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  • Articles (2,126)
  • BCS provides doctors views on EHRs

    Is addictive texting especially annoying during meals? Some hospital doctors in the US think it is, and think it’s annoying for patients when they’re accessing EHRs during consultations. A study in the Journal of Innovation in Health Informatics, (JIHI) surveyed hospital doctors’ perceptions of EHRs’ impact on patient-doctor interactions. It compared these to perceptions to doctors working from offices. JIHI’s a publication of the BCS Chartered Institute for IT, the British Computer Society (BCS).

    Data for the survey came from the 2014 Rhode Island Health Information Technology Survey. It asks eHealth users about their practice settings and specialties, their EHR and ePrescribing functionalities and frequencies of use, and free-text questions. They include open-ended questions analysed by the BSC study.

    Five main themes emerged from the free texts:

    • Less time spent with patients, more time spent on computers documenting EHRs        
    • Lower quality of patient-doctor interactions and relationships
    • But, no effect because doctors change their workflows
    • Improves access to information and preparation
    • Frequent unintended negative consequences.

    Hospital doctors report benefits ranging from better information access to better patient education and communication. They also frequently say EHRs help them to feel more prepared for clinical encounters. Office-based doctors more frequently say they’ve changed their workflow, while have depersonalised relationships. 

    The study team says its findings have two uses. One’s to modify interventions to improve EHRs’ use in inpatient settings.  The other’s to develop interventions to specific specialties. Both contribute to improving doctors’ satisfaction and patients’ experiences. Africa’s eHealth projects can incorporate these. Will it help to avoid texting at the dinner table?

  • Kenya accesses ConnectMed’s telemedicine services

    Launched in 2015, ConnectMed, a South African eHealth start-up, has now launched operations in Kenya. Its aim’s to provide affordable medical advice to patients outside a healthcare setting. It’s gained recognition after being chosen as five winners in the 2016 DEMO Africa start-up pitching event, then its recent involvement in the Lions@frica Innovation Tour in Silicon Valley.

    ConnectMed’s mainly for middle and upper incomers who have easy access to Internet-enabled devices and use private healthcare. However, it’s been successful in Kenya’s rural areas and big cities. During trials in Kenya, it became evident that elderly patients who found it challenging to travel for sexual and mental health advice had adopted the platform.

    The start-up gives patients a platform to schedule a secure virtual 15 minutes access from 8am to 11pm, seven days a week. Users can set appointments with doctors for the same day over a video for common ailments. These are either directly through ConnectMed Prime or indirectly through clinic partners ConnectMed Care.

    Like most of Africa, Kenya’s healthcare relies on insufficient doctors, is inaccessible to many communities, has high travelling costs and limited available hours. The virtual doctor services aim to deliver scalable healthcare to solve these challenges.

    At least 50 doctors licensed by the Kenya Medical Practitioners and Dentists Board (KMPDU) have signed onto the platform. They can provide ePrescriptions, sick notes or referral letters. ConnectMed patients are given discounts on medication and follow-on services from service partners.

    An article on eHealth news says ConnectMed also offers an enterprise solution suitable for clinics experiencing a shortage of doctors. It enables clinics to treat more patients and improves the medical skills of existing staff. Melissa McCoy, CEO of ConnectMed said to Demo-Africa that the company plans to establish physical hubs in cyber-cafes and pharmacies where the general public can access its health information. It may not be long before its available across most of Africa.

  • eHealth start-up EMGuidance wins SA’s Seedstars

    Talent competitions are always good motivators for contestants, especially those who top the list. The winners of the South African stage of the Seedstars World competition, EMGuidance, an eHealth start-up’ll be highly focused on the next round. The team’ll be competing for a US$500,000 funding stream at the global final in Switzerland.

     An article in Disrupt Africa EMGuidance was chosen from ten finalists from its early-stage start-ups competition. Its largely about solving a fundamental problem for the medical profession: how to aggregate medical content from regional experts into one place. Its app does it by allowing for fast access to diverse but reliable data. 

    Zlto, a digital rewards platform incentivising its users for positive behaviour, was runner-up. It uses a mobile wallet to access a marketplace. Empty Trips came third, with an online trip exchange using algorithms and transport auctions to fill empty spaces to places.

