eHealth Articles (1,988)

mHealth improves access to essential medicines in Nigeria

Tracking and stocking essential medication are challenges for many African countries. People living in rural areas often don’t have access to primary health care facilities, and even if they do, facilities frequently run out of essential medicines. To address this problem, Kaduna State Ministry of Health, the third most populous region in Nigeria, Vodacom and Novartis have implemented SMS for Life 2.0, an mHealth programme.

SMS for Life 2.0 isn't a new concept. It builds on the SMS for Life programme launched by Novartis in 2009, which used cell phones to manage stock-outs of malaria medicines in more than 10,000 healthcare facilities across sub-Saharan countries says an article in eHealthNews.

Pharmi web has the Novartis press release. It says SMS for Life 2.0 uses smartphones and tablet computers to improve access to medicines and increase disease surveillance, helping to provide better care for patients. It also builds on its success and introduced eLearning for local health workers.

SMS for Life 2.0 allows healthcare workers to track stock levels for  HIV, TB and leprosy treatments, and antimalarial vaccinations. It also allows them to send notifications to district medical officers when stock levels are low, ensuring adequate and timely supplies of all essential medicines.

SMS for Life 2.0 will also:

  1. Monitor disease surveillance parameters of maternal and infants deaths, malaria, yellow fever and cholera
  2. Improve stock visibility which will improve supply chain management, by allowing authorities to improve demand forecasts for the treatments
  3. Facilitate health workers’ training in local facilities using eLearning modules
  4. Improve healthcare by better access to essential medicines so reducing disease prevalence in communities

Zambia’s Ministry of Health has recently signed a Memorandum of Understanding (MOU) with Novartis to roll out SMS for Life 2.0 to some 2,000 health facilities. It’ll start in 2017.

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Feb 02, 2017
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Prof says health ICT won’t replace doctors

Benefit claims for big impact ICT diminishing health professionals’ role may be exaggerated. Steve Jobs said “Technology is nothing. What's important is that you have a faith in people, that they're basically good and smart, and if you give them tools, they'll do wonderful things with them". It puts health ICT in a role as a tool for health professionals, not a replacement. It’s an important concept for Africa’s eHealth.

Instead, medicine’s fundamentally about human interaction. It’s the most important challenge, but he says the technology sector hasn’t locked onto that part of eHealth.

Dr Ezekiel Emanuel is a senior fellow for the Center for American Progress and chair of the Department of Medical Ethics and Health Policy at Pennsylvania University. In an interview with KQED Science, his views seem in line with Steve Job’s. He sees himself as a techno-sceptic, saying eHealth should augment healthcare, and the idea ““I am much more skeptical that the computer is going to replace a doctor. That a computer is going to interface with the patient and take care of them. Not gonna happen.”

He sees this stretching across the eHealth continuum. While wearables for continuous monitoring can provide valuable and prompt clinical information, the challenge’s how health professionals use it, so human utilisation and interaction’s essential for realising eHealth’s benefits.

Some of Africa’s eHealth proponents see eHealth as a means of extending healthcare as part of Universal Healthcare Coverage (UHC) within existing, inadequate resources. However, the impact may be diminished with eHealth augmenting care rather than expanding access to it. It means eHealth is just one of the resources needed for UHC.

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Feb 02, 2017
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Acfee and Rome Business School collaborate on eHealth Masters

Today Acfee signed a collaborative agreement with Rome Business School (RBS) to enrol more African students on its Masters in E-Health Management. It’s a course with a proven track record and includes students from across the spectrum of health and healthcare professions, not just people working directly on eHealth. RBS already has students from Africa. Acfee members can now benefit from discounted fees.

A core goal for Acfee is helping our colleagues across African countries to develop their countries' human eHealth capacity. Formal, university education is part of this and Acfee is building partnerships with a number of institutions in Africa and beyond. There’s now an opportunity for all types of Africa’s health and eHealth entities to set up programmes of eHealth learning for all types of workers who want to advance eHealth to achieve healthier Africans.

It’s a big step forward for Africa’s eHealth to have wider access to RBS's proven Masters programme. The course is a combination of theory and case studies from live eHealth projects. The next one, in English, starts in March 2017 and completes in September 2017. Another course is planned to start later in the year. There are also opportunities for seminars and workshops.

