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  • Architecture and IOp are the core of good health data

    “You cannot change your destination overnight. You can change your direction” is a view of the entrepreneur Jim Rohn. The MITRE Corporation, a not-for profit technology organisation in Virginia USA has a similar view with a sense of urgency. In A Robust Health Data Infrastructure, it says that effective software architecture and interoperability (IOp) are the keys and foundations of health data infrastructure, and it needs fixing within a year.

    MITRE proposes an urgent need for the USA to construct an architecture with core principles that:

    Is agnostic about the type, scale, platform, and storage location of the data Uses public Application Program Interfaces (API) and open standards, interfaces, and protocols Encrypts data at rest and in transit Separates management from data management Includes the corresponding metadata, context, and provenance information with data Represent data as atomic data with associated metadata Follows the robustness principle of being liberal in what’s accepts and conservative in what’s sent Provides a migration pathway from legacy EHR systems.

    Architecture has to incorporate a migration pathway from legacy software used to store and process EHRs to future systems of broad interoperability. APIs provide the pathways. API is a set of published programming instructions and standards for accessing web-based software applications and tools.

    “It also says that the lack of interoperability among the data resources for EHRs is a major impediment to the effective exchange of health information.” Using a common mark-up language is not enough. It needs published APIs too so that other software providers and users can link from current systems to future software ecosystems built on stored data.

    The Agency for Healthcare Research and Quality commissioned the report. Its goal is better quality, safety, efficiency, and effectiveness of health care for all Americans. It’s part of the USA’s Department of Health and Human Services.

    African countries planning EHRs and exchanging health information can learn and benefit from MITRE’s thinking, insights and proposals. It’s part of what Audre Lorde, a poet, referred to as “We are all in the process of becoming.”

     

  • The Pharmacology Science Gateway extends across Africa

    Sharing scarce resources can be beneficial, but it can be hard to assess. Antonio Porchia, the Argentinian poet, summed it up when he said “I know what I have given you … I do not know what you have received.”  The EU-project eI4Africa Pharmacology Science Gateway (PSG) seems clearer on the benefits of sharing.

    Its e-Science platform simplifies collaboration and sharing resources in Africa. The specific goals are to promote and implement African medical science collaboration on biomedical and pharmacological sciences and clinical trials and clinical drug studies to improve healthcare in Africa.

    The platform makes accessible open sources software for study designs, biomedical data processing and facilities for sharing data and discussing scientific and technical topics. It enables stronger north-south and south-south capacity and capability building as African researchers and their international collaborators have easy access and links to people dealing with similar challenges.

    PSG has six main activities:

    Genomics and bioinformatics Bioanalysis, drug analysis and metabolism Pharmacokinetics and pharmacometrics resources Clinical trial sciences Digital library Multimedia contacts and eLearning tools.

    The network includes the African Institute of Biomedical Science & Technology (AIBST), seven universities from six African countries. The PSG website lists them and the e14Africa supporters. They seem to know much about Antonio Porchia’s ideas, like “We become aware of the void as we fill it.”

  • Kenya releases its new ICT master plan

    Kenya has unveiled the national ICT Master Plan 2017, which will guide the country’s ICT direction for the next three years and spur on economic growth. The Master Plan was launched at the Connected Kenya Summit 2014 in Diani, and provides details on how these projects will be implemented, the timelines required and funding options.

    The policy document identifies three key ICT projects: a Citizen Service Portal, Government Shared Services and National Digital Registry Services.

    The Kenyan Government shows its commitment by increasing the ICT national budget allocation to 2.5%. It will continue to put aside more projects in the coming years until the country is on a par with international best practices. This could take several years, but Kenya is determined.

  • Smart pills anybody?

