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  • What's needed to help improve EHRs?

    Millennia ago, primitive people huddled in caves to keep warm and protect themselves from big, wild beasts, many now extinct. As people advanced, huddling became less important, but it’s emerged in healthcare, and EHRs are the catalyst. 

    Safety huddles to proactively identify and address electronic health record safety, a study in the Journal of the American Medical Informatics Association (JAMIA) identified 245 safety concerns related to EHRs. To be more precise, safety huddles found them. Four main types were: 

    42% EHRs’ technology working incorrectly26% EHRs’ technology not working at all17% EHRs’ technology missing or absent16% user errors.

    Huddling theory says the activity’s helpful in creating collective situational awareness, leading to increased organisations’ capacity to respond to concerns, limitations and weaknesses. The study shows it: 

    Promoted discussion of several technology issues in organisationsServed as a promising technique to identify and address EHRs’ safety concerns.

    The team recommends that healthcare organisations consider huddles as a strategy to promote understanding and improvement of EHR safety. If it works for safety, it could help with other weaknesses in EHRs. If it works for EHRS, it could work for some other eHealth services too.

    It seems that our ancient ancestors were on to a modern management technique, so announcement in waiting rooms could soon be saying “A doctor will see you shortly. At the moment, they’re all huddling for eHealth.”

  • Are Africa’s eHealth start-ups on the move?

    Africa’s health systems need a vibrant eHealth start-up environment that provides local solutions. It’s good news that the number of Africa’s eHealth start-ups is rising. Most don’t leverage mHealth.

    The report from the start-up portalDisrupt Africa High Tech Health: Exploring the African E-health Startup Ecosystem Report 2017, identified 115 eHealth start-ups in 20 African countries, about 37%. It reveals the need to stimulate eHealth start-ups in the other 63%.

    Investment’s increasing too, especially finance for businesses growth. The combined eHealth start-up investment’s exceeds US$19 million. Most eHealth start-ups in the report don’t use mHealth. It’s about 44%. 

    Niche solutions are an important component of Africa’s eHealth investment. As demand and opportunities expand, especially for mHealth, the scope for Africa’s eHealth supply side can expand with it. A report in Standard Digital summarises the landscape using data from the 20 countries over three years from Disrupt Africa, it says about 73% of Africa’s eHealth ventures provide mHealth solutions. Local eHealth innovators are emerging in Uganda, Ghana, Egypt, and Senegal. Start-ups launching across Africa has increased over three years. Investors are starting to support start-ups planning to grow expand.

    Africa has an estimated 115 eHealth start-ups. About 28%, 32, are in East Africa. Nearly half of these, 15, of East Africa’s eHealth start-ups in are in Kenya, about 13% of Africa’s total. They may be confronting challenges in attracting finance, unlike reported significant investment in other countries in the region. Does it mean that the available finance’s being spread more evenly, or is it because better investment opportunities are emerging from other countries?

    Total investment in eHealth start-ups over the period is estimated at US$19 million. Kenya start-ups raised US$379,600, under 2%.

    Africa.com has a different perspective. Its report identifies Tunisia emerging as the next eHealth hub. It says there are more than 300 African tech start-ups, 54, 18%, in South Africa , 27, 9%, in Kenya, 23, 8% in Nigeria and 15, 5%, in Tunisia. After creating a successful incubator in Kenya, Merck will launch a start-up incubator in Tunisia by 2019 to collaborate with innovative eHealth start-ups.

    It’s not all rosy. Several challenges to growth are seen as access to finance, uncertain policies, competition from established brands and finding and recruiting talent. 

    Africa’s eHealth strategies need to parallel these initiatives. They’re creating opportunities to improve health and healthcare.

  • Telehealth may increase healthcare demand

    Telehealth, using telephones and including telemedicine, can benefit patients, health workers and healthcare organisations. One probable benefit is reducing reliance on GP and Emergency Department (ED) visits with virtual visits, so reducing healthcare costs. Another’s convenience for patients. It seems that can patients’ convenience’s reducing healthcare benefits, a case of supply led demand. 

    A study in Health Affairs,  Direct-To-Consumer Telehealth May Increase Access To Care But Does Not Decrease Spending, found that the convenience of telehealth services for patients may mean they solve access issues long before they bend healthcare’s cost curve.  It may be these much shorter waiting times and earlier utilisation may increase healthcare spending.

    The research team analysed over 300,000 patients’ commercial claims data spending for acute respiratory illnesses. Data extended over three years. About 12% of telehealth visits replaced visits to other providers. Some 88% was new utilisation with shorter waiting times. Net annual spending on acute respiratory illness services increased by $45 for each telehealth user. 

    eHNA reported on a similar outcome for an eVisit service. The findings seem reinforce each other. Africa’s eHealth programme should include the probability of the phenomenon in their telehealth business cases so additional healthcare resources that may be required can be planned too.

