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  • Is a freemium model the way to go for eHealth apps?

    The proliferation of medical apps for disease prevention and health promotion has made healthcare ever more accessible. It is further facilitated by the ubiquity of smart phones and demand for better healthcare.  

    The number of digital health apps available in the market has reached over 300,000 apps on the top app stores worldwide, almost double the number available in 2015. Over 200 apps are added daily.  

    Sadly, many of these apps aren’t sustainable for more than a year, fail due to a number of reasons, including poorly structured revenue models.  A number of the businesses I evaluated during my master’s research relied on fragmented funding from various sources such as donor organisations to support development of their products.  When this funding is depleted, other revenue models need to be put in place to ensure sustainability. 

    Freemium is a popular model in which the basic application is free for users to download and use for as long as they like, though enhanced functionality is available at a price. Eventually, some of these satisfied, non-paying users will want to upgrade to a better version of the app or make in-app purchases, and hence become paying customers.

    In order to generate revenue from freemium apps, these three attributes need to be fulfilled;

    Capture high market share - the market strategy needs to revolve around capturing as much of the market share as possible because only a small percentage will become paying consumers and support the cost of non-paying users.Have a strong competitive advantage - the free offering must fulfil a need for the user in order to create a positive buzz, and the paid version has to create added value for customers to induce them to upgrade.Continued value creation - the freemium product should continue to add value as the user uses it over time in order to encourage non-paying users to switch over, and to maintain a consistent base of paying users.

    This model works well for innovations that are highly adaptive and iterative. Motivation to become a paying consumer relies on the value that the product adds for the user.  As soon as the value diminishes, interest in using the app wanes as well. The challenge for these companies becomes staying ahead of a rapidly evolving and innovative industry.

  • HELINA 2019 will be in Botswana – submit your paper by 10 July

    The Health Informatics Africa (HELINA) conference is a highlight on the African digital health calendar. The 2019 event will take place in Gaborone, Botswana, 20 to 22 November. eHNA will be there and we hope to see you too.

    The conference theme is “From Evidence to Practice: The implementation of digital health interventions in Africa for achievement of Universal Health Coverage (UHC)”. Its UHC focus provides a timely opportunity for countries to learn from one another’s experiences. Topics include:

    The maturity model approach to implementation of digital health solutionsDigital health learning systemsQuality and use of health data and systemsBig Data Analytics in health careHealth Information Systems InteroperabilityContinuous quality Improvement of health data and systemsDevelopment of competent human capacity for digital healthSustainable ICT-solutions for health service deliveryArtificial Intelligence and frontier technologies in digital health.

    Original presentations are invited in English or French. They should follow HELINA rules and be uploaded by 10 July 2019. Accepted papers will be published in electronic conference proceedings and some will be included in a special edition of the Journal of Health Informatics in Africa.

    Hosts include the Botswana Ministry of Health and Wellness, University of Botswana e-Health Research Unit, Botswana Institute for Technology Research and Innovation, Botswana Health Information Management Association. The event is supported by the US Centers for Disease Control and Prevention and Health First.

    For more information, read the online announcement, email the conference chair Dr. Tom Oluoch or local organizing committee chair Kagiso Ndlovu, or email the scientific committee chair Prof. Nicky Mostert.

    Digital health continues to expand in Africa. We look forward to the Gaborone update on countries’ health strengthening successes.

  • WHO digital health guideline: 2. birth and death notification with mobile devices

    A global effort is underway to strengthen Civil Registration and Vital Statistics (CRVS). Its ambitious goal is to achieve “universal civil registration of births, deaths and other vital events, including cause of death, and access to legal proof of registration for all individuals by 2030”. It’s led by World Bank and WHO.

    The guideline confirms that there is limited evidence on the effectiveness of using mobile devices for birth notification and no evidence of its effectiveness for death notification. It summarises qualitative data that suggest some acceptability, feasibility and equity issues that arise when using mobile phones for CRVS.

    The specific recommendations provided in the guide include an advisory that they only be applied after rigorous assessment of specific contexts and conditions. A number of other legal, workforce, infrastructure and ethical considerations are also discussed.

    WHO recommends the use of birth notification via mobile devices under these conditions:

    In settings where the notifications provide individual-level data to the health system and/or a civil registration and vital statistics (CRVS) systemThe health system and/or CRVS system has the capacity to respond to the notifications.

