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  • 2nd Annual Mobile Health Africa Congress

    The 2nd Annual Mobile Health Africa Congress kicks off in Nairobi, Kenya, tomorrow, 26 March. The two day event aims to support the integration of mHealth in Africa by harnessing the power of mobile technology. In order to bridge the gap between mHealth innovation and taking mHealth to scale, Africa needs to make bolder decisions and strategically integrate mHealth into their healthcare systems. The conference emphasizes the importance of mHealth as a tool to support overall health systems strengthening.

    “The untapped opportunities that mobile technology can offer to healthcare has to be deeply interrogated and strategies need to be put in place so that organisations can partner effectively to ensure that mobile technology becomes entrenched into their continuum of care.”

    A variety of high profile representatives from the healthcare sector and supporting industries will be attending the event. tinTree’s own Dr Sean Broomhead will be speaking about maximising mobile health benefits for Africa. You can follow his and others insights on Twitter @seanehna and @eHealthNewsAfri.

  • Lots of pain, not sure about the gain

    “No pain, no gain” is Jane Fonda’s concept for workouts. For EHRs, it may be lots of pain, not sure about the gain. It’s a bit more clumsy than Fonda’s aphorism, but seems to be a view reported by Politico, a USA political news service. It says that most physicians support switching from paper to EHRs, but many say the changeover timeline needs a brake. Their advice is “Not so fast,” and they want changes.

    In 2013, about 78% of USA physicians used EHRs. Despite this extensive adoption, there are many concerns. They include:

    EHRs systems are difficult to use, they’re “clunky” Savings and better healthcare quality are evident Paperless records don’t flow smoothly between hospitals and patients EHRs are not optimal in meeting users’ needs They don’t communicate with other information systems They needs lengthy data entries They have severe design flaws They need months of training to operate They’re infuriating and cumbersome They slow doctors down They distract doctors from taking care of patients Too many clicks, so not user friendly Implementation costs are too high.

    Many of these concerns seem addressed specifically to commercial EHRs. As African countries move further towards EHRs, they may want to use Politico’s findings as a checklist of topics to include in engagement with health workers, users’ requirements and procurement specifications.

  • Telemonitoring helps to lower blood pressure

    Living in remote mountain areas might have splendid views, but it can limit the reach of healthcare. Astudy from Italy in BMC Medical Informatics and Decision Making shows that a combination of a physician-nurse approach supported by remote telemonitoring of blood pressure (BP) is likely to improve outcomes in patients with uncontrolled hypertension.

    There were two groups, Home-Based Telemedicine (HBT) and Usual Care. At the start of the study, there was no significant difference in BP values between the groups, but there were at the end of the study. The out-of-range BP differences were:

    HBTUsual CareSystolic BP26%81%Diastolic BP  8%62%

    The mean changes in blood pressure were about:

    HBTUsual CareSystolic BP15%5%Diastolic BP15%4%

    The results were a combination of the impact of healthcare professionals and telemonitoring. The study says that “Many epidemiological studies have shown that the treatment and control of blood pressure (BP) is inadequate in more than 50% of hypertensive patients in spite of availability of several classes of well tolerated and effective antihypertensive drugs.” In this context, the healthcare professional and telemonitoring seems to offer a way forward in some circumstances.

    The report says that the cost analysis used in the study considered only the services provided to the patient in the HBT group. It didn’t evaluate the cost effectiveness of the service. More importantly, the study makes no exaggerated claims for benefits. It’d be valuable to know the medium and long term benefits for patients, carers and health services.

  • Is Malaria on the march? Is it an eHealth priority?

    As climate change tightens its grip, temperatures rise. Insect-borne diseases love it. The mosquito vector and pathogen development are moving up to higher altitudes, says a study reported in Science that used Ethiopia as a source of data. The research indicates that millions of people living in the highlands of Africa and South America face an increased risk of catching Malaria as the disease occupies new locations during hotter years.

    The World Malaria Report 2012 FACT SHEET  says that Africa accounts for almost 90% of global Malaria deaths. The main victims are children under five years old.

    WHO estimates that there were about 219 million cases of malaria in 2010. An estimated 660,000 people died. Malaria mortality rates fell by 26% from 2000 to 2010 globally. In the WHO African Region, the drop was 33%. An estimated 1.1 million malaria deaths were averted globally, largely due to scaled-up interventions.

