Sean Broomhead

Chief Technology Officer

  • Rome Business School has a short course on using the Digital Health Investment Framework

    eHealth finance and economics are core components of the  Masters in eHealth and Telemedicine Management at Rome Business School. The module includes an assignment on using outputs for the Digital Health Investment Framework (DHIF), an Asian Development Bank initiative.

    An important theme in DHIF is equipping users with the skills and knowledge to begin using it to support eHealth investment decisions. Building on this, the School now has a short course of five sessions on DHIF, all available online.

    The first course starts in February 2019. Participants can Enrol now.

    The course objectives are:

    • Identify the architecture, characteristics and the roles of a DHIF model
    • Understand the concepts and methodology using illustrative DHIF models
    • Apply DHIF to real-life projects
    • Review DHIF illustrative models.

    Learning outcomes are:

    • Understand and develop investment goals of health, healthcare, and digital health strategies
    • Define different stakeholders’ types, user requirements and required functionality
    • How to develop DHIF architecture and content
    • Identify appropriate network requirements, and data and capacity dependencies from other eHealth investments
    • Develop personal skills in stakeholder engagement, human capacity building in using the DHIF and change management skills

    Contents are:

    • Introduction to DHIF
    • Introduction to eHealth costs and benefits
    • Introduction to decision making
    • Putting it into practice, using participants own DHIF models.

    Two organisations, Società per la Salute Digitale e la Telemedicina (SIT) and Acfee are patrons of the School's Masters in eHealth and Telemedicine Management. The DHIF short course is linked to its eHealth finance and economics module.


    The DHIF course is appropriate for Acfee’s eHealth Investment Model for Africa (eHIMA), reported in eHNA. It will enable participants from Africa’s health systems to achieve a fast start up.


  • A manual for Africa to use Asia's Digital Health Impact Framework

    Following the completion of the Digital Health Impact Framework (DHIF), an Asian Development Bank project, Acfee is completing its version for Africa. It draws directly from DHIF, and emphasises ways that Africa’s health systems can start simply and use it as a platform for increasing sophistication in appraising planned eHealth investment.

    The prototype, eHealth Investment Model Africa (eHIMA), mirrors the development track of DHIF’s forerunners that include the eHealth Impact model and the Five Case Model for business cases.  Both methodologies were less sophisticated in their original formats, and have been enhanced to meet increasing needs of decision takers. eHIMA is at the equivalent entry point for African health systems.

    eHIMA combines socio-economic , financial and accounting concepts to estimate eHealth projects’ Value for Money (VFM) and affordability over time.  These are dealt with in DHIF’s ten steps:






    • Identify timescales
    • Identify stakeholders
    • Identify benefits
    • Identify resources needed
    • Estimate socio-economic benefits' monetary values
    • Estimate socio-economic costs
    • Adjust for sensitivity, optimism and risk
    • Calculate net benefits, the Socio-Economic Returns (SERs)
    • Estimate financial costs and affordability
    • Refine and iterate SERs and affordability to find an optimal link



    eHIMA will guide Africa’s users in selecting which steps are the most important to being modelling and appraising for decision-takers’


    report on eHNA describes DHIF in more detail. It was presented to the Asia eHealth Information Network (AeHIN) conference in Sri Lanka in October.

    Acfee’s overall aim is to help Africa’s eHealth decision-takers and analysts in dealing effectively with increasingly complex eHealth investment scenarios and options. Good, affordable eHealth strategies are the starting point.  eHIMA will be available in January 2019. eHNA will post updates on progress.





  • Acfee’s director supporting SIL-Asia

    eHealth proponents know the importance of standards and interoperability. In Asia, it has an effective regional umbrella. The Standards and Interoperability Lab – Asia (SIL-Asia)’s powered by the Asia eHealth Information Network (AeHIN). It has significant, sustained support from the Asian Development Bank (ADB) and co-sponsorship by the People's Republic of China Poverty Reduction and Regional Cooperation Fund (PRCF).

    This substantial support has enabled SIL-Asia to provide a wide range of services to its members. Its Tooling page includes:

    • Investing in Digital Health: Digital Health Impact Framework (DHIF)
    • Guidance on Investing in Digital Health
    • Digital Health Terminology Guide
    • Transforming Health Systems with Good Digital Health Governance: Health Governance Architecture Framework
    • Health Enterprise Architecture Framework
    • SIL-Asia Cloud Set-up
    • SIL-Asia FHIR Service.