The discounted price is only available to Acfee members. Acfee membership is free to individuals working in health and eHealth, health and healthcare organisations and professional bodies and health ICT entities. If you’re already a member, you can use your Acfee membership number in your RBS application. To join, email info@acfee.org with details of your current role and employer, and Acfee will send you a membership number and information pack. For security purposes, Acfee holds members’ details offline.

RBS is a managerial training and research institute of excellence. It operates internationally. Its aims are to help to close the gap between academia and job markets by providing managerial training courses that convey the knowledge needed to kick off or develop professional careers or business activities. Its mission is to train entrepreneurs, managers and professionals to a level of excellence in their competence and ethics in business and work. This extends to them contributing to developing economic humanity, more prosperous and fair societies and respect of the central role of individuals.

Building from this ethos, Acfee will help people achieving their Masters to become part of a growing community of African eHealth professionals. Please don’t hesitate to contact Acfee for more details and help in designing an eHealth training programme tailored to your country's needs.

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Feb 01, 2017
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WHO shows Africa’s health eLearning is trailing – unpacking the 3rd Global Survey on eHealth

Both health and healthcare rely on intensive, continuing learning. Reaching everyone who needs it’s challenging for African countries. While eLearning can help, Africa’s trailing global trends. eLearning data from WHO Global Survey 2015the data source for the  WHO and Global Observatory for eHealth (GOe) publication eHealth Report of the third global survey on eHealth Global diffusion of eHealth: Making universal health coverage achievable, provides insights for Chapter 4.                                                                                              

It found at least two thirds of responding Member States use eLearning for health science education, both pre-service education and in-service training, with Africa at 48%, so about 70% of the global average. Putting this outlying performance in the context of healthcare spending per head shows it as a considerable achievement.

Africa’s average healthcare spending per head’s some US$145, about 14% of the World Bank global average of about US$1,061. The highest’s about 62%, the lowest less than 2%. WHO’s eLearning score of 70%’s well above these, indicating a relative high priority accorded to eLearning in a stringent resource context.

A global eLearning profile’s:

  1. Medical students education at 91%
  2. Doctors education at 84%
  3. Pre-service education at 80%
  4. In-service public health education at 68%.

Five barriers to eLearning programmes supporting Universal Health Coverage (UHC) are, lack of capacity, availability of courses, human resources, finance and cost-effectiveness evidence. WHO’s report says evidence shows that eLearning for health professionals’ education is effective or more effective than traditional teaching. This offers a good case for advancing eLearning if Africa can ease through the other barriers.

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Feb 01, 2017
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Mamaope’s a biomedical jacket that diagnoses pneumonia

Pneumonia accounts for 16% of all deaths of children under five, killing roughly 920,000 children globally each year. It’s a massive challenge for Uganda, where nearly 24,000 children die each year. A lack of access to laboratory testing and infrastructure in rural communities means that health workers often have to rely on simple clinical examinations to make their diagnoses. This often leads to misdiagnosis and preventable deaths.

To tackle this problem, Olivia Koburongo Brian Turyabagye and a team of doctors from Uganda, created the MamaOpe (Mother's Hope) kit to help diagnose pneumonia. It comprises a mobile app and a biomedical wearable smart jacket, says an article in Daily Nation.  

MamaOpe kit is simple and easy to use. Health workers simply slip the smart wearable onto a child so the sensors on the jacket can detect his or her breathing rate, temperature and the lungs’ sound patterns. The information’s then sent via Bluetooth to the mHealth app. An analysis determines the severity of the disease. Once the information’s captured and stored in the cloud, doctors can access it remotely, helping health workers make better decisions.

Although the smart jacket’s still a prototype, early results are promising. Studies by the engineers indicate that it can detect and diagnose pneumonia three times faster than a health worker can. It reduces human error too.

The team’s currently patenting the kit, which’s shortlisted for the 2017 Royal Academy of Engineering Africa Prize. Plans are underway to pilot the kit in Uganda's referral hospitals, then distribute it to remote health centres.

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Jan 31, 2017
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eHealth for sexual and reproductive health has challenges

As a solution for better health, eHealth may not always be straightforward. A team from Mexico and Colombia reviewed the evidence for eHealth and Sexual and Reproductive Health (SRH) and found clear progress for eHealth for SRH in Latin America and the Caribbean (LAC), many persistent institutional and technological challenges too, and the need for more studies should test eHealth’s beneficial effects on improving access to SRH services. It has an important value for Africa’s health systems and their strategies and plan for eHealth in SRH.

