A Whole-of-Government approach to investing in digital technologies to achieve the SDGs
What do school children, farm animals and patients have in common? Well, rather a lot, according to the International Telecommunications Union (ITU) and some of its partners. Especially when it comes to investing in Information Communication Technology (ICT) to advance progress towards Sustainable Development Goals (SDGs).
The SDG Digital Investment Framework calls for countries to take a whole-of-government approach to investing in digital technology. The paper shows how to “identify which technologies matter most to achieve the SDGs.” The approach was developed by teams from ITU and the Digital Impact Alliance (DIAL).
Its theory of change is shown in the figure below, extracted from the ITU document. It is about a small set of common ICT building blocks helping countries to deliver many high-impact use cases that support progress towards SDGs.
Figure: SDG Digital Investment Framework theory of change.
The paper provides an approach for countries to identify reusable ICT building blocks across sectors, particularly education, health and agriculture, and calls on governments and the private sector to work together to fund these shared foundation elements. The list of candidate ICT building blocks is extensive, including:Analytics and Business Intelligence ServicesArtificial Intelligence ServicesClient Case Management ServicesCollaboration Management ServicesConsent Management ServicesContent Management ServicesData Collection ServicesDigital RegistrieseMarketplace Services Mobility Management Services Geographical Information Services Identification and Authentication Services Information Mediator Services Messaging Services Payment Services Reporting and Dashboard Services Scheduling ServicesSecurity Services Shared Data Repositories Terminology Services Workflow and Algorithm Services.
It’s a bold approach that resonates with other initiatives underway in African countries, and across African regions. eHNA looks forward to reporting on further developments.
Image from the SDG Digital Investment Framework report.
- 235 views
- March 26, 2019
- Sean Broomhead
An ITU/WHO “how to” guide for building interoperable digital health infrastructure
As we strengthen African national eHealth strategies, interoperability is gathering momentum too. It's a critical component of our national eHealth programmes. We are looking for a common, comprehensive framework, incorporating all data sources and information flows, both electronic and paper-based, providing a clear development and consolidation path for all components, along a digital development maturity model.
Fortunately, there’s a handbook about how to do it: Digital Health Platform: Building a Digital Information Infrastructure (Infostructure) for Health, published by the International Telecommunications Union (ITU) in collaboration with the World Health Organization.
The figure below provides a high level overview of the Digital Health Platform (DHP) concept, its components, and how users interact with it.
Figure: How a DHP interacts with external applications and users
The handbook suggests that a well-designed DHP will help countries to achieve the following priorities:Overall quality and continuity of careAdherence to clinical guidelines and best practicesEfficiency and affordability of services and health commodities, by reducing duplication of effort and ensuring effective use of time and resources Health-financing models and processesRegulation, oversight, and patient safety resulting from increased availability of performance data and reductions in errorsHealth policy-making and resource allocation based on better quality data.
The DHP Handbook illustrates how DHP components are derived from the National eHealth Strategy. It is a detailed guide including illustrative case studies from Liberia, Estonia, Canada, India and Norway. It’s essential reading for African countries’ as we invest in our national eHealth programmes.
- 212 views
- March 25, 2019
- Sean Broomhead
African countries setup Country Health Situation Rooms for better health monitoring
Two weeks ago, I was fortunate to participate in a workshop in Ethiopia hosted by the African Union, Africa CDC and UNAIDS. The workshop aimed at strengthening the Country Health Situation Room initiative and roll-out across African countries. Its goal is to support better use of health data and help countries keep populations healthier by improving their response to infectious diseases and epidemics.
Kenya was the first African country to adopt the Situation Room in 2015. A further six countries – Cote d’Ivore, Lesotho, Namibia, Zambia, Uganda and Zimbabwe – have launched their Situation Rooms and are currently at different stages of scale-up and roll-out.
The Situation Room software integrates health data from multiple sources such as the DHIS2 and logistics management information systems (LMIS) at a country level. Data are presented visually to help countries track progress and identify gaps in key health indicators. The customisable interface allows countries to design their Situation Room around their health areas of interest and user types.