    We have all heard of smart phones, and smart TVs, but what about smart pills? According to Ariana Eunjung Cha, in Health & Science, many predict that smart pills will be at the forefront of a “revolution in medicine powered by miniature chips, sensors, cameras and robots with the ability to access, analyze and manipulate your body from the inside”

    Mary Ellen Snodgrass, is a 91 year old school teacher who swallows a computer chip everyday. It’s embedded in one of her pills and roughly the size of a grain of sand. When it hits her stomach, it transmits a signal to her tablet computer indicating that she has successfully taken her heart and thyroid medications. The smart pill technology allows her to view an hourly timeline of her day with images of white pills marking the times she ingested a chip.

    Snodgrass’s son, Doug Webb, a 62-year-old electrical engineer, can track his mother’s progress. He recently brought up a web page with his mother’s name with a multitude of charts and numbers.“Sometimes I see very strange numbers and I’ll call her up and say, ‘What’s going on?’ ” he said.

    This was the first smart pill to be approved by the Food and Drug Administration (FDA) and the European Union, in 2012 and 2010, respectively. It is still being tested by a handful of doctors and hospitals, as the company continues to refine its software. Proteus Digital Health, who developed the technology, hopes to make it more widely available within the next few years.

  • Can genetic diversity foil hackers?

    Standardisation is often seen as a solution to computer challenges and to many sorts of diversity. Charles de Gaulle once said “How can you govern a country which has 246 varieties of cheese?”Maybe he meant that 246 cheeses don’t offer enough diversity, although it’s a bit doubtful.

    If computer systems are a bit genetically diverse, like living organisms, will it make life harder for hackers and cyber-criminals? Michael Franz, a computer scientist at the Samueli School of Engineeringof the University of California (UCI) and Director of UCI’s Secure Systems and Software Laboratory says it can.

    His proposition is set out in an article in The Economist, and says that the slight genetic diversity in individuals helps to ensure that virus and bacteria attacks don’t destroy whole species. Applying the same principle to computer systems means that a compiler that creates minor variations to software can extensively inhibit hackers effectiveness.

    It’s not a new idea. Some applications that have high security requirements already use slightly different codes in different installations. Compilers work in a different way.

    They convert applications written in conventional languages into the machine code used by computer’s processors. Michael Franz’s solution is a mutli-compiler that can create billions of unique versions of the same original program. All test attacks have failed. This doesn’t mean that hackers are deterred forever, just that they’ll have to work out how to make their attacks more specific, and possibly, or even probably, have to put up with smaller scale attacks. Franz estimates the breach rate of his multi-compiler model is about one in a billion, so each bespoke attack would only affect a few computers globally. An estimate of the total number of computers globally is about 2 billion. There are over a million PC sales a year. On these scales, a multi-compiler as an effective deterrent can slow down the effect of hacking.

    The case for multi-compilers being the norm seems obvious. Will it’s genetic diversity be the next cyber-security solution? The late Maya Angelou, the poet and civil rights activist, may have seen it when she said “In diversity there is beauty and there is strength.”

  • Oracle sees Nigeria as its core country

    Oracle has identified Nigeria as its development centerpiece in Africa, according to a report in BiztechAfrica News. This shouldn’t come as too much of a surprise: Nigeria is now officially the largest economy in Africa and 26th largest in the world. The country’s economy is growing at a staggering rate, moving away from an agricultural dominant economy and into service sectors.

    Martin Peck, Sales Consulting Senior Director, Europe Middle East and Africa, said “We are determined to partner with the relevant organisations, government agencies to help develop the human capacity requirements. Now we are focusing so much on Africa and Nigeria will become a hub for all the activities that we are doing. We are going to do more on our internship programme through which we try to bring graduates on board, take them through some technical training and make them ready for jobs. So this is a very good opportunity for us to hire young people but of course in some cases, they complete the training and get fixed up in other companies. We are doing this not just for us an organisation but to also give back to society.”

    According to the company, more businesses and governments see ICT as a key component of economic growth, recognizing that ICT skills development is vital if they are to take advantage of the new opportunities IT provides.

    Oracle works closely with established educational institutions in countries the world over to help young people develop the skills needed in their local marketplace. The Oracle Academy supports some 268,000 students in 1,800 education institutions across Africa. It is already a well-established part of Africa’s eHealth landscape.

  • Will the Internet of Things be routine by 2025?