  • mHealth keeps expanding, but Africa and South America are trailing

    The mHealth market’s been growing steadily, and will keep it up. In its report mHealth App Economics 2017 Current Status and Future Trends in Mobile HealthResearch2Guidance (R2G), a strategy advisory and market research company, assesses how digital intruders are taking over the healthcare market. 

    This year, there are 325,000 health and fitness apps available from all major app stores. It’s 78,000 more than last year.

    Most eHealth practitioners come from Europe, 47%, and 36% from the US, a combined 83%. Asia-Pacific accounts for 11%. South America and Africa trail at 4% and 2% respectively, confirming the need for increased human capacity development.

    Other findings include:

    Android’s overtaking Apple in health app numbers84,000 health app publishers release appsWidening demand and supply gap, with high number of developers and low downloads growth ratesUS$5.4bn investment in eHealth start-ups fuelling the marketUsers will download an estimated 3.6bn apps in 201718% are not developing health apps because of uncertain regulations53% of eHealth practitioners expect health insurances to be  the future distribution channel with best market potentialAn estimated 28% pure eHealth market players in the eHealth industry.

    Two app types may have a big healthcare impact. Artificial Intelligence (AI) is seen as the most disruptive technology.  It’s seen as combining with remote monitoring to be the technologies that will disrupt healthcare most. The profile’s:

    AI 61%Remote monitoring and assistance 43%Wearables 34%IoT 30%Virtual reality and intelligence 27%3D printing 22%Blockchain 18%5G 8%Other 5%. 

    It seem that there’s an opportunity for Africa’ health systems to support and expand their local health app supply side. An integrated demand and supply strategy could do it.


  • Ponemon shows cyber-security knowledge’s improving

    As cyber-attacks expand in sophistication and volume, knowledge about them’s expanding too. Ponemon Institute, a US research organisation, surveys ICT and security leaders about cyber-security each year. For five consecutive years, its State of Endpoint Risk Report, has added to organisations knowledge. Barkly, a cyber-security firm, has released a preview. The findings are important for Africa’s healthcare and its eHealth and its cyber-security plans. 

    Organisations are struggling to secure their endpoints against new and evolving threats. It’s exacerbated by its high cost for each successful attack. Three other themes are:

    Fileless cyber-attacks area an increasing risk, now about 77% of all cyber-attacksTrust in Anti-Virus (AV)  programs that rely on file scanning and signature matching has waned, with about 80% of organisations replacing or augmenting AV in 2017Endpoint security is becoming more costly and complex.

    False positives are the most significant hidden cost of endpoint protection. Almost 50% of alerts were false alarms. Costs and complexity is increased too because organisations have an average of seven different agents installed on endpoints. Each one needs its own monitoring, so diseconomies of scale. About 75% of organisations find cyber-security management a challenge.

    Affordability and capability’s starting to bite. Only a third of organisations have enough resources to manage cyber-security effectively, a salutary finding for Africa’s health systems.

    Four measures needed to respond to the trend are:

    Move beyond traditional AVInvest against protection against fileless cyber-attacksReduce endpoint management complexityFocus on prevention first, before detection and response.

    These match Ponemon’s findings. There are two challenges are, first, how can the two-thirds of organisations with insufficient resources afford them? Second, can the one third afford the extra cost? Answers to both are vital for Africa’s health systems?

  • eHealth’s goals need shifting to meet doctors’ needs

    There’s a vicious circle revolving around eHealth. As eHealth moves ahead, it’s creating a demand for better eHealth. Dr James Madara, CEO at the American Medical Association (AMA) set some of these out in his recent speech, recorded on YouTube. He sees doctors confronting “Oceans and oceans of data, but only puddles of clinical meaning.” It seems the eHealth challenge’s moving from providing data to giving health professionals the means to navigate their way through the rising tide. His “Longer timelines” view included the utilities needed for a “secure and timely data flow“ needed to improve clinical data liquidity. 

    Fierce Healthcare has summarised some of his themes on the ability of doctors to extract clinical meaning from rapidly expanding data sets and as disorganized and siloed eHealth ecosystem. He equates it to “The fable of the blind men touching the elephant. One feels the trunk, another the tail, one the ear, and each one of the men [sic] has in his mind some different image. That’s what healthcare data are today. Each of us touching data bit-by-bit, then spending time conceptualising the elephant.” AMA’s Integrated Health Model Initiative (IHMI) is helping to deal with these concerns. It includes building a common data-sharing structure with Intermountain Healthcare. 

    An example he uses is a concept from EHRs that existing data in them can be shared and used for current clinical decisions. He set out a scenario of a doctor who suspects patients suffer from hypertension, so “effortlessly” accesses their blood pressure readings from previous healthcare providers. He said doctors can’t do that.