    As African countries review their eHealth investments, they have an opportunity to adopt eHealth solutions that help health workers to aver this expansion of Malarias’ territories. The benefits are there for the taking.

  • Google Glass has an EHR app

    Most of us would like our healthcare team to keep an eye on us. It’s becoming easier for them. Google Glass can now provide access to our EHRs. Reuters has a report that says physicians’ growing demand for Google Glass has encouraged Drchrono, a USA EMR supplier, to develop a new app. It claims it’s the world’s first wearable health record.

    Doctors who register for the Drchrono app can use it to record a consultation or surgery. Patients’ have to consent first. It stores patients’ videos, photos and notes in their EHRs held in a Box in the Cloud. Patients can access their data. Security settings need rigorous enforcement.

    Drchrono claims to have 60,000 physicians registered to use its EHR for doctors and patients. More than 300 of them have already opted to use it: not many, but is it the start of a big trend?

    A BBC’s technology correspondent Rory Cellan-Jones didn’t think so, but others love it. Even though glass is experimental, what does its trajectory look like?

    The app is currently free, but Drchrono may charge a fee in the future.

  • Doctors choose how to use their EHRs

    Not only is there more than one way to tie a tie, but a USA study in the Journal of American Medical Informatics Association (JAMIA) says there’s more than one way to use EHRs. It identifies differences in the way that 112 physicians use EHRs and its features for 430,803 visits by 99,649 patients. It found that:

    Users using the same EHR developed their own patterns of using EHR features. Users in the same practice vary substantially in how they use EHRs.

    Differences include;

    Personal EHR metrics to capture how providers accessed and added to patient data, such as problem list updates Using clinical decision support, such as responses to alerts Communication, such as printing summaries after patients’ visits Using panel management options, such as viewing reports.

    Variability was high. The annual average proportion of encounters with updated problem lists ranged from 5% to 60% between uses. Another was where problem list updates were more likely for new patients than established ones. Alert acceptance and alert frequency has a negative correlation.

    Reasons for the differences include:

    Users’ overall familiarity with an EHR system Users’ familiarity with patients’ medical problems Staffing differences at the health centres which affected workflows.

    These differences throw a light on a vital issue for benefits realisation: variations in physicians EHR features and utilisation may be a valuable additional predictor of EHRs’ impact on healthcare quality, efficiency and costs. It also confirms the validity of a core component of tinTree’s eHealth Organisational Change Matrix: organic change. This is where users decide for themselves how to use eHealth for their own and their patients’ benefits. It’s critical in the success or failure of changing some clinical and working practices that are essential for benefits realisations. The study is a reminder of two critical questions about utilisation in eHealth evaluations:

    How much do you use your EHRs How do you use them?

    It’s where economic evaluation bumps up against psychology, and it’s a vital part of continuous engagement. African countries need to know about the phenomenon when introducing large-scale eHealth initiatives. It’s an important finding.

  • Cyber-legislation is a key priority for ECOWAS states

    A four-day conference on cyber legislation in the West African sub-region ended last week in Accra.

    The aim was to strengthen regional harmonization of laws on electronic commerce. It hoped to do this by implementing at national level and regional legal frameworks on electronic transactions, cyber-crime and data protection. The concept is to build from the Budapest Convention on cyber-crime.

    Participants included individuals from the judiciary, law enforcement agencies, academia, civil society and security experts from 14 countries.

    Dr Edward Kofi Omane Boamah, Minister for Communications in a speech read on his behalf by Mr Desmond Boateng, a Director at the Ministry, said that ECOWAS should be looking for inspiration from Europe and elsewhere in building its capacity to address the challenges. He warned against using a copy and paste approach toward policies to mitigate cyber-crimes, declaring that “we should make our mark with home grown initiatives”.

    It is crucial that African countries harness the power of ICT to develop their economies. It is just as important to ensure that personal data and information is safe and secure. This is especially true for healthcare where sensitive health and financial data needs to remain private and confidential.

  • Health eVillages on the international stage

    As a program of the Robert F. Kennedy Center for Justice and Human Rights, the Health eVillages initiative already has international connections. They were on display at HIMSS 14, a conference organized by the Health Information Management and Systems Society.