    Fanny Dauchez, associate for Seedstars World Africa, told Disrupt Africa that “We had a pleasure of meeting talented entrepreneurs from different cities and backgrounds in South Africa, and seeing them do such an amazing job representing themselves and their start-ups on this big South Africa finals stage.”  Hopefully, it won’t be too long before EMGuidance’s and the other competitors solutions are used across all Africa.

  • Masters in eHealth management applications open now

    Like all health systems, developing eHealth management and leadership skills are essential for Africa. In February this year, Acfee and Rome Business School (RBS) set up an arrangement to support the RBS Masters in eHealth and Telemedicine Management. The next course starts in October 2017. Online applications are already now.

    Part of the arrangement is a discounted price for applicants from Africa. It’s only available to Acfee members. Acfee membership’s free to people working in health and eHealth, health and healthcare organisations, professional bodies and health ICT entities.

    If you’re already a member, you can use your Acfee membership number in your RBS application. To join, email info@acfee.org with details of your current role and employer, and Acfee will send you a membership number and information pack.

  • Broadband infrastructure’s crucial for SDGs

    The Broadband Commission for Sustainable Development, set up by the ITU and UNESCO, is urging policymakers, the private sector and other partners to make deployment of broadband infrastructure a top priority. The goal’s to help accelerate Sustainable Development Goals (SDG). 

    In a statement to the High-level Political Forum on Sustainable Development (HLPF) in New York from 10 to 19 July 2017, the Commission highlighted the many ways that broadband can improve global sustainable development, and improve millions of lives says an article in BIZTECH Africa. It includes addressing basic needs such as healthcare, food production and helping lift people out of poverty.

    "We must work together," said the Commission in its statement, "to harness the opportunities and benefits of ICTs, new and emerging technologies such as big data and artificial intelligence, as well as broadband-based technologies, while safeguarding against their downsides and risks. This will be critical to achieve the SDGs and realize the future we want. Let us seize the historical opportunity of the SDGs to build a model of sustainable development anchored by universal access to affordable broadband technologies and digital literacy in order to fulfil a future where no one is left behind."

    A report from ITU says only 15.4% of Africa’s households are connected to the Internet. There’s much to be done.

  • Luckily, it wasn’t treating patients

    As AI takes control and robots push us to one side, can we really rely on these smart machines? Maybe we can, if we allow them some degree of human frailty. 

    A security robot drowned itself by diving, or maybe only stumbling, into a shopping centre and office block’s ornamental pool in aptly named Georgetown Waterfront, pun intended, Washington DC. Fortunately, it didn’t make it through medical school, so wasn’t operating on patients at the time.

    The Knightscope security robot bid farewell to all around, and added a poignant extra meaning to Shakespeare’s anguish expressed by Hamlet:

    “For in that sleep of death what dreams may come

    When we have shuffled off this mortal coil,

    Must give us pause: there's the respect

    That makes calamity of so long life.” 

    If it senses a threat, it can squeak, whistle and make other loud alarming noises to deter criminals and nuisances. It can withstand attacks too. It can’t swim. It rejected John Lennon’s advice, that “When you're drowning, you don't say 'I would be incredibly pleased if someone would have the foresight to notice me drowning and come and help me,' you just scream.” Eye witnesses said they weren’t sure if it was waving, drowning or just cooling off.

    It looks like it’s back to the drawing board. Maybe it should be a surf board.

  • eHealth takes a step forward in Namibia

    Namibia has officially launched the second version of the District Health Information System (DHIS2). This is in line with the government’s priorities of implementing an efficient and effective eHealth system to streamline and strengthen data-driven healthcare.


    Speaking at the launch on Friday July 7, the Minister of Health and Social Welfare, Dr Bernard Haufiku, said his ministry is moving in the right direction towards a paperless healthcare system that is web-based and more efficient.  


    The country has been using the first iteration of the DHIS since 2005 as a routine health information monitoring system. This initial version was a desktop application using Microsoft Access installed on individual computers. The application was useful in supporting the capturing, analysis and use of data. However, other data quality components, such as timeliness in reporting for decision making, remained a challenge.


    DHIS2 brings a host of new features and possibilities that enable vastly improved routine health monitoring through a single platform that can capture and aggregate all health data. It also maintains the free and open source philosophy of the previous version.


