Asian Development Bank presents its Digital Health Impact Framework at AeHIN conference
eHealth investment decisions usually end up by balancing value for money with affordability. It’s a regular end point for business cases for eHealth and a core ADB eHealth theme for its Digital Health Impact Framework (DHIF). It presented this and other components to the Asia eHealth Information Network (AeHIN) 6th annual conference this week in Colombo, Sri Lanka
DHIF is a methodology for estimating and analysing socio-economic costs and benefits over time to identifying value for money and how long it takes to achieve it. Then it converts these into financial and accounting estimates to assess affordability. Tom Jones, the project lead, set out these issues that included:Deriving eHealth benefit requirements for health and healthcare strategiesIdentifying and engaging with stakeholdersManaging assumptions and estimateseHealth leadership, change management and new business models.
The methodology has ten steps, but modellers and decision takers using DHIF for the time should choose only those components that are critical to the immediate decisions. From these, they can build up expertise and move towards using the full set.
Risk is a constant in eHealth investment. DHIF can be used to estimate risk exposure that leads on to risk mitigation plans.
Optimism is also common. DHIF provides adjustments for optimism bias, which can increase cost estimates with a range of lower than 40% up to 200%.
Other material from the presentation is available from AeHIN’s Standards andInteroperability Lab (SILA). They can help Africa’s health systems improve their Health decisions, especially where parallel investment is needs in healthcare resources and new business models.
- 406 views
- October 10, 2018
- Sean Broomhead
How do Africa’s mHealth strategies match the modern profile?
With mHealth a standard component of Africa’s eHealth strategies, what’s a good benchmark to test them against? Spok, a US communications firm, as a profile of mHealth strategies that can help. Its eighth annual survey shows some marked priorities.
Mobile Strategies in Healthcare Results Revealed says mHealth that reflects overall clinical goals for the health system or hospital are most successful. It also underpins larger eHealth strategies to deliver more efficient, higher quality care and increase satisfaction for patients, carers and health workers.
mHealth strategies extend across a wide range of information and areas. The top two are:mHealth management and security, for 56% of respondents Device selection, at 52%.
The bottom two are mobile, and business development and reporting strategies.
The full profile’s:Management and security 56%Device selection 52%EHR integration 48%Infrastructure assessment 45%Clinical workflow evaluation 43%Device ownership, including BYOD 34%Mobile app strategy 29%Mobile app catalogue 16%Mobile strategy governance 14%Business development and reporting strategy 12%
The third item, EHR integration, matches findings from another Spok survey of hospital CIOs. They said integrating with the EHR was their top priority for respondents. Clinical workflow evaluation’s high score on is seen as revealing. It’s an indication that doctors, nurses, and other health workers in direct patient care roles use mHealth to define safe, efficient and effectively managed workflows.
- 339 views
- October 02, 2018
- Tom Jones
Biggest financial support achieved by Egyptian start-up Vezeeta
Start-ups need a financial prop in their early years. They often need a second wave to finance expansion. A report in Disrupt Africa says Egyptian start-up Vezeeta has raised US$12m. It’s the largest single investment ever received by an Egyptian start-up. It builds on its US$5m support achieved in 2017, as reported in Disrupt Africa.
Set up by its Ceo Amir Barsoum in Cairo in 2015, Vezeeta’s eHealth enables users to find and book appointments with over 10,000 doctors. It’s available in Jordan and Saudi Arabia too. For the region, it manages three million bookings for 2.5m patients. It also provides Software as a Service (SaaS) solutions using cloud computing and big data for patients and doctors.
The financing round was led by the Saudi Arabia-based STV Capital. It included existing investors BECO Capital, Vostok New Ventures, Silicon Badia and CE-Ventures. Vezeeta’s will deploy its extra finance to two initiatives.
One’s to continue its expansion in Saudi Arabia. The other’s to develop new products.