    Donato Tramuto, Health eVillages founder and Physicians Interactive CEO, lead “Apps Save Lives: How mHealth Technology Improves Healthcare Quality Worldwide,” a session with Dr Milton Ochieng’ from Kenya’s Lwala Community Hospital and Lwala Community Alliance.  mHealth News has a reporton the presentation, saying that Dr Ochieng’ uses iPads, supplied by Health eVillages, with healthcare content to train and teach doctors, nurses and community health workers in his hometown, where he built the region’s first health clinic in 2007, then a hospital. From then, infant mortality rates fell sharply. Now, about 96% of mothers have their babies in a health facility, up from 26% before 2011: more than twice Kenya’s current average of 47%.

    Health eVillages has several small-scale pilots across the world. It includes initiatives in Kenya and Uganda.

  • Databases can still rule OK

    With all the excitement about Big Data, it’s good to see a traditional database initiative. The Duke Clinical Research Institute (DCRI), the Centers for Medicare & Medicaid Services and the Society of Thoracic Surgeons (STS) aim to collaborate to link clinical data to track long-term patient outcomes so that the STS can improve its understanding of how patients are several years after procedures. This overcomes the limitations of the current STS National Database that has short-term clinical data, at most, up to 30 days after hospital discharge. An STS announcement points this out and says that the collaboration is a first for specialty medical societies.

    The STS national database is the largest cardiothoracic database in the world containing outcomes of surgery and quality improvements. It holds some 5.2 million procedures. It will expand to have accurate and current risk models and long-term survival calculators for individual procedures. Surgeons will then be able to estimate individual survival probabilities for patients.

    FierceHealthIT has a report on the US$15 million initiative and of another consortium of universities and hospital systems in South Carolina’s Clinical Data Warehouse (CDW) housed at Clemson University and operated by Health Sciences South Carolina.

    Another initiative in 2013 by the University of Pittsburgh Medical Center used a data Warehouse to integrate clinical and genomic data about breast cancer patients. This is on a much smaller scale than the STS proposal and the CDW.

    Setting up Big Data initiatives now may be a considerable challenge for many African countries. It’s encouraging that databases still offer good solutions for improving healthcare quality. They’re not a cheap alternative to Big Data, and often need extra ICT and informatics support to ensure sustainability. They continue to form an important strategic resources.

  • Heartbleed can put health data at risk

    The Hearbleed risks keep coming. A report in Modern Healthcare says that the Heartbleed bug can lead to healthcare sites having big security threats and hints at considerable remedy costs. It’s the view of health information technology experts. Vulnerable healthcare sites include provider websites, physician and patient portals, secure e-mails. Hackers could potentially use the program to get sensitive information from:

    Email servers Laptops Mobile phones Security firewalls.

    But, a post on iHealthBeat says that it’s not unclear if the nation’s healthcare providers are any more vulnerable than other organisations. It quotes, CynergisTek CEO that “Web networks that rely on two or three-factor password authentication should be safe” from a report in mHealthNews.

    There are several other citations in the iHealthBeat post with a range of views on the bug. It’s hard to be clear on the precise position, other than it’s a massive issue that needs constant vigilance for a few more days.

  • Is fixing security too hard? A five-year old can do it

    It now seems that Groucho Marx was nearly right playing Rufus T Firefly in Duck Soup by Paramount in 1933, when he said, “A four year old child could understand this report! Run out and find me a four year old child. I can’t make head nor tail out of it.” Now, the Huffington Post is reporting that Microsoft has added a five-year old boy to its list of recognised security researchers.

    Kristoffer Von Hassel from San Diego worked out how to log in to his dad’s Microsoft Xbox Live account without the password. He entered the wrong password into the log-in screen, which then brought up a second password verification screen. Kristoffer discovered that pressing the space bar to fill up the password field let him into his dad’s account.

    Microsoft has fixed the security problem and given Kristoffer four free games worth $50 and a one-year Xbox Live subscription. Now we know the combined cost of embarrassment and weak security.

    In A Day at the Races by MGM in 1937, Groucho bought a 1$ book from his brother, Chico, who couldn’t change a $10 note. Chico’s logic was: “I don’t have change I’d have to give you nine more books.”  That’s an incentive for Kristoff to keep looking for more ways in.

  • Africa’s economies are booming

    The latest numbers for forecast growth in Gross Domestic Product (GDP) from the International Monetary Fund (IMF) show Africa’s on the move.

