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  • Articles (2,328)
  • Duplicate patient records keep turning up

    Achieving accurate patients’ IDs’s a constant theme of managing EHRs. Duplicate records just won’t go away. University of Washington (UW) Medicine based in Seattle regularly reviews and improves the reliability and accuracy of its EHRs. Cleaning duplicate records is an important part of the task. 

    Its latest initiative, available from EHR Intelligence, is  with Just Associates,  a consultancy that identifies and resolves patient data integrity problems, reveals some critical lessons for Africa’s eHealth. It found that the duplicate rate was significantly higher than the 10% to 20% it usually finds. The main cause was inadequate information. Many records contained only four of six ID components. They’re last name, first name, middle name, gender, fate of birth and social security number. 

    The review identifies the source of ID issues and issues that create duplicates. This information has helped UW Medicine to develop its strategy and planning to control duplicate rates.

    There’s a long-standing ID challenge. It’s an “uphill battle to dedicate the appropriate resources.”

    Sustaining appropriate staffing levels for ID management’s a challenge. Part of the solution’s relying on ICT tools. An objective’s to using technology to improve efficiency and reduce staff time manually accessing and matching records. It means that staff can then deal directly, efficiently and successfully with awkward ID cases and records.

    A valuable lesson for Africa’s eHealth’s that EHRs alone are not enough. Extra resources are needed to ensure the value of data in EHRs. With a typical duplicate rate of 10% to 20%, any drift in ID management seems to lead to higher rates, so greatly diminished value of EHRs’ data.

  • A coffee case study has lessons for blockchain in healthcare

    Coffee has loads of health benefits, though it’s not typically the go-to place for innovative approaches to health information systems. So I was intrigued by a coffee story that appeared in a June edition of Seattle Business magazine.

    Scott Tupper is an anthropologist and founder of Onda Origins coffee, a company that combines ideas on improving wealth disparity in the world, with a passion for information technology, and coffee. He uses the unique characteristics of blockchain technology to improve information accuracy and accountability in the coffee trade, driven through Yave, a company he started for this purpose.

    Blockchain structures are used to capture information at key steps along the coffee supply chain, from farmer to consumer. This creates a single source of truth about the coffee bean’s journey, encrypted and shared across a trusted, distributed network. And that sounds a lot like what we aim to achieve when building health records.

    Yave constructs multiple registers for each coffee consignment journey. The first register records the coffee producer’s name and electronic ID, the shipment’s ID, the coffee’s place of origin, the amount of coffee and the coffee’s description and quality score. That is encrypted and becomes the first block in a new blockchain.

    At key stages in the supply chain, an additional block is added to the chain, such as when the shipment is received at a mill, or passes through exporters and importers, or roasters. The mill register includes details about the milling process followed, initial roasting, and the results of taste test scores. At each stage new registers are created and existing data, such as taste scores, may be updated with new values. Since blockchain data is immutable, the old data is never overwritten. When new data is added, both new and old values remain in the chain and are auditable. At each stage, the new data is broadcast to the network, which can access all the information.

    How these details change across the supply chain helps to set the final assessment of the quality of the coffee bean, which affects pricing, and helps to review the quality of the supply chain, which drives operational improvements. The coffee-folk believe that one of the most valuable aspects of this application of blockchain is the ability to verify coffee’s origin and other key details of steps along the way to our cups, thereby making it easier to make value judgements about the final product and what you and I should pay for it.

    As we learn more about Blockchain technical attributes, we are beginning to recognise it as a tool for democratisation, sharing data ownership and access equally with all participants. This distributed architecture puts participants in control of their data in new ways that are technically extremely challenging with more conventional systems architectures.

    While Blockchain protects our coffee supply chain, it has the potential to transform ownership of our health data too. 

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    Image from the Yave site, https://www.yave.io/

    @yave_io

  • mHealth can help to reduce hospital readmissions

    Using mHealth to improve hospital services’s a common theme in Africa’s eHealth strategies and plans. Reducing readmissions’s an important part of these initiatives. A report from MobileSmith says how three mHealth solutions can help. 

    How to Reduce Preventable Readmissions with Healthcare IT describes:

    Efficient mHealth strategies for reducing hospital readmissionsStrategic use cases for prompt implementationSix best practices for cost-effective apps for engaging patient and doctors. 

    Efficient mHealth should provide:

    Relevant discharge communicationFamily and carer engagementImproved medication adherenceChronic disease control.

    The six best practices are: 

    Research and know target patient groupsThink big, start small, act fast, so avoid mHealth that does everything for everybody, so unlikely to be user-friendlyPolish user interfaces and experiencesKeep mHealth freshEstablish secure data exchangesAdopt analytics. 

