eHealth Articles (1,944)

Rwanda benefits from VFAN’s eye care service

As a small charity with a big vision, Vision for a Nation (VFAN) thinks everyone should be able to access eye care and affordable glasses. It started its work in 2012, helping over 90% of its 10.5 million people who had no access to local, affordable eye care. Over a million only needed a simple pair of glasses to see clearly again. Many more could benefit from eye drops administered on-the-spot or a referral to a hospital for specialist treatment to prevent potentially blinding conditions.

The project has lessons for managing and succeeding with all-Africa’s health and eHealth projects. The management model is an essential component that runs across project and operational management and benefits realisation.

VFAN’s response was an innovative programme, building and integrating local primary eye care into Rwanda’s national health system. It’s planned for completion later in 2017.

 The programme’s goals are ambitious. They include:

  1. Making primary eye care permanently available for services such as medication, reading glasses and innovative adjustable lens glasses and referrals for specialist treatment
  2. Through the country’s network of over 500 local health centres and with revenue generated from the sale of glasses at $1.50 each, but free for the poorest 20%, sustain the programme beyond 2017 when VFAN’s direct role has ended
  3. Nurturing local Rwandan talent, capacity and capability, extending from language skills to advanced degrees.

With over a million people already screened, VFAN’s this high impact approach enables it to screen an extra 1.5 million people by the end of 2017 and deal with the national backlog too. It’s succeeding because it thinks and operates like a successful business. It sees Return on Investment as critical, sets clear goals and measures outcomes against targets at every stage. Its founder, James Chen and major international institutions provide continuing support that enables financial flexibility and adaptability.

Rwanda’s Ministry of Health will assume full responsibility for new eye care services from January 2018. eHNA will be posting about the transformation and lessons from VFAN for other African projects and countries.

Feb 21, 2017

A checklist for EHRs can help

Like eHealth, there’s more than one definition of EHRs. Consequently, when it comes to procurement, it’s important to be specific about your definition and requirements. Dr Chrono has provided a checklist that can help Africa’s health systems with their eHealth strategies, plans and procure their EHRs. It has twelve components:

  1. Intelligent time-saving charting tools for operational efficiency, such as customisable medical templates, medical speech-to-text, dynamic photo charting and macros
  2. Customisation and flexibility, to tailor EHRs to practices and specialties
  3. Fully functional on mobile devices
  4. Integrated with laboratories so test  and imaging requests, provide referrals and send prescriptions are seamless, minimise paperwork and streamline administrative tasks
  5. Real time eligibility verification and billing
  6. Patient portal that’s user-friendly
  7. Flexible and simple patient admissions and check-ins
  8. Sharable patient educational material
  9. Available training and support for EHRs
  10. Regulatory compliance
  11. Data flexibility and portability
  12. Application Programming Interface (API) and third party integrations.

For Africa’s health systems, sustainable affordability’s a vital matter. Other sustainability requirements, such as connectivity, are essential too. With all these in place, they can concentrate on mitigating investment risks and benefits realisation. There’s always more work to follow on with eHealth.

Feb 21, 2017

AI’s revolutionising healthcare

In 2016, supercomputer IBM Watson diagnosed a rare form of leukaemia in a patient at a hospital linked to Tokyo University. Using Artificial Intelligence (AI) and operating on the cloud, IBM Watson can cross reference and analyse data from millions of international oncology papers. From this data, it can extract information much faster than humans ever can. Evidence of its capabilities were  reported by the University when IBM Watosn correctly diagnosed a Japanese woman in ten minutes.

Health advances initially seen as futuristic, like virtual avatars and chatbots, are quickly becoming a reality. An article in The Irish Times, says these technologies apply AI to match discussions with people, connect to the Internet and perform tasks that normally require human intelligence.