    WHO recommends the use of death notification via mobile devices under these conditions:

    In the context of rigorous researchIn settings where the notifications provide individual-level data to the health system and/or a CRVS systemThe health system and/or CRVS system has the capacity to respond to the notifications.

    The guideline development group (GDG) acknowledged that despite evidence limitations, the following potential advantages justify consideration of mobile notifications, after careful due diligence. The GDG notes that:

    Birth notification represents a vital first step in a care cascade that can ultimately lead to increased and timely access to health services and other social services, though birth notification should not be viewed as a substitute for legal birth registrationDeath notification Is recommended via mobile devices in the context of rigorous research and where notifications can be linked to health and/or CRVS systems, to address the lack of information on deaths, especially deaths outside of facilities.

    These CRVS recommendations and cautionary notes emphasise the complexities of digital health and the critical importance of understanding human contexts before promoting the use of mobile devices. African countries, which have numerous mobile health initiatives already underway, will find the discussion of this guidelines chapter useful to carefully consider mobile approaches to CRVS.

    This is the second piece in an eHNA series on the WHO guideline Recommendations on Digital Interventions for Health Systems Strengthening. The previous one was about acceptability and feasibility. My next piece will unpack the third guideline chapter on stock notification and commodity.

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    The Guideline provides evidence-based recommendations for ways to use digital health to improve health services. It has a specific focus on mobile devices and emerges out of guidelines on digital health interventions for RMNCAH developed by this team.

    You can find more eHNA coverage of WHO initiatives here.

  • WHO digital health guideline: 1. acceptability and feasibility

    This is the first piece in an eHNA series to unpack the WHO Guideline Recommendations on Digital Interventions for Health Systems Strengthening. The perspectives are relevant to digital health in African countries, where digital health is becoming a key driver of our health systems transformation.

    The chapter on acceptability and feasibility begins by describing factors that increase digital health acceptability for health workers, such as to:

    Help health workers to be more efficientSave travelling time, allowing health workers to spend more time with their clients or to provide more services, remotely to clients in rural areasAllow health workers to expand their range of tasks and take on tasks previously assigned to higher-level workers.

    It suggests that some health workers appreciate how digital technologies:

    Improve flexibility to work when convenient Reduce the need to be office-bound to access informationImprove coordination by connecting people, including clients and communities Raise health workers’ social status and increase the trust and respect they receive in communities.

    The guideline also recognises that digital health can be a double-edged sword, and some factors may decrease acceptability. It points out that some health workers may:

    Experience workload increases due by technological interventionsFace data costs that are not covered by the employerBe anxious about carrying multiple devices and fear loss, damage or theft of the devicesFear job security risks if they have poor digital literacy.

    The authors list factors that affected the feasibility for health workers to take up digital health opportunities, such as:

    Network connectivity and access to electricity to charge their mobile phones Usability of digital devices and integration with other digital systemsUser interface issues, particularly around language and utility of the interface for capturing and retrieving dataThe extent to which confidentiality of medical information and data security issues are addressedChange management issues such as training and familiarity with digital technologies to help support users Supportive supervision to build confidence in new approachesHealth workers’ perception about whether tracking and monitoring, which makes their work more visible, is positive or negativeThe extent to which health workers’ efforts are limited by broader health systems challenges, such as underlying medical supplies shortages that reduce health system effectiveness regardless of digital health interventions.

    Since clients are often active participants in digital interventions, the guideline describes factors that may influence their acceptance of digital health. This includes that:

    Some clients appreciate the fact that someone is taking the time to send them messages, appreciating the support, guidance and information, reassurance and motivation.Individuals who are dealing with health conditions that are personal or stigmatized, such as HIV or family planning services, may worry that their confidential health information might be disclosed if they participate in digital healthSome clients prefer face-to-face contact to telemedicine services, yet these services can also help to give individuals who speak minority languages access to health workers who speak this language Telemedicine may help clients save money and reduce the burden of travel for specialist opinionsOut of pocket expenses may be an issue where clients are charged to participate in digital health Barriers such as poor access to network services, electricity or mobile devices, low literacy or digital literacy skills need to be addressed.

    My next eHNA piece will unpack the next chapter in the guideline, birth and death notification via mobile devices.

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    The Guideline provides evidence-based recommendations of ways to use digital health to improve health services. It has a specific focus on mobile devices and emerges out of guidelines on digital health interventions for RMNCAH developed by this team.