    Countries can use SIL-Asia’s tools for their digital health implementation programmes. There’s more to come, including :

    • A technology benchmarking framework
    • Interoperability toolkit
    • Implementation guide.

    SIL-Asia’s assets for countries’ use include:

    • RxBox, a telemedicine device
    • OpenMRS
    • CHITS, an OpenMRS EMR
    • Bahmni,a HIS based on OpenMRS
    • Zato.io, a python based Enterprise Service Bus
    • WSO2, a Java-based, open source enterprise service bus
    • MedicCR, a Master Patient Index (MPI) developed by Mohawk Lab
    • OpenHIM, a JS-based mediator developed by Jembi Lab.
    • OpenEMPI, a Java-based MPI
    • OpenInfoMan, a health worker and facility registry
    • DHIS2.

    Having completed his initial work on the DHIF, Acfee’s Tom Jones has taken on the role as a SIL-Asia partner. As Acfee’s Director of Strategy and Impact, it will provide a valuable bridge between Asian and African eHealth initiatives and challenges. Acfee envisages that Africa’s health systems will benefit considerably.

  • Asian Development Bank presents eHealth guidance at AeHIN conference


    Weak eHealth strategies lead to weak digital health investment. Maximising success and minimizing failure’s a core ADB eHealth theme. It sees effective eHealth strategies as requirement, and it presented its Guidance for Investing in Digital Health to the Asia eHealth Information Network (AeHIN) 6th annual conference this week in Colombo, Sri Lanka

    The guidance describes the healthcare context that’s needed for eHealth strategies. Peter Drury, the project lead, then set out essential issues that included identifying and engaging with stakeholders and pursuing digital health strategies that are drawn from health and healthcare strategies and that achieve a balance between value for money and affordability.

    He sees strategies as only part of the process, and similar to his word association of fish and chips and bacon and egg. For eHealth, it’s strategies and investment. Sharing experiences of the two are important.  There are examples of effective strategies that he’s seen across Asia available from AeHIN’s Standards and Interoperability Lab (SILA). These provide valuable insights for Africa’s health systems and for African countries contemplating new national eHealth strategies. 



  • Asian Development Bank presents its Digital Health Impact Framework at AeHIN conference

    eHealth investment decisions usually end up by balancing value for money with affordability. It’s a regular end point for business cases for eHealth and a core ADB eHealth theme for its Digital Health Impact Framework (DHIF). It presented this and other components to the Asia eHealth Information Network (AeHIN) 6th annual conference this week in Colombo, Sri Lanka

    DHIF is a methodology for estimating and analysing socio-economic costs and benefits over time to identifying value for money and how long it takes to achieve it. Then it converts these into financial and accounting estimates to assess affordability. Tom Jones, the project lead, set out these issues that included:

    • Deriving eHealth benefit requirements for health and healthcare strategies
    • Identifying and engaging with stakeholders
    • Managing assumptions and estimates
    • eHealth leadership, change management and new business models.

    The methodology has ten steps, but modellers and decision takers using DHIF for the time should choose only those components that are critical to the immediate decisions. From these, they can build up expertise and move towards using the full set.

    Risk is a constant in eHealth investment. DHIF can be used to estimate risk exposure that leads on to risk mitigation plans.

    Optimism is also common. DHIF provides adjustments for optimism bias, which can increase cost estimates with a range of lower than 40% up to 200%.

    Other material from the presentation is available from AeHIN’s Standards andInteroperability Lab (SILA). They can help Africa’s health systems improve their Health decisions, especially where parallel investment is needs in healthcare resources and new business models.


  • Intermountain Healthcare integrates telehealth and mHealth in a connected care platform

    Information silos are huge obstacles to integrated healthcare. And integrated care is the kind most of us want for ourselves and for our loved ones. It's a key eHealth challenge.

    In a report in Research Information, research platform outfit Dimensions says they’re usually created unintentionally, and are a phenomenon to “escape” from.