    Africa’s eHealth strategists need to consider Dr Madara’s perspectives. As eHealth investment generates more data, Africa’s health systems simultaneously can put in place the tools that healthcare professionals need to navigate their way through it. eHealth benefits depend on them.

  • KLASified IOp needs to progress

    A bit like an horizon, as eHealth Interoperability (IOp) takes a step forward, its horizon seems like two steps further away. KLAS, the eHealth analyst outfit, has published its Interoperability 2017 report of its Cornerstone Summit. First Look at Trending – Some Progress toward a Distant Horizon,” summarises the findings. It’s the third interoperability summit. The KLAS 2017 research provides the first year-on-year comparison measuring progress. There’s plenty left to do.

    KLAS research shows that shared patient data often fails to benefit patient care much. It’s an important insight for EHR business cases, and reveals the ubiquitous gap between eHealth’s potential and its probability in realising its benefits. An essential question to ask before driving ahead investing scarce resources is asking eHealth sponsors to estimate the percentage of patient encounters in which:

    Outside data informs healthcare delivery betterUsers have access to needed data from outside their organisations. 

    Most of the report deals with methodologies and questions about measuring IOp. They provide a wide range of detailed and precise themes that Africa’s eHealth programmes can use to specify and test their IOp components.

    Other issues are: 

    Should behavioural health and home medical equipment be incorporated in post–acute care interoperability?Pharmacies are key partners in post–acute care IOp, so need includingWhich IOp capabilities and synergies should or should not exist between post–acute care and hospital systems?Should hospitals’ Emergency Department (ED) systems query HIEs to identify if patients receive home health services, and can the home health records and their patient information be added to ED systems?

    Healthcare’s concerns and insights include:

    Securing national IOp inter-organisational trust of incoming data and its accuracyClarity on liability of outgoing data not being used securely or guarded How to co-ordinate between organisations sharing data, especially when different users  need different data?How can patients help bridge IOp?IOp gaps in healthcare transitions are a significant market oversight and need fixingHow should information blocking be defined and implemented?

    Africa’s eHealth programmes can extract invaluable insights from the KLAS report. I can help them extend the stride of the next step. Whether it takes them closer to the IOp horizon’s another matter.


  • Is connected eHealth enough to lead to healthier people?

    eHealth’s ICT network, and especially mHealth’s, offers considerable potential for healthier people. Like all eHealth, its probable impact is always less than its potential. A study in the Journal of Medical Internet Research (JMIR) by a research team in Montreal, Canada, identified the phenomenon for connected health tools.

    Is Connected Health Contributing to a Healthier Population? Reviews  mHealth’s health impact. It,

    It’s clear that mHealth enables more precise diagnostics, personalised health recommendations that enhance patient experiences and outcomes and contains healthcare costs. But, for mHealth to achieve its full potential, at least five issues need addressing.

    JMIR’s editor says JMIR Publications discourages the use of Connected Health (cHealth). It’s not clear if how it differs from eHealth, mHealth or Ubiquitous Health (uHealth). eHNA’ll stick with eHealth and mHealth.

    One issue’s achieving active engagement in mHealth use, privacy, security, quality, and developing evidence-based guidelines. The expanding mHealth market, at over 165,000 apps in 2015, conveys an urgent imperative to deal with these. With such a profile and plethora, it’s a bit odd that only 12% of health-related apps have 90% of downloads; a considerable underutilisation and corresponding limited impact on health.

    Maybe, as the study hints, the current focus technology may be too extensive, while simultaneously ignoring the need for a paradigm shift in healthcare providers from fixer to coach, that welcomes, encourages, requires and activates patients’ engagement in their own wellness and care. It could be that uptake strategies are needed to ensure individual’s mHealth engagement is their highest prior for health and illness issues. Succeeding may need a better understanding of the health literacy gap causes.

    Quality’s a challenge. Many consumers, developers and manufacturers aren’t aware of many of mHealth’s technological standards and regulations. Lacking supporting evidence, users often rely on subjective five-star ratings to gauge quality. Apple’s App Store advises that “medical apps that could provide inaccurate data or information, or that could be used for diagnosing or treating patients may be reviewed with greater scrutiny.” Recent initiatives might help overcome this risk and misplaced dependency:

    Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework evaluates health behaviourMobile App Rating Scale (MARS) assess and scores qualityConsolidated Standards of Reporting Trials (CONSORT-EHEALTH) encompasses initiatives developed by the CONSORT Group to alleviate problems arising of inadequate randomised controlled trial (RCT) reporting.

    Africa’s mHealth emphasis should take note of these. Without them, mHealth may become just a bit of Health.