Matthew Greenall’s case study on the Country Health Situation Rooms describes the progress so far. Achievements include;Enhanced collaboration between different health programmesImprovements in health decision makingImprovements in data qualityIncreased data use for decision makingImproved data sharing between stakeholders at national and regional levels
Important challenges are also identified, such as;High turnover of staff and leadership compromised progressOperational and budgeting constraints interrupted roll-out in some countriesPoor quality of data at sub-national levelsOwnership – a strong desire for countries to host the software themselvesMaintenance of the Situation Room software requires strong technical support
The Health Situation Room is a bold step for the participating African countries. We look forward to reporting the progress of this important eHealth contribution to health systems strengthening.
- 211 views
- March 05, 2019
- Ameera Hamid
International SOS Foundation releases a teleconsultation guide
The Medical Dictionary describes two types of teleconsultation. One is between doctors. The other’s between doctors and patients. It refers to networks and video links. Smartphone services such as Figure 1 is an example of a more modern version. It includes nurses too.
Help in setting up and managing teleconsultation is available from the the International SOS Foundation. It’s launched a white paper on the topic, endorsed by the International Society for Telemedicine & eHealth (ISfTeH).
Teleconsultation Services for the Mobile Workforce; Considerations & Guidelines for the Provision of Global Services in Compliance with Regulations & Best Practice Clinical Standards of Care provides insights into essential aspects needed to assess teleconsultation services. They include:Country level review of legal requirementsGuidelines on clinical best practices, including local healthcare environment, clinical expertise of disease threats at patients’ locations and integration into the local healthcare systemsCase studies for corporate and educational sectorsGlobal best practices for assessing teleconsultation services.
It can help Africa’s health systems to develop their telemedicine services towards broader teleconsultation services. Modern mHealth technology offers considerable opportunities.
- 119 views
- February 13, 2019
- Tom Jones
ISfTeH’s next annual meeting’s in Portugal
On 19 to 20 March 2019, the International Society for Telemedicine & eHealth (ISfTeH) conference will be underway in Lisbon, Portugal. Partners include the annual Portugal eHealth Summit which’s co-organised by ISfTeH’s institutional member, Centro Nacional TeleSaúde, part of the Shared Services of the Portuguese Ministry of Health (SPMS). The Portugal eHealth Summit is the largest eHealth event in Europe, bringing together some 10,000 stakeholders from the Portuguese National Health Service.
It’s ISfTeH’s 24th International Conference. The range of topics is huge. They include:Technology to:
o Monitor vital signs for long term conditions
o Health management of service users with severe mental illness
o Facilitating integrated care in wider communitiesGlobal Digital Health Index’s state of global digital health Telemedicine’s potential for UHC in Portuguese-speaking CountriesInjecting the human side of telemedicine and eHealthEconomic evaluation of an new guideline of an online clinic in Japan Considerations and guidelines for global teleconsultationPhysicians' experiences, attitudes and challenges in a paediatric telemedicine serviceAlgorithms for predictive medicine AI for healthcare professionals Big Data and tele-ECG eHealth data protection with GDPREffective digital tools for everyday practicePortugal’s experience of telehomecare and telemonitoringPutting IoT to work for caregiversIs technology the solution for chronic disease management?Tele-ECG network in Southern BrazilAI and telemedicine for heart failure diagnostic supportPractice guidelines for primary and urgent careCan telemedicine reflect healthcare system investment Needs?
Details of the event will be available soon.
- 225 views
- February 11, 2019
- Tom Jones
AMA has a structure for choosing EHR providers
Procurement sits between EHR strategy and implementation. It’s a challenging process and needs a rigorous structure to assess providers and choose a few to move on to a procurement short list, The American Medical Association (AMA) has a checklist that helps to find a vendor worthy of a long-term partnership. It’s step 4 in the Part 2, the Pre-Game section of the American Medical Association® Digital Health Implementation Playbook.