    Underpinning each of these’s the core goal to empower patients. mHealth’s the bridge that healthcare can leveraging now to empower patients. It can only work with easy-to-use mHealth so patients are encouraged to become more proactive towards their health. These themes need expanding in Africa’s next wave of mHealth strategies and plans. They also need setting alongside high priority patient groups and clinical conditions.

  • Five main insights on the impact of EHRs

    While EHRs provide the most comprehensive, up-to-date patient information, more details about their impact’s needed for investment decisions. eHealth investment challenges are:

    What benefits to they bringHow are they realisedHow long does it takeDoes their value exceed their costs.

    Spectralink describes insights into some of these in its technical brief Five ways EHRs improve healthcare delivery. It’s available from EHR Intelligence. The five generic ways are:

    Access to critical data, anytime, anywhereImproved care coordinationMore accurate diagnosticsIncreased work flow efficiencies and cost savingsBetter patient participation.

    Within these five, ten benefits are identified across two groups:

    Physician workflow              

    Accessed patient chart remotely - 74%Alerted to critical lab value - 50%Alerted to potential medication error - 41%Reminded to provide preventative care - 39%Reminded to provide care meeting clinical guidelines - 37%Identified needed lab tests - 28%Facilitated direct communication with patient - 25%

    Patient-related outcomes   

    Enhanced overall patient care - 74%Ordered more on-formulary medications  - 41%Ordered fewer tests due to lab results availability - 29%

    Three other activities show large impacts: 

    Note practice functions more efficiently - 79% Receive lab results faster - 75%Report enhances in data confidentiality - 70%. 

    While these are large increases, there’s no information about how much more efficiently, fasters of enhancing these changes were. These estimated values are important in evaluating EHRs’ impacts. 

    None of the benefits refer to increased patient access as part of Universal Health Coverage (UHC). This needs resources liberated by efficiency gains to be redeployed to communities with no or limited UHCs. Acfee reviews reveal that these seldom happens on a large scale with EHRs. It has to be linked to specific UHC initiatives. 

    Uploading information with mHealth links are in place in about two-thirds of EHRs. This offers scope for further investment. It’s an essential feature for Africa’s eHealth

  • AI and machine learning need data storage resources

    Many things come in bundles. Amit Ray, author of Mindfulness Meditation for Corporate Leadership and Management says “As more and more artificial intelligence is entering into the world, more and more emotional intelligence must enter into leadership.” It’s not enough. A report by Source Media, sponsored by Pure Storage says powerful, advanced computing and storage capacity and capabilities are needed too.

    It recognises AI’s “vast” potential. Currently, some radiology departments use it effectively to improve workloads. Progress across other clinical activities depends on extra computing and storage power for two activities, training and clinical use.

    When researchers deliver AI and machine learning techniques to clinical practice and healthcare, solutions need huge amounts of data for training models, including labelling data. It’s especially important for neural networks. These are hardware and software patterned on the way neurons work in human brains. They’re deep learning technologies often focusing on solving complex signal processing or pattern recognition problems.

    If storage’s inadequate, it can’t keep up with the workload. The result’s diminished AI. Healthcare’s typical eHealth investment model’s to buy enough computing storage infrastructure as a minimum requirement, then expand it a few years after it’s clogged up. Eventually, it’s replaced with modern solutions after a period of obsolescence.

    This doesn’t fit AI and machine learning. It has to match the computer power and storage capacity needed as AI and machine learning expands. Developers and healthcare organisations can then move beyond exploring AI’s potential and bring into full use. The, patients benefit.

    While assembling the resources needed for AI and machine learning’s challenging for Africa’ health systems, the infrastructure requirements add to the constraints. Before venturing into the AI space, it’s essential to contemplate and deal with the whole resource requirements and their affordability. 
  • Robotic surgery is revolutionising prostate care

    Robotic surgery is a remote-control operation. Movements of a surgeon are translated through the tiny robotic arms of a machine.  The surgeon is often not in the same room and can even be on a different continent.

    Surgeons and patients are thrilled with the results.  Specifically, in prostate surgery, the Da Vinci robotic surgical machine has been used successfully in the UK and Africa countries to perform over 10,000 surgeries in men with prostate cancer, with marked improvements. Procedures are quicker, safer, and with fewer side effects than conventional open surgery or laparoscopic radical prostatectomy.  A review of 104 studies covering 230,000 patients confirmed it.

    Robotic surgery demonstrated superiority in:

    Operative timeLength of hospital staysBlood lossTransfusions requiredRate of post-operative erectile dysfunction and incontinenceLong term cost, due to the quick recovery timePositive surgical margin (PSM), which indicate whether the entire extent of the cancer was extracted during the operation. 

    The review is in line with other research on robotic surgery, which shows improved erectile function and reduced urinary continence compared to open surgery.