Will a subsequent investment phase turn Vezeeta’s attention towards the rest of Africa? For this, it may need expanded commercial opportunities driven by large numbers of users.
- 213 views
- September 26, 2018
- Tom Jones
eHealth and a new business model can reduce inpatients’ mortality
It’s more than just ICT. A current research programme in Germany shows how eHealth’s role in precision medicine can reduce hospital patient’s mortality when it’s integrated with investment in a part of a new business model. A report in HealthManagemnet.org on continuing research in Germany says how to optimise and streamline hospital care by separating patients into routine and complex groups improves quality and saves lives, so major benefits.
Separate and concentrate – a sustainable business model for general hospitals describes how a new business model can use new technologies to support precision medicine and improve effective bespoke healthcare. It assigns patients to routine and complex care pathways.
Routine patients are not emergencies and have up to two co-morbidities. Complex patients are emergencies and have three or more co-morbidities. Both groups benefits from better quality. Routine patients’ mortality has dropped by more than 13%; complex patients; by more than 11%. These are attributed to the new business models opportunities to:Optimise the impact and benefits of precision medicineAddress the specific critical care management differences of the two patient groups Minimise the impact of operational factors on healthcare qualityReduce hospitals’ management complexity.
The research’s currently in phase two of three phases. So far, it has disrupted the conventional view that greater patient volumes achieve better mortality results. The new business model emphasises that:Specialisation as a crucial determinant of quality and mortalityBusiness as usual with eHealth may not optimise its opportunities to maximise healthcare quality gains.
It also confirms that eHealth is more than just ICT. The report confirms that redesigning routine and complex patient flows and care pathways has implementation challenges. It also shows that eHealth can offer more benefits when integrated with investment in new business models.
- 268 views
- September 25, 2018
- Tom Jones
Will the new Apple watch be a big hit?
Apple is renowned for technological advancement and innovation. During their annual product launch this year, Apple announced the new series 4 watch. It’s not your average wearable. This watch boasts mHealth features such as electrocardiogram (ECG) monitoring and fall detection, and allows you to share this data with your healthcare practitioner.
These features are impressive. Apple is snapping up opportunities to break into the rapidly expanding mHealth market, from fitness tracking to a health app and now wearable ECG. But there’s a nagging concern too. What impact will this wearable ECG have on the healthcare system? Could Apple’s new innovation spur an increase in unnecessary healthcare utilisation?
These are concerns that I seem to share with other healthcare practitioners who worry that consumers may incorrectly attempt to diagnose complex cardiac conditions themselves. There are also concerns about the sensitivity and specificity of the device, which if not great, could spark a mass of panic-stricken consumers due to false positives.
While this new innovation is an important movement towards better patient management, it is vital that the counsel of healthcare practitioners is not diminished. Consumers must be advised to use it cautiously to augment their healthcare management rather than replace professional management.
Similarly, the medical community needs to work more closely with companies like Apple who drive much needed innovation.
- 388 views
- September 20, 2018
- Ameera Hamid
Medical apps need better UX and UI
With the ubiquitous use of smartphones today, mobile users have great expectations from their apps: fast loading time, intuitive workflows, ease of use and aesthetic appeal. Digital health and mHealth organisations hoping to compete successfully in this vivid ecosystem, can no longer ignore user experience(UX) and user interface (UI) design as an essential component of their product strategy.
So, what is UX and UI?
UX is the process of researching, developing, and refining all aspects of a user’s interaction with a product to ensure that it is meeting the user’s needs. UI is more cosmetic and takes into consideration the visual interaction with a product, including the colour schemes, the size and colour of a button, the consistency of a theme and so on.
Simply put, UX makes apps useful, while UI makes apps beautiful. Together these aspects play an important role in highlighting the value of your product and creating a lasting connection with your users. They also have a positive impact on the bottom line, by reducing development time, increasing sales and improving customer retention.With over 318,000 health apps across the most popular app stores, the difference between a successful and unsuccessful mHealth app will lie in the quality of its UX and UI. The importance of good UX and UI cannot be overemphasized.