    The forecast GDP growth for oil producing countries is 6.7% for 2014 and the same for 2015. For middle-income countries it’s 3.4% and 3.7%. For low-income countries, it’s 6.8% for both years. The average for sub-Saharan Africa is 5.4% then 5.5%. Details are in table 2.7. It was 4.8% in 2013, so economic life is looking up.

    For Algeria, the North African oil exporter, it’s 4.3% and 4.1%. For Egypt, Morocco and Tunisia, it ranges between 2.3% and 3.9% for 2014 and 4.1% and 4.9% for 2015. More information is in table 2.6.

    With this seemingly sustainable extra gain, how will countries deploy these extra resources? Continued economic growth is a priority. So is an expanded Internet and connectivity. So is education. Health is too. eHealth, including the need for an expanded and skilled eHealth workforce, offers good potential for local SMEs and national ICT suppliers that can also help to drive the economy further. Is Africa’s eHealth affordability starting to ease?

  • Should healthcare worry about Heartbleed?

    The USA health ICT sector has a number of Web-based EHR platforms vulnerable to the Heartbleed bug, according to Lauren Still’s report in Government Health IT. 

    The bug’s name, Heartblood, was given by Codenomicon Defensics, the security firm that first disclosed it. It’s a serious vulnerability in OpenSSL cryptographic software library. The bug is not an issue with Secure Sockets Layer (SSL), it’s a bug in the OpenSSL implementation of  Datagram Transport Layer Security (DTLS)  Transport Layer Security (TLS), and was accidentally introduced in OpenSSL version 1.0.1 in March 2012.

    It provides communication security and privacy over the Internet for Web applications and some virtual private networks (VPN). Vulnerability includes potential to intercept private keys, usernames, passwords and other sensitive information such as financial and health information. Attackers can read up to 64KB of memory, and according to the researchers: “Without using any privileged information or credentials we were able to steal from ourselves the secret keys used for our X.509 certificates, usernames and passwords, instant messages, emails and business critical documents and communication.”

    Still’s recommends that end users, patients and consumers should limit communications and avoid logging into any web platform until the organisation confirms its SSL integrity. At minimum, users should change all passwords, but ensure this happens after a patch or fix. Enable two-factor authorization where available and back up important web data files. Deleting any extra or expired online credit card data is advised, and just good practice.

    In the USA, EHR, HIE and third party payers’ software suppliers have received notifications so they can deal with the bug. Suppliers should immediately assess their SSL security implementations for Heartbleed vulnerabilities, and update OpenSSL as needed. They evaluate SSL configuration for web and mail services. It’s not possible to know if a server has been exploited, so suppliers should assume that it has. The safe move, then, is to revoke existing certificates and use new ones.

    They should also consider implementing perfect forward secrecy to prevent future private key compromises from affecting applications. Organizations also have a duty to notify their user bases, inform them of the potential risk, remedial actions and actions that end users can take to protect their information.

    The USA Department of Homeland Security has a commentary on Heartbleed and a website with tips on protecting personal cyber-security and information. It says that:

    “While there have not been any reported attacks or malicious incidents involving this particular vulnerability confirmed at this time, it is still possible that malicious actors in cyberspace could exploit un-patched systems.”

    It’s advice includes:

    Many commonly used websites are taking steps to ensure they deal with this vulnerability and are advising the public When you know the websites you use are secure, change your passwords Monitor email accounts, bank accounts, social media accounts, and other online assets for irregular or suspicious activity, such as abnormal purchases or messages When a website you visit has addressed the vulnerability, make sure that if it requires personal information such as login credentials or credit card information, it is secure with the https identifier in the address bar: the s at the end means secure.

    It’s essential that all eHealth suppliers to healthcare in Africa provide assurances that it’s either not a problem, or that it’s fixed, and the remedial action users need to take. African users need to follow this up.

  • Is aid for healthcare drying up?

    Today’s the last day of a three-day meeting of the World Bank and the International Monetary Fund (IMF). They’re reviewing new ideas for healthcare aid.

    The Economist has a review of the issues. After the Millennium Development Goals (MDG) in 2000, healthcare aid expanded by about 10%, compared to 7% before then. The targets were HIV/AIDS, tuberculosis, malaria and maternal and child health. Growing health challenges for chronic diseases, such as diabetes and heart disease received about 1% of the aid money. Tackling the growing burden of chronic conditions is becoming a big priority.

