eHealth Articles (1,988)

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.

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Feb 16, 2017
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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.

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Feb 16, 2017
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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?

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Image from the WHO report

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Feb 15, 2017
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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.

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Feb 15, 2017
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mHealth can help Lesotho’s huge HIV challenge

HIV’s still a global epidemic affecting most Low and Middle Income Countries (LMIC).  Some 4% of people in Africa are HIV+. At 12% of all deaths, HIV/AIDS is the biggest cause.

Lesotho’s no exception, in fact it’s much worse. According to the UNAIDS Gap Report, 310,000 people in Lesotho are living with HIV, about 23% of the population. Only 42% of adults receive Anti-Retroviral Treatment (ART).  Most of Lesotho’s population live in rural areas, making healthcare access challenging.  

One of the benefits of mHealth is meeting challenges of poor healthcare delivery, especially for HIV treatment. To address this challenge, The Guardian has reported that Lesotho’s Ministry of Health (MOH) has introduced an mHealth programme developed by Vodacom. It’s a combination of a smartphone app for healthcare providers and M-Pesa, a mobile money service for the patients. M-Pesa is a money transfer service for people to receive or send money using a mobile phone. It’s widely available throughout Sub-Saharan Africa. Since women and young children are most affected by the HIV epidemic, the programme focuses mainly on them.

The programme allows healthcare providers to undertake on-site HIV testing through a mobile clinic in remote areas where travelling’s difficult so that community members can receive care. Healthcare providers can register HIV+ patients in the central database that’s used to provide patients with funds through M-Peas for transport costs. Health care providers can also use the database to plan, record and access treatment.

If the mHealth programme’s delivered as planned, it should achieve three benefits set out by Ken Congdom of Health IT Outcomes:

  • Improved data accuracy
  • Improved data access
  • Improved patient care

HIV is an immense healthcare crisis for the people of Lesotho. This programme aims to ensure that thousands of mothers and young children in some of the poorest communities in the world receive the care and support they need.  

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Feb 14, 2017
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A review of EHRs sets out taxonomy challenges and concerns

Like the term eHealth, EHRs are not strictly and unambiguously defined. A study in the Journal of Medical Internet Research (JMIR) has researched the literature and set about the task. It also identified concerns and challenges. The findings are essential for Africa’s health systems as they move their EHRs on.

Its Personal Health Record (PHR) taxonomy comprises three main categories:

  1. Structures, the main data types and standards used
  • Data types in PHRs
  • Standards that PHRs can adhere to
  1. Functions that depicts the main goals and features of PHRs
  • Users profiles and types that interact
  • Interactions of patient types with PHRs
  • Data sources and techniques for information input
  • Goals that represents PHRs’ aims
  1. Architectures types and scope
  • Descriptions of the main architecture models
  • Coverage as physical locations and divisions for data

There’s a wide range of challenges and concerns that need addressing. There are four main categories:

  1. Collaboration and communication
  • Context-aware computing
  • Wearable computing and IoT
  • Artificial Intelligence (AI) for health
  • Personalisation, usability, familiarity and comfort
  • Managing medications
  • Data generated by patients
  1. Privacy, security and trust
  • Confidentiality and integrity
  • Data repository ownership
  • Authorisation and access control technologies
  • Secure transport protocols
  1. Infrastructure
  • Portability between devices, equipment and hardware
  • Efficiency and scalability
  1. Integration
  • Patterns in collecting medical data
  • Terminology
  • Interoperability.

For Africa’s health systems, these range from long-standing eHealth challenges to new challenges coming with constant eHealth innovations. They’re demanding to deal with, and increase with complexity the longer they’re left.

Three common requirements to progress are affordability, benefits realisation and health systems human eHealth capacity and capabilities. They need adding to the list.

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Feb 14, 2017
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Kerala State launches its eHealth project

An ambitious eHealth project has started in India. It offers an investment model that could fit Africa’s health systems. Kerala State Government has launched its project, supported by the World Bank. Its goals are:

  1. EHRs for its population
  2. End-to-end automation of all government healthcare organisations
  3. Integration of an electronic demographic database.    

In its report on the initiative, The Hindu says it builds on a pilot in twelve locations in Thiruvananthapuram district. The new project scales it up across the State and will link with all Health Management Information Systems (HMIS). There are two main components, a public health module and a hospital automation module. The public health module will be launched across the State immediately. The latter is planned for scale up in seven districts in three months as Phase 1.

The seven locations are Thiruvantheapuram, Kollam, Alappuzha, Idukki, Ernakulam, Kararagod and Malapuram. Eventually, all health organisations will connect to the State Data Centre using the Kerala State Wide Area Network. Institutional networks will rely on services from Bharat Sanchar Nigam Limited (BSNL), the Indian state telecommunications company based in New Delhi.

The consortium’s led by Hewlett Packard Enterprise. Hardware’s procured by Keltron, India's first and largest electronics corporation in the State sector. Kelara State IT Mission has the role of technical support.

Not all Africa’s health systems can start as such large-scale eHealth projects. For these, Kerala’s initiative provides a clear profile of an eHealth future that Africa’s health systems can move towards.