    South Africa has seen an increasing uptake of the robotic procedure since it was first implemented at the Urology Hospital in Pretoria in 2013. It is now more widely available.

    Doctors and patients benefit from these types of innovations. Long term net cost-benefits are likely too. The challenge for our health systems is how to find space for these, alongside other healthcare challenges, in ways that are affordable and sustainable.

    Watch a You Tube video about it here.

  • A Global Digital Health Index can help countries track their eHealth progress

    The eHealth landscape is evolving rapidly. So is the range of national and local initiatives under development. It can be difficult for countries and organisations to measure their own efforts against others, to benchmark their progress. The Global Digital Health Index (GDHI) has been developed to help.

    GDHI is an interactive digital resource that tracks, monitors, and evaluates the use of digital technology for health. It uses components of the WHO and ITU eHealth Strategy Toolkit. It was designed collaboratively with representatives from over 20 countries, and 50 international organisations. Online reports describe the consultations that took place in Cape Town November 2016 and Bellagio September 2017.

    GDHI’s three objectives are to empower, evaluate and motivate. GDHI website describes each as follows:

    Empower: The GDHI provides visibility into the status and historical progression of key digital health performance indicators at a national and global level. It empowers health ministries, funders, policy makers, and industry players to make intelligent and informed strategic decisions about why and where to allocate resourcesEvaluate: The GDHI benchmarks countries against standardized digital health criteria. It assesses the presence and quality of national policies and strategies, investment risks, and coverage of key digital health platforms while providing countries with a roadmap for maturing over timeMotivate: The GDHI helps countries track progress and identify weaknesses within their digital health initiatives. It incentivizes improvements in national digital health systems and more targeted investments globally. The GDHI helps facilitate the strategic use of digital health to accelerate and monitor the achievements of Sustainable Development Goal 3: Ensure healthy lives and wellbeing for all at all ages, through enhanced data use and visibility into health systems.

    As the tool develops, we hope to see more on health outputs.

    These types of initiatives are invaluable, particularly when they include deep and meaningful stakeholder consultations. Congratulations to all involved. 

    The initiative is co-facilitated by HealthEnabled and Global Development Incubator, with partners ThoughtWorks to develop the web-based index and Dalberg Design for design aspects of the index.

    Financial support is from Bill & Melinda Gates Foundation, Johnson&Johnson, Philips and HIMSS.

  • Promising future for eHealth in Africa, despite lower than expected growth
    Growth in the eHealth sector has failed to meet initial high expectations, but start ups are starting to gain traction as obstacles are removed.

    Africa’s eHealth sector has always attracted investment, but o far failed to live up to the market’s high expectations. Is change in the air? Disrupt Africa’s latest Africa Tech StartUps Report shows that ten eHealth start ups raised close to USD$9.5 million in 2017, up from USD$8.3 million in 2016. A report from Disrupt Africa summarises the main themes.

    This increase reflects Africa’s health market’s continuing potential for disruption. Nic Klopper, CEO of the hearX Group, a South African based company which develops smart phone hearing solutions, believes that clinical and traditional solutions aren’t meeting African market requirements because they’re prohibitively expensive and static. It means they can’t assist with decentralised healthcare programmes. By changing the way healthcare’s delivered, eHealth solutions are reaching people at the grassroots.

    However, any eHealth project must first find solutions to Africa’s specific social and physical environment to stand a realistic chance of success. So far, the path to growth in the eHealth sector has not been without pitfalls.

    Rob Heath, a South African investor at HAVAIC, says a main obstacles to growth was a of tech-savvy locals to carry projects over the finishing line. Quality’s good, but numbers aren’t. There’s a lack of professional investors who can add real value too.

    Another major obstacle was difficulty in achieving scale. It makes investors hesitant. Yet there are signs that start ups are now beginning to overcome this.

    The key is in the data. While African eHealth solutions meet local solutions, they provide data of global significance which can be sold on the world market.  An example’s Zipline, a drone-based blood delivery service in Rwanda. It  could supply data to organisations on other continents, so the US Federal Aviation Administration could obtain a drone delivery licence based on its data from Rwanda, or use its technology in a disaster relief zone.

    This potential for international growth is a major factor for investors. It’s essential in enabling start ups to achieve scale, which in turn means they’re taken up by the market. This closes a virtuous cycle; scalability attracts investors which allows scalability.