Selecting and Vendor Guide aims to find a long-term partner, not just an organisation to execute a set of transactions. Speaking with similar organisations or practices can provide valuable information and insights needed to construct shortlists of quality vendors. eHealth conferences can be another source.
Discussions are not enough. Structured market research and activity’s needed too. AMA suggests:Build a Request for Proposal (RFP) that clearly outlines the goals that define successSend RFPs to vendors that most closely align to these goals Review RFP responses alongside key representatives from core and advisory teamsAsk for case studies and referrals Schedule live vendor demonstrations with members of the core, advisory and implementation teamsEvaluate vendors across six critical factors:
o Customer service
o Efficacy and clinical validationNarrow options to one or two preferred vendors in the pitch to leadership.
Usability includes interoperability. Efficacy includes the vendors’ abilities to deliver organisational goals, metrics and Key Performance Indicators (KPI). For large-scale, strategic investment lick EHRs, three options may be more appropriate in revealing the differences between vendors’ technical services and cultures that are available.
AMA’s playbook can help Africa’s health systems to enhance the structure and sustainability of moving their EHR projects from investment decisions towards implementation. Procurement’s tough. Vendors are smart and used to the processes. AMA’s guidance helps to rebalance them.
- 316 views
- January 23, 2019
- Tom Jones
An approach to regulating medical devices from the US FDA's now out
Effective regulation’s a vital part of setting and maintaining high standards. In an article in Frontiers in Medicine, Tina Morrison and her colleagues describe an approach by the US Food and Drug Administration (FDA). Its Center for Devices and Radiological Health (CDRH) regulates medical devices, and emphases regulatory science with computational modelling for medical devices.
Computational modelling is an increasingly powerful evaluation and regulatory tool for medical devices. Dealing with merging technologies resulting in novel products is one of the FDAs challenges. Using computational modelling can transform medical device design and evaluation. It can simulate treatment outcomes and clinical trials for imaging systems.
The simplest and most common use of computational modelling for medical devices is simulating their performance under a variety of conditions that mimic aspects of clinical or use environments.
The primary use is for regulatory submissions is identifying appropriate bench testing configurations, such as worst-case or clinically challenging conditions, for cardiovascular, orthopaedic, and surgical implants. Its second common use is to provide evidence that supports safety assessments of patients with and without implanted devices when they’re exposed to radiofrequency (RF) fields of MR systems.
Continuous development is underway too. A CDRH team is developing and validating a framework for streamlining the market entry of imaging systems relying solely on simulation instead of clinical trials.
Using the approach to the increasing range of mHealth and wearables could close the knowledge gap. Directing users, especially clinical professionals to devices that do what the claim to do will be a huge step forward for Africa’s mHealth initiatives.
- 333 views
- January 18, 2019
- Tom Jones
A playbook to help successful eHealth investment's from AMA
Good practice is always a good idea. The American Medical Association (AMA) has combined a wide range of good practices for eHealth. American Medical Association® Digital Health Implementation Playbook is built from an assessment that:Digital tools that enable new methods and modalities to improve health care, enable lifestyle change, and create efficiencies are proliferating quicklyClinical integration of these tools is lacking, so needs changing.
It’s a valuable guide for Africa’s health systems. The four parts:Warm upPre-gameGame-time: remote patient monitoringPost-game resources.
The playbook addresses four key requirements as questions for doctors adopting eHealth:Does it work?Will I receive payment?Will I be liable?Will it work in practice?
These underpin several eHealth perspectives:
1. WARMUPIntroduction to eHealth implementation playbook Introduction to eHealth solutionsWhat’s remote patient monitoring? Remote patient monitoring in practice for hypertension The implementation path
2. Pre-gameIdentifying needsForming teamsDefining successEvaluating vendorsMaking the case for eHealthContracting
3. Game time for remote patient monitoringDesigning workflowsPreparing care teamsPartnering with patientsImplementationEvaluating successScaling
4. Post-game resourcesIdea intake form as an idea prioritisation worksheetTeam structure frameworkTeam structure worksheetWhen to engage teamsUsing the quadruple aim to establish eHealth valueSMART goals overviewSelecting a vendor guideVendor information intake formCyber-security knowledge neededNavigating digital medicine coding and paymentKey financial and legal documentsKey considerations for designing implementation workflowsClinical roles and responsibilitiesWhat if plans for patientsLessons learned worksheet.