    You can find more eHNA coverage of WHO initiatives here.

  • Successful eHealth needs capacity building

    Africa’s health-care system is undergoing an eHealth revolution. The technology is new, but it must be used by the existing health workforce.

    A critical finding in my master’s research, is that eHealth needs better investment in educating and capacitating users of eHealth. Another report by the British National Health Service found that a lack of training for healthcare providers created barriers to eHealth care. In Africa, we face the same challenge. 

    Technology on its own, no matter how effective, cannot bring about healthcare revolution without acceptance and proper use by healthcare workforce. An implementation strategy which addresses the barriers to effective adoption of these technologies will be critical to their success.

    Capacity development has multi-layer benefits;

    For staff it can increase overall job performance and satisfaction. For the healthcare organization or facility, it can improve effectiveness and profitability.Even at the societal level, training and development can increase the quality of the labour force, which in turn is a contributing factor to national economic growth.

    By developing a workforce that is able to confidently use eHealth technologies and services, African countries could implement their national eHealth more successfully and move closer to achieving universal health coverage.

  • Why eHealth needs business modelling

    A substantial number of businesses and start-ups pursuing opportunities to bridge healthcare challenges with eHealth technologies are often confronted with “pilotitis” or failure to implement their technologies in a sustainable way.  In my last article, I described some of the challenges eHealth businesses face. 

    Constructing a business model during the development of eHealth technologies can guide a value-driven evaluation of what is necessary and what is not, in order to overcome implementation failures. A review of the literature suggests that the business model canvas proposed by Osterwalder is a suitable business modelling tool for the eHealth industry.

    The one-page canvas consists of nine building blocks that provides a conceptual framework to describe the business’ activities from four perspectives;

    Value offering – what need is being fulfilled by the business?Value communication and transfer – who are the customers and how does the business communicate with them?Value co-creation – what are the business inputs, including collaborating partnerships? Value capture – how does the business maintain profitability?

    A key observation in my master’s study was that there is a strong focus on the value offering and value capturing activities of the business model, although little focus on value co-creation and value communication and transfer activities.

    While eHealth businesses are aware of the importance of these activities, challenges of the environment create barriers to prioritising these activities. To overcome these challenges, transformation is required in both the micro and macro eHealth environment.

  • Have your say on WHO’s draft Global Strategy on Digital Health
    April 2019 has been a busy month for global digital health, with two key announcements by the World Health Organization (WHO). One is the call for comments on the draft Global Strategy on Digital Health. It is the first strategy of its kind for digital health and an opportunity not to be missed. WHO invites consultation from all stakeholders in the digital health arena on a strategy aiming to help focus our efforts on digital health that achieves maximum impact. It identifies four strategic objectives: Work togetherHelp to accelerate the digital health agenda in countriesAddress global issuesSet the future direction for innovation and research.

    The period for commenting closes 30 April 2019, 00:00 CEST. Inputs can be provided via a web-based accessible here or you can email WHO for more information.

    A second pivotal event was last week’s publication of the WHO Guideline: Recommendations on Digital Interventions for Health Systems Strengthening, a much anticipated and important milestone in digital health’s journey to maturity and health systems impact. It has emerged out of a group that developed guidelines on digital health interventions for RMNCAH and health systems strengthening. 

    As we invest in our African National Digital Health Strategies and implementation plans, global publications like these are timely and helpful. eHNA will unpack the contents and their implications for our African digital health initiatives over the next few weeks.

  • WHO launches digital health guideline, Wednesday 17 April

    Figuring out how to use digital health for health systems strengthening is an important task. Now World Health Organization (WHO) has a guideline document to help, launching 14:00 CEST, Wednesday 17 April 2019. Join the live stream here to be part of the launch and gain access to the guideline.

    The title is WHO Guideline Recommendations on Digital Health Interventions for Health Systems Strengthening. This is the first WHO guideline on Digital Health Interventions. It provides evidence-based recommendations for ten ways that countries can use digital health to improve health services.

    eHNA will have more news on what the guideline contains and how we can use it productively for our African initiatives, after the launch.

  • Competitive telemedicine platform to help achieve UHC

    AfriDOKTA is passionate about transforming the delivery of healthcare in Africa through people, processes and technology. They have developed a telemedicine mHealth platform dedicated to Sustainable Development Goal 3, “Ensuring healthy lives and promoting well-being for all at all ages”. Anyone with a smart phone or internet access can easily download the AfriDOKTA app and would have immediate access to quality outpatient care.

