Sean Broomhead

Chief Technology Officer

  • Five strategies for your eHealth success in 2019

    Closing off 2018, I am struck by how much eHealth has grown up. It’s entering 2019 as a confident, enthusiastic adolescent, emerging almost abruptly from a precocious childhood. With eHealth’s latest pseudonym “digital health” gaining traction, it’s a timely herald of a viable, lucrative and sustainable digital health industry.

    If you are reading this, then securing a substantial piece of the expanding digital health pie is likely part of your organisation’s 2019 agenda. I’ve assembled five New Year’s resolutions to help:

    1.     There’s plenty to go around, and the spectrum of options is wide and growing, so find your niche and claim it

    2.     Take more time to identify and understand the needs and aspirations of your clients and stakeholders, then work with them closely to realise more health benefits

    3.     Use what you learn to develop a robust eHealth Impact Strategy that will provide a rudder for all your efforts through 2019 and beyond, locking onto core health benefits

    4.     Hire people who believe what you believe, then trust them and invest in them in line with your strategy


    5.    Find like-minded partners, growing your business through collaboration and cooperation, fulfilling your role as a unique member of the emerging global digital health community.


    Choosing one or more of these, and succeeding, will be enough to make a big difference.

    At African Centre for eHealth Excellence (Acfee) we have been monitoring the maturing eHealth landscape for more than a decade, examining the health-strengthening benefits, frustrated by the slowness of its arrival, and mindful that many critical foundation elements remained absent. Establishing the foundation more quickly has been a key focus of our work at Acfee, particularly:

    • Developing eHealth leadership
    • Building eHealth capacity
    • Constructing eHealth Strategies that create sustainable health impact.

    Now that progress is tangible, plenty of work remains to nurture and guide the fervent eHealth teenager, so Acfee’s focus on leadership, capacity and strategies will continue, expanding our efforts to meet demands. Priorities for 2019 include to:


    1.     Establish the eHealth Investment Model for Africa (eHIMA) and disseminate its use across African countries to assist Ministries of Health to take good decisions about their digital health investments.

    eHIMA is Acfee’s adaptation of the Digital Health Impact Framework (DHIF).  The DHIF is driven by the Asia eHealth Information Network (AeHIN) with support from the Asian Development Bank (ADB). Development of DHIF and eHIMA have been led by  Acfee’s Director of Strategy and Impact Tom Jones, providing a valuable bridge between Asian and African eHealth initiatives and challenges.

    2.     Expand eHealthAFRO, Acfee’s stakeholder engagement platform.

    We will build on the successes of eHealthAFRO 2017 in Johannesburg and the 2018 2nd EAC Regional eHealth and Telemedicine Ministerial Conference in Kigali, both covered in eHNA. eHA2019 will be in South Africa again. Keep an eye on eHNA for details to be confirmed later this month.

    3.     Grow Acfee’s existing capacity building initiatives:

    More support for academic programmes, such as:

    • Rome Business School short courses on eHealth, including a DHIF short course
    • New York University global public health master’s degree, which includes a collaboration with Acfee around a scholarship program to increase African participation
    • Bespoke eHealth curriculum development for partners
    • Acfee’s eLearning and software development collaborations.

    More support for regional capacity building, such as the role I played alongside Acfee Director Ousmane Ly, and others, on the faculty of the first ITU/WHO AFRO Digital Health Workshop in Lesotho in November 2018.

    Re-launch of Acfee’s popular Future eHealth Leaders summer camps, to cultivate and advance the unique leadership skills and approaches needed for successful digital health.

    “Growing old is mandatory; growing up is optional” says 1960's Jamaican-American baseball player, Chili Davis. As eHealth moves into its teens, ensuring that we get it right will certainly be a collective effort. I look forward to working with each one of you, and all my African colleagues, to succeed in 2019. 




  • SIL-Asia reports on the Digital Health Impact Framework (DHIF)

    Economic and financial evaluations of eHealth investment options rely on modelling. The Digital Health Impact Framework (DHIF) User Manual and Illustrative Models, help health systems to set up and develop them. The DHIF is a ten-step methodology developed by Tom Jones, Peter Drury, Philip Zuniga and Susann Roth, for the Asian Development Bank (ADB).




    A blog form the Standards and Interoperability Lab Asia (SIL-Asia) emphasises the value of using examples to help users. These appear in the manual and online models. The combination of techniques and examples are from six illustrative models:



    • SMS for maternal and child health
    • mHealth for telemedicine for a current patient catchment area
    • mHealth for telemedicine with an expanded catchment areas
    • Malaria surveillance and intervention
    • Capital and leasing finance for an EHR
    • Strategic mix and choices.


    The six models are not templates. DHIF is a generic methodology, with every DHIF model being bespoke. 



    The approach is practical and rigorous and provides a valuable foundation for our efforts at Acfee to develop an eHealth Impact Model for Africa (eHIMA). Acfee colleagues like Tom Jones, who has been involved in many related international initiatives, provide a critical overarching perspective that will help to ensure that the various frameworks emerging are both appropriate to their regions of development, while following a sound, common conceptual methodology.

    Creating options is a DHIF core skill. The first four are single options for the initial stages of digital health projects. In practice, several options for each project are analysed in these early stages. The EHR example has two options and in practice would have more.


    The blog shows two dimensions for options. They’re vertical and horizontal:

     

     

    The vertical dimension is mainly incremental and thus, relatively easy to compile. Meanwhile, the horizontal dimension is more challenging. They have significant differences to options on the vertical dimension, and not incremental.


    An illustrative model on strategic mix and choices shows positive socio-economic returns but have considerable risk exposure and affordability challenges. The comparison can support agreements on decision criteria for eHealth investment. Examples are:


    • Maximum patient impact
    • Lowest risk
    • Highest socioeconomic benefit
    • Lowest cost.


    At the ADB workshop on 31 January 2018 in Bangkok, participants identified decision criteria they would use to select which of the six illustrative DHIF models they would retain in an affordable digital health strategy and why. Their ideas are set out in the DHIF User Manual.

    Modellers new to DHIF should start small. Rome Business School has a short online DHIF course. It’s in English, and coaches modellers using their own digital health projects.





  • 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.