• Strategy
  • 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.

  • Planning, stumbling blocks and learning: Argentina’s advancing health centre eHealth programme

    While considerable challenges remain, Argentina’s eHealth revolution’s gaining ground.

    A report in eHealth Reporter Latin America says it’s the view from the Argentine Association of Users of Information Technology and Telecommunications, (USAIRA) at its 8th Forum of IT Health Argentina  at the National Academy of Medicine in Buenos Aires 

    Dr Daniel Rizzato Lede, Director of Development of Healthcare Information Systems at the Ministry of Health, described how the Argentinian National Digital Health Strategy will promote connectivity between different health centres and develop a dialogue between information systems in provinces. It’s part of a digital strategy for Ministry of Universal Health Coverage (CUS) project that connects 14 provinces and a unique EMR for all patients, regardless of local government, medical institution or facility. 

    Defining national eHealth standards is planned before the end of 2019. It’ll enable implementation of a national eHealth infrastructure with scalable projects in provinces that operate within regulatory and legal frameworks. Before 2023, these services will be in all Argentinian provinces. 

    Guidelines for a strategy for a paper-free environment are underway at the Hospital de Alta Complejidad en Red “El Cruce”, Buenos Aires. Matías Said, functional analyst and project coordinator says it’ll be in place in the 180-bed hospital before 2022. 

    The In addition, , from Swiss Medical Group (SMG) has a long-term project for a unique health information system that integrates management of 30 health care units. It began in 2014. Daniel Castro said it involves 11,000 doctors and dentists, 1,500 nurses, 1,200 administrative employees, 300 telemarketers and 1,700 assistants.

    Gonzalo Rojo, a pediatrician, shared the step by step EMR implementation in the Hospital Britanico de Buenos Aires. The project started from scratch in August 2016. There are 80 project team members, and 200 direct collaborators. Doctors are on the hospital group leading the initiative. His crucial insight that’s a lesson for all eHealth project’s is that “Sometimes, we lose sight how easy it is for the doctor to use paper.” 

    Other contributors included the collaborations between RedHat and the Massachusetts Open Cloud (MOC). Its aim’s to increase processing imaging speeds and diagnostics precision. OMINT in Brazil, presented research into chatbots. They show that only 16% of 1,700 calls required the intervention by a human operator. Some 95% os users registered satisfactory responses.  Here come the robots.

  • 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 resourcesEvaluate: 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 timeMotivate: 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.

  • Saudi’s eHealth programme aims for efficiency and effectiveness gains

    Saudi Arabia’s Vision 2030 aims to improve the efficiency of the health care sector through information technology and digital transformation.

    The ministry has launched the beta version of the e-health system at three hospitals

    The e-health system will be implemented across hospitals in the Kingdom in phases

    RIYADH: The Ministry of Health is implementing a cutting-edge e-health system at hospitals to improve health care efficiency in the Kingdom and provide patients with standardized e-health records by 2020. 

    Three Saudi Arabian hospitals, Yanbu General Hospital, Al-Bukayriyah General Hospital and Al-Kharj Maternity and Children’s Hospital, are set to use eHealth to improve their efficiency. An article in Arab News says it’s the start of National Transformation Program 2020 (NTP 2020), a Kingdom-wide programme to use eHealth in all medical departments including reception, emergency departments, clinics and wards. It’s part of the health ministry’s Vision 2030 to use eHealth to improve healthcare efficiency and effectiveness. 

    Integrated eHealth system will simplify data saving and access, reduce medical errors and ensure that appropriate health services are provided to patients. Benefits stem from the right resources being in the right place at the right time and reduced waste. 

    While Africa’s health systems may find the affordability of such a strategy challenging, the strategy seems transferrable. They’d have much longer timescales, which can create other challenges, such as obsolescence creeping in. These need identifying and addressing with risk mitigation plans as long-term requirements.

     

  • Future health data systems need more of these

    On March 14th I spoke at the ANOVA data summit in Johannesburg. I was asked to talk about the future of health data and its systems. Earlier that morning Stephen Hawking had passed away leaving the scientific community weighing the enormity of one man’s extraordinary contribution. Some of his famous words repeated in my mind, including his terse challenge, “The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge”, an apt warning for those of us in the information space.

    As health systems decisions become more data driven, demands for enough, quality data, and ways to make sense of it, increase too. Expectations are high.

    “It has become increasingly clear that Universal Health Coverage cannot be achieved without the support of eHealth” WHO suggested in the third global survey on eHealth and AMIA proposes that “access to broadband is, or soon will become, a social determinant of health”.