    The Kenyan government is the first African country that has supported the roll-out of AfriDOKTA as part of a nationwide campaign towards universal healthcare. The roll out is supported at the community level by community health workers (CHWs) that train users on how to access health services using the AfriDOKTA app. Users can easily create a personal profile and an electronic medical record to store details of consultations received. The app also gives users referrals to vetted pharmacies and labs with certified medical professionals. 

    A unique design feature of the AfriDOKTA app is that it complies with international data security standards and adheres to the US-based Health Insurance Portability and Accountability Act (HIPAA). The architecture also applies Health Level 7 (HL7), SNOMED, and DICOM standards. These are international principles used for the transfer of clinical data between various software and electronic applications.

    AfriDOKTA's use of international standards for storing, accessing, and processing medical images and related information, their plans for strategic collaboration and relevant product benefits make it a strong competitive differentiator in the market. This solid technical foundation should position the platform to support our Universal Health Coverage (UHC) aspirations too.

  • IoT “in the wild” may help us manage stress better

    In his TEDx talk, Pablo Peredes makes a case for using the Internet of Things (IoT) to help humans manage stress. He points out that to be stress free, humans need more outdoor activity than our modern lives allow, and suggests that our “new” natural environment of homes, offices and cars can be more intuitive and responsive to support what we need. In his talk, he uses a book to explain our current stress-increasing predicament.

    Why Zebras don’t get ulcers is a book by biologist Robert M. Sapolsky. Sapolsky explains that for animals such as zebras, stress is typically episodic, such as when avoiding being eaten by a lion, and this stress is well managed by abundant opportunities for the free Zebra to engage in stress-relieving activities rambling around the savanna. In contrast, modern human stress is often chronic, such as worrying about losing a good job or how to survive a stressful one, and our natural environment is no longer the ubiquitous outdoors, but confined to homes, offices and cars, which offer too few opportunities for natural stress relief.

    Since we are unlikely to abandon our homes, offices and cars, Peredes suggests that IoT can help repurpose common household objects to make these devices able to help us manage our health better, transforming our homes, cars and workplaces into environments that identify and manage our stress. He suggests starting existing devices, avoiding the costs of adding new sensors. By collecting and analysing data from things we touch, such as a PC mouse, or a steering wheel in a car, Peredes says we can identify stress and do something about it.

    Peredes describes two reasons for people not managing stress: lack of willpower and lack of time. He suggests that we use the time available during our commute from home to office to diagnose stress levels and improve our stress management, such as making car seats talk us through breathing exercises, office chairs remind us to stand when we’ve been sitting too long, and adding imperceptible screen colour changes to adjust our breathing and heartrates.

    Peredes believes that the everyday devices around us should help us to manage stress. He calls it “stress management IOT in the wild” and invites us to share new design ideas via email.

    Many of our African homes are still connected to the natural environment, providing ample opportunities to blow off steam. Nevertheless, in Africa people are urbanising rapidly too, and it is reassuring to know that people like Peredes are thinking about how to make our modern environments more supportive. I look forward to writing more eHNA pieces about his IoT adventuring in the wild. 

  • Successful eHealth needs better business models

    eHealth is a complex business type, integrating many stakeholders acting across interwoven networks. Yet the characteristics of successful business models remain understudied.

    Despite the promise of eHealth to overcome healthcare access challenges, reduce costs and improve quality , successful implementation is low, especially in developing countries.  In fact, over 50% of eHealth businesses find it difficult to sustain their implementations sustainably beyond the pilot phase. I have been investigating these dynamics and will be sharing them over the next few weeks in a series of eHNA pieces.

    Recurring challenges of eHealth include;

    Financial institutions unwillingness to fund eHealth start-upsHigh start-up costs and ongoing maintenance costsRegulatory legislation that lags behind technology developmentResistance from end-users to adopt new innovationseHealth technologies lack user experience designPoor scalability of eHealth technologies after their pilot phasePoor ICT infrastructure in the environmentLack of leadership and political supportLack of research.

    To overcome these challenges, change is required in both the micro and macro eHealth environment. I’ll be sharing ideas on what changes are needed in my next piece.