    Intermountain Healthcare, based on Salt Lake City, US, seems to be free of these troubles. A report in mHealth Intelligence says it’s integrated 35 different telehealth and mHealth services into Connect Care Pro, a single connected care platform. Objectives are to improve care coordination and keep care in communities, both of which could be good for patients and health systems. It took five years to plan. 


    The services it supports include: 


    • Virtual or tele-programmes
    • Telestroke
    • Telehealth programmes for behavioural health
    • Telehealth programmes for newborn critical care
    • Telepharmacy services
    • eHealth services using connected health devices.


    The legacy was a history of launches of several telehealth and mHealth programs and pilots that didn’t integrate easily. Intermountain sees their integration initiative as the next telehealth phase.


    The initiative has valuable lessons for our African countries' mHealth and telehealth programmes. It makes sense to start constructing equivalent platforms without delay. It’ll be easier and cheaper than waiting until more silos need integrating. Even more important, it’ll bring extra patient and healthcare benefits, sooner, for our patients, our families and ourselves. 


  • A coffee case study has lessons for blockchain in healthcare

    Coffee has loads of health benefits, though it’s not typically the go-to place for innovative approaches to health information systems. So I was intrigued by a coffee story that appeared in a June edition of Seattle Business magazine.


    Scott Tupper is an anthropologist and founder of Onda Origins coffee, a company that combines ideas on improving wealth disparity in the world, with a passion for information technology, and coffee. He uses the unique characteristics of blockchain technology to improve information accuracy and accountability in the coffee trade, driven through Yave, a company he started for this purpose.



    Blockchain structures are used to capture information at key steps along the coffee supply chain, from farmer to consumer. This creates a single source of truth about the coffee bean’s journey, encrypted and shared across a trusted, distributed network. And that sounds a lot like what we aim to achieve when building health records.

    Yave constructs multiple registers for each coffee consignment journey. The first register records the coffee producer’s name and electronic ID, the shipment’s ID, the coffee’s place of origin, the amount of coffee and the coffee’s description and quality score. That is encrypted and becomes the first block in a new blockchain.

    At key stages in the supply chain, an additional block is added to the chain, such as when the shipment is received at a mill, or passes through exporters and importers, or roasters. The mill register includes details about the milling process followed, initial roasting, and the results of taste test scores. At each stage new registers are created and existing data, such as taste scores, may be updated with new values. Since blockchain data is immutable, the old data is never overwritten. When new data is added, both new and old values remain in the chain and are auditable. At each stage, the new data is broadcast to the network, which can access all the information.

    How these details change across the supply chain helps to set the final assessment of the quality of the coffee bean, which affects pricing, and helps to review the quality of the supply chain, which drives operational improvements. The coffee-folk believe that one of the most valuable aspects of this application of blockchain is the ability to verify coffee’s origin and other key details of steps along the way to our cups, thereby making it easier to make value judgements about the final product and what you and I should pay for it.

    As we learn more about Blockchain technical attributes, we are beginning to recognise it as a tool for democratisation, sharing data ownership and access equally with all participants. This distributed architecture puts participants in control of their data in new ways that are technically extremely challenging with more conventional systems architectures.

    While Blockchain protects our coffee supply chain, it has the potential to transform ownership of our health data too. 


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    Image from the Yave site, https://www.yave.io/

    @yave_io


  • A Global Digital Health Index can help countries track their eHealth progress

    The eHealth landscape is evolving rapidly. So is the range of national and local initiatives under development. It can be difficult for countries and organisations to measure their own efforts against others, to benchmark their progress. The Global Digital Health Index (GDHI) has been developed to help.

    GDHI is an interactive digital resource that tracks, monitors, and evaluates the use of digital technology for health. It uses components of the WHO and ITU eHealth Strategy Toolkit. It was designed collaboratively with representatives from over 20 countries, and 50 international organisations. Online reports describe the consultations that took place in Cape Town November 2016 and Bellagio September 2017.