    In African countries, competition for resources is fuelled by smaller budgets trying to address substantial service gaps. Decisions to invest in eHealth and data need to be taken with considerable care, and must be economically sound, affordable, and evidence-based.

    Data systems should be built in steps that are sustainable and yield information that can be trusted. Emphasis should be on integration and consolidation and embracing emerging opportunities. It needs sound strategic planning too, with emphasis on:

    More substantive partnering among stakeholders Better agreement on architectural frameworks and evolving standardsMore opportunities for data collection from individuals, through mobile phones and other devices that become ubiquitousExploring new approaches to unique identifiers, including understanding the potential role of a medical blockchainIncorporating AI and machine learning to augment progress.

    Alongside these, cyber-security requires constant vigilance.

    Acfee is building a toolkit of good practice for help knowledge workers navigate these issues and make good choices.

    Talking about the future is fun but too often gratuitous. Hawking pointed out that “Intelligence is the ability to adapt to change”. The ability of our health data to provide value is also about our ability to adapt to health’s changing needs, to ensure that our efforts remain relevant and support impact.

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    Sean is CTO at HISP-SA and Chairperson of Acfee. HISP-SA supports the South African Department of Health in its efforts to build information systems that support health transformation.

    Acfee advances eHealth’s health strengthening and transformation role for Africa through the eHealth Network for Africa blog and eHealthAFRO stakeholder platforms, engagement with African Ministries of Health and other regional eHealth leadership groups, and the collection and sharing of knowledge and tools.

  • mPowering frontline health workers’ launches WASH health domain on ORB

    Exhortations to people to wash their hands frequently have a long history. Continuous, accessible reminders are still essential.  Handwashing’s the single most cost-effective intervention to prevent pneumonia and diarrhoea in children. It reduces infections during pregnancy and childbirth too.

    In the eHealth age, there are more sophisticated ways of disseminating the advice than numerous signs with lots of slogans. mPowering Frontline Health Workers is launching a new domain using on Object Request Broker (ORB) for Water, Sanitations and Hygiene (WASH). It contains training materials for health workers. ORB’s middleware that allows program calls from one computer to another. It relies on a computer networks.

    The need’s clear. In 2013, WHO and The Partnership for Maternal, Newborn & Child Health (PMNCH)  identified the challenge of diarrhoea. Diarrhoeal disease is the second leading cause of death and a leading cause of malnutrition in children under five. It’s in children under five years old

     years old. It is both preventable and treatable. There’s an estimated 1.7 billion cases of diarrhoeal disease every year, leading to about 760,000 children under five dying. A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene.

    Another report says an estimated 10-15% of maternal deaths are due to two causes. One’s infections linked to unhygienic conditions during labour. The other’s poor hygiene practices during six weeks after birth. 

    ORB’s WASH materials provide training and information on waste management, urban water supplies, sanitation planning, environmental health. All content’s quality assured to ensure accuracy and relevance for health workers. It’s accessible from mobile devices. 

    mPowering Frontline Health Workers is an initiative of USAID and the mHealth Alliance. It has six goals:

    Crowdsource innovative multi?media health contentCreate an online library of downloadable digital health content for organisations in developing countriesProduce a digital dictionary to enable integration and standardised reporting across several mHealth applicationsAccelerate the sustainable expansion of mHealth for frontline health workers in more than three developing countriesRigorously evaluate partnership impactShare experiences through a virtual global learning platform. 

    An estimate of 42% of global deaths from diarrhoea of children under five are in Africa. That’s about 320,000 children. mPowering Frontline Health Workers has an essential role.

  • Cape Town’s eHealth accelerator programme offers opportunities for graduates

    Many of us have good ideas. Turning them into action is often harder.  Cape Town's Accelerator Programmes aims to help. It offers opportunities for graduates to access finance and work experience to turn their ideas into a viable business.

    There are two pilot programmes. Accelerator two opens for applications on the 15th March 2018. Accelerator one has announced its eight finalists. They participate in a ten week online programme and have face to face interactions with their mentors. 

    Business coaches in eHealth started on the 23rd January 2018. The course extends over 10 weeks. There is one topic each week taking about ten hours. Finalists take part in discussions about health problems and solutions. Strategic planning, alignment to health-care environments, defining and marketing proposals are the main themes.  Discussions on topics relevant to running a profitable and beneficial eHealth business are included too.