    Eleven years from now, the Internet of Things (IoT) will be commonplace, says a report from the Pew Research Center. It brought several experts together who said that the rise of embedded and wearable computing will bring the next revolution in digital technology. For health and healthcare, it says that many people will wear devices that enable them to connect to the Internet and provide feedback on their activities, health and fitness. They will also be monitoring other people, such as their children, parents or employees, who also wearing the devices.

    Other changes include:

    Homes where people can control almost everything remotely, from heating and cooling, when their gardens are watered and with sensors that warn about events like prowlers to broken water pipes Communities with embedded devices and smartphone apps that enable more efficient transportation, provide updates on pollution levels, deliver electricity and water more efficiently and warn about infrastructure problems Goods and services where factories and supply chains have sensors and readers that track materials precisely so quicken and smooth the manufacture and distribution of goods An environment with real-time readings from fields, forests, oceans, and cities about pollution levels, soil moisture, and resource extraction that allow for closer monitoring of problems, including health priorities.

    The technology change that will deliver this is likely to comprise:

    The IoT, a global, immersive, invisible, ambient networked computing environment built through the continued proliferation of smart sensors, cameras, software, databases, and massive data centres Augmented reality enhancements to the real-world input that people perceive through their use of portable, wearable and implanted technologies Disrupted business models that were established in the 20th century, especially finance, entertainment, publishers and education Tagging, databases, and intelligent analytical mapping of physical and social realms.

    Some simple facts are:

    In 2008, the number of Internet-connected devices first outnumbered the human population In 2013, there were 13 billion Internet-connected devices In 2020, there will be 50 billion.

    Charles Babbage, the 19th century polymath and acknowledged inventor of a programmable computer, said that “Errors using inadequate data are much less than those using no data at all.” It seems impossible to avoid data. Incidentally, Charles Babbage was a forerunner of sex equality. He employed Ada Lovelace, a mathematician and daughter of Lord Byron, the English poet. She’s recognised as the first female programmer.

    Eleven years isn’t long for African countries to put the IoT infrastructure in place.

  • Samsung responds to ICT challenges in Kenya

    Samsung continues to expand its efforts to improve learning and education through the use of ICT in the remote areas of Sub-Saharan Africa. It recently launched the Solar Powered Internet School (SPIS) in Kenya in a bid to address insufficiency by providing learning material, low electricity connectivity as well as access to ICT’s in public schools. Samsung’s Vice President for East and Central Africa, Mr. Robert Ngeru, said the intervention is part of the company’s global vision of strengthening the minds and fostering the creativity of young people in Africa.

    The SPIS at Arap Moi Primary School is set to benefit nine other nearby schools; Kiserian, Nakel, Naro Moru, Nkoroi, Ole Kasasi, Oloosurutia, Olteyian and Rongai Primary Schools.

    The SPIS are fitted with solar powered panels to produce the power to run the technology inside which includes, net books, multifunction printer and Internet Protocol (IP) camera for remote monitoring to support teachers and enhance the learning experience of learners. The schools are also specially customised to endure conditions of remote areas.

    Intel and Korea Education Research Information Service (KERIS) joined Samsung by installing content on the computers. Educators will also be equipped with the necessary skills in curriculum development as well as integrating technology within the syllabus. The collaboration of Samsung and Safaricom to facilitate connectivity for information and research also plays a very important part to enhancing learning.

  • Healthcare isn’t up to cyber-threats

    If healthcare in the USA isn’t well-tooled up for cyber-security, what chance do African countries have? A USA approach to a cyber-threat simulation is in CyberRX: HITRUST Health Industry Cyber Threat Exercise  report by the US Department of Health and Human Services (HHS) and the Health Information Trust Alliance (HITRUST). A summary of the findings are in Results of first cyber-attack simulation point to need for collaboration, a Clinical Innovation + Technology blog.

