• Strategy
  • 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. 

  • AeHIN says good eHealth governance methodology can transform health systems

    Information from eHealth investment’s reaches into many health and healthcare activities. Successful utilisation and benefits realisation needs effective governance.

    Asia eHealth Information Network (AeHIN), with support from the Asian Development Bank (ADB) and CC and C Solutions, an ICT training firm, has crafted a set of governance and architecture methodologies.  It aims to help health systems start the work needed to guide their eHealth projects at national scale.

    In a blog on Standards and Interoperability Lab Asia (SIL-Asia), Alvin Marcello says nine countries agreed to create the Health Information Governance and Architecture Framework (HIGAF). It’s based on a simplified Control Objectives for Information and Related Technologies 5 (COBIT 5) framework. 

    HIGAF helps developing countries address their health sector needs. It complements the Convergence Workshop for Ministry of Health national eHealth strategies. Many developing countries are accelerating their eHealth investment, but have yet to work out their governance approaches. 

    The governance initiative is part of a long-standing series of AeHIN initiatives that include: 

     WHO-ITU National eHealth Strategy Toolkit, introduced in 2012Training six countries in national eHealth strategy development in 2013Myanmar’s first Convergence Workshop to convene international NGOs, development partners, and the private sector in 2015 Guidance for Investing in Digital Health, 2018 Digital Health Impact Framework User Manual, 2018.

    AeHIN’s sustained focus and support is a collaborative model for Africa’s health systems. A challenge is the raising the finance to achieve.

  • 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 healthmHealth for telemedicine for a current patient catchment areamHealth for telemedicine with an expanded catchment areasMalaria surveillance and interventionCapital and leasing finance for an EHRStrategic 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 impactLowest riskHighest socioeconomic benefitLowest 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.

  • An eBook sets out six steps for clinical mHealth

    Clinical teams have increasing mHealth opportunities. mHealth strategies should provide the bases for decisions to use them. An eBook by Spectralink, a communications provider, available from Health IT Security, sets out six steps. The goal’s to invest in clinical smartphones for healthcare professionals to communicate, collaborate and co-ordinate patient care across wide arrays of teams and team members. 

    Six Steps to Developing a Successful Clinical Smartphone Strategy combines generic strategic concets, such as vision, with technical components. The six steps are:

    Define an overall vision for mHealth technology initiativesUnderstand information flows, application and technology requirementsEvaluate enterprise-class smartphone solutionsAssess ICT infrastructure and requirements, including Wi-FiImplement a proof of concept and pilot programmeAddress operational issues, including training and support requirements. 

    Creating successful clinical mHealth strategies need measured, forward-thinking. Improving patient care and outcomes, and accounting for future technology advancements  must be the focus. It should include people, processes and technology to maximise organisation’s benefits.

    The eBook extends from strategy to mHealth investment. Acfee would include a step for business cases to generate and compare options to identify and estimate:

    Strategic fitSocio- economic impact, including optionsManagement capacity to deliver and realise net benefitsFinance and affordabilityCommercial themes, such as contractual options.

    Completing this would be before and after step 5. Step 6 should also address benefits realisation issues. These lay foundations for M&E as step 7. 

    Africa’s health systems assign a high priority to mHealth. The eBook provides a process that they can adopt and ehance.

  • ADB eHealth guidance says look at the forest and the trees

    Managing and investing in eHealth’s seen as similar to forest management. Both are complex ecosystems. A Peter Drury blog from the Standards and Interoperability Lab – Asia (SIL-Asia) emphasises the large number of dynamically, interacting elements that where. Each element in the system may not know about the behaviour of the whole system. 

    Five-year strategic visions and plans help. The WHO/ITU National eHealth Strategy Toolkit provides guidance for these, but they’re not enough. Managing a complex sets of real-time elements is a greater challenge. It’s the core of Guidance for Investing in Digital Health, an Asian Development Bank initiative. 

     It’s based on how stakeholders engage, or don’t engage, with current systems, and how well, or not, they’re supported by management, technical, and workforce foundations. Investment appraisals and decisions spring from these,

    Instead of a five-year cycle, eHealth policy-makers should:

    Monitor progressAdapt to emerging challenges and opportunitiesManage expectations and investment. 

    The ADB’s Digital Health Impact Framework User Manual, linked to the Guidance, provides a methodology for these activities. It too is iterative, and addresses short and long-term requirements. 

    Pressure for quick wins doesn’t help. To counter this, the Asia eHealth Information Network (AeHIN) and SIL-Asia support work on Digital Health Governance Architecture and the Mind the GAPS programme covering governance, architecture, programme management, standards and Interoperability.

    While these are Asian initiatives, Africa can begin to adopt them. Using components that fit each countrys’ health systems is the way to start. It’ll set them on a trajectory of proven good practices.

  • AeHIN sets up its Community of Interoperable Labs (COIL)

    Six countries’ health systems have formed the Asia eHealth Information Network (AeHIN) Community of Interoperable Labs (COIL). The Standards and Interoperability Lab-Asia (SIL-Asia) is guiding the initiative. Viet Nam, Malaysia, Thailand, Philippines, Indonesia, and Taiwan commitment to interoperable health systems at the 6th Asia eHealth Information Network (AeHIN) General Meeting and Conference on Interoperability for Universal Healthcare Coverage (UHC).

     

    A blog by SIL-Asia says the Regional Interoperability Workshop organised by the AeHIN at the the Global Health Research Forum in August 2015 was the genesis. SIL-Asia was set up as a regional health interoperability lab to meet the needs of Asian countries for a facility to benchmark emerging digital health technologies in the market. The benchmarking criteria are common international standards for interoperability or systems to exchange usable data and information.

     

    COIL is a community of Asian countries committed to establishing their own interoperability labs (IOL). These will focus on digital health interoperability and facilitate national health data and information exchange to support evidence-based healthcare.

     

    It’s a knowledge sharing community too. Each country is expected to share their lab technologies, artifacts and documents with one another to promote inter-country co-operation on standards and interoperability.

     

    Other countries can join COIL too. Teaming with SIL-Asia is the way in.

     

    SIL-Asia and COIL are models that can benefit Africa’s health systems and their eHealth initiatives. Which entities will provide the sustainable finance needed.  

  • 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.