  • How to deal with with ransomware

    A perspective on eHealth cyber-security is the challenge to cope with changes in government regulations, a revolution in medical device and mobile technology expanding at about 20% a year and healthcare transformation. Its eBook Ransomware: What every healthcare organization needs to know, Cisco sees this as a “Perfect storm of complexity and vulnerability” for information security. 

    Cisco Umbrella is a cyber-security platform for the cloud. Supporting advice in the eBook covers:

    What is ransomware?How prevalent is the threat?Why healthcare?How does infection happen?How does an attack work?How to protect organisations?The first line of defence.

    It sets out four main causes of infections:

    Phishing emailsCompromised web sitesMalvertisingFree software downloads.

    Cyber-attacks come from two sources, email and web sites. Clicking on an illicit link in an email or visiting a compromised or malvertising web site can trigger a sequence of events:

    Launching a download and installation of an exploit kit.Exploit kit identifies vulnerabilities in users’ systems and sends these back to the malicious infrastructureInstalling a targeted payload on users devices that can exploit the vulnerabilitiesCall-back to retrieve private malicious encryption keys that encrypt dataNotify users that a ransom payment will release the encryption key.

    Stopping ransomware attacks needs a set of actions to:

    Monitor global cyber-criminal activities for insight into where hackers are staging infrastructure for future attacksProtect patient devices, medical IoT endpoints, Protected HealTHInformation (PHI) and Personally Identifiable Information (PII) data systems, including ones that don’t support agentsDiscover and block likely malicious domains and Internet Providers (IP)Feed contextual threat intelligence into security management or incident response environments to identify which incidents need attentionKnow how unmanaged mobile and IoT devices connect to networks to prevent patient data exfiltration. 

    After a cyber-attack, assess what happened by:

    Identifying the root causeDeveloping a proactive cyber-security plan that leverages a multi-layer defenceUsing predictive intelligence to understand how and where attacks are staged on the InternetInternally segmenting networks to contain a breachRestoring data from backupsEducating employees about security best practicesDeploying first line defences that stop opportunities for lateral movement of ransomware in networks, eliminate its propagation and reduce the time cyber-attacks have to operate in networks.

    Cisco’s eBook adds to Africa’s eHealth knowledge. It’s an essential document for its cyber-security library.

  • Predictive analytics needed for better infectious disease tracking

    When outbreaks of new diseases emerge, public health’s impact inevitably follows events. Eventually, it catches up. The US Government Accountability Office (GAO) report in May 2017, Emerging Infectious Diseases Actions Needed To Address the Challenges of Responding to Zika Virus Disease Outbreaks, found that the Zika virus case counts from the national disease surveillance system underestimate the total number infections because: 

    Infected people may not seek medical care because they have only mild or no symptoms, or other reasons,May not be diagnosed because of limitations in Zika virus diagnostic testingIncomplete surveillance reporting.                                                                                                                                   

    Better, prompt and accurate information’s still needed. Three Congress representatives have written to the GAO boss, the Comptroller General, suggesting a subsequent study into predictive models and systematically integrating modelling into outbreak responses. They think the US can respond more effectively bt learning if:

    Federal agencies use predictive modelling to inform planning for emerging infectious diseases?How federal agencies use models to inform regulatory decisions about infectious disease outbreaks?Do medical product sponsors use predictive modelling?What funding’s available for infectious disease predictive modelling?What challenges do predictive modellers face?If and how, federal agencies validate models’ predictions? 

    With predictive modelling and analytics expanding their potential, these seem like a good set of questions that all countries should ask. Answers can inform eHealth strategies and strengthen the role and impact of public health professionals.

  • Disaster and emergency preparedness may be needed for nine coastal African cities

    The Earth’s warming. There’s a consensus among Earth scientists that melting land ice contributes to Sea-Level Rise (SLR).  Research from the University Corporation for Atmospheric Research (UCAR) says future warming will exacerbate the risks to human civilization. Ice sheets, glaciers, and ice caps have melted during the 20th century leading to SLR. UCAR says it’s accelerating.

    A report from a team at the Jet Propulsion Laboratory, California Institute of Technology, Should coastal planners have concern over where land ice is melting? published in Science Magazine says the technique of Gradient Fingerprint Mapping (GFM) benefits long-term coastal planning. An appendix to the report identifies nine coastal African cities that could be affected. They’re:


    While the report deals with cities, other coastal communities will be affected too. If measures to reduce global warming succeed, it may not happen. If they’re too late or don’t work, it seems that it will.

    One response is building sea defences. Another’s to relocate communities. Doing nothing could mean emergencies and unplanned population migration. All have consequences for health and healthcare. The results from the study need factoring into the nine countries’ longer term disaster and emergency response and eHealth strategies and plans. Africa’s other coastal countries may need to start planning too.

  • Does spambot Onliner have your email address?