The team describes its study in an article in the Journal of Public Health Policy, Health information technologies for sexual and reproductive health: Mapping the evidence in Latin America and the Caribbean. It includes an evidence map of articles published between 2005 and 2015 about using eHealth to enhance SRH services in LAC countries. Most documents retrieved correspond to information provided by technology developers and primarily for sexually transmitted infection prevention and adolescent health.

Maternal mortality rates in LAC have dropped by 38% over the past 15 years. Despite this success, LAC faces many challenges in guaranteeing good quality and affordable SRH services, including controlling HIV infection in vulnerable groups, reducing adolescent pregnancies, and high caesarean section delivery rates. eHealth’s widely proposed as an element of a complementary strategy to strengthen health systems.

There’s a substantial number and type of eHealth and mHealth services available. The percentage distribution across eHealth from the 31 reports included in the study shows SMS and websites as the most used for SRH.

There were five main health categories in the review, but they’re not mutually exclusive because eHealth covers more than one. HIV is set apart as the main emphasis.

About two-thirds of the studies focused on free eHealth. Their distribution across SHR service access priority group focus was wide. The international priority was greatest, communities second.

The study provides a valuable eHealth status for SRH and a foundation to build from for the next stages of eHealth development. There’s more to do. The report shows that the LAC’s recent efforts to increase the use of eHealth for SRH isn’t derived from a general strategy to expand and evaluate eHealth’s use. Learning from successes in other developing countries should be part of the next steps. This’s good advice for Africa’s health systems too.

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Jan 31, 2017
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Doctors are divided on EHRs’ benefits

eHealth can offer benefits, but new costs too. Even good eHealth can end up with limited potential due to inept or unfulfilled implementation and operation. In the British Medical Journal (BMJ), two teams of doctors in the USA offer their opposing views on EHRs’ benefits. They’re not a representative sample, but the divergent views provide insights that Africa’s health systems can expect to encounter and deal with as they pursue EHRs’ and other eHealth goals.

The team from Christus Health in Texas refers to studies showing EHRs reduce prescribing errors, shorten hospital stays and reduce mortality. This is despite its EHRs being immature, so containing some flaws. An encouraging theme’s that the team sees EHRs on an improving trajectory.

Another benefit’s helping to reduce iatrogenic harm, illnesses caused by medical examinations or treatments. Progress’s seen as avoiding the eHealth trap and delay of pursuing a perfect EHRs delay instead good and developing EHRs sooner. Preventable iatrogenic errors cause 200,000 to 400,000 deaths a year in the US, so a leading cause of death.

Related eHealth also provides benefits. Computerised Physician Order Entry (CPOE) accelerates healthcare delivery, improves efficiency, reduces the number of professionals in clinical workflows, and decreases delays, adverse events, and errors from illegible handwriting and miscommunication.

These seem valuable benefits, so what’s the problem with EHRs. The team from Yale School of Medicine and the University of California, San Francisco (UCSF) says EHRs are detrimental to physician and patient relationships. Physicians can spend twice as much time staring into a computer compared to face time with patients. He team isn’t against EHRs and eHealth. They’re more against the position where EHRs aren’t yet ingrained in physician workflows. This may be due to approaches to EHRs that have inadequate needs assessment and adjustments for end user needs.

The teams describe their views on a BMJ podcast. It seems that the maturity of EHRs’s a common thread. Choices extend across a continuum of go for EHRs now to improve them or wait until they’ve improved. At is simplest, a choice depends on the balance between the value and timing of EHRs’ probable costs and benefits. Probable’s more important than potential benefits, which are considerable, but rarely achieved, if ever.

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Jan 30, 2017
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Phishing gave hackers access to 80 million health records

While phishing’s an elementary cyber-attack, its results can be enormous if it works. The US Anthem health insurance attack in 2015 resulted in an employee in a subsidiary organisation opening a phishing email. Attackers then had remote access to move across at least 50 accounts, 90 over systems, including Anthem’s enterprise data warehouse where the bulk of more than 78 million records were stolen.

A report from the California Insurance Commissioner found that Anthem took “reasonable measures” to protect patient information prior to the breach, the attacker targeted specific weaknesses within the system. On Feb. 18, 2014, an employee within an Anthem subsidiary opened a phishing email, allowing the attacker to gain remote access to the computer and then move laterally across  accounts, including the insurer’s enterprise data warehouse where the bulk of the information was stolen.

Investigators believe perpetrators of the 2015 Anthem hack that exposed personal records of more than 78 million people may have been acting on behalf of a foreign government, exploiting weaknesses in the insurer’s system that are commonplace within the industry.