  • A Whole-of-Government approach to investing in digital technologies to achieve the SDGs

    What do school children, farm animals and patients have in common? Well, rather a lot, according to the International Telecommunications Union (ITU) and some of its partners. Especially when it comes to investing in Information Communication Technology (ICT) to advance progress towards Sustainable Development Goals (SDGs).

    The SDG Digital Investment Framework calls for countries to take a whole-of-government approach to investing in digital technology. The paper shows how to “identify which technologies matter most to achieve the SDGs.” The approach was developed by teams from ITU and the Digital Impact Alliance (DIAL).

    Its theory of change is shown in the figure below, extracted from the ITU document. It is about a small set of common ICT building blocks helping countries to deliver many high-impact use cases that support progress towards SDGs.

     

    Figure: SDG Digital Investment Framework theory of change.

    The paper provides an approach for countries to identify reusable ICT building blocks across sectors, particularly education, health and agriculture, and calls on governments and the private sector to work together to fund these shared foundation elements. The list of candidate ICT building blocks is extensive, including:

    Analytics and Business Intelligence ServicesArtificial Intelligence ServicesClient Case Management ServicesCollaboration Management ServicesConsent Management ServicesContent Management ServicesData Collection ServicesDigital RegistrieseMarketplace Services Mobility Management Services Geographical Information Services Identification and Authentication Services Information Mediator Services Messaging Services Payment Services Reporting and Dashboard Services Scheduling ServicesSecurity Services Shared Data Repositories Terminology Services Workflow and Algorithm Services.

    It’s a bold approach that resonates with other initiatives underway in African countries, and across African regions. eHNA looks forward to reporting on further developments.

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    Image from the SDG Digital Investment Framework report.

  • An ITU/WHO “how to” guide for building interoperable digital health infrastructure

    As we strengthen African national eHealth strategies, interoperability is gathering momentum too. It's a critical component of our national eHealth programmes. We are looking for a common, comprehensive framework, incorporating all data sources and information flows, both electronic and paper-based, providing a clear development and consolidation path for all components, along a digital development maturity model.

    Fortunately, there’s a handbook about how to do it: Digital Health Platform: Building a Digital Information Infrastructure (Infostructure) for Health, published by the International Telecommunications Union (ITU) in collaboration with the World Health Organization.

    The figure below provides a high level overview of the Digital Health Platform (DHP) concept, its components, and how users interact with it. 

    Figure: How a DHP interacts with external applications and users

    The handbook suggests that a well-designed DHP will help countries to achieve the following priorities:

    Overall quality and continuity of careAdherence to clinical guidelines and best practicesEfficiency and affordability of services and health commodities, by reducing duplication of effort and ensuring effective use of time and resources Health-financing models and processesRegulation, oversight, and patient safety resulting from increased availability of performance data and reductions in errorsHealth policy-making and resource allocation based on better quality data.

    The DHP Handbook illustrates how DHP components are derived from the National eHealth Strategy. It is a detailed guide including illustrative case studies from Liberia, Estonia, Canada, India and Norway. It’s essential reading for African countries’ as we invest in our national eHealth programmes.

  • African countries setup Country Health Situation Rooms for better health monitoring

    Two weeks ago, I was fortunate to participate in a workshop in Ethiopia hosted by the African Union, Africa CDC and UNAIDS.  The workshop aimed at strengthening the Country Health Situation Room initiative and roll-out across African countries.  Its goal is to support better use of health data and help countries keep populations healthier by improving their response to infectious diseases and epidemics.  

    Kenya was the first African country to adopt the Situation Room in 2015.  A further six countries – Cote d’Ivore, Lesotho, Namibia, Zambia, Uganda and Zimbabwe – have launched their Situation Rooms and are currently at different stages of scale-up and roll-out. 

    The Situation Room software integrates health data from multiple sources such as the DHIS2 and logistics management information systems (LMIS) at a country level.  Data are presented visually to help countries track progress and identify gaps in key health indicators.  The customisable interface allows countries to design their Situation Room around their health areas of interest and user types. 

    Matthew Greenall’s case study on the Country Health Situation Rooms describes the progress so far. Achievements include; 

    Enhanced collaboration between different health programmesImprovements in health decision makingImprovements in data qualityIncreased data use for decision makingImproved data sharing between stakeholders at national and regional levels

    Important challenges are also identified, such as;

    High turnover of staff and leadership compromised progressOperational and budgeting constraints interrupted roll-out in some countriesPoor quality of data at sub-national levelsOwnership – a strong desire for countries to host the software themselvesMaintenance of the Situation Room software requires strong technical support

    The Health Situation Room is a bold step for the participating African countries. We look forward to reporting the progress of this important eHealth contribution to health systems strengthening.  