- 492 views
- September 11, 2018
- Ameera Hamid
Dr Conuslta’s eHealth and technology business model’s transforming Brazil’s healthcare
Extending healthcare access is one of eHealth’s objectives. Using it to improve healthcare efficiency can help, but modestly. Dr Conuslta, a Brazilian start up in 2011, shows that an imaginative and innovative business model that uses eHealth and medical technology to relocate blocks of healthcare and slashes its costs for low-income families may have more impact. It’s a model that can fit Africa’s UHC goals.
An article in Forbes describes the initiative. Dr. Consulta charged patients a flat $30 fee for a consultation with a physician of their choosing from 50 specialties. Some patients pay nothing, depending on their health condition and ability to pay. Prices for on-site exams, such as MRIs, blood tests and mammograms range from $3 to $30.
Typical premiums for Brazil’s health insurance plans for access to one GP can be about $120 a month Off-site exam fees for lab work or specialist visits can be about $200 each, more than six times Dr Consulta’s higher rates. Only about 25% of Brazil’s population can afford this.
These low prices are achieved by a business model that invests in diagnostic technology and services in clinics and using AI to develop its own EMRs. It also engages some healthcare professionals as co-workers who use Dr Consulta’s clinics as a resource, not as employees. These combine to achieve high patient volumes, long-term relationships with patients and low-price out-of-pocket payments that sustain financial viability. The large, stored clinical data volume helps to achieve precise medical outcomes, which in turn, reinforces this long-term relationships with patients
Dr Consulta’s eHealth includes AI to analyse scientific and medical statistics to identify the probability of people contracting chronic health conditions. It can then treat them promptly to minimise or eliminate the risks. It engages patients with updated information and recommendations about their illnesses or conditions.
These bespoke communications are constructed from information in the core health management data warehouse using the Oracle marketing tool Responsys. For each patient, using age, health history and treatment plan, the Responsys automatically recommends:The new health services provide links for patients to schedule services. After each visit, Dr Consulta sends follow-up surveys to solicit feedback on patients’ experiences with their doctors and their results. Cloud applications support its marketing, finance and supply chains complete the eHealth profile. While it’s extensive and modern, its benefits depend on the transformative impact of its business model. Large, established hospitals with eHealth legacies are often less agile in reaching under-served, low-income patients. Dr Consulta’s a healthcare model that Africa’s health system could consider as part of their UHC pursuits.
- 315 views
- September 06, 2018
- Matt Jones
AI helps to predict cancers’ trajectories
Many years ago, people in the UK referred to cancers as “a growth.” While it might have lacked scientific precision, it encapsulated cancers’ changing characteristics. The country’s Institute of Cancer Research (ICR) at London’s Royal Marsden Hospital, and part of University College London (UCL), says tumours’ constantly changing nature’s one of the biggest challenges in treating cancer, especially when they evolve into drug-resistant forms.
It reports that its ICR scientists, working with colleagues at Edinburgh University have used AI to identify patterns in DNA mutations in cancers. The information can forecast future genetic changes to predict how cancers will progress and evolve. The technique, Repeated Evolution of Cancer (REVOLVER), predicts cancers’ next moves so doctors can monitor tumour’s progress and design the most effective treatment for each patient.
Three organisations financed the research, published in Nature Methods. They were the Wellcome Trust, the European Research Council and Cancer Research UK. Their support for REVOLVER’s created what’s seen as a powerful AI tool. It’s revealed previously hidden mutation patterns located in complex data sets.
Teams from ICR and the University of Edinburgh working with colleagues from the Birmingham University, Stanford University and Queen Mary Universities London found a link between some sequences of repeated tumour mutations and survival outcomes. It suggests that repeating patterns of DNA mutations could be prognoses indicators. This can help to specify future treatment.