All four parts contain an eHealth investment process for healthcare organisations. In defining the steps, their next job is to assemble the information to support each decision.
- 321 views
- January 17, 2019
- Tom Jones
AXA Health Tech & You Awards wants bids for consumer-driven health innovation and excellence
Driving proactive consumer engagement in health and supporting innovation are to success of the AXA Health Tech & You Programme. The current award has two categories, innovation and excellence. Applications close on 15 February 2019.
AXA, an international health insurer, has focused the 2019 awards on celebrating entrepreneurs who provide the most valuable, trusted innovations for consumers in the market. The innovation and excellence categories will be underpinned by core values embracing diversity, health equality, and social inclusion.
It’s seeking two types of solutions. One’s standalone solutions that help citizens take charge of their health and wellbeing. The other’s smart applications that enrich relationships between people and their careers, whether health professionals, friends or family.
The results could offer Africa’s health systems transformation models for some of their health promotion and community services. It’s worth looking out for the results.
- 385 views
- January 16, 2019
- Ameera Hamid
Servicio Extremeño de Salud and the MEDEA Project seeking bids to reduce adverse events
Bids are needed for a precision medicine project. It’s part of Extremadura’s MEDEA project that combines genomics, scientific literature and patient data to optimise prescriptions, patient outcomes and clinical trial recruitment.
Supported by Servicio Extremeño de Salud, applications should aims to build a clinical support decision system with three main objectives:Predict any drug adverse reactionsRecommend the most effective treatmentsIdentify the most suitable candidates for clinical trials.
Five second-level objectives are:Predict drug efficacyRecommend dosagesIncorporate lifestyle choices and behavioursInclude genetic testing capabilities or a partnership with a genetic testing partnerTarget adverse events in psychiatry, cardiovascular diseases and cancer treatments.
The brief specifies digital solutions with a Technology Readiness Level (TRL) < 6 are appropriate. They’re from conception to early development stages.
The intention is to implement the project and solutions at regional level first. It’ll be extended to other healthcare systems at the national level later.
Available finance for the project’s €5.4m. The Spanish government will allocate 70% to SMEs. Applications are needed by 31 December 2018.
The resulting impact and solutions could provide a benchmark for Africa’s health systems. Encouraging local SMEs to contribute can be part of it.
Images from https://saludextremadura.ses.es
- 309 views
- January 15, 2019
- Matt Jones
Research2Guidance publishes its eHealth connectivity report
Working within ecosystems is increasingly important for eHealth. Research2Guidance third report of its mHealth Economics 2017/2018 program deals with connectivity. It sees mobile apps as the core of eHealth connectivity hubs. These extend connectivity to wearables, tracking sensors, medical devices, tools, access to third party aggregated health data and EHRs.
The report is an introduction to mHealth connectivity in mobile health. It discusses the connectivity landscape too. Contents are:Tool usageConnecting to health data via APIsConnecting to sensors and wearablesConnecting to API aggregatorsConnecting to electronic health recordsOutlook on the future of connected devices.
These provide answers questions of:What eHealth connectivity options exist?To what extent are eHealth publishers connecting to sensors and wearables?Which tools are mHealth app developers using?Are mHealth app developers offering Application Programming Interfaces (API) for their apps?To what extent do they use aggregated health data through APIs?Which roles do EHRs play in eHealth?How will connectivity to sensors change in the near future?
It’ll provide a wide range of stakeholders with insights needed for mHealth strategies, plans and initiatives. As Africa’s health systems keep building on their mHealth investments, the report is helpful in moving them on.
- 340 views
- January 08, 2019
- Tom Jones
A roadmap for AI in healthcare can help set its trajectory
It seems that AI’s popping up in lots of healthcare settings. It’s trajectory becoming a bit random? If it is, does it need a roadmap? An article available from xtelligence Healthcare Media says it does and describes several AI initiatives. It seems more a scan of AI’s horizon that how to reach it.