    Finalists are :

    Petrus Van Niekerk :  Udok allows doctors to interact with patients who are far away as well as administer treatment and monitor patient careDr William Mapham : Vula Mobile is a system which allows doctors to refer patients to specialists in tertiary hospitals Dr Anuschka Coovadia : HealthAtHome is a company that will provide patients with the best care from the comfortability of their homes at an affordable price. Brighton Khumalo : ConnecTB is an online tool which allows health care providers to register and monitor TB patientsNicole Van Der Merwe : GeneCare Molecular Genetics will provide patients with access to customised diet plans as well as exercise programmes which will be accompanied by educational video coachingDr Musaed Abrahams : Aviro Health has developed an app that will mentor nurses in primary health care to efficiently treat patients with HIVSuretha Erasmus : GC Network  has developed a pregnancy screening app that educates pregnant mother of their individual risk for a chromosome abnormality as well as provides detailed information regarding available prenatal testing which will help the mothers make informed decisionsVere Shaba : RAR Group VRHEALTH is a company that created a virtual yet realistic world for substance abuse patients who have been placed in a rehabilitation to develop new behavioral patterns through the virtual world Is the programme a model for Africa’s other health systems? It offers a smart way to encourage and develop Africa’s budding eHealth entrepreneurs. 

  • eHealth for mental health needs more intelligence

    Cinderella never thought that her success would attach her name to parts of healthcare. Countries’ mental health service is one of them, and its eHealth investment is being held back too. A study in the Journal of Medical Internet Research (JMIR) sets out to explain why. It investigated individual characteristics that influence both preferences and intentions to use eHealth for mental health in Australia. It identifies factors that might inhibit or enable eHealth.

    It found low reported preferences for eHealth for mental health services. Despite this, intentions to access these services are higher. This raises the challenge of how to translate these intentions into activities that use eHealth services. It found that strategies designed to enhance confidence and familiarity and ease people into new Internet-based mental health service programs may be important for increasing the chances of sustainable use. But, will users return to eHealth later? 

    It’s a worthy goal, but the study found that most respondents, almost 86%, prefer face-to-face services. The scope to engage eHealth users was found to be up to 40%. It’s a significant user base that needs supporting.

    Acfee identifies several factors that needed in eHealth to secure benefits. They include:

    Stakeholder engagementMeeting users’ information requirementsEasy to useHigh level of utilisation. 

    Putting these in place for the 40% will increase the chances of sustainable use and benefits realisation. For Africa, with its limited healthcare resource base, supporting up 40% mental health patients with eHealth access offers a valuable way to expand mental health services at minimal cost. It’s an opportunity. It’s not easy to achieve.

  • Can Africa adopt a modern master patient index?

    Paper patient administration and medical records can be unreliable in sustaining patient identification. Overcoming their limitations needs a sound Master Patient Index (MPI) and effective patient identification as a foundation for dependable eHealth. A white paper from Verato, an MPI vendor, describes a way to do it.

    A thesis in The Future of Healthcare Depends on a New Architecture for Patient Identity Interoperability has five components:

    Healthcare will involve extensive co-ordination across the full care continuumThe ability to access patient information is the cornerstone of co-ordinationResolving patient identities across disparate systems and enterprises is critical to accessing informationCurrent MPI technologies can’t resolve patient identities consistently enough or well enough to support emerging information needsMPIs patient identity resolution technology must support the new needs as part of a highly accurate, national patient identity resolution service.

    Africa’s health systems can apply these criteria to their strategic and procurement choices. They apply to all types of eHealth, not just EHRs. It’s a core requirement for improving healthcare efficiency. It supports a shift from point-in-time service towards effective healthcare co-ordination too.

    Three themes are needed for effective access to patient information: 

     Agreed rules and policies for sharing patient dataStandardised access protocols and content in EMRs and EHRsPatient identity matching.

    A unique national patient ID number is seen as supporting these. But Verato sees this as logistically

    Impossible, politically untenable because of privacy implications and would not help link people to pre-existing medical records. Relying on basic demographic identifiers such as name, address, birthdate, gender, phone, email, and social security numbers aren’t a solution because they’re prone to error when patients register at receptions and can change over time. About 8 to 12% of people may have more than one identity in any given hospital system, with actual medical histories spread randomly across them.

    MPI matching techniques was invented in 1969, and obsolete. Verato sees the solution as a pre-built, cloud-based, nationwide MPI that healthcare organisations  can plug into. It can avoid the need for extensive algorithm tuning, data standardisation, data governance, data cleansing, or data stewardship. It can help to achieve better compliance with data standards. 

    As Africa’s eHealth moves on, the concept can be assessed as an investment option. If it’s not, then an option to deal with the limitations of conventional MPIs may be needed.