AI success stories provide material to consider in Africa’s new eHealth strategies, to support leading specialist hospitals to set up a wide range of AI initiatives. They could focus on Africa’s current and emerging health and healthcare priorities.
- 381 views
- September 04, 2018
- Ameera Hamid
Digital Health Week (DHW) 2018 starts 7 October in Sri Lanka
A full week on eHealth’s coming up in Sri Lanka. DHW combines an array of initiatives:Commonwealth Digital Health AwardsBiennial Conference of the Asia Pacific Association for Medical Informatics (APAMI)International Medical Information Association (IMIA) Global TelehealthAsia eHealth Information Network (AeHIN).
The first day includes the AeHIN’s 6th General Assembly. Its main theme’s interoperable digital health for UHC. There’s an AeHin pre-conference event too. It includes presentations on Asian Development Bank (ADB) initiatives:Guidance for Investing in Digital HealthDigital Health Impact FrameworkCurrently in draft format and scheduled for completion in September.
Other pre-conference topics includethe Standards and Interoperability Lab for Asia (SIL-Asia) project HIE Implementation Costing ToolData science for the SDGs and UHCVarious M&E methods for national eHealth programmesDHIS2 Knowledge Exchange And Latest UpdatesGlobal public goods from the Health Data Collaborative.
The main DHW theme’s Transforming Healthcare through Digital Health Innovation. The wide range of eHealth perspectives should provide everyone with sufficient takeaways to step up sharing and convert ideas into practice.
- 474 views
- September 03, 2018
- Tom Jones
Patient portals are under-utilised and need promoting
Portals are a routine way to access information from entities. It seems that US residents haven’t been as keen on them for health and healthcare information as they are for other requirements.
A US survey of more than 5,000 people aged over 17 in 2015 by the Council of Accountable Physician Practices (CAPP) and the Bipartisan Policy Center found that most Americans were either unaware of, or don’t have access to the technology they could use to communicate with their doctors for better quality healthcare.
Conducted by Nielsen Strategic Health Perspectives, the results were:
While portal use was low, it had the highest growth rate of the nine components, 13% since 2014, the year before. Does it mean it’s on the rise? If it is, will it a slightly rising or steep trajectory?
Four groups most interested in using digital and electronic technology for greater access to their doctors are:Parents with children covered under their health plansChronically ill patientsPatients with acute conditionsAdults younger than 35.
These factors of reluctance and specific high-use groups are important insight for Africa’s online services. Determining the high-use groups is helpful in determining capacity and content. Both need establishing to ensure a foundation for future growth.
Identifying the time scale to reach high levels of utilisation was beyond the survey’s goals. With specific high-use groups, it may take several years for contagion to change other groups’ portal behaviours.
- 281 views
- August 31, 2018
- Tom Jones
Can duplicate records be eliminated?
Operational and health analytics benefits from EHRs can be diminished by duplicate records. Minimising them’s a step forward, but can they be eliminated. Northwell Health in New York State thinks they can. Its case study, available from Health IT Analytics, describes its plan.
Eliminating Duplicate Records Once and for All says after implementing its Master Patient
Index (MPI), it still had a large and growing queue of potential duplicates in over two million records that needed manual reviews to resolve. It tied down health workers’ time. Northwell’s solution was to deploy Verato Auto Steward™ which:Reduced task queue by 87%Shifted staff from tedious task review to higher-value projects.
A significant benefit is staff liberated from resolving duplicate records are now redeployed to training other people on creating accurate records and preventing duplicates. The case study doesn’t estimate when the lower, 13% duplicate rate’ll be eliminated, but it does show that it it needs two initiatives.
As Africa’s eHealth programmes expand EHRs, Northwell’s lessons are:Include a patient matching systemBegin to redeploy staff from patient matching to training staff dealing with patient identification and managing EHRs. While duplicate records may not be eliminated for some time, or maybe not at all, the two initiatives will enhance the benefits from EHRs. The longer it’s deferred, the bigger the removal task will be.
