• Strategy
  • 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.

  • 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 careAdherence to clinical guidelines and best practicesEfficiency and affordability of services and health commodities, by reducing duplication of effort and ensuring effective use of time and resources Health-financing models and processesRegulation, oversight, and patient safety resulting from increased availability of performance data and reductions in errorsHealth policy-making and resource allocation based on better quality data.

    The platform will “help to democratise the health information systems development space for more stakeholders to participate” by creating reusable tools and architecture. 

    Now that the strategy has been published, and we enter the phase of implementation, collaboration becomes critical. We need to get better at how we do this, as we explore how to cooperate to achieve the aspirations of the strategy. It’s an exciting time for those of us who believe in digital health and its role as an enabler of health systems transformation.

    There is lots to be done and how we work together will be an important success factor. What parts of the strategy will you be helping to implement?

  • Is a freemium model the way to go for eHealth apps?

    The proliferation of medical apps for disease prevention and health promotion has made healthcare ever more accessible. It is further facilitated by the ubiquity of smart phones and demand for better healthcare.  

    The number of digital health apps available in the market has reached over 300,000 apps on the top app stores worldwide, almost double the number available in 2015. Over 200 apps are added daily.  

    Sadly, many of these apps aren’t sustainable for more than a year, fail due to a number of reasons, including poorly structured revenue models.  A number of the businesses I evaluated during my master’s research relied on fragmented funding from various sources such as donor organisations to support development of their products.  When this funding is depleted, other revenue models need to be put in place to ensure sustainability. 

    Freemium is a popular model in which the basic application is free for users to download and use for as long as they like, though enhanced functionality is available at a price. Eventually, some of these satisfied, non-paying users will want to upgrade to a better version of the app or make in-app purchases, and hence become paying customers.

    In order to generate revenue from freemium apps, these three attributes need to be fulfilled;

    Capture high market share - the market strategy needs to revolve around capturing as much of the market share as possible because only a small percentage will become paying consumers and support the cost of non-paying users.Have a strong competitive advantage - the free offering must fulfil a need for the user in order to create a positive buzz, and the paid version has to create added value for customers to induce them to upgrade.Continued value creation - the freemium product should continue to add value as the user uses it over time in order to encourage non-paying users to switch over, and to maintain a consistent base of paying users.

    This model works well for innovations that are highly adaptive and iterative. Motivation to become a paying consumer relies on the value that the product adds for the user.  As soon as the value diminishes, interest in using the app wanes as well. The challenge for these companies becomes staying ahead of a rapidly evolving and innovative industry.

  • Successful eHealth needs capacity building

    Africa’s health-care system is undergoing an eHealth revolution. The technology is new, but it must be used by the existing health workforce.

    A critical finding in my master’s research, is that eHealth needs better investment in educating and capacitating users of eHealth. Another report by the British National Health Service found that a lack of training for healthcare providers created barriers to eHealth care. In Africa, we face the same challenge. 

    Technology on its own, no matter how effective, cannot bring about healthcare revolution without acceptance and proper use by healthcare workforce. An implementation strategy which addresses the barriers to effective adoption of these technologies will be critical to their success.

    Capacity development has multi-layer benefits;

    For staff it can increase overall job performance and satisfaction. For the healthcare organization or facility, it can improve effectiveness and profitability.Even at the societal level, training and development can increase the quality of the labour force, which in turn is a contributing factor to national economic growth.

    By developing a workforce that is able to confidently use eHealth technologies and services, African countries could implement their national eHealth more successfully and move closer to achieving universal health coverage.

  • Why eHealth needs business modelling

    A substantial number of businesses and start-ups pursuing opportunities to bridge healthcare challenges with eHealth technologies are often confronted with “pilotitis” or failure to implement their technologies in a sustainable way.  In my last article, I described some of the challenges eHealth businesses face. 

    Constructing a business model during the development of eHealth technologies can guide a value-driven evaluation of what is necessary and what is not, in order to overcome implementation failures. A review of the literature suggests that the business model canvas proposed by Osterwalder is a suitable business modelling tool for the eHealth industry.

    The one-page canvas consists of nine building blocks that provides a conceptual framework to describe the business’ activities from four perspectives;

    Value offering – what need is being fulfilled by the business?Value communication and transfer – who are the customers and how does the business communicate with them?Value co-creation – what are the business inputs, including collaborating partnerships? Value capture – how does the business maintain profitability?

    A key observation in my master’s study was that there is a strong focus on the value offering and value capturing activities of the business model, although little focus on value co-creation and value communication and transfer activities.

    While eHealth businesses are aware of the importance of these activities, challenges of the environment create barriers to prioritising these activities. To overcome these challenges, transformation is required in both the micro and macro eHealth environment.