Sensley’s an example. It’s a mobile triage mHealth app currently being tested by the UK’s NHS. Sensley has an AI nurse that guides patients  through their personal healthcare needs. It’s available all day, every day. Dressed in blue NHS scrubs, Seneley collects information by listening and asking questions similar to interactions between a clinicians and patients. Richard Corbridge, the developer and chief executive of eHealth Ireland says “Things are moving so fast that technologies we would have regarded as sci-fi last year, will become a reality this year. Over the last couple of years, Ireland has made some really big strides in digital healthcare.”

Corbridge believes that by 2019, all Irish maternity hospitals will be using advanced monitoring technology for newborns. Every newborn will have three devices in their cot, monitoring respiration, temperature and heart rate. Information will transfer automatically to their EHRs. In Healthcare Dive Corbridge says instead of constantly checking these levels individually, nurses will have a tablet to monitor the vital information and requests for tests, scans and results.“It’s an amazing leap for Ireland in a short space of time,” says Corbridge.

Will Africa’s health systems use AI soon too? Their eHealth strategies should now include a section on medium term plans for adopting AI.

Feb 20, 2017

WFPHA says PHA’s need to do more on eHealth

Opportunities for eHealth to improve public health need developing and promoting by Public Health Associations (PHA). These are the conclusions of an article in the Journal of Public Health Policy, Digital technologies for population health and health equity gains: the perspective of public health associations, by an international team. How did it reach them?

The World Federation of Public Health Associations (WFPHA) conducted a semi-structured interview with its national PHA members about their eHealth use, their eHealth challenges, and their experiences and thoughts on how to assess its impact. There were 17 responses, with more detailed discussions with ten PHAs, including Cameroon and Uganda.

A survey of the relative public health priorities showed:

This led onto three questions:

  1. How does eHealth facilitate the capacity of a PHA to achieve its mandate?
  2. How do PHAs use eHealth as a core element in their programmatic and advocacy activities?
  3. How do PHAs assess eHealth’s impact on population health and health equity?

How they use eHealth is:

These fulfil three main roles:

  1. Communicate with members
  2. Disseminate information about public health issues, best practices, and policies to members, stakeholders, and the general public
  3. Advocate, primarily to government representatives, policies and programmes to improve their country’s health system and have a positive impact on the public’s health.

Examples of PHAs eHealth use are:

  1. Governance
  2. Policy and advocacy
  3. Mobilising partnerships
  4. Identifying and solving health problems
  5. Informing, educating, and empowering people about health issues
  6. Analysing and investigating health problems and hazards
  7. Contributing to create and maintain a competent public health workforce
  8. Improving effectiveness, accessibility and quality of public health services.

Alongside these initiatives, advancing PHA’s eHealth has to address a long list of challenges and constraints that limit their capacity:

  1. Lack of qualified people to design and manage websites
  2. Lack of internal ICT competency in PHAs
  3. Internal human resource ICT capacity in PHAs is limited
  4. Using volunteers to design and manage their websites helps, but it’s insufficient
  5. Lack of resources, including donor funding, to support core operational costs
  6. While external funding can provide funds to start eHealth, it doesn’t extend to operating costs
  7. Some eHealth initiatives are specific to other projects and operate as long as funding is available
  8. Several projects share similar aims but use incompatible apps that can’t be scaled to national systems
  9. Lack of an explicit communications strategy that includes eHealth
  10. Need for leadership that encourages and supports change management to overcome internal resistance, experiments with new technologies, and improving effectiveness
  11. For PHAs in low income countries, problems with local infrastructure, Internet connectivity, low bandwidth capacity, interruptions in electricity supply, high costs of hardware and software maintenance, and inadequate real-time videoconferencing capability.

For Africa’s PHAs these are insurmountable on a significant scale in the short, and probably medium, term. Health systems also endure these constraints for their eHealth programmes.

A very encouraging consensus emerged from the survey. PHAs should include evaluation of eHealth impact on population health and health equity gains in their strategies’ communications components. This requires PHAs to use eHealth to identify all determinants that affect health and to explore how to exploit eHealth fully. Acfee’s working on frameworks and methodologies the help PHAs and health ministries to do this. It’s a welcome finding from the WFPHA.