    CyberRX is seen as essential as part of the security response to the growth of connected technologies in healthcare. It’s a complex exercise. A steering committee overseen by Booz Allen Hamilton designed the CyberRX simulation. It was applied to a wide range of healthcare activities, including providers, health plans, prescription benefit managers, pharmacies, HITRUST Cyber Threat Intelligence and Incident Coordination Center HITRUST C3 and HHS.

    The CyberRx goals included:

    Build awareness of cyber threats Explore responses to maintain operations that face complex risks Understand systematic risks to patients from disruptions Promote information sharing about cyber-attacks.

    Findings include:

    Healthcare organizations have the technical skills and knowledge to deal with threats, but collaboration is inadequate Cyber-threat simulations prepare organizations to deal with the real thing, even when they have mature and comprehensive information programmes Preparation for the real thing benefits from better threat intelligence, processing capabilities and wide stakeholder engagement Better capabilities for incident response coordinating and collaborating incident response s are crucial Organization should communicate and collaborate during cyber-crises and take a view across the whole healthcare system A generic national cybersecurity framework is insufficient for healthcare organizations facing the current types and range of cyber-threats It’s hard to share cybersecurity information and removing the barriers needs long-term solutions that include legislation and policy changes.

    It’s obvious that resources for eHealth cyber-security in Africa are nowhere near those available in the USA, so Africa needs different solutions. They include better user training, relying more on ICT suppliers, training more cyber-security specialists, learning from other countries, especially the USA and better eHealth regulation. It’s a big agenda, but cyber-attacks have big, damaging consequences.

  • Track outbreaks with Twitter! Google, or Wikipedia.

    There’s a new race underway between Internet giants Google, Wikipedia and Twitter. It’s anyone’s guess who might be winning, but from an outsider’s viewpoint they are all doing rather well.

    Google’s been estimating flu trends for some time. But not many expected the announcement that Wikipedia estimated peak Influenca-like illness (ILI) activity 17% more often than Google Flu Trends. eHealth News Africa’s Tom Jones wrote about this in April, including a P LOS Computational Biology headline “Wikipedia Usage Estimates Prevalence of Influenza-Like Illness in the United States in Near Real-Time.” PLOS is a non-for-profit open access scientific publishing project.

    Two months earlier, Matt Petronzio at Mashable, a top social media news outlet reported that a team of researchers at the University of California, Los Angeles (UCLA) found that Twitter and other real-time social media can be used to track HIV outbreaks and drug behavior. It has a big potential to help to detect and prevent infection.

    Preventive Medicine published the study, suggesting a link between geographic outbreaks in the USA and tweets with phrases that indicate drug-related and sexually risky behaviour. Sean Young, co-director of UCLA’s Center for Digital Behavior, said in a statement, “This is the first [study] to suggest that Twitter can be used to predict people’s health-related behaviors and as a method for monitoring HIV risk behaviors and drug use.”

    Whichever horse you’re betting on, it’s sure to be an exciting race. Could they all come in first?

  • Zambia to use analytics to improve access to life-saving drugs

    IBM will soon be collaborating with the Zambian Ministry of Health (MOH) to provide citizens with improved access to some 200 life-saving drugs. The initiative has the support of the World Bank, the Department for International Development, UNICEF and London Business School. Zambia’s Medical Stores Limited (MSL) will deploy the new medical supply chain pilot using sophisticated analytics and mobile technologies to manage medicine inventory and delivery.

    Every year, Zambia’s public health sector records nearly 100,000 deaths that are caused by preventable and treatable diseases. The medicine supply chain management project aims to save more lives by making life saving medicine available when and where it’s needed.

    The pilot will manage a scalable supply chain and control the use, supply, availability and access to essential medicine within the country’s health sector. The solution will also provide real-time view of drug use and stock levels, and analyze data to identify trends and forecasts to prevent gaps in the medical supply chain.

    “With help from our partners, we have already introduced simple improvements in the medical supply chain that will save the lives of thousands of children across our country by 2015,” said Dr. Bonface Fundafunda, CEO at MSL. “To build on these gains, we’re working with IBM to replace our paper-based inventory system with cutting-edge technology that can pinpoint the exact locations where stocks of essential medicines are running dangerously low.”

