TB diagnoses in the community. It’ll enable the detection of Multi-Drug Resistant Tuberculosis (MDRTB) too, which is especially hard to diagnose in HIV positive patients.

    Dr Abdur Razzaq, Acting Director of KNCV Tuberculosis Foundation in Nigeria said, “TB still constitutes a serious public health problem in Nigeria, despite the implementation of the DOTS centres since 1993 and the adoption of the WHO “Stop TB strategy” in 2006. We set 2017 as the year of accelerated case finding for TB, we believe that the GeneXpert machine in St Kizito Clinic will further improve their capability to detect TB cases and prevent further infections in the community.”

    The test’s reliability makes it a valuable tool in the fight against TB. That the results are available in under two hours and can identify resistance to the antibiotic rifampicin are major benefits compared to the current service. Normally, it can take weeks to have drug resistance results. The technology should help Nigeria strengthen its position in its fight against TB.

  • Africa’s relative poverty’s increasing

    Poverty and poor health worldwide are inextricably linked, and it’s both a cause and a consequence of poor health, which traps communities in poverty. The Health Poverty Action (HPA) initiative’s clear about it, and says links between poverty and poor health are:

    • Economic and political structures that sustain poverty and discrimination need to be transformed for poverty and poor health to be tackled
    • Marginalised groups and vulnerable individuals are often worst affected, and deprived of the information, money or access to health services that would help them prevent and treat disease
    • Very poor and vulnerable people may have to make harsh choices, knowingly putting their health at risk because they can’t see their children go hungry
    • Cultural and social barriers faced by marginalised groups, including indigenous communities, can mean they use health services less, with serious consequences for their health, perpetuating their disproportionate levels of poverty
    • Costs of doctors’ fees, courses of drugs and transport to reach health centres can be devastating for poor people and their relatives who care for them or help them reach and pay for treatment
    • In the worst cases, the burden of illness may mean that families have to sell their properties, take their children out of school to earn money, sometimes  by begging
    • Caring burdens are often taken on by female relatives who may have to give up their education, or take on waged work to help meet households’ costs
    • Missing education has long-term implications for women’s opportunities and their health
    • Overcrowded and poor living conditions can contribute to the spread of airborne diseases such as tuberculosis and respiratory infections such as pneumonia
    • Reliance on open fires or traditional stoves can lead to deadly indoor air pollution
    • A lack of food, clean water and sanitation can be fatal.

    The Economist has reviewed data from the World Bank.  The good news is that the number of people living in absolute poverty, defined as having less, than US$,90 a day at 2011 purchasing parity, has dropped from over 1.8 billion in 1990 to under 0.8 billion in 2013, down by about 55%. Within this considerable achievement, Sub Saharan Africa’s (SSA) relatively worse off.

    In 1990, about 15% of its population were in absolute poverty. In 2013, it was approaching 50%. Two reasons are first, absolute poverty in South Asia and East Asia and the Pacific has dropped enormously. Second, Africa’s population has expanded by about 2.5% a year, more than twice Asia’s growth rate. SSA’s absolute poverty rate has dropped from 54% to 41%, but the relatively high population growth means that more people in SSA are now living in absolute poverty.

     For many years, SSA’s been attributed with a relatively high burden of disease. Now that other global regions are pulling away from absolute poverty, it has an increasing relative absolute poverty burden. The HPA commentary indicates a heightening challenge. It’s clear where Africa’s eHealth’s focus should be.

  • Is eHealth’s cyber-security on the march?

    As Africa’s eHealth expands, its exposure to cyber-security risks increase. A cyber-security report from Acfee summarises these cyber-threats. They include:

    • Medical identify theft
    •  Ransomware
    • Denial of Service (DOS) attacks
    • Malware
    • Fraud.