The study suggests that PHAs should:

  1. Examine their eHealth’s impact
  2. Incorporate eHealth and allocate and reallocate resources for adoption and management into strategic and business plans and plans to assess eHealth’s impact the PHAs’ mandates and health and health equity
  3. Where PHAs have experiences using and assessing eHealth, mentor other PHAs and provide financial and technical assistance to help build eHealth capacity

WFPHA should:

  1. Put into place a programme to help PHAs, especially in middle and lower income countries, develop their capacity to use and assess eHealth
  2. Work with PHA members to develop an eHealth evaluation framework
  3. Customise and adapt methodologies and metrics to the needs of PHAs, including assessing inter-sectoral eHealth impact on health and building relationships with software developers

Host a session during the 15th World Congress on Public Health, bringing together PHAs, multilateral organisations, Canada’s International Development Research Centre (IDRC), and organisations outside of the health sector with experience in using and assessing eHealth impact, laying the groundwork for a global action plan on eHealth use and assessment of population health and health equity.

It’s a set of ambitious initiatives. As eHealth expands, these activities will have to expand with it.

Feb 20, 2017

Barkly sets out three ransomware predictions

As a criminal business, ransomware’s big. It’s set to be bigger. Jack Danahy, a Barkly co-founder, writing in Barkly’s blog says cyber-attackers will use three new methods in 2017.

  1. An extra threat of doxxing, public disclosure of private records, either a file at a time or as a catastrophic dump to increase the chances of victims paying the ransom
  2. Ransomware infections will spread more quickly and easily
  3. Fileless ransomware will increase rapidly.

A Barkly survey reports only 5% of US organisations say they paid ransoms. Better back-ups and easier data recovery have reduced ransom attack’s effectiveness. Cyber-criminals are shifting their attacks to businesses instead of consumers to demand more. It means they’re increasing the potential damage and disruption of not paying. Other countries are seen as softer targets too. It’s a warning for Africa’s eHealth and healthcare.

Ransomware attacks will also increasingly bypasses scanners and signature-based anti-virus security. It raises the chances of infection for less sophisticated organisations. These’ll add to the more common technique of phishing emails with malicious attachments. Fileless attacks aren’t easy to identify using conventional endpoint security tools.

The lessons for Africa’s eHealth are stark. Two main themes are:

  1. Stepping up basic cyber-security measures rapidly, and not just to deal with ransomware
  2. Adopt more sophisticated cyber-security to deal with emerging new threats, especially ransomware threats.

Health systems will need investment in new cyber-security skills and solutions. They’ll need new eHealth strategies too.

Feb 17, 2017

There are plenty of eHealth startups to watch out for in 2017

Technology and startups keep growing across Africa as more people search for unique solutions to everyday problems. Disrupt Africa monitors technology startups on the continent and recently published a report identifying South Africa, Nigeria and Kenya as the top three destinations for technology investors in 2016, both in terms of numbers of deals and total funding.

A Disrupt Africa list now sets out the top technology start-ups for 2017, ITNEWS Africa  selected ten start-ups it predicts will influence the market this year. Of the ten innovations, three are in healthcare. They are:

Flare, a Kenyan start-up. Its app aggregates available ambulances onto a single system and allows patients or hospitals to request emergency help using a smartphone. Flare underwent testing with ambulances throughout 2016 ahead of the release of an Uber-style consumer-facing app.

Jumaii. a Tanzanian company. Its app provides a mobile micro-health insurance product for low income and informal sectors. It’s built a mobile policy management platform that performs all the administrative activities of an insurer and allows users to access cheap insurance. Jamii won the Tanzania Seedstar World competition and is set to launch in Kenya, Uganda, Ghana, Nigeria and South Africa in 2017.