    GDHI’s three objectives are to empower, evaluate and motivate. GDHI website describes each as follows:

    • Empower: The GDHI provides visibility into the status and historical progression of key digital health performance indicators at a national and global level. It empowers health ministries, funders, policy makers, and industry players to make intelligent and informed strategic decisions about why and where to allocate resources
    • Evaluate: The GDHI benchmarks countries against standardized digital health criteria. It assesses the presence and quality of national policies and strategies, investment risks, and coverage of key digital health platforms while providing countries with a roadmap for maturing over time
    • Motivate: The GDHI helps countries track progress and identify weaknesses within their digital health initiatives. It incentivizes improvements in national digital health systems and more targeted investments globally. The GDHI helps facilitate the strategic use of digital health to accelerate and monitor the achievements of Sustainable Development Goal 3: Ensure healthy lives and wellbeing for all at all ages, through enhanced data use and visibility into health systems.

    As the tool develops, we hope to see more on health outputs.

    These types of initiatives are invaluable, particularly when they include deep and meaningful stakeholder consultations. Congratulations to all involved. 

    The initiative is co-facilitated by HealthEnabled and Global Development Incubator, with partners ThoughtWorks to develop the web-based index and Dalberg Design for design aspects of the index.

    Financial support is from Bill & Melinda Gates Foundation, Johnson&Johnson, Philips and HIMSS.


  • What GDPR means for African countries

    If you struggled to access your favourite news site this morning, due to pop-ups insisting that you refresh your privacy settings, you are not alone. And the site is invariably based in the European Union (EU), or doing business with individuals in the EU.

    Today is GDPR Day. The General Data Protection Regulation (GDPR) is a regulation created in EU law to protect the privacy of individuals’ data. It applies to data of all individuals in the EU, whether that data is used within the EU, or anywhere else in the world. It comes into force today, May 25 2018.

    GDPR brings in sweeping changes to how businesses and public sector organisations can handle information. Under the new rules, permission is required before any personal data can be used and how long it is kept is now closely controlled. Anyone can ask a company to delete their personal information too. Read the statement from the European Commission and its links to resources.


    Personal data is the gold of the 21st century. And we leave our data basically at every step we take, especially in the digital world. When it comes to personal data today, people are naked in an aquarium" said Vera Jourová, Commissioner for Justice, Consumers and Gender Equality.

    The GDPR sets out key principles:

    • Lawfulness, fairness and transparency
    • Purpose limitation
    • Data minimisation
    • Accuracy
    • Storage limitation
    • Integrity and confidentiality (security)
    • Accountability

    The accountability principle requires those who use data to take responsibility for complying with the principles, and to have appropriate processes and records in place to demonstrate that compliance, including appropriate technical and organisational measures to ensure accountability. Regular testing and reviews are required to make certain that the measures remain effective, or to guide remedial action id required.

    These principles form the building blocks of the legislation. Compliance with the spirit of the principles is regarded as critical for good data protection practice. Even though the principles to don’t include fixed rules, penalties for ignoring them are substantial. Failure to comply with the basic principles are subject to fines of up to €20 million, or 4% of total worldwide annual turnover, whichever is higher.

    Individuals have:

    • The right to be informed
    • The right of access
    • The right to rectification
    • The right to erasure
    • The right to restrict processing
    • The right to data portability
    • The right to object
    • Rights in relation to automated decision making and profiling.

    The GDPR introduces a duty on all organisations to report certain types of personal data breach within 72 hours of becoming aware of the breach, and if the breach is likely to result in a high risk of adversely affecting individuals’ rights and freedoms, companies must also inform those individuals without undue delay. This requires that robust breach detection, investigation and internal reporting procedures are place to facilitate detection and decision-making.

    Close Circuit Television (CCTV) falls under the GDPR too.

    The UK Information Commissioners Office has extensive guidance. Many companies, such as IBM and Oracle, offer guidance too.

    While the GDPR does not apply to African countries directly, many African businesses will already be affected, due to their business relationships with the EU or its people. Whether you're affected yet or not, GDPR provides a best-practice model for incorporating into business practices and regulatory strengthening.


    African countries' regulatory strengthening is well underway. South Africa's Protection of Personal Information "POPI" Act is one example and provides many components of the GDPR.

    First steps towards compliance could be to:

    • Brush up your cyber-security policy, and
    • Implement a privacy management framework to help embed accountability measures and create a culture of privacy across your organisation.