- 294 views
- August 30, 2018
- Tom Jones
China’s tertiary hospitals’ social media offer a good strategic template
Social media’s increasingly prevalent and important for health care. This doesn’t mean that it’s easy to succeed with it. Charles Mingus, the jazz bassist, composer, bandleader and legend, said “Making the simple complicated is commonplace; making the complicated simple, awesomely simple, that’s creativity.” A survey of social media use in the Journal of Medical Internet Research (JMIR) in China’s tertiary hospitals provides insights and experiences that other hospitals can use as a foundation for their creative social media initiatives.
The objective of Social Media Landscape of the Tertiary Referral Hospitals in China: Observational Descriptive Study was to map out the social media use in patient engagement by China’s best tertiary hospitals, 705 of them. They’re usually in city centres, serving as medical hubs providing specialised medical care for several regions. Their social media initiatives using Sina Weibo and WeChat are often seen as pioneering and innovative in connecting and communicating with their patients.
Data collected and analysed had three main characteristics:Hospital characteristics of time since established, number of beds, hospital type, and regions or localitiesStatus of social media use of China’s two most popular local social media platforms defined as post-initiation time, number of followers and number of tweets or postsA logistic regression model to test the association between hospital characteristics and social media adoption.
About 76%, 537, hospitals have created official accounts on either Sina Weibo or WeChat, with the latter being more frequent. The larger and newer the hospitals, the greater resources were for social media. Hospitals type and affiliation with universities were not significant predictors of social media adoption.
The highest penetration rate was about 97%, the lowest 20%. The investment profiles is perhaps more important than the penetration rate. Since 2009, investment in Sino Weibo climbed steadily then flattened. Later, from 2014, WeChat investment plodded along until 2016 when it surged and became the most used in 2017. In parallel, Sino Weibo use we sustained. Now, both services are used.
WeChat’s bigger profile is only part of the comparative profiles. While it has about 75% more hospitals as users compared to Sino Weibo, over 25% of the hospitals had inactive Sino Weibo accounts over six months. WeChat’s equivalent rate was less than 7%. Their time scales were different too. Sino Weibo’s nine years compares to WeChat’s four.
- 352 views
- August 29, 2018
- Tom Jones
Texting between healthcare professionals and patients increases
For Africa’s health systems, investment in mHealth could be laying the foundation for an increasing trend in relationships between healthcare professionals and patients. A survey by West Corporation, sponsored by Tele Vox Solutions, and available from mHealth Intelligence, says more patients are texting with their healthcare providers.
It’s gone beyond appointment reminders. Provider-Patient Texting Is Poised for Growth has identified five other activities that have a large texting component. Demand by patients is:Preventive care 95%Chronic condition management 87%Post-treatment instructions 85%Check-ins based on remote monitoring data 84%Co-payment information and reminders 83%Delays that impact appointments 80%Appointment reminders 71%.
In addition, 60% of patients say it is very or extremely important for their healthcare provider to text them about five other topics:Remote health monitoringPreventive careDisease managementBillingScheduling delays.
There’s a mismatch between supply and demand. For example, for preventive care patients demand 95% and providers text 25%, and chronic condition management patients demand 87% and providers text 31%. A similar trend is found across services such as post-treatment instructions (85% vs 7%), check-ins based on remote monitoring data (84% vs 6%), co-payment information and reminders (83% vs 6%), and delays that impact appointments (80% vs 49%).
It seems that USA patients are more mobile-savvy than their healthcare providers. The findings indicate that Africa’s health systems may have an opportunity to build on their mHealth investment and expand their direct connections and engagements with their patients.
- 481 views
- August 27, 2018
- Tom Jones
Telemedicine can help patients with opioid dependencies
Addiction isn’t pleasant. Trying to reverse its impact is always challenging. An issue brief from Polycom, a global communications firm, and available from mHealth Intelligence, says opiod addiction’s an epidemic, so inevitably, can stretch across all sectors of society.
