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  • Articles (2,411)
  • eDecision switches into Clinical Quality Framework

    There’s nothing new about quality. Aristotle said that “Quality is not an act, it is a habit.”  The USA’s Office of National Coordinator for Health Information Technology (ONC) seems keen on the idea. Over the days 21 to 27 March, it switched its Health eDecision (HeD) project into its Clinical Quality Framework (CQF). The change is set out in Dr Doug Fridsma’s blog on Health IT buzz.

    HeD is linked to the Standards and Interoperability Framework, (S&I Framework) and created three implementation guides and authored six HL7 standards with the guidance of the HL7 Clinical Decision Support (CDS) Work Group. The six standards are:

    CDS Knowledge Artifact Implementation Guide Decision Support Service (DSS) Implementation Guide Virtual Medical Record (vMR) Logical Model vMR XML Specification vMR Templates DSS Standard.

    HeD also completed work on two Use Cases:

    Clinical Decision Support Artifact Sharing, dealing with using a good clinical decision support rule with someone else in an electronic format, so they can use the rule in their EHR Clinical Decisions Support Guidance Service, dealing with the technicalities of sending important data to an up-to-date website or service that provides advice on immunizations or other complex decisions.

    CQF’s goal is to harmonise CDS standards and electronic clinical quality measurement (eCQM). It takes HeD’s work further.

    These are long-term initiatives that need stamina and patience. Like Aristotle said, “Friendship is a slow ripening fruit.” He hadn’t heard of S&I.

  • Is foreign ICT an eHealth security risk?

    The increase of foreign ICT in the country is capable of threatening the security of Nigeria, NigComSat Limited has warned.

    NigComSat Board chairman, Prof. Turner Isoun, is concerned about the proliferation of foreign vendors, arguing that the increase in the number of vendors supplying equipment and security solutions to the country poses a serious threat. Isoun warned that the practice exposes Nigeria “to a myriad of potential security threats from otherwise restricted data being exposed to numerous vendors.”

    The same goes for health data. The increase in vendors in the sector intensifies the risk of personal and private health data being exposed. It is crucial to have the eHealth regulations in place to keep health data private and secure. Alongside this, countries need to test compliance. This is the teeth of the barking dog of regulation.

  • Google’s Android is now for wearables

    Building on its experience with Google Glass, Google has developed Android Wear, version of its Android operating system specifically for wearable devices. A BBC report on its technology web pages says the first release is with smart watches to support and follow voice commands. There are a wide range of partners involved, including electronics firms, chip makers and fashion labels on wearable gadgets that run Android. The software is for gadgets that monitor key health parameters and fitness monitors for people who jog, run or cycle, and equivalent activities. It can lead to devices that respond promptly to voice commands, such as answering short questions, booking a taxi or sending a text without having to tap input on a smartphone touchscreen.

    Motorola’s Moto 360 smart watch will be an early adopter. It’ll be on sale in the summer.

    Google announced the initiative on its Google blog. It’s a major step for the company into the wearables sector.

    Entering the wearables market expands Google’s competition with Apple, so there’s a good spectator sport for the next few months. Which versions will succeed in Africa?

  • How secure is your cloud data?

    Cloud is gaining popularity the world over as an effective way to exchange and store large amounts of information. Everything from personal documents and photo’s to critical and confidential business documents are in the cloud. How can we be sure our information is secure and safe?

    Simon Campbell-Young, CEO of Phoenix Distribution says we can’t. “Snowden’s revelations last year have raised concerns as to how secure information in the cloud really is, and who is able to access our most personal information.”

    According to Simon, legislation on data privacy isn’t keeping up with the speed of the development and roll out of new technologies. This is in line with the findings of the eHealth regulation study completed by a consortium led by Greenfield Management Solutions.

    Cloud security is now top of the security agenda. He added that “Over and above companies implementing additional security measures to secure their data stored off-premise, they will also re-evaluate policy on what data can be stored in the cloud, and what data cannot. We will see businesses blocking access to data storing sites that they do not control, such as Dropbox, and will start focusing on the more secure private clouds, and move away from public clouds. In this way, they will take steps to ensure that their most valuable data remains firmly in their control.”

    African eHealth initiatives need to take these risks into account and make sure that personal data is not stored in cloud applications that are accessible to anyone outside the predetermined group. Healthcare facilities could be risking losing personal patient data if the necessary security measures are not put in place.