Investigators determined the identity of the hacker with “high confidence.” They concluded with “medium confidence” that the attacker was working on behalf of a foreign government, but didn’t identify the offenders. Officials have previously linked the attack to Black Vine, a Chinese cyber-espionage group. Symantec, the cyber-security firm, says it’s “highly resourceful” and been targeting several high profile entities since 2012, and believes it’s behind the Anthem attack.

 Africa’s health care’s not immune. While cyber-crime opportunities may be more attractive in other health systems, Africa still needs effective cyber-security

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Jan 30, 2017
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Algorithms can carry rare, but big risks

As algorithms expand and replace human decisions, they make life easier and can make better decisions. They also have another, less valuable effect. They reduce users’ skill and decision-taking levels. So, when users have to intervene for the rare decisions that are beyond algorithms’ capabilities, users may not be sharp enough.

This phenomenon’s set out in Messy How to be Creative and Resilient in a Tidy-minded World by Tim Harford, published by Little, Brown. He describes several examples where it’s happened, and they’re often catastrophic. This’s the territory that Big Data and analytics are taking eHealth.

Gary Klein, a psychologist, has researched decision taking and supports Harford’s view. In Streetlights and Shadows Searching for the Keys to Adaptive Decision Making published by MIT Press, he says when algorithms take decisions, users tend to stop improving their skills and performance. Algorithm dependency’s associated with people’s eroded judgement, increasing their algorithm dependency in a vicious cycle. Eventually users become passive and less vigilant. In healthcare, it can be catastrophic.

A solution’s to use algorithms to confirm healthcare professionals’ decisions. Where it’s been tried in aviation and meteorology, human decisions are usually supported by algorithms. This creates a role for algorithms of ensuring people haven’t overlooked something significant in a critical decision. It also keeps people in control and their decision-taking prowess sharp.

As Africa’s health systems adopt algorithms, it’s important they don’t become replacements for healthcare professionals. If they do, on the rare occasions when algorithms can’t do it, people who intervene might not have skills that are too rusty to be able to do it either.

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Jan 27, 2017
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mHealth might not help to improve health more than switching to a Mediterranean diet

Tucking into a tasty Mediterranean diet’s seen as adopting traditional healthy habits of people living in countries bordering the Mediterranean Sea, especially France, Greece, Italy and Spain. While their cuisines vary, and sometimes within countries’ regions, so has a range of definitions, its common components are mainly vegetables, fruits, nuts, beans, cereal grains, starchy foods like bread and pasta, olive oil, fish and modest amounts of meat. The diet’s similar to the UK government's healthy eating advice set out by the NHS in the Eatwell Guide.

It’s not feasible for all Africans to comply with this advice. Many of the required ingredients aren’t readily available across all-Africa. Where they can, it’s worth the attempt. Strokes and Ischaemic heart disease are the causes of about 8% of deaths across Africa. The diet’s associated with good health and a healthier heart. In 2013, a study found that people eating a Mediterranean diet had a 30% lower risk of heart disease and stroke. With such good results, researchers have sought the best way to convert people’s dietary preferences and exercise more. A report in the Journal of Medical Internet Research (JMIR) on the Short-Term Effectiveness of a Mobile Phone App for Increasing Physical Activity and Adherence to the Mediterranean Diet in Primary Care: A Randomized Controlled Trial (EVIDENT II Study) tested the value of mHealth in Spain.

The randomised controlled clinical trials included 833 participants. It had a follow-up of twelve months with a three month short-term follow-up. Two groups were counselling and mHealth combined with counselling. A GT3X accelerometer from ActiGraph recorded continuous, physical activity, and sleeping and wake information.

Measurements looked for:

  1. More Physical Activity (PA) evaluated by the seven-day Physical Activity Recall (PAR)
  2. More leisure time spent on Moderate-to-Vigorous PA (MVPA)
  3. Mediterranean Diet Adherence Screener (MEDAS) scores.

Both groups achieved more PA, with the mHealth and counselling group increasing a bit more for MVPA. The differences weren’t significant. The accelerometer analysis showed the mHealth and counselling group that used GT3X most had a net increase in MVPA, and a net decrease in sedentary times. Both groups had similar MEDAS scores too.

There’s still no conclusive evidence for mHealth in improving lifestyles. This’s an important finding for Africa’s mHealth programmes. Rigorous assessment and business cases are vital before committing resources.

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Jan 27, 2017
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