    Siraaj Adams, CEO of Digital Health Cape Town, a dedicated eHealth accelerator programme, says eHealth’s a sector that’s now attracting the much-needed attention it needs. He sees a bright future. Start ups in Africa find solutions for specific issues within their immediate environment. Scalability with the right backing can become a reality. Plummeting hardware and software costs means the cost of rolling out eHealth projects is becoming more affordable. It enables net benefits AI’s in the frame too plugins, web-hosted servers, and natural language processors can turn good ideas into products very quickly and affordably.

    eHealth’s future looks promising. Africa needs mHealth and cost-effective solutions delivered in communities, but it’s their value to the international community that will provide funding streams to turn these visions into action. 

  • Saudi’s eHealth programme aims for efficiency and effectiveness gains

    Saudi Arabia’s Vision 2030 aims to improve the efficiency of the health care sector through information technology and digital transformation.

    The ministry has launched the beta version of the e-health system at three hospitals

    The e-health system will be implemented across hospitals in the Kingdom in phases

    RIYADH: The Ministry of Health is implementing a cutting-edge e-health system at hospitals to improve health care efficiency in the Kingdom and provide patients with standardized e-health records by 2020. 

    Three Saudi Arabian hospitals, Yanbu General Hospital, Al-Bukayriyah General Hospital and Al-Kharj Maternity and Children’s Hospital, are set to use eHealth to improve their efficiency. An article in Arab News says it’s the start of National Transformation Program 2020 (NTP 2020), a Kingdom-wide programme to use eHealth in all medical departments including reception, emergency departments, clinics and wards. It’s part of the health ministry’s Vision 2030 to use eHealth to improve healthcare efficiency and effectiveness. 

    Integrated eHealth system will simplify data saving and access, reduce medical errors and ensure that appropriate health services are provided to patients. Benefits stem from the right resources being in the right place at the right time and reduced waste. 

    While Africa’s health systems may find the affordability of such a strategy challenging, the strategy seems transferrable. They’d have much longer timescales, which can create other challenges, such as obsolescence creeping in. These need identifying and addressing with risk mitigation plans as long-term requirements.

     

  • Experts offer their different views on London hospital’s AI

    The AI project announcement by a major London hospital’s attracted a wide span of opinions and ideas. Building on the plan reported in eHNA, the Times has several letters on the initiative. 

    Prof Sir Robert Lechler, President of the Academy of Medical Science emphasised the requirement to have the basics in place to realise the benefits and more healthcare to lead toe fourth industrial revolution. It includes sufficient resources for collaboration with industry, academia and regulators.  He sets the goal of people’s good mental and physical health.

    Hilary Evans, CEO Alzheimer’s Research UK, sees AI as an opportunity to revolutionise dementia research. Her goal is to improve early detection and diagnosis of the progressive disease. 

    Another prof, Harold Thimbleby from Swansea University has a different view. He says more AI’s a simple theory and that much of it data is flawed. Instead, fixing bad ICT would be more cost-effective, offer increased medical value and extend across more health conditions. The effect can be dramatic. 

    Nicola Perrin, Head of Understanding Patient Data, says AI success relies in patients having confidence in how their data’s used. A constructive dialogue’s needed with the public, She evokes the alarms raised from the Facebook and Cambridge Analytic controversy.

    J Merrion Thomas, a surgeon, says the money for AI would be better spent  on earlier benefits, such as highlighting known risk factors and early diagnosis. These will save lives immediately, rather than wait for AI’s benefits.

    These wide-ranging comments are just as relevant for all types of eHealth. They illustrate the engagement and commitment challenges of eHealth’s numerous stakeholders and provide valuable lessons for Africa’s health systems. eHealth never goes ahead in a straight line.

     

  • Cancer detecting pen to be piloted in Texas

    We often hear from surgeons that distinguishing cancerous tissues during surgery may be difficult. This  is a challenge that has been tackled by a group of researchers from the university of Texas who have developed a revolutionary pen. The MasSpec Pen is coupled to a mass spectrometer and can identify cancerous tissue during surgery in real time.

    The MasSpec Pen is able to diagnose cancer within twenty seconds during surgery.  The pen is placed over a tissue and uses touch to make a diagnosis. A foot pedal triggers the device to release water droplets which extract molecules from the tissue. The water is drawn into the mass spectrometer.  It then analyses the molecular compositions to determine if the tissue is cancerous or not. This also eliminates time waiting for results to return from the pathologist.

    While the diagnosis may be quick, the accuracy is still spot on. During a trial, 300 patient samples were analysed and the MasSpec Pen was able to detect four types of cancer; breast, thyroid, ovarian and lung cancer with over 96 % accuracy.  This could allow surgeons to remove all cancerous tissue and prevent further complications later on.  Similarly, it will eliminate the risks of unnecessary removal of normal tissue.

    Over the next several months, three of the devices will be installed in Texas hospitals.  The cost of this revolutionary pen is still being debated, but this could well be a useful tool for rural and remote hospitals in Africa to quickly and easily detect cancers.