  • Kenya’s draft cyber security strategy out for review

    Kenya is putting the finishing touches to its cyber security strategy. The ICT Ministry has recently released the draft strategy document and encourages Kenyans and interested stakeholders to provide comments and inputs which will be incorporated in the final document.

    The new strategy document will guide the management of cybersecurity issues in the country. According to Phyllis Nyambura, Communication Department, ICT Authority, the strategy will address loopholes in Information Security.

    “Cyber-crimes take various forms and include all manner of offences against the confidentiality, integrity and availability of computer data systems, content, copyright and trademark, computer offences and cyber terrorism, cyber warfare and cyber laundering among other crimes.”

    To participate in the review all comments should be submitted by Friday, 28th March, 2014.  Comments can be sent to cybersecuritystrategy@ict.go.ke. Stakeholders are invited to download the Draft Cybersecurity Strategy at http://goo.gl/6CyMRO

  • tinTree to release eHealth Regulation Handbook for Africa

    Africa’s eHealth regulation deficit is already analysed and understood by tinTree. Knowing this isn’t enough. Starting to close the gap is vital for sustained eHealth development. But, it’s challenging.

    The tinTree team has started to convert its eHealth regulation data into a handbook for African countries, healthcare providers and eHealth suppliers to use in preparing for the next steps. These connect through to the critical last step: compliance. eHealth regulation is a bit limited without compliance.

    An indicative online publication date is towards the end of April 2014. It’ll be firmed up in a few weeks.

    Are there any priorities that you want the tinTree team to include? Let us know in the comment box, and we can deal with them. eHNA will have regular updates on progress.

    The plan is to publish the Handbook on eHealth Regulation for Africa Countries on 30 June 2014.

  • USA’s IOp strategy is good for Africa

    How much interoperability (IOp) is enough? Mark Twain thought that “Sometimes too much to drink is barely enough.” Too much IOp seems a long way off. According to West Health Institute and the Office of the National Coordinator for Health Information Technology (ONC), based in San Diego, USA, healthcare has barely enough IOp. It’s released Igniting an Interoperable Healthcare System, a White Paper, setting out eight action needed for substantial IOp.

    Recognize that the lack of IOp is a crisis and advocate for rapid change Frame the IOp problem correctly: everyone is in the business of gathering and sharing data to best serve patients Accelerate the full adoption of unambiguous, open standards for IOp Align stakeholder incentives to drive IOp Ensure validity, privacy, and security of data Reduce technical complexity for hospitals, health systems and healthcare workers Develop new ways to use data streams that will result from IOp to drive an adaptive system that will improve patients’ health Guarantee secure access to data for patients and researchers.

    The report identifies potential benefits of US$30 to 40 billion by using IOp to integrate medical devices into hospitals information systems.

    This is constructive and imaginative. It integrates IOp with eHealth regulation in action 7, security in 5 and 8 and analytics in action 7. Some of these may prove to be compromises. That won’t be a disaster. Some of the best-performing eHealth initiatives build on trade-offs arising from effective engagement.

    African countries can save lots of time by adopting similar IOp strategies. Mark Twain would probably drink to that, but he did say “Be careful about reading health books. You may die of a misprint.”

  • Can eHealth soar like a drone?

    Engaging with people about eHealth is daunting, especially when their enthusiasm is towards the opposite end the continuum to yours. If you’re stuck for ideas, trying finding an eHealth picture that’s the equivalent of this on Dronestagram, which takes you wing-tip to wing-tip with an eagle mid flight.

    It’s the winner of a competition for the best drone photo, sponsored by National Geographic. It was flying over Bali Barat National Park in Indonesia. The ornithologist William Henry Hudson is proved right when he said that “You cannot fly like an eagle with the wings of a wren.”

    So what’s Unmanned Aerial Vehicles (UAV), the drones, got to do with eHealth? Quite a bit for health, healthcare leadership and investment.

    Open Health News has a list of drone uses for health. They include:

    Search and rescue missions to find lost and injured people Surveillance and assessments of areas damaged by disasters Deliver food, vaccines and medical supplies to remote communities Contact with people cut off from normal communication channels Deliver mobile technology, portable shelters and other materials areas where critical infrastructure damage prevents ground or typical air transport Track and find wandering Alzheimer or mental health patients.

    eHNA has touched on the role of drones in healthcare in previous posts. It’s a new technology for healthcare, and seems set to become an operational component of eHealth.