  • International SOS Foundation releases a teleconsultation guide

    The Medical Dictionary describes two types of teleconsultation. One is between doctors. The other’s between doctors and patients. It refers to networks and video links. Smartphone services such as Figure 1 is an example of a more modern version. It includes nurses too.

    Help in setting up and managing teleconsultation is available from the the International SOS Foundation. It’s launched a white paper on the topic, endorsed by the International Society for Telemedicine & eHealth (ISfTeH).

    Teleconsultation Services for the Mobile Workforce; Considerations & Guidelines for the Provision of Global Services in Compliance with Regulations & Best Practice Clinical Standards of Care provides insights into essential aspects needed to assess teleconsultation services. They include:

    Country level review of legal requirementsGuidelines on clinical best practices, including local healthcare environment, clinical expertise of disease threats at patients’ locations and integration into the local healthcare systemsCase studies for corporate and educational sectorsGlobal best practices for assessing teleconsultation services.

    It can help Africa’s health systems to develop their telemedicine services towards broader teleconsultation services. Modern mHealth technology offers considerable opportunities.

  • ISfTeH’s next annual meeting’s in Portugal

    On 19 to 20 March 2019, the International Society for Telemedicine & eHealth (ISfTeH) conference will be underway in Lisbon, Portugal. Partners include the annual Portugal eHealth Summit which’s co-organised by ISfTeH’s institutional member, Centro Nacional TeleSaúde, part of the Shared Services of the Portuguese Ministry of Health (SPMS). The Portugal eHealth Summit is the largest eHealth event in Europe, bringing together some 10,000 stakeholders from the Portuguese National Health Service.

    It’s ISfTeH’s 24th International Conference. The range of topics is huge. They include:

    Technology to:

    o   Monitor  vital signs for long term conditions

    o   Health management of service users with severe mental illness

    o   Facilitating integrated care in wider communities

    Global Digital Health Index’s state of global digital health Telemedicine’s potential for UHC in Portuguese-speaking CountriesInjecting the human side of telemedicine and eHealthEconomic evaluation of an new guideline of an online clinic in Japan Considerations and guidelines for global teleconsultationPhysicians' experiences, attitudes and challenges in a paediatric telemedicine serviceAlgorithms for predictive medicine AI for healthcare professionals Big Data and tele-ECG eHealth data protection with GDPREffective digital tools for everyday practicePortugal’s experience of telehomecare and telemonitoringPutting IoT to work for caregiversIs technology the solution for chronic disease management?Tele-ECG network in Southern BrazilAI and telemedicine for heart failure diagnostic supportPractice guidelines for primary and urgent careCan telemedicine reflect healthcare system investment Needs?

    Details of the event will be available soon.

  • AMA has a structure for choosing EHR providers

    Procurement sits between EHR strategy and implementation. It’s a challenging process and needs a rigorous structure to assess providers and choose a few to move on to a procurement short list, The American Medical Association (AMA) has a checklist that helps to find a vendor worthy of a long-term partnership. It’s step 4 in the Part 2, the Pre-Game section of the American Medical Association® Digital Health Implementation Playbook.

    Selecting and Vendor Guide aims to find a long-term partner, not just an organisation to execute a set of transactions. Speaking with similar organisations or practices can provide valuable information and insights needed to construct shortlists of quality vendors. eHealth conferences can be another source.

    Discussions are not enough. Structured market research and activity’s needed too. AMA suggests: 

    Build a Request for Proposal (RFP) that clearly outlines the goals that define successSend RFPs to vendors that most closely align to these goals Review RFP responses alongside key representatives from core and advisory teamsAsk for case studies and referrals Schedule live vendor demonstrations with members of the core, advisory and implementation teamsEvaluate vendors across six critical factors:

    o   Business

    o   ICT

    o   Security

    o   Usability

    o   Customer service

    o   Efficacy and clinical validation

    Narrow options to one or two preferred vendors in the pitch to leadership.

    Usability includes interoperability. Efficacy includes the vendors’ abilities to deliver organisational goals, metrics and Key Performance Indicators (KPI). For large-scale, strategic investment lick EHRs, three options may be more appropriate in revealing the differences between vendors’ technical services and cultures that are available. 