Eduardo Galeano, the Uruguayan journalist and writer, identified horizon’s dynamic that fits AI and eHealth. “Utopia is on the horizon. I move two steps closer; it moves two steps further away. I walk another ten steps and the horizon runs ten steps further away.”
AI in Healthcare’s perspectives and initiatives include:Tapping the value of data at the right place, in real time; top questions for healthcare leadersWelcome to the age of intelligence: matching mind and machineHealthcare researchers using AI: don’t let data access derail clinical breakthroughsAn inside-out look at AI in outpatient radiologyChallenges in AI for radiologyWhen will AI be added to radiology training?Enterprise imaging infrastructureGreenlighting medical AI appsInside healthcare’s research revolution.
Two important roles for AI are seen as:Personalised, precision medicineClinical research.
These are already transforming healthcare. The potential and opportunities need health systems to implement effective strategies forAI and eHealthHealth and healthcare transformation. AI reinforces the need for tight integration of eHealth strategies and health and healthcare strategies. It’s widely recognised as important. AI needs it strengthening. It’s a challenge for Africa’s health systems.
- 499 views
- January 07, 2019
- Ameera Hamid
Using drones in healthcare supply chains is now proven
Healthcare for Africa’s rural and remote communities is demanding. Supply chains can be long and time-consuming. Drones can help, and while they may have been a bit fanciful as an idea, they’re now proven. Two companies are doing it.
Zipline, a global drone company, has a regular service in Rwanda. It delivers drugs and vaccines to remote communities. The steps to delivery are:Health workers use text message to the Zipline distribution centre to order the medical products they needItems are pack and prepared for flight in a few minutes, maintaining cold-chain and product integrityConfirmation to health workers that their order launchesDirect delivery at over 100 kmh, faster than other transport modes, delivered gently by parachute into a designated area the size of a few parking spaces, obviously with no pilot Health workers receive a text message notifying them that a delivery is completed.
In April 2018, the UPS Foundation announced it was expanding its work with Gavi, the Vaccine Alliance and Ziplineto to use drones to deliver blood and medicines to Rwandas’ remote communities. Since October 2016, the partnership has made over 4,000 drone deliveries of over 7,000 units of blood to remote hospitals across the country. UPS says it’s the world’s first national medical drone delivery network, and is being developed throughout Rwanda.
In Tanzania, an article in UAS Vision says DHL, a global delivery services, has completed a trial using Wingcopter to deliver medicines over 60 km in 40 minutes from Mwanza to Nansio district hospital on the island of Ukerewe in Lake Victoria. Over 160 proving flights were completed. It takes about six hours to deliver by road.
Now, 400,000 people living in Ukerewe District now have healthcare access in hours, not days. Three other districts are served too, totalling over 10 million people. It follows the success of DHL’s test to ensure reliability of deliveries beyond line-of-sight and the return of the drone.
These services show that drones should be a routine component of Africa’s healthcare supply chains. While remote services are current priorities, urban areas will benefit too as drone technology develops.
Image from dronebelow.com
- 396 views
- January 03, 2019
- Tom Jones
WHO can help you keep up to date on global eHealth trends
Awareness of eHealth achievements and dynamics from other users is crucial in framing eHealth strategies, investment decisions, benefits realisation and mitigating risk exposure. Finding the information’s often a challenge. A new publication from Johns Hopkins University Bloomberg School of Public Heath in collaboration with WHO can help.
The first issue of Global Health: Science and Practice was supported by an Aetna Foundation grant. It deals with five themes:Establishing standards to evaluate eHealth’s impact on health systemsGovernanceFinancing UHC in low and middle income countriesWorkforceHealth service supply side and demand generation.
These themes fit into WHO’s eHealth themes of information and research, governance, financing, workforce and health services. Africa’s health systems can use the findings to support the sustainability and direction of their eHealth trajectories.