    Drone photography offers a new vision and perspective of the world. The eagle’s photo is a superb way to convey it. eHealth leaders have to convey their eHealth visions, and it’s opportunity for new health and healthcare. While it’s obviously much harder than using a drone photo, the eagle sets a very high standard that’s a lot better than death by PowerPoint.

    Another benefit of the eagle is its metaphor for leadership and the value of eHealth workers, and the impact of various levels of eHealth investment. Ken Blanchard, The One Minute Manager author, posed a choice “Don’t quack like a duck, soar like an eagle.” It could be a good test of the ambitions of eHealth projects. Insufficient investment can risk turning an eagle of a project into one of Blanchard’s ducks. The challenges are:

    Find your eHealth eagles Avoid eHealth ducks.

    There are lots of eagles in Africa.

  • Two MDGs show good progress

    After nearly 14 years, it’s good to see progress. Two new studies in The Lancet assess the progress of UN Millennium Development Goals (MDG) 4 and 5, lowering child and maternal death rates in developing countries. They’re the first papers in the Global Burden of Disease, Injuries and Risk Factors Study 2013 (GBD 2013) that aims to describe the global distribution and causes of a wide array of major diseases, injuries, and health risks. Neonatal, infant and under five mortality rates reduced significantly for under-fives between 1970 and 2013, albeit with significant regional variations: 

    Between 1970 and 2013, there was a 64% drop in global under-five deaths globally Child deaths are as a high as 152 per 1000 in Guinea-Bissau compared to 2.3 per 1000 in Singapore Rates of child death have fallen faster from 2000 to 2013 compared to 1990 – 99 in 188 countries Some child mortality rate reductions are due to rising income per capita and maternal education

    Global maternal death rates fell between 1990 and 2013 despite some regions seeing increases.

    The global number of maternal deaths fell from 376,000 in 1990 to 293,000 in 2013 Regional variations in progress include South, East and Southeast Asia with consistent death rate decreases compared to increases in much of sub-Saharan Africa during the 1990s Maternal mortality rates were highest in the South Sudan and the lowest in Iceland Causes of death varied widely by region, including a combination of medical complications of pregnancy, haemorrhage, and abortion in lower income regions Deaths from haemorrhage, sepsis, obstructed labour and hypertension have decreased dramatically since 1990.

    There’s still much to do in Africa. eHealth needs to do more to help too.

  • mHealth consultation starts in the EU

    Two new publications from the European Commission (EC) are the Green Paper on mHealth and the Staff Working Document. The EC wants comments on the barriers and issues by 3 July. These will help the EC team to identify the right way ahead to unlock mHealth’s potential in the EU.

    The Green Paper has a set of specific questions it needs answering. They include the role that satellite links can play in mHealth innovation: a very relevant issue for African countries too.

    The Staff Working Document is more wide ranging than its title conveys. It’s not about healthcare staff and working practices and issues. The emphasis is on a working document that provides the foundation for a legal framework applicable to lifestyle and wellbeing apps, and providing simple guidance to app developers on EU legislation in the field. The report deals with data protection, consumer rights commercial issues and legislation. It’s a good overview, not exhaustive, as it says, of some of mHealth’s regulatory challenges.

    Whilst eHealthers in Africa have a limited role in participating in the consultation, the two documents are valuable material for their countries’ mHealth initiatives. It’ll also be useful to look out for the consultation response and results.

    tinTree is watching the EU exercise to see if the findings provide new information for its eHealth Regulatory Model.

  • eHealth helps with Guinea’s and Liberia’s Ebola outbreaks

    Ebola is deadly. WHO’s Fact Sheet 103 says:

    Ebola Virus Disease (EVD) was known as Ebola Haemorrhagic Fever (EHF) and is a severe, often fatal illness in humans EVD outbreaks have a fatality rate of up to 90% The virus transmits to people from wild animals and spreads in the human population through human-to-human transmission Fruit bats of the Pteropodidae family are considered the natural host of the Ebola virus Severely ill patients need intensive supportive care No licensed specific treatment or vaccine is available for people or animals EVD outbreaks are primarily in remote villages in Central and West Africa, near tropical rainforests.