Enabling Providers to Address the Opioid Epidemic with Telemedicine describes how Circle Park Behavioral Health Services, a US provider in rural South Carolina, uses telemedicine to support people dealing with opioid addiction. Prescribing Medication-assisted Treatment (MAT) has to comply with strict legal controls, including numbers of patients who can access MAT. Polycom’s platform helps healthcare professionals to match patients need MAT with providers who have the waiver space to treat them.
Providers can connect with patients at times and places of their choosing too. Fitting consultations in daily time commitment and giving patients comfortable place to communicate rather than doctors’ offices all help with the journey that can leave addiction behind. These frequent contacts give healthcare professionals opportunities to assess patients’ daily routines, issues and progress.
While MAT’s the main telemedicine role, it’s not the only one. Addicts often have to deal with chronic health issues such as high blood pressure, diabetes and heart failure. The telemedicine initiative’s seen as an opportunity to connect with patients outside the office on these and other care management and co-ordination activities.
Africa’s priorities for telemedicine should be showing equivalent benefits. Establishing the impact of these provides valuable knowledge to justify more investment.
- 568 views
- August 24, 2018
- Tom Jones
Will AI and Blockchain converge to enhance health analytics?
While AI and Blockchain are seen by some to offer powerful tools, a view’s emerging that combining them offers significantly more potential for Big Data and health analytics. Or, is it just another dose of eHealth hype? An article in Health IT Analytics says in the US, AI and Blockchain are now tools of choice for developers, providers and payers in improving their eHealth infrastructure.
But, it acknowledges that both are near their hype curves peaks. Some providers and payers are reluctant to invest heavily at their maturity stages. Concerns over security, utility and Return on Investment (ROI) are justifications for some organisations to defer investment, leaving others to provide evidence that combining AI and Blockchain can succeed in secure the large data sets and exchanges that Big Data needs for innovative analytics.
Access to data’s one obstacle. Most data resources are held securely and privately by several institutions. Opening them can create cybersecurity vulnerabilities. Despite this, ideas are fermenting of using Blockchain to produce metadata about the datasets available at several organisations. It can also provide secure, peer-to-peer data exchange. Blockchain can be a pointer to where full data sets are stored, allowing for discoverability without requiring data sets to move each time a transactions completed.
This strategy enables organisations to keep sensitive data, such as Protected Health Information (PHI) and Personally Identifiable Information (PII) off Blockchain. It’ll reduce risks of breaches. Instead, minimal but sufficient data should be held in Blockchain.
These comprise complex decisions and projects. It seems premature for Africa’s health systems to pursue combined AI and Blockchain strategies in the medium term. There are other eHealth priorities to address, such as using mHealth to support remote health workers with access to test results and improving their co-ordination with colleagues.
If the AI and Blockchain are converging in healthcare, Africa’s health systems can watch trajectories and learn from them. If they deliver a significant proportion of their potential, a challenge for Africa’s health systems may be to avoid a sudden disruption to their eHealth strategies and plans. While this can be costly, missing new eHealth opportunities has a cost too, often of missed benefits.
- 598 views
- August 23, 2018
- Ameera Hamid
Patients rely on health information on the Internet
Trusting doctors is a crucial requirement of successful healthcare. The Internet has added a variable into the relationship between patients and their doctors compared to the traditional set up. An empirical study by a team from China and the US in the Journal of Medical Internet Research (JMIR) investigated the effects of the quality and source of Internet health information on patient compliance. It relied on social information processing and social exchange theories.
Relationship Between Internet Health Information and Patient Compliance Based on Trust: Empirical Study found that the quality and source of health information from the Internet affects patients’ compliance through the mediation of Cognition-based trust (CBT) and Affect-based Trust (ABT).