Within these, it’s important to avoid strategic mistakes identified by Rosabeth Kanter:Rejecting opportunities that initially seem too smallAssuming that new services and improved processes aren’t strategic goalsLaunching too many minor service changes the confuse stakeholders and increase internal complexity.
These are some of her innovation traps. Africa’s health systems don’t need them.
- 275 views
- January 02, 2019
- Tom Jones
Five strategies for your eHealth success in 2019
Closing off 2018, I am struck by how much eHealth has grown up. It’s entering 2019 as a confident, enthusiastic adolescent, emerging almost abruptly from a precocious childhood. With eHealth’s latest pseudonym “digital health” gaining traction, it’s a timely herald of a viable, lucrative and sustainable digital health industry.
If you are reading this, then securing a substantial piece of the expanding digital health pie is likely part of your organisation’s 2019 agenda. I’ve assembled five New Year’s resolutions to help:
1. There’s plenty to go around, and the spectrum of options is wide and growing, so find your niche and claim it
2. Take more time to identify and understand the needs and aspirations of your clients and stakeholders, then work with them closely to realise more health benefits
3. Use what you learn to develop a robust eHealth Impact Strategy that will provide a rudder for all your efforts through 2019 and beyond, locking onto core health benefits
4. Hire people who believe what you believe, then trust them and invest in them in line with your strategy
5. Find like-minded partners, growing your business through collaboration and cooperation, fulfilling your role as a unique member of the emerging global digital health community.
Choosing one or more of these, and succeeding, will be enough to make a big difference.
At African Centre for eHealth Excellence (Acfee) we have been monitoring the maturing eHealth landscape for more than a decade, examining the health-strengthening benefits, frustrated by the slowness of its arrival, and mindful that many critical foundation elements remained absent. Establishing the foundation more quickly has been a key focus of our work at Acfee, particularly:Developing eHealth leadershipBuilding eHealth capacityConstructing eHealth Strategies that create sustainable health impact.
Now that progress is tangible, plenty of work remains to nurture and guide the fervent eHealth teenager, so Acfee’s focus on leadership, capacity and strategies will continue, expanding our efforts to meet demands. Priorities for 2019 include to:
1. Establish the eHealth Investment Model for Africa (eHIMA) and disseminate its use across African countries to assist Ministries of Health to take good decisions about their digital health investments.
eHIMA is Acfee’s adaptation of the Digital Health Impact Framework (DHIF). The DHIF is driven by the Asia eHealth Information Network (AeHIN) with support from the Asian Development Bank (ADB). Development of DHIF and eHIMA have been led by Acfee’s Director of Strategy and Impact Tom Jones, providing a valuable bridge between Asian and African eHealth initiatives and challenges.
2. Expand eHealthAFRO, Acfee’s stakeholder engagement platform.
We will build on the successes of eHealthAFRO 2017 in Johannesburg and the 2018 2nd EAC Regional eHealth and Telemedicine Ministerial Conference in Kigali, both covered in eHNA. eHA2019 will be in South Africa again. Keep an eye on eHNA for details to be confirmed later this month.
3. Grow Acfee’s existing capacity building initiatives:
More support for academic programmes, such as:Rome Business School short courses on eHealth, including a DHIF short courseNew York University global public health master’s degree, which includes a collaboration with Acfee around a scholarship program to increase African participation Bespoke eHealth curriculum development for partnersAcfee’s eLearning and software development collaborations.
More support for regional capacity building, such as the role I played alongside Acfee Director Ousmane Ly, and others, on the faculty of the first ITU/WHO AFRO Digital Health Workshop in Lesotho in November 2018.
Re-launch of Acfee’s popular Future eHealth Leaders summer camps, to cultivate and advance the unique leadership skills and approaches needed for successful digital health.
“Growing old is mandatory; growing up is optional” says 1960's Jamaican-American baseball player, Chili Davis. As eHealth moves into its teens, ensuring that we get it right will certainly be a collective effort. I look forward to working with each one of you, and all my African colleagues, to succeed in 2019.