    IBM was recently involved in a similar project to combat the number of deaths from malaria in Tanzania. The “SMS for Life” solution was successfully piloted in 135 villages and has now been rolled out across the whole of Tanzania.

    The 12-month pilot project kicks off this month and hopes to contribute to the overall strengthening of Zambia’s health care system.

  • Copy and paste: is it the big risk for EHRs?

    When patients visit their doctors, do they think that their doctors listen to the concerns and review the specific signs and symptoms of each patient and record them in unique notes, or do doctors categorise them and save time by copying and pasting text to record typical complaints and treatment plans? If the treatment options are limited, is it reasonable to expect that signs, symptoms and diagnoses are in a narrow band too? Either way, copying and pasting brings with it increased security risks.

    In the USA, the Department of Health and Human Services’ Office of Inspector General has reviewed these practices in the Centers for Medicare & Medicaid Services (CMS) and produced CMS and its Contractors Have Adopted few Program Integrity Practices to Address Vulnerabilities in EHRs. It found that:

    EHRs can make it easier to commit fraud such as using some EHR to conceal true authorship of medical records and distort information to inflate health care claims The transition from paper records to EHRs may present new vulnerabilities and require the CMS and its contractors to modify their techniques for identifying improper payments and investigating fraud CMS and its contractors had adopted few program integrity practices specifically for EHRs Few contractors were reviewing EHRs differently from paper medical records Not all contractors said they could determine whether a provider had copied language or over-documented in a medical record CMS had provided limited guidance to Medicare contractors on EHR fraud vulnerabilities.

    Over-documentation is a USA term meaning inserting false or irrelevant documentation to create the appearance of support for billing higher-level services than provided. Identifying over-documentation increased from 78% to 83% with EHRs. Identifying copied language with EHRs dropped from 61% to 50%.

    Of the contractors, 22% conducted additional reviews. About 17% used data from audit logs.

    The report recommends that CMS should:

    Compile and provide guidance to its contractors on detecting fraud in EHRs Work with contractors to identify best practices and develop guidance and tools for detecting fraud in EHRs Direct its contractors to use providers’ audit logs.

    As African countries introduce and expand their use of EHRs and related eHealth, it’s a good idea not to switch paper-based practices into them without a thorough, rigorous review of their use and implications.

  • Avoiding risks is sometimes elementary

    Risk, red faces and costs often go together. A constructive reaction when it happens to someone else is to use it to reduce the chances of it happening to you. In France, the railway system has revealed an elementary, high cost measurement mistake. The Société Nationale des Chemins de fer Français (SNCF), the French train operator, has bought a new set of trains, the Regiolis Regional Express Train (TER). It then discovered that some of the platform edges are too close to the tracks, so the TER can’t enter these stations.

    It seems that Réseau Ferré de France (RFF), the national rail operator, provided SNCF the wrong dimensions. It measured comparatively new platforms built less than 30 years ago, but many regional platforms are older, and built when trains were narrower. The estimated correction costs are at least 15bn euros, or US$20.5bn.

    At least all the stations are in France. In 1816, the USA accidentally started to build Fort Montgomery in Canada because of an error in aligning the 45th parallel.

    Samuel Marx, nicknamed Frenchie, and father of the Marx Brothers, was a tailor. He guessed his customers’ sizes instead of measuring them. When they returned to collect them, they usually didn’t fit, so he started again. After he’d accumulated enough rejected suits, he took the bundle to sell them door-to-door. This isn’t a good way to set eHealth requirements and specifications.

    African countries can’t afford to fix resources on these large scales or deal with smaller scale disruptions. A simple lesson to mitigate risk is when the correction or disruption costs are high, rigorously check the data and the methodology. It applies to all eHealth design decisions.

  • Africa’s new ICT strategy’s completed

    This month Africa finalised a continental strategy to guide ICT development over the next decade. It’s a bold step forward and a culmination of extensive stakeholder engagement across the vast continent.