    It offers the ability to collect aggregated data across all primary healthcare programmes, from expanded programmes on immunisation, family planning, HIV and AIDS services, etc., to bringing in data from other sectors.


    As a web-based solution, DHIS2 provides data in real-time and enables expanded access. The system also offers more user-friendly presentation and visualisation of data, so decision-makers no longer have to wait to get hold of the data they need, in the format they need it, to inform planning and take action.  


    The DHIS2 was fully deployed across the country by December 2016, with funding support from the President’s Emergency Plan for AIDS Relief (PEPFAR), technical assistance and capacity development support from Health Information Systems Program (HISP) Namibia, and additional technical support from the University of California at San Francisco.


    A crucial factor in any health information system is ensuring that data is not only timely, but that it is of the highest quality. As Dr Haufiku stated at the launch, “We know that if you put garbage in you will get garbage out, therefore training must emphasise data quality”.


    For this reason, not only does the DHIS2 have strong built-in data quality functionalities, HISP Namibia also provides extensive support to the ministry to strengthen national and regional health information management.


    This includes training and mentoring ministry and healthcare facility staff and partners on the use of the DHIS2 system, data quality and information use, as well as supporting the health information technical working group and the successful implementation of Namibia’s health information systems strategy.


    “We have a good platform and we want to use this platform for further expansion”, said Dr Haufiku, with the ministry looking at using DHIS2 as a surveillance system for disease outbreaks, to improve efficiency in response rates, and to improve overall quality of health service delivery.

    As the routine health information system in use in over 50 countries worldwide, the DHIS2 is certainly contributing to the eHealth revolution. Hopefully the benefits to healthcare will soon be felt by all. 

  • Health wearables keep evolving

    Sensors in wearables are becoming less expensive and increasingly homogenous as devices and services become relatively indistinguishable across the market, the phenomenon of commoditisation. An article in HIT Consultant says health wearables makers have to develop more holistic offerings with software that makes wearables smarter and offer more benefits.

    It’s one reason why wearable makers are focusing on using AI in their devices. An Apple initiative, AirPods, could use Siri to become a high-impact wearable. At Amazon, Alexa, a voice service, has already been integrated into several devices.

    Somewhat gruesomely, sweat sensors offer potential. The ideas captured the digital health ecosystem’s attention when a study from Stanford University found they can help diagnose disease.

    A characteristic of sweat wearables is its fast pace of advances. Spectrum, the Institute of Electrical and Electronics Engineers (IEEE) outlet, says, researchers at Saudi Arabia’s King Abdullah University of Science and Technology have created an inexpensive paper watch using flexible sensors that measures body temperature, sweat and blood pressure. A team at Purdue University has developed paper skin patches that measure dehydration. North western University has created patches too. Measuring hydration may lead to bloodless screening for diabetes.

    Some experts believe sweat sensors are health wearables’ next big step up. They could provide critical medical and wellness data. Developments are happening quickly, and African countries and start-ups are facing new opportunities.

  • The NHS in the UK and Australia top a league table

    eHealth lessons from other countries are always beneficial. With developed countries ahead, they can offer valuable insights on both good and bad experiences. The same’s true for health systems comparisons. Africa needs both.

    The US’s a good source of eHealth stories, but its health system’s ranked bottom of eleven countries.  An assessment from the US Commonwealth Fund shows that the UK, Australia and the Netherlands performed best. Mirror, Mirror 2017 shows that these health systems may offer Africa’s an overview of the beneficial features of health systems that eHealth should support.

    The ranking for the eleven countries over five healthcare features is:

    While Australia has a lower simple total score than the UK, the methodology uses several weighting and statistical adjustments to reach the overall scores, then ranking. The UK’s NHS had the widest range of all countries, one to ten. Its health outcomes were second from bottom. These include the population’s general health, early deaths and cancer survival rates. 

    For the others, it was praised for the safety of its care, systems that prevent ill-health, such as vaccinations and screening, the speed at which help’s delivered and equitable access regardless of income. 

    The UK was top in care process. Australia was second. It has several eHealth themes. It includes four sub-domains, preventive care, safe care, co-ordinated care and engagement and patient preferences. Safe care includes three items: two indicators of safe care based on patient reports of experiencing medical, medication, or laboratory mistakes, and failure to receive effective prescription medication management, as well as one measure indicating whether primary care doctors use electronic clinical decision supports in their practice to improve safety.