  • What GDPR means for African countries

    If you struggled to access your favourite news site this morning, due to pop-ups insisting that you refresh your privacy settings, you are not alone. And the site is invariably based in the European Union (EU), or doing business with individuals in the EU.

    Today is GDPR Day. The General Data Protection Regulation (GDPR) is a regulation created in EU law to protect the privacy of individuals’ data. It applies to data of all individuals in the EU, whether that data is used within the EU, or anywhere else in the world. It comes into force today, May 25 2018.

    GDPR brings in sweeping changes to how businesses and public sector organisations can handle information. Under the new rules, permission is required before any personal data can be used and how long it is kept is now closely controlled. Anyone can ask a company to delete their personal information too. Read the statement from the European Commission and its links to resources.

    “Personal data is the gold of the 21st century. And we leave our data basically at every step we take, especially in the digital world. When it comes to personal data today, people are naked in an aquarium" said Vera Jourová, Commissioner for Justice, Consumers and Gender Equality.

    The GDPR sets out key principles:

    Lawfulness, fairness and transparencyPurpose limitationData minimisationAccuracyStorage limitationIntegrity and confidentiality (security)Accountability

    The accountability principle requires those who use data to take responsibility for complying with the principles, and to have appropriate processes and records in place to demonstrate that compliance, including appropriate technical and organisational measures to ensure accountability. Regular testing and reviews are required to make certain that the measures remain effective, or to guide remedial action id required.

    These principles form the building blocks of the legislation. Compliance with the spirit of the principles is regarded as critical for good data protection practice. Even though the principles to don’t include fixed rules, penalties for ignoring them are substantial. Failure to comply with the basic principles are subject to fines of up to €20 million, or 4% of total worldwide annual turnover, whichever is higher.

    Individuals have:The right to be informedThe right of accessThe right to rectificationThe right to erasureThe right to restrict processingThe right to data portabilityThe right to objectRights in relation to automated decision making and profiling.

    The GDPR introduces a duty on all organisations to report certain types of personal data breach within 72 hours of becoming aware of the breach, and if the breach is likely to result in a high risk of adversely affecting individuals’ rights and freedoms, companies must also inform those individuals without undue delay. This requires that robust breach detection, investigation and internal reporting procedures are place to facilitate detection and decision-making.

    Close Circuit Television (CCTV) falls under the GDPR too.

    The UK Information Commissioners Office has extensive guidance. Many companies, such as IBM and Oracle, offer guidance too.

    While the GDPR does not apply to African countries directly, many African businesses will already be affected, due to their business relationships with the EU or its people. Whether you're affected yet or not, GDPR provides a best-practice model for incorporating into business practices and regulatory strengthening.

    African countries' regulatory strengthening is well underway. South Africa's Protection of Personal Information "POPI" Act is one example and provides many components of the GDPR.

    First steps towards compliance could be to:

    Brush up your cyber-security policy, andImplement a privacy management framework to help embed accountability measures and create a culture of privacy across your organisation.

    The commissions’ seven steps for businesses provide pointers too. They are:Check the personal data you review and process, the purpose for which you do it, and on what legal basisInform your customers, employees and other individuals when you collect their personal dataKeep the personal data for only as long as necessarySecure the personal data you are processingKeep documentation on your data processing activitiesMake sure your sub-contractors follow the same rulesConsider additional provisions, such as :Organisations might have to appoint a Data Protection Officer, particularly if processing of personal data is a core part of your businessData Protection Impact Assessment Such an impact assessment is reserved for those that pose more risk to personal data, for instance they do a large-scale monitoring of a publicly accessible area, including video-surveillance.

    In the meantime, dealing with your privacy preference update requests will ensure that data protection remains in the forefront of your mind, at least for today. Happy GDPR Day.

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    Image from this tweet by @EU_Commission

  • eHealth for SDG promoted at East African Ministerial Conference

    Kigali, Rwanda has been a magnanimous host to eHealth events, this Autumn. Following on from last week’s EAC Regional eHealth and Telemedicine Workshop, the 2nd EAC Regional eHealth and Telemedicine Ministerial Conference was Thursday 17 April. The Ministerial Conference considered the report and recommendations of the workshop, under the theme “harnessing science, technology and innovation to transform healthcare delivery  and accelerate the attainment of sustainable development goals in East Africa". It’s yet another high level African meeting exploring the role of eHealth in helping us to achieve universal health coverage, hosted by the East African Science and Technology Commission (EASTECO).

    “Discuss how technology can be used to enhance healthcare delivery” was a challenge posed by Rt Hon Dr Ali H Kirunda Kivejinja, Chairperson of the EAC Council of Ministers, to conference delegates, in his opening remarks. He emphasised the importance of cooperation to secure the technologies’ “ultimate goal of improving standards of living and increasing life expectancy of East Africans”.