  • Have your say on WHO’s draft Global Strategy on Digital Health
    April 2019 has been a busy month for global digital health, with two key announcements by the World Health Organization (WHO). One is the call for comments on the draft Global Strategy on Digital Health. It is the first strategy of its kind for digital health and an opportunity not to be missed. WHO invites consultation from all stakeholders in the digital health arena on a strategy aiming to help focus our efforts on digital health that achieves maximum impact. It identifies four strategic objectives: Work togetherHelp to accelerate the digital health agenda in countriesAddress global issuesSet the future direction for innovation and research.

    The period for commenting closes 30 April 2019, 00:00 CEST. Inputs can be provided via a web-based accessible here or you can email WHO for more information.

    A second pivotal event was last week’s publication of the WHO Guideline: Recommendations on Digital Interventions for Health Systems Strengthening, a much anticipated and important milestone in digital health’s journey to maturity and health systems impact. It has emerged out of a group that developed guidelines on digital health interventions for RMNCAH and health systems strengthening. 

    As we invest in our African National Digital Health Strategies and implementation plans, global publications like these are timely and helpful. eHNA will unpack the contents and their implications for our African digital health initiatives over the next few weeks.

  • Successful eHealth needs better business models

    eHealth is a complex business type, integrating many stakeholders acting across interwoven networks. Yet the characteristics of successful business models remain understudied.

    Despite the promise of eHealth to overcome healthcare access challenges, reduce costs and improve quality , successful implementation is low, especially in developing countries.  In fact, over 50% of eHealth businesses find it difficult to sustain their implementations sustainably beyond the pilot phase. I have been investigating these dynamics and will be sharing them over the next few weeks in a series of eHNA pieces.

    Recurring challenges of eHealth include;

    Financial institutions unwillingness to fund eHealth start-upsHigh start-up costs and ongoing maintenance costsRegulatory legislation that lags behind technology developmentResistance from end-users to adopt new innovationseHealth technologies lack user experience designPoor scalability of eHealth technologies after their pilot phasePoor ICT infrastructure in the environmentLack of leadership and political supportLack of research.

    To overcome these challenges, change is required in both the micro and macro eHealth environment. I’ll be sharing ideas on what changes are needed in my next piece.

  • A roadmap for AI in healthcare can help set its trajectory

    It seems that AI’s popping up in lots of healthcare settings. It’s trajectory becoming a bit random? If it is, does it need a roadmap? An article available from xtelligence Healthcare Media says it does and describes several AI initiatives. It seems more a scan of AI’s horizon that how to reach it.

    Eduardo Galeano, the Uruguayan journalist and  writer, identified horizon’s dynamic that fits AI and eHealth. “Utopia is on the horizon. I move two steps closer; it moves two steps further away. I walk another ten steps and the horizon runs ten steps further away.” 

    AI in Healthcare’s perspectives and initiatives include: 

    Tapping the value of data at the right place, in real time; top questions for healthcare leadersWelcome to the age of intelligence: matching mind and machineHealthcare researchers using AI: don’t let data access derail clinical breakthroughsAn inside-out look at AI in outpatient radiologyChallenges in AI for radiologyWhen will AI be added to radiology training?Enterprise imaging infrastructureGreenlighting medical AI appsInside healthcare’s research revolution. 

    Two important roles for AI are seen as: 

    Personalised, precision medicineClinical research.

    These are already transforming healthcare. The potential and opportunities need health systems to implement effective strategies for 

    AI and eHealthHealth and healthcare transformation.

    AI reinforces the need for tight integration of eHealth strategies and health and healthcare strategies. It’s widely recognised as important. AI needs it strengthening. It’s a challenge for Africa’s health systems.

  • WHO can help you keep up to date on global eHealth trends

    Awareness of eHealth achievements and dynamics from other users is crucial in framing eHealth strategies, investment decisions, benefits realisation and mitigating risk exposure. Finding the information’s often a challenge. A new publication from Johns Hopkins University Bloomberg School of Public Heath in collaboration with WHO can help.

    The first issue of Global Health: Science and Practice was supported by an Aetna Foundation grant. It deals with five themes:

    Establishing standards to evaluate eHealth’s impact on health systemsGovernanceFinancing UHC in low and middle income countriesWorkforceHealth service supply side and demand generation.

    These themes fit into WHO’s eHealth themes of information and research, governance, financing, workforce and health services. Africa’s health systems can use the findings to support the sustainability and direction of their eHealth trajectories.

    Within these, it’s important to avoid strategic mistakes identified by Rosabeth Kanter:

    Rejecting opportunities that initially seem too smallAssuming that new services and improved processes aren’t strategic goalsLaunching too many minor service changes the confuse stakeholders and increase internal complexity.

    These are some of her innovation traps. Africa’s health systems don’t need them.

  • 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 leadershipBuilding eHealth capacityConstructing 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 courseNew 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 partnersAcfee’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.