    Australia’s top for administrative, again with several eHealth themes. They include limited availability of medical records, or test results, primary care clinicians’ reports of time and effort spent dealing with paperwork and disputes related to documentation requirements of insurance plans and government agencies.

    Both the UK and Australia have well-developing and continuously developing eHealth programmes. The US and Canada do too, but were ranked eleventh and tenth. Does it seem that their eHealth programmes aren’t making a big enough difference, or is it due to fixed structural features of the healthcare systems? Is it both? These could be vital eHealth characteristics that can help Africa’s eHealth.

  • SANAC looks to eHealth to help combat HIV, TB and STIs

    South African National AIDS Council (SANAC) is a voluntary association of institutions established by the national cabinet of the South African Government that embodies the government, private sector and civil society to build a controlled and coordinated response to the HIV, TB and STIs. It's not restricted to AIDS response challenges. Its obligations cover STIs and TB, both of which are associated with HIV and AIDS. SANAC advises the government on related HIV, TB and STI strategies and policies, mobilises resources domestically and internationally to finance projects and monitors progress against targets in the National Strategic Plan (NSP) for HIV and AIDS, TB and STIs (2017-2020)

    A key focus is working towards the UN 90-90-90 goals i.e. to provide 90% of people with an HIV diagnosis (including 175 000 children) antiretroviral therapy and ensure that 90% of them (including 158 000 children) achieve HIV viral suppression, and attain a 90% treatment success rate for drug-sensitive and 70% for multi-drug resistant TB. 

    SANAC has an ambitious software development programme underway to build tools to support people working locally to combat HIV and AIDS. One of these projects provides a web-application in support of the Focus for Impact approach defined in the NSP. Health Information System Program South Africa (HISP-SA) has partnered with SANAC to build a web-tool that produces heat-maps that show high burden areas and associated factors affect different communities. It is already supporting decision-making for coordination of interventions planned locally. HISP's Greg Rowles and Jaco Venter have built the technical aspects, for SANAC. The team was led by SANAC's Petro Rousseau.

    SANAC has set eight NSP goals, each supported by clear objectives and sub-objectives and activities to realise them:

    • Accelerate prevention to reduce new HIV and TB infections and STIs 
    • Reduce morbidity and mortality by providing HIV, TB and STI treatment, care and adherence support for all
    • Reach all key and vulnerable populations with customised and targeted interventions
    • Address the social and structural drivers of HIV, TB and STIs, and link these e orts to the NDP 
    • Ground the response to HIV, TB and STIs in human rights principles and approaches
    • Promote leadership and shared accountability for a sustainable response to HIV, TB and STIs 
    • Mobilise resources to support the achievement of NSP goals and ensure a sustainable response 
    • Strengthen strategic information to drive progress towards achievement of the NSP goals 

    Thursday 13 July, SANAC's Petro Rousseau and Western Cape's Robin Dyers presented on GIS and HIV at ESRI's Applying the Science of Where Users Conference in San Diego. HISP's Jaco Venter was also there as technical support to the team.

  • eHealth data centres need to seek constant improvement

    Knowledge as value isn’t a modern concept. Benjamin Franklin, a polymath and USA founder promoted it in 1758 as “An investment in knowledge pays the best interest” in his book The Way to Wealth. As Africa’s eHealth moves towards bigger and wider data centres, it needs to be sure that its users can maximise its value.

    Insight, an ICT supplier, has a white paper that sets out eleven good practices. 11 Best Practices for Healthcare Data Center Discovery sets out two over-arching goals as a discovery process. One’s to improve data centres’ roles in supporting healthcare. The other’s securing personal patient data.

    The eleven good practices aim to simplify healthcare data centres’ discovery and evaluation challenges and emphasise using the cloud:

    • Gather a diverse group of internal stakeholders
    • Invite external expertise
    • Create and use a scoring matrix for decisions
    • Assess existing infrastructure, including the role of Configuration Management Databases (CMDB)
    • Define and create  cost models
    • Define reasons for using the cloud
    • Examine the cloud’s economics
    • Identify good first projects for the cloud
    • Gain support for using mobiles and the Internet of Things (IoT)
    • Take account of Governance, Risk and Compliance (GRC).
    • Focus on security.