    Clear directives were provided on the way forward. The Ministerial Conference: The 2nd EAC Regional e-Health and Telemedicine Ministerial Conference:

    "Urged the EAC Partner States that do not have a National e-Health Strategy develop it in line with the WHO - ITU National e-Health Strategy Toolkit [to develop one] by 2020;Directed EASTECO to conduct an EAC regional e-Health readiness assessment incorporating aspects of systems interoperability, costs and benefits of investing in e-Health by 30th December 2019 in collaboration with the EAC Secretariat, East African Health Research Commission, Partner States’ National Science and Technology Commissions/Councils and Partners;Directed EASTECO to promote incubation of local digital health solutions in collaboration with the EAC Secretariat and the Partner States’ Ministries and Agencies responsible for ICT, Science, Technology and Innovation and submit progress reports to relevant Sectoral Councils and the Council of Ministers every two years;Urged the Sectoral Council on Health to coordinate the development of regional policies, laws, regulations, guidelines, standards, on health facility/patient safety, data sharing, data security and privacy to facilitate e-health enabled in country and cross border patient referrals within the EAC Partner States by 30th June 2020 directed the EAC Regional Centre of Excellence for Biomedical Engineering and eHealth to conduct a study in the application of eLearning systems for training Health Professional in the Region and IUCEA to develop a regional framework to enhance regional and south-south collaboration in capacity building for e-Health by Jan 2020;Directed EASTECO to take leadership in convening the EAC regional e-health and telemedicine workshops, ministerial conferences and international exhibitions every two years on a rotational basis among the Partner States in last week of October as part of the meetings of the EAC Sectoral Council of Ministers responsible for Health in collaboration with the EAC Secretariat, the EAHRC and the EAC Regional Center for Excellence for Biomedical Engineering and e-Health; andApproved hosting of the 3rd EAC regional e-health and telemedicine workshops, ministerial conferences and international exhibitions by the Republic of Uganda from 28th to 30th October 2020 as approved by the 16th Ordinary Meeting of the EAC Sectoral Council of Ministers of Health."

    Collaboration and cooperation for eHealth for impact is a growing theme in African regional communities. Congratulations to the organising team and it’s tireless leader, Ms Gertrude Ngabirano Executive Secretary, EASTECO. It is a timely theme for eHealth to realise its potential and its critical role I supporting UHC.

    Photo – Ministerial Panel Picture, from left to right: Dr. Rashid Aman, Chief Administrative Secretary in the Ministry of Health, Republic of Kenya; Hon. Ken. Obura, Chief Administrative Secretary, Ministry of East African Community and Norther Corridor Development, Republic of Kenya; Rt. Hon. Dr. Ali H. Kirunda Kivejinja, Second Deputy Prime Minister and Minister for EAC Affairs, Republic of Uganda and Chairperson of EAC Council of Ministers; Hon. Sarah Achieng Opendi, State Minister for Health - General Duties, Republic of Uganda;  Dr. Patrick Ndimubanzi, Minister of State in the Ministry of Health in charge of Public Health and Primary Health Care, Republic of Rwanda; Mr. Toritoi Ngosayon Bunto, Ag. High Commissioner of the United Republic of Tanzania in Rwanda; representing Hon. Dr. Ummy Ally Mwalimu, Minister of Health, Community Development, Gender, Seniors and Children in URT.

    Photo - Ms. Gertrude Ngabirano, Executive Secretary of EASTECO

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    Cover photo – Rt. Hon. Dr. Ali H. Kirunda Kivejinja, Second Second Deputy Prime Minister and Minister for EAC Affairs, Republic of Uganda and Chairperson of EAC Council of Ministers giving remarks

  • Is AI set to take off in a London hospital?

    As marches go, AI in healthcare’s still in its early stages. It may be that it’s about to make a big leap forward. The UK’s Guardian newspaper  reports that University College London Hospitals (UCLH) and the Alan Turing Institute has agreed a three-year partnership to realise AI’s benefits to healthcare on an “unprecedented scale.” Planned projects include using AI to: 

    Improve UCLH’s A&E department’s performance, currently below 77% of patients needed urgent care treated within four hours, well below the standard set for England and stuck at 2010 levelsAnalyse CT scans of 25,000 former smokers recruited as part of a research projectAutomate cervical smear tests assessments. 

    A challenge is avoiding learned helplessness. It’s where health professionals become too reliant on automated instructions and abandon common sense. AI’s algorithms might be correct 99.999% times, but are rarely 100% reliable.

    Another’s sustaining rigorous data governance standards, especially privacy and confidentiality. The plan’s to apply algorithms to UCLH’s servers to avoid breaches. Private companies won’t have access. 