Consequently, patients’ compliance can be improved by strengthening the quality of health information management on the Internet. It also suggested that doctors should obtain health information from health websites to expand their understanding of patients’ knowledge of their conditions and their compliance with their treatment regimes.
More specifically, the mutual demonstration of care and respect in physicians’ and patients’ communication’s important in promoting patients’ ABT in their physicians. CBT doesn’t have any direct effect on patients’ compliance, but directly affects ABT, then indirectly impacts patient compliance.
For Africa’s health systems, the study emphasises the need to invest in high quality, accurate, sustained Internet health information. Setting up the service with minimal operational resources may be unhelpful and disruptive.
- 382 views
- August 20, 2018
- Ameera Hamid
Will a new tech-giant coalition on interoperability move Africa’s eHealth on?
Coalitions mean co-operation and joint action towards a common cause. They’re usually for the each participants own self-interest. The latest initiative in eHealth’s sphere should offer considerable benefits to health and healthcare organisations.
A report in Healthcare IT News says a broad coalition of technology giants emerged in an unscheduled session at the Blue Button 2.0 Developer Conference on 13 August at the White House. Amazon, Google, IBM, Microsoft, Oracle and Salesforce joined forces to set about removing interoperability barriers.
The US Information Technology Industry Council lead the session, Its CEO described the initiative as a commitment to eliminate friction in healthcare systems. The solutions will affect cloud computing and architecture, moving towards open standards through Fast Healthcare Interoperability Resources (FHIR) and the Argonaut Project.
While details seem limited, an indication of the coalitions trajectory includes:Supporting healthcare as it shifts to the cloudMaking AI more availableEnabling connected careBetter access for patients to their dataFlexibility to use products and services across different systems to work seamlessly for their care.
While it’s obviously aimed at the US healthcare market, the outcome of the coalition should have significant implications for Africa’s health systems’ eHealth strategies, investment options and procurement. As the coalition improves interoperability, it should open up expanded and new eHealth benefits, including opportunities to enhance and transform health and healthcare.
- 548 views
- August 16, 2018
- Tom Jones
AI passes a stiff test at London’s Moorfields Eye Hospital
England’s Grand National run at Aintree is gruelling. It has 30 fences, two with open ditches, in a distance of 2.25 miles that’s completed twice. AI has just moved up the field in the eHealth equivalent.
An AI project at London’s Moorfields Eye Hospital with Google’s DeepMind has accurately diagnosed eye conditions from scans. As ophthalmologists’ workloads and their complexities increase, diagnostic imaging is expanding faster than specialists can interpret the results. AI already has a constructive reputation in classifying two-dimensional photographs of some common diseases it’s reached the performance of expert clinicians in a real-world clinical pathway with three-dimensional diagnostic scans.
At Moorfields, a novel, deep learning architecture is now applied to a clinically heterogeneous set of three-dimensional optical coherence tomography scans from patients. The research found that after training on 14,884 scans, AI’s referral recommendations of sight-threatening retinal diseases reached, and sometimes exceeded that of experts.
Other benefits include:Tissue segmentations produced by the architecture are device-independent representationsReferral accuracy’s maintained when using tissue segmentations from a different devicePrevious barriers to wider clinical use without prohibitive training data requirements across several pathologies have been removed.
After training, the algorithm assigned diagnoses to 1,000 patients’ scans whose clinical outcomes were already known. The same scans were shown to eight clinicians. Four were leading ophthalmologists, four were optometrists. They classified the diagnoses into four referral types, urgent, semi-urgent, routine and observation. AI performed as well as two of the world's leading retina specialists. The error rate was 5.5%. More strikingly within this performance, the algorithm didn’t miss any urgent cases.
The impact of the project’s global. For Africa’s health systems, the challenge’s entering the AI Grand National and making sure they don’t fall at any of the daunting fences. It offers an eHealth strategic scenario that extends what is now relatively conventional EHRs and mHealth. AI can extract more value from them than originally imagined.