    Stakeholder groups play avital role in the other ten topics. Engaging them effectively and continuously is a pre-requisite for successful data centres. It complies with another of Benjamin Franklin’s aphorisms, “Tell me and I forget. Teach me and I remember. Involve me and I learn.”

  • An SMS service improves HIV mothers’ and babies health

    The UN’s SDG 3 has two goals to improve health and wellbeing for pregnant women and babies. A study reported in Taylor and Francis Online shows that SMSs can help to improve these.

    An international research team from the University of Witwatersrand, the Karolinska Institutet, Johns Hopkins University, Princeton University and the United Nations Foundation evaluated the effectiveness of an SMS service aiming to improve the maternal health and HIV outcomes of HIV+ pregnant women. 

    Twice a week, SMSs were sent to 235 HIV+ pregnant women. They continued until their children’s first birthday. Content included maternal health advice and HIV support information.

    Outcomes were measured as Ante-Natal Care (ANC) visits, birth outcomes and infant HIV testing. They were compared to a control group of 586 HIV+ pregnant women who received no SMSs. Results showed marked benefits. Intervention group women attended more than 31% more ANC visits, and were more likely to attend at least the recommended four ANC visits.

    Birth outcomes of the intervention group improved too. The women had an increased chance of a normal vaginal delivery and a lower risk of a low-birth weight baby. 

    The intervention group had a trend towards higher infant polymerase chain reaction (PCR) testing for HIV within six weeks of birth. It also had a lower mean infant age in weeks for HIV PCR tests.

    The team concluded that its results add to the growing evidence that mHealth can have a positive impact on health outcomes. It should be scaled nationally after comprehensive evaluation. For a large-scale mHealth programme, Africa’s health systems may have to invest in extra ANC and PCR testing capacity.

  • A healthcare equipment tracking seizure shows eHealth’s risks

    eHealth’s never easy. Combining technical ICT with changing organisations’ and people’s behaviour’s always difficult. A project at the US Department of Veterans (sic) Affairs (VA) has come against these.

    A recent report from the DVA’s Office of the Inspector General (OIG) set out serious deficiencies in the way medical equipment was managed. They included:

    • No effective inventory system for managing medical equipment and supplies availability
    • No effective system to stop the use of supplies and equipment with patient safety recalls
    • Over 70% of 25 sterile satellite storage areas for supplies were dirty
    • Over $150m of equipment or supplies weren’t inventoried, so not accounted for
    • A lease on large warehouse of non-inventoried equipment, materials and supplies had a very short remaining, but subsequent accommodation was planned
    • Senior staff vacancies inhibit prompt solutions.

    Now, an eHealth solution started in 2012 track medical equipment’s seized up. Worth $543m, the contract with Hewlett-Packard Enterprise Services, now DXC Technology, offered a Real-Time Locating System (RTLS), a type of Internet of Things (IoT) that should be able to resolve some the OIG’s concerns. A report in My Statesman says in 2016, some four years later, the pilot was facing “catastrophic failure".  The VA and DXC say it’s due the change challenges of big-scale ICT projects. 

    This’s a routine eHealth phenomenon with healthcare as a Complex Adaptive System (CAS), so not an unexpected challenge. My Statesman also discovered two other factors. VA’s ICT spending seldom realises its benefits, and bureaucratic barriers often stifle innovation. 

    Fierce Healthcare has also highlighted VA’s plans to replace Veterans Information Systems and Technology Architecture (VISTA) with a Cerner EHR, another change challenge. A review by a House Oversight committee recently says the VA was ranked F on its data centre consolidation and ICT portfolio savings. In addition, the OIG had found “material weaknesses” in the VA’s cyber-security.

    This string of events shows that converting large healthcare organisations into fleet-of foot eHealth users isn’t easy. Without the transformation, eHealth risks rocket, bot salutary lessons for Africa’s health systems and their eHealth programmes.