    Reasons for cyber-crime differ from criminal to criminal. Some want money. Others, such as hacktivists, use it as a political campaign strategy. Examples of cyber-criminals’ goals for healthcare are:

    • Diverting funds or pharmaceutical stocks
    • Forging prescriptions
    • Stealing social security data to make fraudulent claims
    • Changing treatment regimens

    South Africa aims to implement comprehensive cyber-security measures driven by the South African Protection of Personal Information (POPI) Act. In the USA, the Health Insurance Portability and Accountability Act (HIPAA) provides the foundation. It fits another, the wider National Institute of Standards and Technology (NIST) initiative reported by eHNA to improve the US cyber-security framework. The Payment Card Industry Data Security Standard (PTI DSS) provides a generic standard that fits healthcare.

    Fortinet, a cyber-security company, has an integrated approach set out in its white paper Countering the Evolving Cybersecurity Challenge with Fortinet Security Fabric. It provides an integrated cyber-security architecture that includes Advanced Threat Protection (ATP), Application Programming Interfaces (API) and layered, segmented firewalls.

    Typically, cyber-security aims to add new devices and cyber-security measure to an over-burdened cyber-security service. This increasing network eventually becomes dysfunctional, failing to solve the problem. Fortinet says there’s a hazardous contradiction. Deploying new devices helps to decrease the time to discover some new cyber-threats. In parallel, cyber-threats are compromising organisations at a faster rate. Hence the need for a shift to a new cyber-security model.

    Africa’s eHealth hasn’t adopted a cyber-security framework like Fortinet’s. As cyber-security awareness increases, it seems like an essential option.

  • Are mobiles part of Africa’s eHealth last mile?

    Connecting all Africa’s communities and citizens to communication networks has been a longstanding and challenging objective. It seems that the ambition remains unfulfilled. In an interview with Health Enabled, Dr Dustin Gibson, Assistant Scientist at the Johns Hopkins Bloomberg School of Public Health, described his research activities in Kenya. He said it’s “been very difficult to reach the last mile populations – that last 15-20% – with public health interventions.” Scaled up to all Africa, that’s between about 190,000 and a quarter of a million people.

    A solution included leveraging the widespread access to mobile phones combined with financial incentives through a widely used mobile-money system, like m-pesa. The result was an increase in full immunisation coverage in Kenya’s children from about 82% to 90%. The project took some four years to complete.

    Does this show that the mobile phone network’s an essential part of the solution to eHealth’s last mile? It seems that it can be.

  • Healthcare can save billions with eHealth transformation

    Over the years, there’s been many claims that eHealth can save money. By savings, they usually mean resources can be liberated and redeployed. Accenture researchers have projected that healthcare organisations in the US could save as much as US$60 billion collectively from strategic eHealth investment. An article in HealthcareITNews says Accenture’s report Digital Affectability: Quantifying the Economic Impact of Digital Assets pinpoints six services ready for significant savings. They’re Alzheimer’s, breast cancer, Congestive Heart Failure (CHF), diabetes, HIV and multiple myeloma.  

    Accenture also found that US$2 billion could be avoided every year by using eHealth to predict and mange CHF more effectively. Diagnosing Alzheimer’s early can yield significant savings too.

    “We’ve found that the highest-impact digital opportunities often lie outside the chronic, high-prevalence diseases that receive the most investment attention,” the report authors wrote. “Our analyses showed that 50 percent of system costs can be prevented by targeting investments to rarer, specialized disease states with lower prevalence.” 

    The report goes onto say thatUnderstanding the economic value potential of digital assets in distinct therapeutic areas and across the patient journey paves the way for the development of products, services and solutions that will optimize returns—for patients, as well as the business.”

    Seeing the long term value and savings in investing in healthcare technology is critical. Acfee’s keen on healthcare organisations understanding the eHealth costs, change management and risks of the investment needed to achieve the benefits. The report reveals eHealth’s potential impact on health systems’ costs. The report shows actual value in dollars of cost reduction in each disease across the phases of prevention, early diagnosis, intervention and monitoring.

    It shares critical insights for African countries starting to invest in eHealth. Africa’s health systems, with their constrained resources, often wrestle with eHealth investment when the benefits can’t bee seen in the short term and seem extremely challenging to realise.