Is your digital health strategy delivering the health system changes you need? These three suggestions might help your 2020 planning.
“Day’s sweetest moments are at dawn” wrote American poet Ella Wheeler Wilcox. It’s a time for fresh starts when almost anything seems possible. This new year feels a little like that for digital health, with technology maturing and unprecedented readiness of people and systems to use digital health to change how our health systems work.
So, are we giving our users what they need to make big changes to the health system?
Health workers have not always been keen to embrace digital tools, their position largely justified by poor usability and inadequate value-add, so the growing enthusiasm is encouraging. It should not be taken for granted, particularly as new techniques emerge to transform data, drive decisions and change the way both patients and health workers experience the health system. It is heightening the need to make sure we build solutions that really do respond to users' priorities and improve their lives, whether they are patients, health workers or citizens wanting to keep healthy.
As we go into 2020 I have renewed optimism and humility as I look at the foundation of work that has been completed over the last few years. There's a sense of common purpose across the digital health community too, tangible at digital health events around the world. Our countries' health leaders have fuelled this, with overwhelming support for the rousing World Health Assembly 2018 digital health resolution, followed in 2019 by the WHO Recommendations on Digital Interventions for Health Systems Strengthening, summarised in this eHNA series.
The Principles of Donor Alignment for Digital Health continue to gain supporters and we are approaching a consolidation of digital health peer networks, most recently seen at the Global Digital Health Forum gathering of friends and colleagues from Asia's AeHIN, Africa's Acfee, Central America's RECAINSA, and colleagues from a Pacific Islands network, Digital Square, RHINO, HISP-SA and others.
WHO has been busy too. It has selected a new digital health Technical Advisory Group (TAG) to take over from the previous eHealth TAG established in 2013, which I was honoured to be part of, and initiated a round of global consultations on a draft global Digital Health Strategy set to be finalised in 2020.
On the African front there is a lot underway. An emerging digital health curriculum is being developed in partnership by WHO-AFRO and ITU with support from a number of global organisations. I have been thrilled to contribute to this work, along with many African digital health colleagues. This year I also had the privilege of joining writing teams for a number of new national digital health strategies. My home country, South Africa, has a new strategy available here, or you can read this short eHNA summary. New strategies for Namibia and Botswana are expected to be out in the first part of 2020. I have been humbled by the innovative work delivered by the tireless colleagues with whom I collaborate at WHO-AFRO, ITU, HISP-SA, Acfee, and many Ministries of Health across the African continent. I am sure you have had similar experiences too, with many more organisations.
While this big global push builds a momentum that moves us forward towards maturity, on the implementation side, sober reflection reveals that our successes are proving hard to scale up and net health benefits remain largely elusive. There are lots of commentaries about how to improve readiness. As we take these steps, addressing all kinds of important issues from interoperability architectures and regulatory strengthening to data science, I believe we must focus more on what is happening with the people in the system. I have three suggestions for 2020:
- Let’s expand our circles of engagement. Patients are largely absent or extraneous to most digital health conversations and health workers at the coal face of clinical care remain peripheral too. Our talk of more user focused design and UxD needs to find a good footing to begin changing how we design systems, and in turn, the usability of what we produce for our users.
- We should examine how investments shape our local digital health communities and ecosystems and how they create meaningful, sustainable opportunities for people, whether academic, professional or commercial. While many of our countries struggle to raise adequate investment for ICTs, we see sparse resources further diluted by heavy licensing costs for underperforming applications, many of which use outdated design, architecture and technologies, misaligned with changing care pathways, to ultimately fail to contribute sufficiently to a sustainable local digital health ecosystem. This must be turned around with a deliberate local economic digital health investment approach.
- A new decade provides a chance to refresh our aspirations, ideals and motivation. It allows us to revisit our vision, re-galvanise our strategies around it, and help our teams embrace their parts in achieving it.
Dawn can be a confusing time. No longer asleep yet not quite awake. These three suggestions may help enrich our numerous important activities, pushing hard towards the health systems transformation that we know is possible as we recommit to our teams, and our users, and launch into the new day.
I look forward to hearing about your 2020 successes.
Happy new year everyone.
- 1,453 views
- January 01, 2020
- Sean Broomhead
WHO digital health guideline: 8. Digital tracking of clients’ health status and services
Patient tracking is the topic of the eighth part of the WHO Guideline on Digital Interventions for Health Systems Strengthening. Key points are summarised below.