    Guinea and Liberia suffered the latest EVD outbreak in April 2014. The United Press International has a report saying that for the first time, the Center for Disease Control Prevention (CDC) health workers used its Epi Info™7 tool for the data analysis needed to trace, identify and diagnose people possibly exposed to the Ebola virus. Epi Info™7 is a suite of lightweight software tools that deliver ad-hoc epidemiologic functionality without the complexity or expense of large, enterprise applications. It’s easy to use where there’s limited network connectivity or resources that have to rely on commercial software and professional ICT support.

    Epi Info 7™ is flexible, scalable, and enables data collection, advanced statistical analyses of clinical, epidemiological and laboratory data. It has a geographic information system (GIS) mapping capability too.

    Epi Info 7™ is free. It’s in 13 languages and used in over 180 countries, all continents are registered as users.

    Even with the advanced tools, the challenge isn’t over. Medicins San Frontieres (MSF) says it remains vigilant in dealing with the EVD outbreaks in Guinea and Liberia. For an EVD outbreak declared over, 42 days have to elapse with no new cases. Liberia has survived about 21 days; half way. There’s still a few of new cases in Guinea, where the death rate stands at about 65%, lower than the maximum rate expected by WHO’s statistics, but still a sad outcome.

  • How to find a way through security’s molasses

    Day after day, it seems, cyber-criminals find a new way to exploit eHealth vulnerabilities whilst simultaneously exploiting the old ones. Chasing breaches doesn’t sound like a good idea for a strategy. Cyber-criminals seem to run faster than CIOs. So what is a good strategy?

    John D. Halamka, a physician and technology leader has some ideas. His geekdoctor blog of 30 April sets out a selective approach. It’s main principle is that cyber-security is a process, not a project. Five initiatives stem from this.

    1. Denial of service and distributed denial of service mitigation

    A proactive plan is to deploy the appliances and services provided by specialist companies to reduce the impact of denial of service attacks as a preventive measure.

    2. Security information and event management

    Introducing new security technologies creates an explosion of log files, increasing the risk of stolen credentials, so integrate multiple data streams with a threat analysis based on analytic rules to identifying and manage threats.

    3. Intrusion protection systems

    Modern cyber-threats are subtle and complex, and include invasions of building control systems and cunningly crafted spearfishing attacks, so invest in advanced sensors to identify malicious activity, log information about it, attempt to block it, and report it.

    4. Network forensics

    As successful and attempted cyber-breaches occur, use specialized tools for root cause analysis to reconstruct incidents, identify bad actors, examine actors’ actions and report enough information to authorities that can prosecute or take regulatory action.

    5. Anti-malware

    Endpoint protection is increasingly as malware becomes more virulent. Deploy anti-virus and zero-day protections, including malware signature identification and removal processes.

  • USA public health data projects planned

    Public health data in the USA is set to take advantage of the expansions of EHRs. Issue Brief: Health IT for Public Health Reporting and Information Systems from the Office of the National Coordinator for Health IT, proposes the development of public health data infrastructures that can process and analyse large volumes of health, clinical and administrative data from providers’ EHRs. The aim is to:

    Improve the study of diseases in communities and nationally Respond more efficiently and quickly.

    These can contribute to improved

    Healthcare quality Health research Patient safety Population health.

    Achieving these goals needs several initiatives. They include improved uniformity in the terminology and definitions of data components, and developing semantic interoperability across both EHRs and public health needs. This will enable bidirectional data exchange.

    The value of EHR data for public health is the increasing availability of real-time and near-time data. For some population health activities, speed can make a difference. The potential is there.

    African countries can begin this type of public health initiatives as they select, implement and operate EHRs as part of their eHealth strategy. It can sit alongside their Big Data initiatives.

  • South Africa’s phishing problem

    Drew van Vuuren, CEO of information security and privacy practice 4Di Privaca, has said that South Africa is the second most targeted country globally when it comes to Phishing attacks.

    The cost of phishing in South Africa amounted to approximately $320 million in 2013 accounting for 5% of the total phishing attacks globally. According to Vuuren, it’s not a matter of if you or your company are a target, but rather when. If you are not already worried about phishing attacks, you should be!