- 763 views
- January 01, 2019
- Sean Broomhead
AeHIN says good eHealth governance methodology can transform health systems
Information from eHealth investment’s reaches into many health and healthcare activities. Successful utilisation and benefits realisation needs effective governance.
Asia eHealth Information Network (AeHIN), with support from the Asian Development Bank (ADB) and CC and C Solutions, an ICT training firm, has crafted a set of governance and architecture methodologies. It aims to help health systems start the work needed to guide their eHealth projects at national scale.
In a blog on Standards and Interoperability Lab Asia (SIL-Asia), Alvin Marcello says nine countries agreed to create the Health Information Governance and Architecture Framework (HIGAF). It’s based on a simplified Control Objectives for Information and Related Technologies 5 (COBIT 5) framework.
HIGAF helps developing countries address their health sector needs. It complements the Convergence Workshop for Ministry of Health national eHealth strategies. Many developing countries are accelerating their eHealth investment, but have yet to work out their governance approaches.
The governance initiative is part of a long-standing series of AeHIN initiatives that include:WHO-ITU National eHealth Strategy Toolkit, introduced in 2012Training six countries in national eHealth strategy development in 2013Myanmar’s first Convergence Workshop to convene international NGOs, development partners, and the private sector in 2015 Guidance for Investing in Digital Health, 2018 Digital Health Impact Framework User Manual, 2018.
AeHIN’s sustained focus and support is a collaborative model for Africa’s health systems. A challenge is the raising the finance to achieve.
- 306 views
- December 20, 2018
- Tom Jones
SIL-Asia reports on the Digital Health Impact Framework (DHIF)
Economic and financial evaluations of eHealth investment options rely on modelling. The Digital Health Impact Framework (DHIF) User Manual and Illustrative Models, help health systems to set up and develop them. The DHIF is a ten-step methodology developed by Tom Jones, Peter Drury, Philip Zuniga and Susann Roth, for the Asian Development Bank (ADB).
A blog form the Standards and Interoperability Lab Asia (SIL-Asia) emphasises the value of using examples to help users. These appear in the manual and online models. The combination of techniques and examples are from six illustrative models:SMS for maternal and child healthmHealth for telemedicine for a current patient catchment areamHealth for telemedicine with an expanded catchment areasMalaria surveillance and interventionCapital and leasing finance for an EHRStrategic mix and choices.
The six models are not templates. DHIF is a generic methodology, with every DHIF model being bespoke.
The approach is practical and rigorous and provides a valuable foundation for our efforts at Acfee to develop an eHealth Impact Model for Africa (eHIMA). Acfee colleagues like Tom Jones, who has been involved in many related international initiatives, provide a critical overarching perspective that will help to ensure that the various frameworks emerging are both appropriate to their regions of development, while following a sound, common conceptual methodology.
Creating options is a DHIF core skill. The first four are single options for the initial stages of digital health projects. In practice, several options for each project are analysed in these early stages. The EHR example has two options and in practice would have more.
The blog shows two dimensions for options. They’re vertical and horizontal:
The vertical dimension is mainly incremental and thus, relatively easy to compile. Meanwhile, the horizontal dimension is more challenging. They have significant differences to options on the vertical dimension, and not incremental.
An illustrative model on strategic mix and choices shows positive socio-economic returns but have considerable risk exposure and affordability challenges. The comparison can support agreements on decision criteria for eHealth investment. Examples are:Maximum patient impactLowest riskHighest socioeconomic benefitLowest cost.
At the ADB workshop on 31 January 2018 in Bangkok, participants identified decision criteria they would use to select which of the six illustrative DHIF models they would retain in an affordable digital health strategy and why. Their ideas are set out in the DHIF User Manual.
Modellers new to DHIF should start small. Rome Business School has a short online DHIF course. It’s in English, and coaches modellers using their own digital health projects.
- 359 views
- December 19, 2018
- Sean Broomhead
Web sites need cyber-security too
Malevolent hackers are smart. They know that many organisations’ websites are vulnerable to attacks. Akamai, a cloud security outfit, estimates that it costs attackers about US$40 to mount an attack, smaller than a peanut compared to the gains.
