• Strategy
  • 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 timescalesIdentify stakeholdersIdentify benefitsIdentify resources neededEstimate socio-economic benefits' monetary valuesEstimate socio-economic costsAdjust for sensitivity, optimism and riskCalculate net benefits, the Socio-Economic Returns (SERs)Estimate financial costs and affordabilityRefine 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’

    A  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.

  • Heidelberg University launches an eHealth policy course.

    Three entities have combined to create a five-day residential course on eHealth policy at Heidelberg University. The other two are evaplan, a University Hospital Heidelberg consultancy, and the Institute for Global Health.

    Developing national digital health policy: Laying the Foundations is designed for health planners and policy advisers. It will help them to explain eHealth’s national requirements for success. A specific emphasis is on low and middle income countries. It aims to help participants to:

    Understand how well-crafted eHealth strategies support smart investment Use available toolkits to design and improve country’s eHealth policiesStrengthen participants’ eHealth adviser roles Support decision making for interoperable eHealth and avoid further fragmentation Understand organisational and behavioural changes needed to maximise eHealth benefits.

    The curriculum for the first four days includes: 

    Health Strategies and eHealth strategies in developing countriesDeveloping eHealth strategiesPlanning for interoperabilityManagement and behavioural change. 

    The dates are 4 to 8 February 2019 at the university’s Internationales Wissenschaftsforum Heidelberg (IWH), Germany. The final day includes a guided tour of Heidelberg and time for mentoring and networking. Presenters are Peter Drury and Michael Stahl, The course is in English. Applications close on 15 November 2018.

  • Commonwealth Centre for Digital Health and ECH Alliance to launch their joint action plan

    Working and sharing with eHealth agencies offers mutual benefits. At the Digital Heath Week 2018 in Sri Lanka, the Commonwealth Centre for Digital Health (CWCDH) and the European Connected Health Alliance (ECH Alliance) met and agreed their joint action plan. It was originally envisaged in the partnership agreement announced in May 2018.

    The full action plan will be announced shortly. It will include:

    On 20 November 2018, launch of an ecosystem in Malta, both a European and a Commonwealth countryUganda’s ecosystem will be a nexus for collaboration across East Africa for CWCDH. HealthOrganisation of a Commonwealth Digital Health Skills Summit early in 2019 to connect existing skills programmes with the needs of many Commonwealth countriesLaunch of ecosystems in Sri Lanka and Uganda in early 2019. 

    These will comprise the beginnings of the Commonwealth Connected Health Alliance. Its aim will be exemplars for ecosystems across the Commonwealth. 

    Prof Dissanayake’s chair of CWCDH. He said “We decided to work together because we share the same mission and values and by joining forces we hoped we could deliver faster and do more better.” He is satisfied that considerable progress has been achieved in just a few months. The plan now’s to build on the value of the partnership with ECH Alliance and move forward with constructive activities as part of the commitment to work jointly with.

    COO of CWCDH, Anoop Singh said the partnership’s main goal’s to deliver real benefits, not to try to do everything. Bringing together eHealth stakeholders and collaborators from Europe, the Commonwealth and beyond will contribute to meeting numerous needs and opportunities.

    ECHAlliance chair Brian O’Connor is convinced that the collaboration will bring mutual benefits to everyone involved. His view’s based on discussions with people from over 40 Commonwealth countries. He sees their progress, innovations, determination and passion as a vital ingredient for future success.

    CWCDH will hold an event during the World Health Assembly (WHA) in Geneva in May 2019. The goal’s to obtain the commitment of Commonwealth governments to CWCDH’s planned activities. 

    Nineteen countries are Commonwealth members. If the benefits spill into the rest of Africa, the partnership will have proven its worth.

     

  • How far into the future should eHealth strategies look?

    By definition, eHealth strategies are about investing in the future. They’re also about taking existing eHealth investments forward, either by switching, enhancing and rolling out further. In 2006, Rosabeth Kanter identified several lesson for innovation strategies. They included an “innovation pyramid” where:

    Not every innovation idea has to be a blockbusterSufficient numbers of small or incremental innovations can lead to big gainsBig bets at the top that get most of the investmentA portfolio of promising midrange ideas in test stageA broad base of early stage ideas or incremental innovations.