    It’s described as the largest spambot. ZDNet has a report about the finding by Benkow, a cyber-security researcher in Paris, who discovered an open and accessible web server hosted in the Netherlands which stores dozens of text files. They contain a batch of 711 million email addresses, passwords server login information and 80 million email servers used to send spam. The credentials came from other data breaches, such as the LinkedIn and Badoo hacks.

    Malevolent goals are to send email spam through legitimate servers to defeat many spam filters. Onliner delivers Ursnif banking malware into inboxes globally. Ursnif is a Trojan. It steals data such as login details, passwords and credit card data. A spammer then sends a dropper file as normal-looking email attachments. When it’s opened, the malware downloads from a server and infects the machines. Spamming is still an effective way to deliver malware, but email filters are becoming smarter, with many spamming domains blacklisted. 

    There’s been over 100,000 unique infections up to the end of August 2017. Cyber-attackers need large lists of Simple Mail Transfer or Transport Protocol (SMTP) credentials that authenticate them to send bogus legitimate emails that by-pass spam filters. The more servers they find, the bigger the campaign. 

    When bogus emails are opened, they send back to the cyber-crookss the IP address and user-agent information used to identify the type of computer, operating system and other information about the devices. Cyber-attackers use this to identify who to target with Ursnif. They specifically target Windows computers. iPhone or Android users aren't affected by the malware.

    Focused hacking instead of scatter bombing reduces the malevolent campaign’s cyber-noise. It can help to slow down responses from law enforcement agencies. 

    Benkow’s discovery re-emphasises the need for Africa’s eHealth programmes to train, then train again and again, health workers in cyber-security. It’s an essential components in the constant cyber-security response. 

  • Managing high risk populations’ health needs better information

    Successful population health management need health organisations to learn and know how to manage risks, outcomes, utilisation and well-being of high and increasing risk communities. Components Necessary for Managing High-Risk Population, a report from Cerner, available from EHR Intelligence, sets out ways that organisations can use information to manage people’s care as part of health risks cohorts and identify opportunities to reduce avoidable costs.

    The report says about 5% of the population are high risk. Another 20% are grouped as rising risk. Globally, these health risks are increasing. In a report, on global health risks, WHO says “Health risks are in transition: populations are ageing owing to successes against infectious diseases; at the same time, patterns of physical activity and food, alcohol and tobacco consumption are changing. Low- and middle-income countries now face a double burden of increasing chronic, non-communicable conditions, as well as the communicable diseases that traditionally affect the poor. Understanding the role of these risk factors is important for developing clear and effective strategies for improving global health.”

    Cerner’s report focuses on care management requirements and patients. The principles apply to health promotion and illness prevention too. Selecting the right people for care management plans is essential to improve their health and enable healthcare to cost outcomes. Cerner proposes three components:

    Risk stratification strategiesHealth IT needs for managing high-risk populationsChoosing the right care management approach.

    These are supported by six eHealth requirements.

    Longitudinal healthcare recordsChronic condition and wellness registries for patient cohortsCare management and co-ordination systemsLongitudinal plansData analytics and modellingReferral management system. 

    Linked to information on social determinants of health, some of this approach can support health interventions in high risk communities in low and middle income countries. It could include local data and predictive analytics to identify changes communities’ behaviour, and needs and demands for healthcare and related services such as education and social care.

  • Mobicure wins World Expo grant

    A Nigerian eHealth start-up Mobicure has won an Expo Live grant. An article in Disrupt Africa says it

    OMOMI application, which helps expectant mothers and parents of under-five-year-olds monitor the wellbeing of their children from home. The award’s up to US$100,000, made available incrementally depending on progress and results. 

    OMOMI’s a mobile platform. At the touch of a button, mothers can easily monitor their children’s health, access life-saving maternal and child health information and medical expertise. It was launched in Benin City in 2015 and now has 31,000 users with over 4,000 active monthly users. In the last nine months, it’s seen a 450% rise in users. The Expo Live grant will help it achieve three more goals. One’s an expanded reach to more families. Another’s adding more features and health information. The third’s promoting OMOMI to more parents in Sub-Saharan Africa.

    Emirates is delighted to host the next World Expo, in Dubai in 2020. Will another African eHealth start-up succeed there?

  • Burkina Faso’s MOS@N muestra el valor de compromiso

    Para alcanzar la Cobertura Universal de Salud (UHC)  se necesita que el acceso a la atención médica sea mas amplio. En Burkina Faso, MOS@N, un proyecto de mHealth está ayudando a las poblaciones vulnerables del distrito de Nouna a mejorar su acceso y lograr una mejor salud. Tambien, al superar los prejuicios de género, ha mejorado el estatus de las trabajadoras de la salud. 

    Las altas tasas de mortalidad materna son un importante desafío de la salud pública para Burkina Faso. Nouna tiene 341 muertes maternas por cada 100.000 nacidos vivos. Solo el 70% de las mujeres recibe atención prenatal y el 34% da a luz en el hogar. Las tasas de VIH / SIDA siguen siendo altas, con alrededor del 30% de las personas infectadas que no siguen el tratamiento requerido. 