  • KardioPro helps to tackle cardiometabolic disease

    Cardiometabolic disease, a cluster of inter-related risk factors that can lead to atherosclerotic vascular disease and type 2 diabetes, is the world’s leading cause of morbidity and mortality. It kills more people than AIDS and malaria combined and places tremendous strain on healthcare resources and costs. Currently, the epidemic of cardiometabolic disease worldwide is being diagnosed, treated and managed in separate silos. Healthcare systems rely on repetitive, duplicated tests and services, which inevitably leads to reduced patient outcomes and increased costs. To address this challenge, the Kardiogroup, a connected health company, has developed the first comprehensive cardiovascular risk reduction and treatment approach.

    The Kardio Ecosystem links connected health devices as a Technology Enabled Care (TEC) to validated Point of Care (POC) blood tests. It provides accurate and validated risk analyses, links to emergency care and access to treatment protocols informed by local and international guidelines.


    KardioPro, an mHeath app, is part of the ecosystem. It integrates with diagnostic tools, including a cardiolabs to measure patients’ blood pressure and Ankle-Brachial Index (ABI), a pulse oximeter, a professional wireless core body scale, and a glucometer.  Path Pro’s part of the configuration too. It provides the Alere Affinion Machine and the Abbott Istat POC pathology diagnostic equipment.

    Healthcare workers can use KardioPro to take measurements, connect to the KardioPro app from iPads or Androids, then visualise, track and share the results. It performs tests in 15 – 20 minutes, stores and organises results, simplifies patient monitoring and edits reports in PDF format so they can be shared by treatment teams. It also helps with the interaction of healthcare workers and patients to:


       Improve adherence

       Reassess treatments

       Reassure patients and explain to them the evolution of their health status

       Fix goals for patients


    The App:

       Is simple and easy to use

       Provides accurate risk analysis

       Has multi step reporting

       Provides treatment suggestions based on guidelines

       Delivers secure cloud based data capturing


    Tests performed by the app includes:

    1. HBA1C - Glycated Haemoglobin - This is used to test the 3 month average glucose of patients. It is used for screening for diabetes and used to monitor diabetic patients. 
    2.  Lipogram - This is a full cholesterol panel which is one of the important components in cardiovascular disease. It measures the different types of cholesterol in the body which is important in assessing cardiovascular risk in patients
    3. Crp - known as C-Reactive Protein - This is an inflammatory marker test can be used to determine if antibiotic therapy is required in patients who are ill.
    4. Urine ACR - known as Albumin to Creatinine Ratio - These are the two key markers to test for chronic kidney disease. 
    5. U&E - Urea and Electrolytes - This is an important and common type of biochemistry test. It is used to assess Renal Function in Diabetic patients and are important screening test for patients with hypertension.

    All health data generated by the device is secured and stored in an approved secure healthcare database. This is increasingly important with the rise in cyber-security threats.

    KardioPro is currently being used by 40 practitioners in South Africa. The solution has the potential to benefit resource poor communities across the continent. KardioPro is looking to expand internationally with interest to collaborate with international partners. 

  • Choosing cyber-security services needs a methodology

    As the fight against ransomware hots up with WannaCry and Notpetya expanding the terms of engagement, it’s essential that Africa’s health systems are structured in adding to their cyber-security measures. A white paper from Imperva, a cyber security firm, sets out seven steps needed to choose an effective data-centric audit and cyber-security solution.

    Seven Keys to a Secure Data Solution proposes that the focus should shift to Data-Centric Audit and Protection (DCAP) instead of relying on tools and methods with several disconnected pockets of coverage. Choosing a solution has to navigate the wide range of services and a rigorous evaluation processes. Seven steps are needed: 

    1.     Seeking faster times to achieving value

    2.     More flexibility and adaptability

    3.     More functional breadth and depth

    4.     Increased scalability and predictable planning

    5.     Constant real-time visibility and blocking

    6.     Lower Total Cost of Ownership (TCO)

    7.     Increased focus and responsiveness.

     The approach becomes increasingly relevant as healthcare organisations move beyond using database tools and other narrow products as a cyber-security foundation and governance infrastructure. Instead, effective and efficient DCAP solutions are needed that combine extensive data security and audit functionality with a capability to eliminate the need for disparate management silos and inconsistencies. They achieve this by co-ordinating policies across types of data stores.

    It seems inevitable the growth, reach and brutality of cyber-crime needs a stiffer eHealth resolve. Assessing and applying new cyber-security techniques should now be routine part of eHealth services.