    The last one’s relevant for a perspective set out in an eBook from Oracle. Technology Takes Healthcare to Next Level proposes strategies for disruptive technologies of:

    AIBlockchainChatbotsIoT. 

    Each one offers promise for healthcare. Combined, Oracle sees the sum of the parts as greater than the whole. Combining blockchain and IoT allows frictionless data exchange. AI and machine learning put data in motion with minimal human intervention. AI tools can study blockchain’s large volumes of data to find patterns that need responses

    For Africa’s health systems, investment in ICT foundations and patients’ clinical and demographic data’s needed to. The strategic challenge is to choose between sequential investment and progress in an innovation pyramid where these four technologies start their journey. While leaving the disruptive technologies into the future, it can defer the costs. It will also defer the benefits.

     

  • 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 HealthDigital Health Terminology GuideTransforming Health Systems with Good Digital Health Governance: Health Governance Architecture FrameworkHealth Enterprise Architecture FrameworkSIL-Asia Cloud Set-upSIL-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 frameworkInteroperability toolkitImplementation guide.

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

    RxBox, a telemedicine device OpenMRSCHITS, an OpenMRS EMRBahmni,a HIS based on OpenMRSZato.io, a python based Enterprise Service BusWSO2, a Java-based, open source enterprise service busMedicCR, a Master Patient Index (MPI) developed by Mohawk LabOpenHIM, a JS-based mediator developed by Jembi Lab. OpenEMPI, a Java-based MPIOpenInfoMan, a health worker and facility registryDHIS2.

    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. 

  • How do Africa’s mHealth strategies match the modern profile?

    With mHealth a standard component of Africa’s eHealth strategies, what’s a good benchmark to test them against? Spok, a US communications firm, as a profile of mHealth strategies that can help. Its eighth annual survey shows some marked priorities.

    Mobile Strategies in Healthcare Results Revealed says mHealth that reflects overall clinical goals for the health system or hospital are most successful. It also underpins larger eHealth strategies to deliver more efficient, higher quality care and increase satisfaction for patients, carers and health workers.

    mHealth strategies extend across a wide range of information and areas. The top two are:

    mHealth management and security, for 56% of respondents Device selection, at 52%.

    The bottom two are mobile, and business development and reporting strategies. 

    The full profile’s:

    Management and security 56%Device selection 52%EHR integration 48%Infrastructure assessment 45%Clinical workflow evaluation 43%Device ownership, including BYOD 34%Mobile app strategy 29%Mobile app catalogue 16%Mobile strategy governance 14%Business development and reporting strategy 12% 

    The third item, EHR integration, matches findings from another Spok survey of hospital CIOs. They said integrating with the EHR was their top priority for respondents. Clinical workflow evaluation’s high score on is seen as revealing. It’s an indication that doctors, nurses, and other health workers in direct patient care roles use mHealth to define safe, efficient and effectively managed workflows.

  • eHealth and a new business model can reduce inpatients’ mortality

    It’s more than just ICT. A current research programme in Germany shows how eHealth’s role in precision medicine can reduce hospital patient’s mortality when it’s integrated with investment in a part of a new business model. A report in HealthManagemnet.org on continuing research in Germany says how to optimise and streamline hospital care by separating patients into routine and complex groups improves quality and saves lives, so major benefits.

    Separate and concentrate – a sustainable business model for general hospitals describes how a new business model can use new technologies to support precision medicine and improve effective bespoke healthcare.  It assigns patients to routine and complex care pathways.

    Routine patients are not emergencies and have up to two co-morbidities. Complex patients are emergencies and have three or more co-morbidities. Both groups benefits from better quality. Routine patients’ mortality has dropped by more than 13%; complex patients; by more than 11%. These are attributed to the new business models opportunities to:

    Optimise the impact and benefits of precision medicineAddress the specific critical care management differences of the two patient groups Minimise the impact of operational factors on healthcare qualityReduce hospitals’ management complexity.