    El acceso a la atención materna enfrenta numerosos obstáculos. Incluyendo las distancias a los centros de salud, la escasez de personal de salud calificado, la falta de información sobre la salud sexual y reproductiva y los altos costos del tratamiento médico. La información de salud para mujeres embarazadas y proveedores de servicios de salud a menudo no se entrega en el momento adecuado y podria estar desactualizada. Los valores sociales paternalistas profundamente arraigados pueden llevar a que muchos hombres prohíban a sus esposas asistir a los centros de salud en lugar de trabajar en los campos. 

    Lanzado en 2013, el nombre de MOS@N se deriva de móvil y santé. Su objetivo es mejorar el acceso de la atención de calidad para madres, niños y personas con VIH / SIDA. Al principio, los investigadores del Centro de Investigación en Salud de Nouna, un instituto de investigación del Ministerio de Salud, se dispusieron a determinar si las TIC y los teléfonos móviles podrían mejorar la administración de la salud para un acceso más equitativo a la asistencia sanitaria. Financiado por el Centro Internacional de Investigaciones para el Desarrollo (IDRC) y llevado a cabo en colaboración con la Universidad de Montreal, MOS@N se desplegó en centros de salud que prestaban servicios en 26 aldeas.

    El estudio, Posicionamiento de la Salud Movil: un estudio cualitativo de las expectativas de mHealth en el distrito de salud rural de Nouna, Burkina Faso, publicado en Springer, confirmó el éxito de MOS@N en el fortalecimiento del sistema de salud y la mejora del acceso. A fines de 2016, 2.161 mujeres embarazadas habían recibido atención prenatal. Los partos asistidos aumentaron en un 50% a más del 97%. Los trabajadores de la salud pudieron rastrear a casi 260 pacientes que viven con el VIH y lograron una baja tasa de abandono de solo el 1.6% de los casos. 

    MOS@N también aumentó la equidad y la participación en la administración de la salud. Las mujeres fueron fundamentales para la implementación del proyecto y ayudaron a determinar los servicios de salud materno e infantil ofrecidos. Unos contactos directos más fuertes con los centros de salud y un fácil acceso a la información les ayudará a mantener los logros alcanzados. 

    Un artículo del IDRC en la web de Relief dice que “marraines”, madrinas, que usan teléfonos móviles, se han convertido en actores centrales en la educación y movilización de la salud, roles que anteriormente desempeñaban los trabajadores de la salud de la comunidad masculina. Elegidos por los líderes de las aldeas para acompañar a las mujeres durante el embarazo y el parto, las “marraines” son intermediarias entre su comunidad y los trabajadores de la salud.

    MOS@N enfatiza el papel de la comunidad en la entrega de tratamiento, el seguimiento de pacientes y la entrega de mensajes y recordatorios de concientización. Integra los roles de los centros de atención primaria de salud local, trabajadores de salud, técnicos de TIC, “marraines”, líderes comunitarios e investigadores de salud pública. 

    Se desarrolló localmente utilizando software de código abierto y permite el acceso a la información sobre atención médica materno e infantil y la vida con VIH. Los sistemas de mensajes de texto e interactivos brindan mensajes en cinco idiomas locales, personalizados para satisfacer sus necesidades específicas, que incluyen recordatorios de citas para madres, asegurando la inclusión y una mayor accesibilidad. Todo el contenido cumple con las pautas nacionales para una amplia gama de atención médica. Incluye atención pre y posnatal, parto asistido, vacunación contra la polio y el tétanos, prevención del paludismo y seguimiento de pacientes. Otras características son un sistema central de información de salud desarrollado e integrado en las instalaciones de salud del distrito para recopilar los datos necesarios para el seguimiento y toma de decisiones.

    MOS@N y los hallazgos del estudio ayudarán a guiar las iniciativas de mHealth. El diseño y la implementación que satisfagan las necesidades específicas de los usuarios optimizarán las posibilidades de éxito. Proporciona lecciones para mHealth de África.

  • Kenya’s eHealth prioritises healthcare access in remote communities

    A report on relief web from the International Development Research Centre (IDRC) says the high mobile penetration has spawned an mHealth boom, the KEMRI-Wellcome Trust Research Programme reveals that it hasn’t improved healthcare accessible.

    A map identifying Kenya’s eHealth projects  shows 70 initiatives clustered in and around Nairobi, Kisumu, and Mombasa. Few are in the arid and semi-arid regions, home to people most in need of services. The lack of a well-defined national eHealth strategy and standards, now being addressed, contributes to an inequitable service distribution and duplication and waste of resources. These comprise a set of clear benefits for mHealth’s next generation.