The WHO recommendation is to use digital tracking with decision support (with or without targeted client communication) in settings where the health system can support implementing these interventions in an integrated manner and for tasks that are already defined as within the scope of practice for the health worker. Furthermore, potential concerns about data privacy and transmitting sensitive content to clients must be addressed.
WHO describes digital tracking as “the use of a digitized record to capture and store health information on clients in order to follow-up on their health status and services received”. It may be combined with decision support systems and may also be linked with targeted demand-side interventions to engage clients/patients, such as via mobile devices
Evidence is mixed. It suggests that the digital tracking may improve health service use such as attendance of antenatal care appointments, taking iron tablets during pregnancy, immediate breastfeeding, receipt of the third dose of polio vaccine, and use of postpartum contraception six months after birth, though makes little impact on other indicators, such as proportion of children under five who are vaccinated, proportion of women who give birth in a facility, or women breastfeeding exclusively for six months.
The recommendations align with recommendation 11 of the WHO guideline on health policy and system support to optimize community health worker programmes, which suggests that practicing community health workers should “document the services they are providing” and “collect, collate and use health data on routine activities, including through relevant mobile health solutions”. Evidence suggests that most health workers, and particularly those working in rural settings, see advantages to digital tracking to help overcome geographical barriers and link patients to the broader health system, they regard it as a burden to maintain paper-based systems in addition to digital systems.
As with the guideline on client communication via mobile devices, measures should be taken to address inequities of access to mobile devices and concerns about sensitive content and data privacy.
There is extensive additional discussion in the Guideline. Emphasis includes the need to address legal implications, such as accurate client identification, and recognising that these multifaceted interventions may pose challenges in infrastructural and technical complexity
The next and final piece in this eHNA series deals with using mobile devices for training and education.
The WHO Guideline provides evidence-based recommendations of ways to use digital health to improve health services. It has a specific focus on mobile devices and emerges out of guidelines on digital health interventions for RMNCAH developed by this team.
There are nine main topics. Each is summarised in an eHNA post:
- Acceptability and feasibility findings
- Birth and death notification via mobile devices
- Stock notification and commodity management with mobile devices
- Client-to-provider telemedicine
- Provider-to-provider telemedicine
- Targeted client communication for behaviour change
- Health worker decision support
- Digital tracking of clients’ health status and services
- Training and education via mobile devices
Evidence is presented under headings of:
- Resource use
- Gender, equity and human rights.
Implementation considerations address key topics from the WHO/ITU National eHealth strategy toolkit, such as:
- Legislation, policy and compliance
- Interoperability and standards
Explore more eHNA coverage of WHO initiatives here.
- 485 views
- November 28, 2019
- Sean Broomhead
South Africa’s new Digital Health Strategy emphasises person-centred health services
South Africa's National Digital Health Strategy 2019-2024 has been published online. It updates the previous National eHealth Strategy 2012-2017. It presents a vision of Better health for all South Africans enabled by person-centred digital health.
People are at the centre of the strategy. They include health workers, helping them experience better working lives; patients and their families, helping them access better care, and citizens, supporting them to make sound health-seeking choices. This strategic focus is encapsulated in the first of five cross-cutting strategic principles, which emphasises person-centeredness. The other four principles are expanded access to services, innovation for sustainability, workforce for economic development and a whole-of-government approach.
Nine strategic components are:
- Leadership: develop leadership capacity for digital health innovation and adaptive management
- Stakeholder engagement: undertake appropriate multi-stakeholder engagement for shared opportunities and successful digital health implementation
- Strategy and investment: develop sustainable interventions and appropriate investment and funding mechanisms for digital health implementation
- Governance: review and strengthen governance structures and oversight mechanisms for the implementation of the strategy
- Architecture and standards: establish an integrated information architecture for interoperability and effective, safe sharing of health information across health systems and services
- Applications and services: develop appropriate digital applications and services that improve health services for patients and health workers
- Infrastructure: establish a robust physical and network infrastructure and broadband connectivity for priority digital health applications and services
- Legislation, policy and compliance: formulate national legislative, policy and regulatory framework for digital health
- Capacity and workforce: develop enhanced digital health technical capacity and skilled workforce for digital technology support and implementation.
An important aspect is the National Digital health Platform, which builds on previous standards and interoperability work. It will provide online technical resources to support developers in the digital health space to achieve:
- Overall quality and continuity of care
- Adherence to clinical guidelines and best practices
- Efficiency and affordability of services and health commodities, by reducing duplication of effort and ensuring effective use of time and resources
- Health-financing models and processes
- Regulation, oversight, and patient safety resulting from increased availability of performance data and reductions in errors
- Health policy-making and resource allocation based on better quality data.