    A previous AI project in Engalnd’s NHS was a collaboration between London’s Royal Free Hospital and Google’s DeepMind. The Royal Free accidently gave Google access to 1.6 million records of identifiable patients.

    Alan Turing was an English computer scientist, mathematician, logician, cryptanalyst. He was highly influential in developing theoretical computer science, formalising concepts of algorithm and computation using the Turing machine. In the 1940s at Bletchley Park, he was instrumental in developing the Bombe machine to crack enemy’s complex and rapidly changing Enigma code.

     

  • US EHR solution judged not up to the job

    eHealth has risks. A report from the US Office of the Secretary of Defense, and available from EHR intelligence, highlights some of these. They provide valuable themes for Africa’s health systems to use in their EHR assessments and procurements. Is says “a partial  IOT&E [Initial Operational Test and Evaluation] was adequate to determine that MHS GENESIS was neither operationally effective nor operationally suitable.” It raises an important challenge: how could this have been established before procurement? 

    Inappropriate performance included: 

    MHS GENESIS is neither operationally effective nor operationally suitable. DOT&E recommends that the Under Secretary of Defense for Acquisition and Sustainment delay further fielding until JITC completes the IOT&E and the PMO corrects any outstanding deficiencies. Detailed recommendations are included in the main body of this report;

    It doesn’t demonstrate enough workable functionality to manage and document patient care in 56% of the 197 tasksof performance Poorly defined user roles and workflows increased the time needed for health care providers to complete daily tasks, including overtime and seeing fewer patients a dayUsers questioned information accuracy in exchanges between external systems and MHS GenesisPoor usability of 37%, on the System Usability Scale (SUS), well below the 70% thresholdInsufficient trainingInadequate help desk supportSystem unplanned downtime outages indicated that the end-to-end system and supporting network didn’t have sufficient availability to support operations at the four IOT&E locationsUsers reported increased lag times when other IOT&E sites went live, suggesting the supporting network configuration wouldn’t support the hundreds of additional planned sitesSurvivability is undetermined because cybersecurity testing isn’t complete. 

    This salutary experience shows the importance of rigorous assessment processes before procurement. Across the global eHealth community, it’s not the first time, and it’s not likely to be last. Africa’s health systems can afford this type of risk exposure experience. 

  • Robot Tug to help aid nurses in hospitals

    The field of robotics is making great leaps in health care today.  Take for example, Tug, the robot nurse. The aim of this robot is to improve patient care in hospitals by doing the mundane tasks like hauling food, linens, specimens and medications around the facility. This enables the healthcare workers to focus on other relevant duties and patient care.

    Appearance wise, Tug does not look like a typical humanoid robot. Instead, it looks like an oven that has wheels.  Staff begin the day by uploading activities that they would like Tug to do and then it wheels itself around the hospital performing those duties. It is programmed in such a way that employees can change the order of the tasks based on urgency.

    Tug navigates a facility using dozens of lasers therefore it is able to make quick decisions such as stopping when a person is in the way. It can carry up to a 1000 pounds on its back which can also be swapped with different models to meet other needs besides medical deliveries and food.

    This is a great use case for the overburdened, understaffed hospitals in Africa – a robot to aid nurses and health workers with their daily activities.  Will we being seeing Tug in African hospitals soon?

  • Blockchain for beginners is still needed

    Blockchain is a hot topic everywhere, including in healthcare. I have been writing about it for eHNA, exploring use cases and applications. I've had lots of positive feedback, yet a question remains for many: how does blockchain technology actually work? Today's piece introduces some basic concepts. 

    Firstly, bitcoin and blockchain are not the same thing. Bitcoin is a digital currency or cryptocurrency that is administered on blockchain technology.  It combines many existing concepts, including large databases, voluntary participation, peer-to-peer networks, distributed ledgers, and cryptography, to protect users' information against fraud.

    There are three levels of how blockchain technology is currently being used:

    Storage of digital recordsExchange of digital assets in the form of tokens, and Execution of smart contracts.

    Smart contracts set the ground rules for how transactions take place. They execute the contracts while monitoring compliance and automatically validate the results of each transaction.

    To work, blockchain relies on consensus. This gives rise to the concept of mining. Each new block added to a given blockchain follows a consensus model which is approved by the network of connected nodes.  The level of agreement in consensus models may vary across blockchain networks.

    Encryption of information on a blockchain is achieved by hash functions. These map data of arbitrary size to data of a fixed size through a cryptographic method or algorithm. Hash function outputs are unique, asymmetric and random, ensuring security on the blockchain.

    That's probably not enough information to get you started on mining your own blockchain, but hopefully sufficient to tweak your curiosity about this elegant technology.  I'll post more over the next few weeks.