  • WannaCry and NotPetya don’t need eHealth users

    Africa’s health systems need to match ransomware attacker’s sophistication. Neither Wanna Cry nor Not Petya, the latest types of attack, relies on files and users’ clicks to open email attachments. Instead, they seek systems vulnerabilities to access and spread across networks. Barkly, a cyber-security firm, describes it as misusing legitimate system tools and processes. Unlike previous methods of using suspicious executables, the new wave can avoid scrutiny from some cyber-security products. A Barkly’s video shows how they work.

    Its solution includes:

    • Learn how cyber-attackers exploit tools to spread ransomware without files and  interaction instead of phishing emails
    • Know why attacks that don’t use interaction are becoming more popular, with two thirds of ransomware in Q1 2017 using the Remote Desktop Protocol (RDP) from Microsoft.
    • Test your security against fileless attack scenarios using a malware simulation tool.


    This approach may help Africa’s eHealth programme to step up their cyber-security measures for ransomware. Simulation’s better than dealing with a ransomware aftermath.

  • UK’s NHS made illegal patient data transfer to Google’s DeepMind

    As eHealth expands its reach, and Artificial Intelligence (AI) becomes routine, benefits will increasingly depend on health systems handing over their patient data to specialist companies. It seems inevitable, but it might not always be legal. The UK’s NHS found that it wasn’t.

    An article in the UK’s Guardian says the Royal Free London NHS Trust, based in London, broke the law in November 2015 when it transferred 1.6m patient-identifiable records to DeepMind, the AI outfit owned by Google. It was part of a project where DeepMind’s built Streams, an app that provides clinical alerts about kidney injury. It needed the data for testing.

    The ruling says by transferring the data and using it for app testing, the Royal Free breached four data protection principles and patient confidentiality under common law. It sees the transfer as not fair, transparent, lawful, necessary or proportionate. Patients wouldn’t have expected it, they weren’t told about it, and their information rights weren’t available to them. 

    The UK’s Information Commissioner agreed. Its view’s that the core issue wasn’t the innovation. It was the inappropriate legal basis for sharing data which DeepMind could use to identify all the patients. A better way’s to keep the data in the health system and interface with apps such as Streams only when a clinical need arises. 

    Two issues are important. One’s dealing with an apparent data-grab of millions of patient records by a global organisation. The other’s the way the NHS seems keen to embed a global company into its routing working. Both need regulating and protection of patients’ rights and interests. 

    These offer insights for Africa’s health systems to deal constructively with external eHealth and AI firms. The relationships are already on a trajectory. A lesson from the NHS and DeepMind project’s essential that Africa avoids being dragged along its wake. There’s still time to do it.

  • Gamification can improve some short-term memory

    As people live longer, memory impairment becomes a bigger challenge. A study by a team led by Cambridge University, reported in The International Journal of Neuropsychopharmacology, found that episodic memory improved in the cognitive training group using gamified cognitive training. It also may enhance visuospatial abilities in patients with amnestic Mild Cognitive Impairment (aMCI), a potential precursor to dementia. aMCI’s a transitional phase between the normal forgetfulness of cognitive decline that’s a natural part of aging and serious memory problems of dementia’s onset and subsequent stages

    The gamification used by the study maximised engagement with cognitive training by increasing motivation. It’s seen as a potential complement to pharmacological treatments for aMCI and mild Alzheimer’s disease. Larger, more controlled trials are needed to replicate and extend these findings. 

    Cambridge Neuropsychological Test Automated Battery Paired Associates Learning Task (CANTAB), wittily, the same suffix shortened from Cantabrigiensis, used to reveal the origins of degrees from Cambridge University, was the game used in the study. It was accessed with iPads. There were several measures used to test performance. The Cognitive Training Group (CTG) achieved improvements on:

    • Total errors by 23%
    • Total trials by 25%
    • First trial memory score by 21%
    • Outperforming the control group on:

    o   Reduced errors at the second- and third-pattern stages

    o   Number of trials needed for completion

    o   Correctly remembering locations of more patterns after the first trial summed across all stages completed, the first trial memory score.

    Using the game for cognitive training improved the CTG members’ motivation. It maintained high levels of enjoyment and motivation and promoted confidence and subjective memory abilities. iPads probably increased active engagement. 