    The research’s currently in phase two of three phases. So far, it has disrupted the conventional view that greater patient volumes achieve better mortality results. The new business model emphasises that:

    Specialisation as a crucial determinant of quality and mortalityBusiness as usual with eHealth may not optimise its opportunities to maximise healthcare quality gains.

    It also confirms that eHealth is more than just ICT. The report confirms that redesigning routine and complex patient flows and care pathways has implementation challenges. It also shows that eHealth can offer more benefits when integrated with investment in new business models. 

  • Will a new tech-giant coalition on interoperability move Africa’s eHealth on?

    Coalitions mean co-operation and joint action towards a common cause. They’re usually for the each participants own self-interest. The latest initiative in eHealth’s sphere should offer considerable benefits to health and healthcare organisations.

    A report in Healthcare IT News says a broad coalition of technology giants emerged in an unscheduled session at the Blue Button 2.0 Developer Conference on 13 August at the White House.  Amazon, Google, IBM, Microsoft, Oracle and Salesforce joined forces to set about removing interoperability barriers.

    The US Information Technology Industry Council lead the session, Its CEO described the initiative as a commitment to eliminate friction in healthcare systems. The solutions will affect cloud computing and architecture, moving towards open standards through Fast Healthcare Interoperability Resources (FHIR) and the Argonaut Project.

    While details seem limited, an indication of the coalitions trajectory includes: 

    Supporting healthcare as it shifts to the cloudMaking AI more availableEnabling connected careBetter access for patients to their dataFlexibility to use products and services across different systems to work seamlessly for their care. 

    While it’s obviously aimed at the US healthcare market, the outcome of the coalition should have significant implications for Africa’s health systems’ eHealth strategies, investment options and procurement. As the coalition improves interoperability, it should open up expanded and new eHealth benefits, including opportunities to enhance and transform health and healthcare.

  • Argentina’s health system aims to balance information needs and privacy

    Balancing competing claims in health systems never ends. Simon Sinek, an author, says “There’s no decision that we can make that doesn’t come with some sort of sacrifice or balance.”  So it is with eHealth. In an interview in eHealth Reporter Latin America, Dr Alejandro López Osornio, director of Information Systems in Argentina’s Ministry of Health says “The challenge is to balance the need to share information while respecting privacy and autonomy of people who generate it.” 

    There’s been progress, and more to do. The next steps are in the National Digital Health Strategy, The goal’s to consider both patients’ rights to share information only with their healthcare professionals and simultaneously respect provinces’ and private institutions’ autonomy to develop their information systems and share data with other authorised users and organisations when necessary.

    Argentina invested in a minimum national infrastructure that integrates and connects all the countries current projects. Anyone working with health information system in different jurisdictions can communicate centrally and automatically with all other authorized participants.

    There are several outcomes. Everyone speaks the same information language and shares the same type of information safely and privately. Healthcare quality’s improved. Patient empowerment’s the core component of strategy and planning.

    Patients can use smartphone apps to record dietary information and their exercise activities. It’s expected that app providers will soon help patients to understand their clinical and health data better. Examples are their cholesterol trends and comparing their weight. This information can help them make important health and life-style decisions.

    Argentina modelled its eHealth strategy on Canada’s It reflects its federal institutions and independent provinces. Local eHealth fine-tuning’s still needed. Human eHealth capacity’s a critical difference between the countries. One Hundred Leaders was Argentina’s strategic response. It plans to train one hundred computer scientists or doctors in this field, four for each province. The National Digital Health Strategy provides for scholarships for a postgraduate course of four to six months, mostly online, to provide local specialists and avoid medical staff having to the Ministry of Health in Buenos Aires for advice. This’s an initiative relevant for Africa’s eHealth strategies.

    The next strategic phase’s being developed. A scenario is to enhance eHealth regulation and integrate different strands, such as digital signatures, electronic documents and privacy and security of documents, into a single law. Existing personal data protection and digital signature laws can be extended to health and its EMR repositories. A general digital health law is an option.

    Argentina’s rapid progress and future strategy offers a constructive comparator for Africa’s health systems. Both technology and human eHealth capacity are moving ahead together. While it’s challenging, it’s essential to maximise eHealth’s benefits.