    IDRC funding in 2013 enabled researchers to determine if and how eHealth fosters health equity and improve health system governance. Questions were, are affordable and timely health services available to people who needed them, and health decisions made transparently and with all stakeholders’ participation? 

    Despite good intentions and the launch of a series of government initiatives to address health system challenges, the team found that more work remains to achieve quality healthcare for all. This is a challenge facing all Africa’s countries. 

    Most of Kenya’s eHealth projects have a strong mHealth emphasis. Nearly 70% rely on mHealth. Most projects were developed by donor-funded NGOs, with an inevitable consequence of isolated data silos and no Ministry of Health approval. Consequently, few were aligned with national needs or priorities and a lack of government engagement and funding led to many abandoned projects after pilot phases.

    Stakeholder engagement and consultation at design stages were limited too. Projects didn’t reflect their needs, a deficiency researches say could’ve been overcome by better accountability, governance and ownership. 

    Only eight projects had been systematically evaluated, with only one evaluated using cost-effectiveness analysis. Little’s known about their impact and there are few lessons about success factors or failures.

    Kenya’s has moved on since the report. eHNA has reported on its excellent work on mHealth standards, a model for all countries. This, and the IDRC findings can benefit all Africa’s eHealth programmes and help to achieve long-term health benefits for all Africans.

  • How to construct the perfect password

    Passwords are personal, secret, vital and too complicated to be guessed. That’s the theory. It seems that expert advice hasn’t complied with the complicated part. A report from the US Joint Task Force Transformation Initiative Appendix A set out password practices. In an article in the Wall Street Journal (WSJ), the author, Bill Burr, a former National Institute of Standards and Technology (NIST) manager, says his advice wasn’t right. 

    The original report in 2003 was NIST Special Publication 800-53 Revision 4 Security and Privacy Controls for Federal Information Systems and Organizations. It’s been updated regularly, and proposed password management should include:

     Changing passwords every 90 days Adding capital letters, numbers and symbols to words, such as password being Pa55?w0rd.

    He now says passwords shouldn’t be changed frequently because people often make only small modifications, such as Pa55?w0rd to Pa55!w0rd. These changes weaken passwords when the intention’s to strengthen them.

    A report by the BBC says a better method’s a random string of words, such as "pig coffee wandered black." It takes malware longer to break this code than using random guesses to find Pa55!w0rd.

    Africa’s eHealth programmes and users can adopt this updated advice. They should also follow research on cyber-security practices. Complying with evidence-based actions is always best.

  • Machine learning use cases for health points to the future

    Machine learning (ML) and artificial intelligence (AI) have quickly rocketed to the top of the industry’s buzzword list, driven partly by heightened interest in big data analytics amongst healthcare providers and vendors

    The allure of intelligent algorithms to mine masses of structured and unstructured data for innovative insights get’s health planners pretty excited. However, a fragmented health ICT landscape and sluggish analytics development have thus far kept that Holy Grail beyond reach.

    Regardless, ML is already making a difference.  Here are some examples;

    Imaging analytics and pathology

    ML can supplement the skills of human radiologists by identifying subtler changes in imaging scans more quickly and potentially leading to earlier and more accurate diagnoses.  At Stanford University, ML tools performed better than human pathologists when distinguishing between two types of lung cancer.  The computer also bested its human counterparts at predicting patient survival times.

    Natural language processing and free text data

    Using natural language processing (NLP), ML algorithms can turn images of text into editable documents, extract semantic meaning from those documents, or process search queries written in plain text to return accurate results.  Anne Arundel Medical Center is using a natural language interface, similar to any of the widely known internet search engines, to allow users to access data and receive trustworthy results.

    Clinical decision support and predictive analytics

    Identifying and addressing risks quickly can significantly improve outcomes for patients with any number of serious conditions, both clinical and behavioral. The University of California San Francisco’s Center for Digital Health Innovation (CDHI) and GE Healthcare are creating a library of predictive analytics algorithms for trauma patients in an attempt to speed up the delivery of critical care.

    Cybersecurity and ransomware

    At the end of 2016, IBM Watson launched its Cyber Security Program.  Watson’s ML and cognitive computing skills are used to flag cyber threats and check for suspicious activity against known malware or cyber crime campaigns.  This helps IT staff take better decisions based on known characteristics of malware.

    ML and AI are the keys to addressing health care inadequacies.  These technologies can help predict and control disease, expand and augment service delivery, and address several persistent social inequities. Ubiquitous health tech is by no means inevitable.  Successful rollout will entail an immense amount of concerted effort, capital, labor, and partnership.

  • Are WAFs part of your cyber-security toolkit?