    The commissions’ seven steps for businesses provide pointers too. They are:

    • Check the personal data you review and process, the purpose for which you do it, and on what legal basis
    • Inform your customers, employees and other individuals when you collect their personal data
    • Keep the personal data for only as long as necessary
    • Secure the personal data you are processing
    • Keep documentation on your data processing activities
    • Make sure your sub-contractors follow the same rules
    • Consider additional provisions, such as :
    • Organisations might have to appoint a Data Protection Officer, particularly if processing of personal data is a core part of your business
    • Data Protection Impact Assessment Such an impact assessment is reserved for those that pose more risk to personal data, for instance they do a large-scale monitoring of a publicly accessible area, including video-surveillance.

    In the meantime, dealing with your privacy preference update requests will ensure that data protection remains in the forefront of your mind, at least for today. Happy GDPR Day.


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    Image from this tweet by @EU_Commission


  • eHealth for SDG promoted at East African Ministerial Conference

    Kigali, Rwanda has been a magnanimous host to eHealth events, this Autumn. Following on from last week’s EAC Regional eHealth and Telemedicine Workshop, the 2nd EAC Regional eHealth and Telemedicine Ministerial Conference was Thursday 17 April. The Ministerial Conference considered the report and recommendations of the workshop, under the theme “harnessing science, technology and innovation to transform healthcare delivery  and accelerate the attainment of sustainable development goals in East Africa". It’s yet another high level African meeting exploring the role of eHealth in helping us to achieve universal health coverage, hosted by the East African Science and Technology Commission (EASTECO).


    “Discuss how technology can be used to enhance healthcare delivery” was a challenge posed by Rt Hon Dr Ali H Kirunda Kivejinja, Chairperson of the EAC Council of Ministers, to conference delegates, in his opening remarks. He emphasised the importance of cooperation to secure the technologies’ “ultimate goal of improving standards of living and increasing life expectancy of East Africans”.


    Clear directives were provided on the way forward. The Ministerial Conference: The 2nd EAC Regional e-Health and Telemedicine Ministerial Conference:

    • "Urged the EAC Partner States that do not have a National e-Health Strategy develop it in line with the WHO - ITU National e-Health Strategy Toolkit [to develop one] by 2020;
    • Directed EASTECO to conduct an EAC regional e-Health readiness assessment incorporating aspects of systems interoperability, costs and benefits of investing in e-Health by 30th December 2019 in collaboration with the EAC Secretariat, East African Health Research Commission, Partner States’ National Science and Technology Commissions/Councils and Partners;
    • Directed EASTECO to promote incubation of local digital health solutions in collaboration with the EAC Secretariat and the Partner States’ Ministries and Agencies responsible for ICT, Science, Technology and Innovation and submit progress reports to relevant Sectoral Councils and the Council of Ministers every two years;
    • Urged the Sectoral Council on Health to coordinate the development of regional policies, laws, regulations, guidelines, standards, on health facility/patient safety, data sharing, data security and privacy to facilitate e-health enabled in country and cross border patient referrals within the EAC Partner States by 30th June 2020 directed the EAC Regional Centre of Excellence for Biomedical Engineering and eHealth to conduct a study in the application of eLearning systems for training Health Professional in the Region and IUCEA to develop a regional framework to enhance regional and south-south collaboration in capacity building for e-Health by Jan 2020;
    • Directed EASTECO to take leadership in convening the EAC regional e-health and telemedicine workshops, ministerial conferences and international exhibitions every two years on a rotational basis among the Partner States in last week of October as part of the meetings of the EAC Sectoral Council of Ministers responsible for Health in collaboration with the EAC Secretariat, the EAHRC and the EAC Regional Center for Excellence for Biomedical Engineering and e-Health; and
    • Approved hosting of the 3rd EAC regional e-health and telemedicine workshops, ministerial conferences and international exhibitions by the Republic of Uganda from 28th to 30th October 2020 as approved by the 16th Ordinary Meeting of the EAC Sectoral Council of Ministers of Health."

    Collaboration and cooperation for eHealth for impact is a growing theme in African regional communities. Congratulations to the organising team and it’s tireless leader, Ms Gertrude Ngabirano Executive Secretary, EASTECO. It is a timely theme for eHealth to realise its potential and its critical role I supporting UHC.