    Health Affairs, a blog, says the annualised growth rate was 6.5% between 1990 and 2000, and 11.3% between 2001 and 2010. Since 2011, the annualized growth has dropped, to 1.1% percent, partly due to the global economic crisis.

    Will the meeting step up the aid money available? Will it rebalance the deployment of aid money? Will the role health informatics and analytics gain from aid money? Will it all remain as it is? Will African countries have to deploy some of their steady, large economic growth to deal with their own challenges?

  • Hackers may be trying to exploit Heartbleed

    Now, the US government has joined the security chorus about OpenSSL’s bug. The Department of Homeland Security has warned that hackers may try to exploit the Heartbleed bug. It’s advice is that the public should change passwords for sites affected once they had confirmed they were secure. So far, it hasn’t found any reported attacks or malicious incidents.

    Several net hardware and software makers said the encryption flaw bug had compromised some of their products. These include network routers and switches, video conferencing kit, phone call software, firewalls and apps that let workers remotely access company data. Experts say home kits are less at risk.

    The BBC technology website says there had been reports that domestic network equipment such as Wi-Fi routers might use of unpatched versions of the OpenSSL cryptographic library used to scramble digitally sensitive data. It says a security researcher at the University of Cambridge Computer Laboratory said it would be relatively rare.

    Some Internet Service Providers (ISPs) have said that their home router suppliers had confirmed that their equipment did not use OpenSSL. That must be a relief for users.

  • Analytics 0 Manual 1 at half time

    Nobel Prize winner Niels Bohr’s amusing observation that “Prediction is very difficult, especially if it’s about the future” seems to resist some of the power of analytics. Kaiser Permanente, the USA health plan and health maintenance organisation, has tested and compared the predictive values of manual and automated 3M’s Potentially Preventable Readmission (PPR) analyses.

    The result was that the two methods differed substantially in the proportion of readmissions classified as potentially preventable. PPR identified many more readmissions as potentially preventable within six weeks of discharge. Insufficient consistency between the two methods means that Kaiser has decided no to automate the manual review.

    Researchers reviewed 459 readmission cases from 18 Kaiser Permanente hospitals in Northern California. They compared the results using both methods on the same data. BMC Medical Informatics and Decision Making has published the results.

    The manual review comprised a chart review tool, interviews with patients, their families and nurse and physician teams. The researchers used a five-point scale to classify the data. Comparing the information generated from 3M’s Potentially Preventable Readmission (PPR) software showed that the PPR 78% of cases could avoid readmissions, the manual review identified 47%. Both methods agreed on the preventability of 56% of readmissions.

    The study is a salutary reminder that analytics is still emerging. It can improve its rigour, so rather than go to extremes and dump analytics initiatives, African countries should consider H M Warner, Warner Brothers founder’s hopeless prediction in 1927, “Who the hell wants to hear actors talk?”

  • 3D printers plummet in price

    Using 3D printers in healthcare is now more viable. M3D has released one for US$299. It’s reported by the BBC that it achieved its Kickstarter goal in eleven minutes. Kickstarter is a crowd-funding website for technology projects.

    The BBC technology website says the printer has very usable software, with access to the web and simple search, drag and drop objects to print. It’s light and portable and fits with Windows, Mac or Linux.

    It’s marketed as a consumer product, so the value to the clinical requirements need testing. If it doesn’t match up, it’s impact on prices may bring the price down of other 3D printers, currently in the US$300 to US$500 range.

    However, there is a slight catch. The printer’s supporters on Kickstarter can buy it for up to $299. M3D hasn’t set a retail price yet, although it’s expected to be similar. Healthcare’s buying power should help to secure a good price. It could be an expanding opportunity for some specialties in African healthcare.

  • Will Apple revolutionize healthcare?

    John le Carré, author of Tinker, Tailor, Soldier Spy said he was “still making order out of chaos by reinvention.” It seems that Apple may have a similar opportunity. It’s set out in This is Healthbook, Apple’s major first step into health & fitness tracking.