Dr CADx, a Zimbabwean start-up founded in 2016. It’s developing a computer-aided diagnostic system to help doctors diagnose medical images more accurately and provide pervasive radiology diagnostics in regions that don’t have radiologists. The solution’s designed to be used by medical professionals on existing computers and tablets. Dr CADx is able to diagnose most diseases but the start-up’s initial focus is on lung diseases such as tuberculosis, pneumonia and lung cancer, as well as head injuries and breast cancer. Dr CADx was named winner of the Zimbabwean edition of Seedstars World.

All the best to the startups. We’re looking forward to reporting on your successes on eHNA soon.

Feb 17, 2017

There’s a new wave of wearables

Wearables in mHealth act as an extension of the wearer’s body and brain. The device usually works in partnership with smartphones that allow us to access digital content without being distracted from the physical environment. The increase in the use of wearables is highly driven by the growth in mobile apps which are designed to monitor and improve the users’ health and wellbeing. MobileEcosystem Forum has estimated that the global health and fitness app market is approximately $4 billion now and could be worth $26 billion in 2017.

Mhealthwatch has a new report on wearable from ABI Research. It says there’s good reason for immense growth in mHealth wearables. Data shows that these devices boost patients’ healthcare, both inside and outside hospitals. The surge in patients using wearables to monitor their healthcare’s is helping to reduce readmission risks and prevent the occurrence of serious medical traumas. It’ll help alleviate the growing performance pressure on healthcare services and providers too.

Devices include blood pressure monitors, continuous glucose monitors, pulse oximeters, and newer devices, like Fatigue Science’s fatigue monitor. These send prompt, real-time alerts about condition, deteriorations or fluctuations. It’s effective by reducing response times by health workers to potentially life-threatening changes, saving healthcare resources.

Stephanie Lawrence, Research Analyst at ABI Research, sees a new wave of wearable benefits. “While previously professional-grade patient monitoring largely limited itself to a doctor’s rounds, new wearables allow medical professionals to remotely and continuously monitor patients in the hospital and beyond.” These offer Africa’s health systems new opportunities to improve health, healthcare and resource utilisation.

Feb 16, 2017

NSA says cyber-attacks in healthcare will be a lot worse

The nature of cyber-crime’s changing. Health systems are no longer safe. Cyber-criminals have moved on from stealing personal data to using more disruptive tactics. An article in Healthcare IT News says healthcare’s seen the largest jump in ransomware attacks, so more than other organisation.

Joel Brenner, a Massachusetts Institute of Technology (MIT) research fellow who focuses on cyber-security, privacy and intelligence policy explained “We’re facing industrial espionage on an industrial scale.  If espionage is not the oldest business in the world, it’s the second oldest.”

While he admits healthcare may not top the list in terms of incidents or breaches, it’s ahead on four unwanted scores:

  1. Highest percentage of incidents
  2. Highest number of incidents by stolen assets
  3. Loses more information
  4. Very high ratio of incidents to breaches.

These combine into an uncomfortably high success rate for the number of cyber-attacks succeeding more often than not.

Tangible actions organisations can take to reduce vulnerabilities include privilege misuse and BYOD, which Brenner caustically calls ‘Bring Your Own Disaster.’ Also recognize that not everyone needs access to everything. “It’s about training your people repeatedly,” Brenner said. “You don’t need a big plan, no one opens that manual in times of crisis. You need a simple checklist.”

Unbroken cyber-security’s essential too. Unfortunately, most organisations can’t afford it and don’t trust a vendor enough to tackle the problem. Information silos offer an equally pressing challenge. Brenner says high-level executives are part of the problem and the solution. “Unless someone high level in these siloes comes in with a baseball bat,” Brenner said, “it’s not going to be solved.” 

Africa’s health systems can learn from the US’s experience. Putting in place an easy check lists for cyber-security measures and continuously training staff may be two simple steps, but they go a long way in keeping eHealth secure. They’re essential components of cyber-strategies, so why wait until the strategies and plans are in place. Checklists and training can be set up now.