    Phishing is a form of email deception where cyber-criminals attempt to obtain sensitive data and information or cause disruption to organizations’ business operations or access high-value information by sending emails to entice recipients into returning personal information, which is then stolen and used improperly, usually by identity theft. The email falsely claims to be from an established organization or person. Phishing emails often direct recipients to click on a link where they are asked to update their personal information like passwords, credit card details, social security number or bank account number.

    Phishing can unleash a major attack on corporate well-being. Attackers can gain access to email systems, social media, social security details, banking details and corporate log-in details. Additionally, organisations and high profile individual victims may suffer damaged reputations if attackers put victims’ personal information in the public domain.

    The most effective defense against phishing is prevention. To prevent, or minimise attacks, businesses need to start and sustain a continuous education program that ensures that their workforces maintain high levels of security awareness and vigilance.

    It’s not just business organizations that need to be aware of phishing’s devastating effects. Healthcare organizations also need to be alert and train their staff accordingly so that the personal health, demographic and financial data of their patients do not fall into the wrong hands.

  • South Africa's eHealth News will be watching

    Politics is too serious a matter to be left to the politicians, said Charles de Gaulle. South African’s now have help from eHealthNews to engage with hot topics affecting eHealth.

    The site had a busy April, with an in-depth look at major political parties’ views on the much debated National Health Insurance (NHI) plans. Contrasting views are presented in Political Parties in Favour of NHI and Western Cape Government Raises NHI Concerns.

    Today votes are being counted after South Africa’s 7 May general election as the country prepares for the 5th general assembly, 20 years into democracy. South Africans and eHealth News Africa will be watching carefully to see what happens with NHI and its massive implications for the country’s health, healthcare and eHealth. It’s good to know that the team at eHealth News will be watching too, and providing ongoing coverage of events, ideas and politics affecting eHealth in South Africa.

  • ENACTS helps to tackle malaria

    In March, ehna reported that climate change is increasing Malaria and asked Is Malaria on the march? Is it an eHealth priority? It was based on WHO’s The World Malaria Report 2012 FACT SHEET. It’s updated to the World Malaria Report 2013. Tanzania and Ethiopia have initiatives to start to deal with it by using climate data more effectively.

    The Thomson Reuters Foundation has a post describing the Enhancing National Climate Services (ENACTS) system established by the Tanzania Meteorological Agency in conjunction with the International Research Institute for Climate and Society (IRI) aims to identify malaria’s long-term drivers by compiling historical climate data for analysis by health policy-makers.

    The Ethiopia version of ENACTS is set out in ENACTS Ethiopia: Partnerships for Improving Climate Data Availability, Accessibility, and Utility. The authors, Tufa Dinku and Jessica Sharoff describe the project, a joint project with Ethiopia National Meteorological Agency, IRI and the University of Reading. It’s the first time that the IRI Data Library was installed and used outside of IRI.

    The project team found that collecting and processing 30 years of raw satellite data for Africa was demanding and took over a year. Now, other countries can adopt the methodologies and computer codes developed for generating the climate time series.

    ENACTS combines ground observations of rainfall and temperature to monitor changes. Tanzania is now applying the knowledge to help to tackle malaria. Augustine Kanemba, principal meteorologist at the Tanzania Meteorological Agency’s is reported saying that they faced difficulties using climate data in Tanzania to track health threats because there are now fewer weather stations that are now unevenly distributed. Satellite data overcomes this limitation.

    African countries’ health strategies can include ENACTS as an eHealth resource for investment. They may also need extra health workers to deal with the information as climate change contributes to an increase in malaria in new locations. It’s an excellent example of a shared and transferrable initiative across the continent.

  • How's progress on more electricity for healthcare?

    It’s not just that “riding a bicycle is about getting back to basics,” like Phil Keoghan, CBS’s Amazing Race presenter, suggests. Healthcare in Africa needs more important basics in place. Electricity is one of them. It’s now over a year since WHO’s report Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability was completed. It was published in Global Health Science and Practice over six months ago. Its survey of eleven countries in sub-Saharan Africa (SSA) found that:

    Only 34% of hospitals in SSA countries have reliable electricity supplies Energy access varies considerably In two countries, modest improvements in electricity access are underway Ambitious plans to improve health service delivery need to address this critical issue The United Nations Secretary-General’s Sustainable Energy for All (SE4All) initiative provides an opportunity to monitor energy access in healthcare facilities.