    The 5th Meeting of the Heads ICT Units in AUC, NEPAD Agency, Regional Economic Communities (RECs) and Associations of Regulators on Harmonisation and Coordination of Regional and Continental ICT Programmes, Projects, and Activities has ended with the adoption of the comprehensive Continental ICT Strategy for Africa (CISA).

    The strategy is anchored on 7 Strategic themes:

    Post and Telecom Infrastructure Capacity Development e-Applications and Services Enabling environment and governance Mobilisation of resources and partnerships Industrialization Research and development.

    The meeting was attended by representatives from the African Union Commission (AUC) , NEPAD Agency (NPCA), United Nations Economic Commission for Africa (UNECA), Southern African Development Community (SADC), Economic Community of Central Africa States (ECCAS), Economic Community of West African States (ECOWAS), East African Community (EAC), Inter-Governmental Authority on Development (IGAD), East Africa Communications Organizations (EACO) and the Communications Regulatory Association of Southern Africa (CRASA).

    The adoption of the new strategy has been deemed a “major achievement toward the harmonization of policies and regulations in Africa”  by Dr. Elham Ibrahim Commissioner for Infrastructure and Energy.

  • Google glass reviewer doesn’t like it

    The BBC’s technology correspondent Rory Cellan-Jones, has worn Google Glass for six weeks. His verdict is that he thinks it’s a failure. He says “sadly my verdict is that, in its present form with its current software, Google Glass is a failure. A fascinating, promising, sometimes brilliant product – but a failure nonetheless.”

    He goes on to say that “the voice control is very good for simple commands (“Ok Glass, take a picture”) but pretty useless for anything longer or more testing such as a search or adding a caption to a tweet. Part of the problem is that Google doesn’t seem to understand my British English.” Many of us have had similar problems with voice recognition generally, so Google Glass may be no different.

    His Google Glass wearing experiences haven’t dented his enthusiasm for wearable computers. He’s still excited by their promise and convinced that they’ll go mainstream in the next five years. If that’s for rich countries, what can African countries plan on?

  • Will Big Data be bigger?

    Is analysing healthcare data about patients’ analytics or Big Data? Does it matter? The Wall Street Journal (WSJ) says that Big Data fits data from routine medical check-ups, so how can eHNA argue? It draws from several Big Data initiatives in the USA. A short summary of three Big Data examples in the WSJ is on the iHealthBeat site. They are:

    Boston Children’s Hospital researchers examined data from 71,776 patients with sore throats then designed a way to help decide whether patients should see a physician to receive strep throat tests Data collected during physician visits and prescription information from a large insurance plan found that patients with autoimmune diseases have a heightened risk of epilepsy Stanford researchers used data from paediatric patients’ EHRs to find a link between patients’ allergies and flare-ups of uveitis in individuals with juvenile arthritis.

    As these positive examples accumulate, the case for analytics and Big Data becomes increasingly irresistible. African countries can start their own Big Data and analytics trajectories now.

  • Latin-America’s first telemonitoring programme underway

    Hospital Italiano in Buenos Aires, Argentina is home to a host of impressive projects. Amongst these is its claim to be Latin America’s first in-home telemedicine programme. In collaboration with telecom provider Telefonica de Argentina, Hospital Italiano’s medical informatics team has launched a pilot project where chronically ill patients receive a home telemedicine kit that will transmit health information directly to their electronic health record. The updates are also immediately available for physicians to use and analyse at the hospital.

    “The system, which works straight out of the box with virtually no user setup, consists of a tablet and various sensors which connect to it via Bluetooth,” explains project leader Dr. Fernando Plazzotta. These sensors include a digital scale, pulse oximeter, and blood pressure cuff, with the potential integration of other devices, such as glucometers for diabetic patients.

    “We are very excited to receive the feedback of patients and physicians alike,” says Dr. Plazzotta. He hopes that the positive results from the pilot will enable a transition into a full telemonitoring programme, which can be expanded in scope and volume.

    The well-executed principles of simplicity, ease-of-use, and user friendly interface make this a promising pilot, with valuable lessons for similar systems for Africa.