• Strategy
  • 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 from 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.

  • 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.