Feb 16, 2017

Africa’s eHealth legal framework needs developing – unpacking the 3rd Global Survey on eHealth

Africa’s eHealth legal and regulatory framework is behind global trends, as eHNA has reported. More insights are provided in Chapter 6 of the WHO Global Observatory for eHealth (GOe) publication eHealth Report of the third global survey on eHealth Global diffusion of eHealth: Making universal health coverage achievable. The report's data source is the WHO Global Survey 2015.

Key findings include:

  • Slow but steady development of general eHealth regulation, with 33% of countries with  specific policies or legislation to define medical jurisdiction, liability or reimbursement of eHealth services
  • About 47% have legislation to promote safety, quality and standards of health related data
  • About 78% have health data privacy legislation and 55% have legislation to protect the privacy of electronically patient data. They’re up from 73% and 31% since 2010, so a big step up for eHealth data laws.

The survey focused on EHRs, which are dealt with in detail in Chapter 5. They are seen as the basis of eHealth systems, so a good indicator of general eHealth regulatory framework maturity. Consequently, countries that don’t have EHRs aren’t covered.

Africa’s overall position’s about half the global average. Catching up is not easy, Much of the current eHealth regulation’s generic, such as data protection laws and telecommunications regulation. It takes time to find a slot in countries' legislative programmes. eHNA posted that Angola took some five years to complete its data protection laws. This’s a typical timescale that other countries have said is needed to move eHealth regulation on.

The challenge is exacerbated because eHealth regulation extends well beyond EHRs. Examples are data transfer and communication using mHealth services and new regulatory aspects such as eHealth governance and cyber-security. African countries will be unable to set up comprehensive regulations for all eHealth settings in the medium term, so setting eHealth regulation priorities is crucial.

From these, eHealth laws and regulations are needed alongside finance and resources for a regulatory body and compliance reviews. These have to compete with finance and resources for expanding eHealth services and emerging demands such as cyber-security and human capacity building. An important question for Africa’s how much eHealth regulation’s needed?


Image from the WHO report

Feb 15, 2017

Africa’s next mHealth phase may have a wider structure

While Africa’s mHealth initiatives scored highly in the 2015 WHO eHealth survey, a constant challenge for all countries is fitting them into the wider eHealth setting. A whitepaper by Athena Health, Going Mobile: Integrating Mobile to Enhance Patient Care and Practice Efficiency identifies how mHealth is used and how its strategic setting can be developed. mHealth Intelligence says healthcare leaders need a “thoughtful approach to integrate mobile health technology.”

The whitepaper says it includes: 

  1. Clinical decision support (CDS) by evaluating and selecting the best mHealth
  2. Workflow efficiencies, using mobile-enabled devices, services, and software to optimise data retrieval, documentation and healthcare transactions
  3. Communication and co-ordination by connecting and sharing information between providers to improve healthcare co-ordination
  4. Patient engagement to support population health, improve compliance, and engaging patients in their care
  5. Security and privacy and ensuring its effective for mHealth.

These present two challenges for healthcare organisations:

  1. Evaluating and selecting mHealth solutions that maximise support for clinical outcomes, co-ordinated healthcare, workflow efficiency, patient engagement, and population health
  2. Protecting the security and privacy of information shared using mHealth.

mHealth features that need assessing in these decisions include:

  1. Secure, and compliant with laws and regulations
  2. Focused on efficiency and measurable results
  3. Integrated with patient communication and EHRs
  4. Supporting CDS and better health outcomes
  5. Easy to use by clinicians and patients
  6. A strong platform for patient engagement
  7. Flexible, to accommodate mHealth innovations and changes.

These provide Africa’s health systems with an initial strategic structure to integrate and direct their current mHealth services and plans. A bigger challenge is evaluating a widening range of mHealth innovations and opportunities as a set of integrated business cases.

Feb 15, 2017