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Feb 13, 2017
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IHE consults on eye care standards

There’s a new supplement to Integrating the Healthcare Enterprise (IHE) Eye Care Technical Committee Framework. It’s C-CDA Based General Eye Evaluation (GEE), and has been available for trial implementation from 29 December 2016.

GEE comprises profiles of patients’ visits and encounters. It defines the structure of data collected during patients’ general eye examinations. The American Academy of Ophthalmology (AAO) created a collection of recommended Practice Patterns (PPP). The supplement’s based on information in the AAO’s Comprehensive 370 Adult Medical Eye Evaluation October 2010 PPP specification. The new GEE profiles enable implementations to populate Intelligent Research in Sight, the AAO IRIS™ Registry.

Comments can be sent to Eye Care Comments. It’s an opportunity for healthcare professionals in African countries to participate in IHE’s standard setting for their speciality.

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Feb 13, 2017
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How safe are hospital devices?

Effective and sustainable eHealth is a longstanding priority for many developed countries in improving healthcare and its information, access and quality. It can be a catalysts between healthcare providers and patients to provide quality healthcare while bridging the gap between inequity and distribution of health resources.

The rapid growth of eHealth has, however, increased concerns about cyber-security. An article in Computer Business Review (CBR) says there are new emerging threats on hospital’s devices connected to web. While there’s considerable emphasis on protecting patients’ records, there’s insufficient accorded to guarding web connected hospital devices. Hacktivists and other cyber-criminals are finding new ways to penetrate hospitals’ health systems vulnerabilities, and these extend to online EHRs and devices.  

Internet of Things (IoT), hospital and wearable web connected devices, such as insulin pumps, pacemakers, heart and blood pressure monitors, are susceptible to targeted attacks by hacktivists, terrorists and organised crimes gangs. When healthcare data’s placed in the wrong hands, the consequences could be fatal.

WHO says  health systems in Africa are investing in eHealth and its mHealth component in their quests for Universal Health Coverage (UHC), accessibility and quality. Despite the expanding programmes, Africa’s eHealth is still nascent, with some healthcare providers and public health agencies still unaware of eHealth’s possibilities in improving health and healthcare quality and access.

As eHealth becomes more widespread in Africa, hospitals should learn from developed countries about a holistic approach in increasing cyber-security in both patients’ records and hospital devices. Allocating equal distribution of resources to implementing eHealth programmess and services and in increasing cyber-security in both hospital records and devices are key. Acfee has a report on eHealth cyber-security. It’ll be available on Acfee’s website soon, then followed up with supplementary commentaries are more information and insights become available. Acfee members will be notified when it’s available.

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Feb 10, 2017
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MamaYe provides MNH benchmarks and lesson

Two stark statistics from Nigeria are “Each day in Nigeria, 109 women lose their lives due to pregnancy-related issues and 660 newborns die from preventable causes.” MamaYe has a clear goal to improve it by making “Life-saving change for mothers and babies in Nigeria.” It’s one of six countries in the Evidence for Action (E4A) programme, E4A-MamaYe. The other five are Ethiopia, Ghana, Malawi, Sierra Leone and Tanzania. The initiative aims to use better information, advocacy and accountability to save lives. It’s financed by the Gates Foundation

Five project reports are published in the International Journal of Gynecology and Obstetrics. They describe accountability arrangements and publicise E4A-MamaYe experiences and achievements in Maternal and Neonatal Health (MNH) that are essential to achieve Sustainable Development Goal (SDG) 3

The first paper provides a review of the MNH accountability mechanisms in sub-Saharan Africa that have been implemented and assessed. It offers a conceptual framework to guide discussion.

The second paper discusses political accountability using a review of three global and regional mechanisms used to monitor and track MNH progress. It draws on how global and regional commitments have impacted national responses, as shown in the E4A countries.

The third paper deals with performance and accountability of Maternal Death Surveillance and Response (MDSR) systems, especially response and action components. It includes describe describes the E4A-MamaYe country experiences in implementing MDSR systems.

The fourth paper sets out a case study on a pilot for social accountability to improve MNH services in Ghana. The project uses scorecards and engaging stakeholders in districts.

The fifth paper provides another case study on how evidence supported a campaign on budget advocacy in Sierra Leone. It advocates financial and budget monitoring to ensure financial commitments for MNH are sustained.

MDSR Technical Guidance proposes several actions to increase effectiveness and sustainability. They include:

  1. A supportive institutional culture fostering a learning environment
  2. Multidisciplinary teams at different health system levels to review, communicate and act on findings
  3. Leadership and commitment of government and healthcare staff
  4. Aggregate data from facility and community to higher levels to provide a deeper understanding of gaps in care quality and system-wide challenges
  5. Recognising that local and less resource-intensive solutions can save lives.

These are relevant for Africa’s eHealth governance. An example is Nigeria’s Commission on Information and Accountability (COIA) tracking progress on maternal and child health. It reviews MNH features such as the latest MNH numbers, their variations between urban and rural areas, and impact of education on young women using contraception. There’s much more evidence on MamYe’s progress that provide benchmarks and lessons for all Africa.

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Feb 10, 2017
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