  • How can online health information avoid negative results?

    Type “health information” into your favourite search tool.  Then, prepare to scroll through over 2.6 million results. The negative effect of these sources on users hasn’t been examined.  A study led by Reem El Sherif at the Department of Family Medicine at McGill University in Montreal, and published in the Journal of Medical Internet Research (JMIR), aims to deal with it.

    Two goals are:

    Describe negative outcomes in primary careIdentify potential preventive strategies from users, health practitioners and health librarians.

    It found three types of interdependent negative outcomes:

    Internal, such as increased worryingInterpersonal, such as a tension in patient-clinician relationshipsService-related, such as postponing clinical encounters.

    The study links them as:

    Three types of strategies were identified that aim to reduce these negative outcomes. They were:

    Providing users with reliable informationEducating users on how to assess websites that provide health informationHelping users to present and discuss their online information with health professionals, their social networks or librarians.

    These are integrated too:

    Librarians have a core role in minimising negative outcomes. Responsible for providing reliable health information and advocating the advantages of using health websites, they’re well positioned to implement the preventive strategies. Their work with users and health practitioners can integrate them with users’ health information–seeking and ensure the reliability of the information they find and use. Improving health literacy can lead to fewer internal tensions. Librarians can also develop discussions with health practitioners, leading to fewer interpersonal tensions. Their third contribution’s helping users to find relevant information so they can make better health and health care decisions, leading to fewer service-related tensions.

    While this might seem a bit obvious, the researchers identified two barriers that needed overcoming. One’s a lack of awareness of available health librarian services. The other’s a lack of access to health librarians by the public. A possible solution is to train community librarians working in public facilities, such as libraries, on how to provide health information services.

    Africa’s health systems should consider these additional costs of online health information. Without these resources, their investments in online health information may not realise the benefits requires of them, so an inadequate return.

  • African Alliance of Digital Health Networks to rally support for African countries

    “We want to go far” said Olasupo Oyedepo, Tuesday, announcing the launch of the African Alliance of Digital Health Networks on LinkedIn. Olasupo is Project Director at ICT4HEALTH Project and Director of the new Alliance. He is a bold man with a bold vision of renewal, to:

    Connect the eHealth and digital health networks emerging in AfricaExpand the platform of support for African countries and their eHealth initiatives.

    The launch was at the Transform Africa Summit in Kigali, Rwanda on 8 May 2018. The Alliance was first conceptualised at the 2016 Global Digital Health Forum that took place in Maryland, USA. A key aim's to ensure that African countries have the support and resources needed to develop strong eHealth “helping to grow a cadre of digital health leaders and entrepreneurs in Africa”. Its programmes will focus on digital health leadership, entrepreneurship, mentorship and peer learning. The leadership and capacity development emphasis is well matched with Acfee's priorities.

    Our African countries’ eHealth expertise and initiatives are growing fast, and beginning to contribute to health systems strengthening. Growth will continue and the additional resources and support that initiatives such as the Alliance may bring will accelerate these efforts. Acfee congratulates Olasupo and the new Alliance and looks forward to learning soon about its programmes and how collaboration plans to make a rapid and significant impact on Africa's eHealth, so the Alliance can go far and fast.

    -----------------------------

    Photo from launch, left to right:

    Gaelle GisubizoDykki Settle – PATHCaren Althauser – PATHHuguette Diakabana – Deputy Director, African AllianceOlasupo Oyedepo – Director, African AllianceBen Aliwa – PATH

  • HearX Group makes hearing screening more accessible

    In 2015, eHNA reported on a South African start-up, HearX Group, founded by Prof De Wet Swanepoel and Dr Herman Myburgh.  They developed a low-cost smartphone app that detects hearing loss and connects patients to health services.  

    The product uses a smartphone and headphones along with a custom-developed software application to detect hearing loss.  This inexpensive alternative to conventional screening is 50-70% less expensive and can be administered by non-specialists and screeners with even basic literacy and low digital skills.

    Today, the company boasts a suite of apps and mHealth devices geared towards improving hearing screening in underserved and remote communities, and especially among children.  Other products included in their collection include hearZA, mHealthStudio, hearTest and hearDigits, as well as a partner product in vision called Peek Acuity.  

    Now, HearX group has taken their solution beyond Africa.  A recent collaboration with the American Academy of Audiology saw the launch of America’s first-ever intensive hearing screening mobile app, hearScreen USA.  This was launched at the Academy’s annual conference April 2018 and is freely available on smartphone devices.

    In many nations, the general awareness of hearing impairment is low and shortage of resources has caused a lack of screening programmes.  HearX Group could soon be turning this into a problem of the past with further collaborations in Africa, Europe and Asia.