- 451 views
- August 15, 2018
- Tom Jones
Argentina’s health system aims to balance information needs and privacy
Balancing competing claims in health systems never ends. Simon Sinek, an author, says “There’s no decision that we can make that doesn’t come with some sort of sacrifice or balance.” So it is with eHealth. In an interview in eHealth Reporter Latin America, Dr Alejandro López Osornio, director of Information Systems in Argentina’s Ministry of Health says “The challenge is to balance the need to share information while respecting privacy and autonomy of people who generate it.”
There’s been progress, and more to do. The next steps are in the National Digital Health Strategy, The goal’s to consider both patients’ rights to share information only with their healthcare professionals and simultaneously respect provinces’ and private institutions’ autonomy to develop their information systems and share data with other authorised users and organisations when necessary.
Argentina invested in a minimum national infrastructure that integrates and connects all the countries current projects. Anyone working with health information system in different jurisdictions can communicate centrally and automatically with all other authorized participants.
There are several outcomes. Everyone speaks the same information language and shares the same type of information safely and privately. Healthcare quality’s improved. Patient empowerment’s the core component of strategy and planning.
Patients can use smartphone apps to record dietary information and their exercise activities. It’s expected that app providers will soon help patients to understand their clinical and health data better. Examples are their cholesterol trends and comparing their weight. This information can help them make important health and life-style decisions.
Argentina modelled its eHealth strategy on Canada’s It reflects its federal institutions and independent provinces. Local eHealth fine-tuning’s still needed. Human eHealth capacity’s a critical difference between the countries. One Hundred Leaders was Argentina’s strategic response. It plans to train one hundred computer scientists or doctors in this field, four for each province. The National Digital Health Strategy provides for scholarships for a postgraduate course of four to six months, mostly online, to provide local specialists and avoid medical staff having to the Ministry of Health in Buenos Aires for advice. This’s an initiative relevant for Africa’s eHealth strategies.
The next strategic phase’s being developed. A scenario is to enhance eHealth regulation and integrate different strands, such as digital signatures, electronic documents and privacy and security of documents, into a single law. Existing personal data protection and digital signature laws can be extended to health and its EMR repositories. A general digital health law is an option.
Argentina’s rapid progress and future strategy offers a constructive comparator for Africa’s health systems. Both technology and human eHealth capacity are moving ahead together. While it’s challenging, it’s essential to maximise eHealth’s benefits.
- 295 views
- August 14, 2018
- Matt Jones
Can Africa’s eHealth projects avoid human burnout?
As countries’ health systems move towards Universal Health Coverage (UHC), a challenge is to afford a new and optimum and sustained balance of resources to meet the increased demand. It includes a mix of extra health workers, more and better eHealth, and resultant gains in quality, access and efficiency. It’s an extremely demanding, integrated strategy.
It’s also starting from a modest base. Africa’s eHealth investment needs boosting significantly and recruiting and retaining extra health workers is a long-term challenge. A report from Athena Insight shows its starting point may have even more constraints.
In The business case for physician capability, US doctors’ burn out is identified as “48% of physicians think they’ll have trouble maintaining their workload over the long term.” The equivalent in Africa’s health systems for all health workers doesn’t offer an effective platform for the sustained engagement needed to expand eHealth for UHC. The time needed away from clinical activities will exacerbate burn out.
On these findings, it’s important to include in eHealth programmes initiatives to fix burn out. Better capability reduces burn out from about to 51% to 27%. It includes skills and organisational changes. Jessica Sweeney-Platt, the report author, says “In an organization that emphasizes capability, team members have clearly defined roles and responsibilities. Leaders listen to the frontline and prioritize training, communication, and alignment. Innovation is prized and rewarded — especially innovation that results in fewer administrative tasks performed by physicians and other providers.”
While the report doesn’t offer the business case one would expect from its title, it sets out some essential themes for organisational development that successful eHealth depends on.
- 382 views
- August 13, 2018
- Tom Jones
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