    Other features of the study included:

    • Public and patient involvement during the game’s development
    • Reduction in negative stigma
    • Cost effective
    • No side effects
    • Potential of combining neuropsychiatry with gaming technology to lead to more innovative non-pharmacological strategies for cognitive restoration and enhancement
    • Alter public perception of cognitive interventions for memory loss. 

    It offers Africa’s health systems an effective option for the dementia services they’ll need. If these expand as the study envisioned, they could help to address the affordability challenges.

  • China’s medical informatics plan has lessons for Africa

    Expanding eHealth needs a considerable investment in medical informatics (MI) as a pre-requisite for success. China’s 2010 health reform included a large MI investment. A study by a team in China, and with a US member, reported in the Journal of Medical Internet Research (JMIR), set out to evaluate this MI component. It compared China’s MI conferences with the US. The findings can guide Africa’s health systems plans too.

    Four events in China were reviewed:

    They were compared with two US events, the:

    The team summarised the scale, composition, and regional distribution of attendees, topics, and research fields for each conference. It found that China had a large deficit for the impact of MI conferences on continuing education. It may not be surprising given the longevity and scale of eHealth in the USA. For Africa’s health systems, it reveals a need to expand and support MI and eHealth conferences that enable sharing of MI information, challenges, experiences and successes.

    Learning from, and collaborating with, other countries are seen as vital by the team too. Africa’s regional groups already offer an existing context for these. An Acfee initiative’s a contribution to these goals with its eHealthALIVE Southern Africa 2017 conference on 2 to- 4 October 2017 at the Emperors Palace, Johannesburg.

    The event will be hosted by South Africa’s National Department of Health in collaboration with an Acfee-led consortium of leading eHealth organisations, including Health Information Systems Program,(HISP-SA) and the South African Health Informatics Association (SAHIA) and HealthEnabled. Plans are being developed for equivalent events in Africa’s other regions. 

  • Whatsapp helps to demystify cancer in Tanzania

    Cancer rates are soaring in Africa and people are taking note. The answer to why the disease is spreading so rapidly on the continent is not straightforward. Doctors and health workers attribute the spike to poor health education, environmental changes, high HIV rates, improved diagnostics and the fact that people are simply living longer.

    WHO has recently warned that Non-Communicable Diseases (NCD) are likely to kill more people in Africa than infectious disease. It set these out as a forecast by 2030. Cancer’s a major contributor.

    The Ocean Road Cancer Institute (ORCI), Tanzania’s major cancer centre, has estimated that the country’s heading for 30,000 new cancer cases a year. The diseases’s a huge public health concern.

    Combating the increase in misleading cancer information is part of Tanzania’s contributing. An article in allAfrica says it includes false cancer cures claims and alarming stories on social media linking some foods and human behaviour with cancer. Experts are trying to demystify the disease by curbing this damaging information.  

    Radiotherapists in Tanzania say WhatsApp, the cross-platform instant messaging service for smartphones, can help to tackle the problem. In February, radiotherapists formed Saratani.info a set of WhatsApp groups to disseminate cancer awareness. Currently, there are five groups. Each one has 251 members, so 1,255 people have so far joined. Each group has five educators, including radiotherapists, doctors and nurses.

    Mr Franklin Mtei, Saratani.info’s founder, and managing director of the Tanzanian Cancer Society (Tacaso), formed in 2014, leads the team of educators.  They’re expected to become future cancer ambassadors. Other group members included people from the general public, the private sector, public officials, students, entrepreneurs, professionals and non-professionals.

    The groups were formed by adding the WhatsApp users that the radiologists already had in their own phone books. Other people were invited through Facebook. People can join and leave any of the groups voluntarily through their Facebook Page.

    A co-founder of Tacaso, Mr Ally Idris, a radiotherapist, says people's perception about cancer in Tanzania has been wrong for many years. Society’s information gap is huge. Many people believe that cancer is contagious, while others think that treatment by radiations causes more cancer.

    The founders want their initiative to provide services beyond the WhatsApp groups. They plan to expand across Tanzania, targeting vulnerable people who lack information about cancer, its causes, prevention and how to access treatment. It’s an initiative that could benefit all Africa.