    Electricity limitations are a “silent barrier” for healthcare. Dealing with it needs several initiatives.

    A first step is establishing electricity access profiles of healthcare facilities. This can identify settings where lack of electricity may be a severe and underreported barrier to healthcare. Better data can inform innovations in the health and energy sectors and direct investments in areas with greatest need. This provides foundations for monitoring and managing progress inclosing energy gaps.

    Whilst the survey excluded off-grid energy used by some facilities, the gap it identified is still an enormous challenge. Since the report, have health and energy ministries integrated strategies for health, healthcare and eHealth to make the most of expanded electricity supplies? Overcoming the barriers is complex set of tasks that will take several years to complete. Using a bicycle isn’t one of them.

  • South Africa releases its health IOp framework

    Interoperability is a massive technical challenge for health and healthcare. South Africa has published its National Health Normative Standards Framework for Interoperability in eHealth (HNSF). It’s a superb document, now signed into law.

    It describes where the HNSF fits into the eHealth context, its scope, the philosophy behind it and how to select the best standards available. It sees four IOp levels

    Local paper-based patient medical records Local paper-based patient medical record system with some IT support Centralised electronic patient record system Fully integrated national shared electronic health record system.

    Achieving total IOp across health and healthcare is a massive task. Many countries are grappling with it, including the European project SemanticHealthNet project.

    The big IOp challenges are how to select enough, affordable IOp to meet current and short-term requirements and simultaneously lay down and expand the IOp foundations for the future. The issues are described in a recent review. The HSNF offers a constructive way into them.

    Affordability, capacity and capability are always challenges for health IOp, especially for a country trying to meet the health and healthcare needs of more than 50 million people. It reinforces the need for continuous, selective IOp implementation over a viable timescale.

    It’s also encouraging that the HSNF identifies the need to deal with security, privacy and data management. African countries lag well-behind high-income countries on eHealth regulation, and IOp creates extra regulatory challenges for privacy, confidentiality, data quality and security. Sixty-four regulatory aspects are described in a detailed regulatory model, which is maintained by African NGO tinTree. Numerous reports keep coming out of the USA on healthcare’s vulnerability to cyber-attacks. The lessons are clear and need learning and implementing.

    For other African countries, the HNSF provides an essential source of learning too.

  • Nigeria in the spotlight again

    Nigeria is in the spotlight again. This time it’s for its bold broadband strategy. Nigeria’s Minister of Communication Technology, Mrs. Omobola Johnson has announced the government’s plan to double investment in the ICT sector from $25 billion level to $50 billion in the coming years.

    She unveiled the ambitious plan during the official launch of the “Broadband Campaign” with the theme ‘Connected Nigeria, Connected Nigerians’.

    According to her, broadband penetration currently stands between 6-7%. The ministry is working with all relevant stakeholders to ensure that the National Broadband Plan 2013-2018 is successfully implemented. She went on to say that “to ensure that the Plan is monitored, we set up the Broadband Council in 2013 to ensure proper monitoring of the Broadband Plan implementation.”

    The ministry has been working with state governments and other stakeholders to tackle technical, financial and environmental obstacles to accelerated broadband roll-out across the country. As more citizens and patients use smartphones and iPads, the potential for eHealth links with each other and with health workers expand, creating new strategic shifts in health and healthcare.

  • Are African countries stuck with security?

    eHealth News Africa has frequently covered eHealth security issues. A common theme is, what can African countries do with their limited resources? HIE Watch, a Healthcare IT News blog, has set out some basic proposals.

    It says that encryption, done properly, and at a high level, is the most effective action an ICT department can do. Part of an encryption initiative is overcoming resistance, often derived from fear of change. A main concern is encryption’s inadvertent impact on usability and on integrated healthcare systems, especially where data shared horizontally between organizations. Licensing issues need dealing with too.

    Done properly, encryption should not cause disruption. It may slow performance, but it’s better than risking patients’ information. A modern complexity is the large number of operating systems in clinical settings that need encryption. Some of the devices have specific challenges. Encrypting and keeping track of these is high cost, so priorities are essential. Encryption is effective when protecting one or two rarely accessed fields, but this isn’t usually sufficient to protect healthcare data.

    So, for African countries, the key seems to be as much encryption as affordable. Deciding what to include and omit is an important decision.