    AMA’s playbook can help Africa’s health systems to enhance the structure and sustainability of moving their EHR projects from investment decisions towards implementation. Procurement’s tough. Vendors are smart and used to the processes. AMA’s guidance helps to rebalance them.

  • An approach to regulating medical devices from the US FDA's now out

    Effective regulation’s a vital part of setting and maintaining high standards. In an article in Frontiers in Medicine, Tina Morrison and her colleagues describe an approach by the US Food and Drug Administration (FDA). Its Center for Devices and Radiological Health (CDRH) regulates medical devices, and emphases regulatory science with computational modelling for medical devices.

    Computational modelling is an increasingly powerful evaluation and regulatory tool for medical devices. Dealing with merging technologies resulting in novel products is one of the FDAs challenges. Using computational modelling can transform medical device design and evaluation. It can simulate treatment outcomes and clinical trials for imaging systems.

    The simplest and most common use of computational modelling for medical devices is simulating their performance under a variety of conditions that mimic aspects of clinical or use environments.  

    The primary use is for regulatory submissions is identifying appropriate bench testing configurations, such as worst-case or clinically challenging conditions, for cardiovascular, orthopaedic, and surgical implants. Its second common use is to provide evidence that supports safety assessments of patients with and without implanted devices when they’re exposed to radiofrequency (RF) fields of MR systems.

    Continuous development is underway too. A CDRH team is developing and validating a framework for streamlining the market entry of imaging systems relying solely on simulation instead of clinical trials.

    Using the approach to the increasing range of mHealth and wearables could close the knowledge gap. Directing users, especially clinical professionals to devices that do what the claim to do will be a huge step forward for Africa’s mHealth initiatives.

  • A playbook to help successful eHealth investment's from AMA

    Good practice is always a good idea. The American Medical Association (AMA) has combined a wide range of good practices for eHealth. American Medical Association® Digital Health Implementation Playbook is built from an assessment that:

    Digital tools that enable new methods and modalities to improve health care, enable lifestyle change, and create efficiencies are proliferating quicklyClinical integration of these tools is lacking, so needs changing.

    It’s a valuable guide for Africa’s health systems. The four parts:

    Warm upPre-gameGame-time: remote patient monitoringPost-game resources.

    The playbook addresses four key requirements as questions for doctors adopting eHealth:

    Does it work?Will I receive payment?Will I be liable?Will it work in practice?

    These underpin several eHealth perspectives:

    1. WARMUP

    Introduction to eHealth implementation playbook Introduction to eHealth solutionsWhat’s remote patient monitoring? Remote patient monitoring in practice for hypertension The implementation path

    2. Pre-game

    Identifying needsForming teamsDefining successEvaluating vendorsMaking the case for eHealthContracting

    3. Game time for remote patient monitoring

    Designing workflowsPreparing care teamsPartnering with patientsImplementationEvaluating successScaling

    4. Post-game resources

    Idea intake form as an idea prioritisation worksheetTeam structure frameworkTeam structure worksheetWhen to engage teamsUsing the quadruple aim to establish eHealth valueSMART goals overviewSelecting a vendor guideVendor information intake formCyber-security knowledge neededNavigating digital medicine coding and paymentKey financial and legal documentsKey considerations for designing implementation workflowsClinical roles and responsibilitiesWhat if plans for patientsLessons learned worksheet.

    All four parts contain an eHealth investment process for healthcare organisations. In defining the steps, their next job is to assemble the information to support each decision.

  • AXA Health Tech & You Awards wants bids for consumer-driven health innovation and excellence

    Driving proactive consumer engagement in health and supporting innovation are to success of the AXA Health Tech & You Programme. The current award has two categories, innovation and excellence. Applications close on 15 February 2019.

    AXA, an international health insurer, has focused the 2019 awards on celebrating entrepreneurs who provide the most valuable, trusted innovations for consumers in the market. The innovation and excellence categories will be underpinned by core values embracing diversity, health equality, and social inclusion.

    It’s seeking two types of solutions. One’s standalone solutions that help citizens take charge of their health and wellbeing. The other’s smart applications that enrich relationships between people and their careers, whether health professionals, friends or family. 

    The results could offer Africa’s health systems transformation models for some of their health promotion and community services. It’s worth looking out for the results.