    As websites’ role in health and healthcare expand across Africa, the need for cyber-security increases too. Web Application Firewalls (WAF) services are part of the solution. WAFs are deployed in front of web servers to protect web applications against cyber-attacks, monitor and control access to web applications and collect access logs for compliance, audits and analytics. Gartner has assessed and classified suppliers in its report Magic Quadrant for Web Application Firewalls. 

    The matrix measures ability to execute and vision completeness. It classifies suppliers into challengers or leaders and niche players or visionaries. Three suppliers are in the leader segment. Imperva is the most visionary. F5 scores top ratings for ability to execute. Akamai is behind these two.

    Vision and execution are important for WAF suppliers as the demand side trends towards cloud-based WAF service platforms that can protect from Content Delivery Networks (CDN), Distributed Denial of Services (DDoS) and bots. Its use is expected to be up from 20% to 50% by 2020 and are in the same quadrant.

    Suppliers were assessed against a wide range of criteria. They provide a basis for Africa’s health systems to evaluate suppliers in their procurements. They are:

    WAF’s capabilities in:

    Maximising detection and catch rate for known and unknown threatsMinimising false positives and alertsAdapting to evolving web applicationsEnsuring broad adoption through ease of use and minimal performance impactAutomating incident response workflows for cyber-security analystsProtecting public and internal facing web applications and Application Program Interfaces (API)Features and innovations to improve web application security beyond conventional network firewalls and Intrusion Prevention Systems (IPS)

    Gartner’s provided its research results for enterprise cyber-security teams to use as part of their evaluation of WAFs’ benefits can improve cyber-security. It offers Africa’s health systems a valuable template for their cyber-security endeavours.

  • Burkina Faso’s MOS@N to improve access to quality care for mothers, children and people with HIV/AIDS

    Achieving Universal Health Coverage (UHC) needs expanded healthcare access. In Burkina Faso, MOS@N, an mHealth project’s helping vulnerable populations in the Nouna district improve their access and achieve better health. By overcoming gender biases, it’s enhanced women health workers’ status too.

    High maternal mortality rates are a major public health challenge for Burkina Faso. Nouna has 341 maternal deaths per 100,000 live births. Only 70% of women receive prenatal care and 34% give birth at home. HIV/AIDS rates remain high, with about 30% of people infected not following up required treatment.

    Accessing maternal care confronts numerous obstacles. They include distances to health centres, shortages of skilled health staff, lack of information on sexual and reproductive health and high medical treatment costs. Health information for pregnant women and health providers is often not delivered at the right time and can be out-of-date. Deep-rooted paternalistic social values can lead many men forbidding their wives attend health centres instead of working in the fields. 

    Launched in 2013, MOS@N’s name’s derived from mobile and santé. Its goal’s to improve access to quality care for mothers, children and people with HIV/AIDS. At the outset, researchers at the Centre de Recherche en Santé de Nouna, a Ministry of Health research institute, set out to determine if ICT and mobile phones, could improve health governance and more equitable healthcare access. Funded by the International Development Research Centre (IDRC) and carried out in collaboration with the University of Montreal, MOS@N was deployed in health centres serving 26 villages. 

    The study, Situating mobile health: a qualitative study of mHealth expectations in the rural health district of Nouna, Burkina Faso,published in Springer, confirmed MOS@N’s success in strengthening the health system and improving access. By the end of 2016, 2,161 pregnant women had received prenatal care. Assisted childbirths increased by 50% to over 97%. Health workers were able to track almost 260 patients living with HIV and achieve a low drop-out rate of only 1.6% of cases. 

    MOS@N also increased equity and participation in health governance. Women were central to the project’s implementation and helped determine the maternal and child health services offered. Stronger direct contacts with the health centres and ready access to information will help them maintain the gains made 

    An article by IDRC in Relief web says marraines, godmothers, using mobiles, have become central players in health education and mobilisation, roles previously played by male community health workers. Chosen by village leaders to accompany women through their pregnancy and childbirth, marraines are intermediaries between their community and health workers.

    MOS@N emphasises the community’s role in delivering treatment, monitoring patients and delivering awareness-raising messages and reminders. It integrates the roles of local primary healthcare centres, health workers, ICT technicians, marraines, community leaders and public health researchers.

    It was developed locally using open source software, and enables access to information about maternal and child healthcare and living with HIV. Text and interactive voice messaging systems provide messages in five local languages, customised to meet their specific needs, including appointment reminders for mothers, ensuring inclusiveness and greater accessibility. All content complies with national guidelines for a wide range of healthcare. It includes pre and postnatal care, assisted delivery, vaccination against polio and tetanus, malaria prevention, and patient follow-up.

    Other features are a core health information system developed and integrated in district health facilities to collect data needed for follow-up and decision-making.

    MOS@N and findings from the study will help guide mHealth initiatives. Design and implementation that meets users’ specific needs will optimise the chances of success. It provides lessons for Africa’s mHealth.