    It’s found its next market for reinvention: mobile healthcare. Apple’s interest in healthcare and fitness tracking will be displayed in an application dubbed the Healthbook. Users can track data about many human functions, including blood capability, heart rate, hydration, blood pressure, physical activity, nutrition, blood sugar, sleep, respiratory rate, oxygen saturation and even weight.

    Arguably one of the initiatives unique applications is its ability to monitor blood capabilities. While the actual capabilities of the so-called Bloodwork section is currently vague, data suggests that the tab can present several different blood-related data points normally provided by healthcare professionals and bloodwork labs. Hospitals often track blood data in patient check-ups, looking at liver function, kidneys, thyroids, and the heart. The blood results are usually distributed to patients through printouts, emails, or faxes. Using the latest software and hardware technology, it seems that Apple wants to reinvent this process.

    Le Carré had strong views about perception. He said that, “A desk is a dangerous place from which to view the world” Nobody can accuse Apple of starting from there, or of chaos.

  • Mozambique has Internet opportunities

    The Internet can help to transform a country’s social and economic development. With this in mind, a team of UK AID, Common Market for Eastern and Southern Africa, (COMESA) and the Mozambique Regional Gateway Programme (MRGP) commissioned Unlocking the Potential of the Internet A Scoping Study in the Mozambique Regional Corridors of Beira and Nacala. Accenture completed the study. It has many investment recommendations, including:

    Develop a clear broadband strategy that:

    aligns each sub-sector’s efforts fosters greater local competition with improved infrastructure sharing regulation reduces the entry cost for new competitors with easier rights of way access to civil infrastructure.

    A research programme to:

    understand the Internet quality needs of small and medium businesses in each province use this for new service quality regulations.

    Test low cost technologies like “TV White Space” for its potential to provide quality connections in rural areas

    Test this technology with the Community Media Centre (CMC) network in the Beira and Nacala corridors

    Promote entry and setup of local production facilities of low cost computers

    Set up a scheme to provide subsidies or tax credits to small and medium enterprise’s to help them access Internet enabled equipment

    Support the Universal Access Fund to deploy its resources for affordable Internet access in rural areas

    Develop and utilise the Community Media Centre infrastructure as ICT labs to:

    train and build the population’s awareness investigate innovative Internet applications that improve SME productivity tailor it for use in Mozambique work with government to ensure there is adequate laws and regulations to protect online commerce users.

    Two challenges seem longstanding. Mozambique is 162 out of 169 countries on the International Telecommunications Union (ITU) broadband index for Internet cost. It’s one of the most expensive countries globally. The second is that the “quality and stability of Internet connection is a critical hurdle to improve Internet penetration.” The second seems an intractable challenge in many parts of Africa.

  • Dr Wikipedia I presume? Or maybe I shouldn’t

    Dr Livingstone didn’t need the Internet to treat his patients. Henry Stanley didn’t need a Google Map to find him by Lake Tanganyika, then enquire with his masterful understatement of “Doctor Livingstone, I presume.” If it happened now, Stanley may go on to say something about his terrible affliction that he’s been looking up on the Internet, then direct Dr Livingstone in firming up the diagnosis and prescribing a treatment.

    With access to loads of material online, who do you now trust most, your doctor or the Internet? Osteopaths have been trying to find the best answer. The research team didn’t review the whole Internet or the whole range of healthcare. Who can? It compared the USA’s top ten most costly conditions defined by public and private expenditure with a corresponding Wikipedia article. A small team identified all assertions of facts then matched these to a literature search to determine the veracity of the Wikipedia entry.

    The findings are in The Journal of the American Osteopathic Association. The report, Wikipedia vs Peer-Reviewed Medical Literature for Information About the 10 Most Costly Medical Conditions, says the researchers found a “statistically significant discordance between 9 of the 10 selected Wikipedia articles (coronary artery disease, lung cancer, major depressive disorder, osteoarthritis, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, back pain, and hyperlipidemia) and their corresponding peer-reviewed sources.”

    The numerous errors mean that people should be cautious using Wikipedia to answer questions about patient care. It seems that doctors and medical students are people in this context. The report says that between 47% and 70% use Wikipedia as a reference source, although its influence on medical decision-making is unclear. Does this mean that the choice between your doctor and Wikipedia has overlapping answers? It probably means that nothing’s changed since Dr Livingstone’s time, when Stanley advised him to read his letters before discussing the news; no email then.