Its infographic, Does my Enterprise Need Web Application Security? is available from Health IT Security. It describes the threats and preventive measures. Most alarming’s its estimate that productivity losses of 98% arose from websites compromised in the last 12 months. About 86% have serious vulnerabilities. Most of the attacks are random, with robots searching for vulnerabilities.
Akamai’s data shows the estimated range of attacks from Distributed Denial of Service (DDoS) activities were:Human - 8%Servers - 30%IoT - 62%
A solution’s a Web Application Firewall (WAF). About 40% of websites have between none and two. The 6% have more than three. Agamai’s estimate is that a WAF needs three Full Time Equivalent (FTE) staff.Africa’s health systems need these types of cyber-security measures in place for their website plans. Without them, the disruption will degrade their benefits.
- 433 views
- December 17, 2018
- Tom Jones
An eBook sets out six steps for clinical mHealth
Clinical teams have increasing mHealth opportunities. mHealth strategies should provide the bases for decisions to use them. An eBook by Spectralink, a communications provider, available from Health IT Security, sets out six steps. The goal’s to invest in clinical smartphones for healthcare professionals to communicate, collaborate and co-ordinate patient care across wide arrays of teams and team members.
Six Steps to Developing a Successful Clinical Smartphone Strategy combines generic strategic concets, such as vision, with technical components. The six steps are:Define an overall vision for mHealth technology initiativesUnderstand information flows, application and technology requirementsEvaluate enterprise-class smartphone solutionsAssess ICT infrastructure and requirements, including Wi-FiImplement a proof of concept and pilot programmeAddress operational issues, including training and support requirements.
Creating successful clinical mHealth strategies need measured, forward-thinking. Improving patient care and outcomes, and accounting for future technology advancements must be the focus. It should include people, processes and technology to maximise organisation’s benefits.
The eBook extends from strategy to mHealth investment. Acfee would include a step for business cases to generate and compare options to identify and estimate:Strategic fitSocio- economic impact, including optionsManagement capacity to deliver and realise net benefitsFinance and affordabilityCommercial themes, such as contractual options.
Completing this would be before and after step 5. Step 6 should also address benefits realisation issues. These lay foundations for M&E as step 7.
Africa’s health systems assign a high priority to mHealth. The eBook provides a process that they can adopt and ehance.
- 373 views
- December 14, 2018
- Tom Jones
ADB eHealth guidance says look at the forest and the trees
Managing and investing in eHealth’s seen as similar to forest management. Both are complex ecosystems. A Peter Drury blog from the Standards and Interoperability Lab – Asia (SIL-Asia) emphasises the large number of dynamically, interacting elements that where. Each element in the system may not know about the behaviour of the whole system.
Five-year strategic visions and plans help. The WHO/ITU National eHealth Strategy Toolkit provides guidance for these, but they’re not enough. Managing a complex sets of real-time elements is a greater challenge. It’s the core of Guidance for Investing in Digital Health, an Asian Development Bank initiative.
It’s based on how stakeholders engage, or don’t engage, with current systems, and how well, or not, they’re supported by management, technical, and workforce foundations. Investment appraisals and decisions spring from these,
Instead of a five-year cycle, eHealth policy-makers should:Monitor progressAdapt to emerging challenges and opportunitiesManage expectations and investment.
The ADB’s Digital Health Impact Framework User Manual, linked to the Guidance, provides a methodology for these activities. It too is iterative, and addresses short and long-term requirements.
Pressure for quick wins doesn’t help. To counter this, the Asia eHealth Information Network (AeHIN) and SIL-Asia support work on Digital Health Governance Architecture and the Mind the GAPS programme covering governance, architecture, programme management, standards and Interoperability.
While these are Asian initiatives, Africa can begin to adopt them. Using components that fit each countrys’ health systems is the way to start. It’ll set them on a trajectory of proven good practices.
- 295 views
- December 11, 2018
- Tom Jones
Rome Business School eHealth Masters
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