• Strategy
  • Technology’s setting timescales for Africa’s eHealth strategies

    A few years ago, eHealth strategies were much simpler. They set and captured relatively straightforward information architectures and standards, and bounded decisions, such as which structured systems were needed, which vendor should provide them, which ones were affordable and how to realise their benefits. These all sat in a temporal setting, rarely more than five years. Relativity in this setting doesn’t mean easy, it’s compared to the immense range eHealth opportunities and decisions now.

    eHealth’s increased and continuing sophistication means that Africa’s health systems and eHealth strategies need to be explicit about how far into the future they want to look. Their settings now are determined more by eHealth’s technology than calendars. Two commentaries can help to set these.

    Machine, Platform, Crowd: Harnessing our Digital Future, a book by Andrew McAffee and Erik Brynjolfsson, both working at MIT Sloan School of Management and on the MIT Initiative on the Digital Economy, sets out changes led by new ICT. They identify three.

    AI that moves more control from people to computersA shift from products to platforms that can scale investmentA move away from centralised institutions to users, the core to the crowd.

    Alongside these, the Institute of Electrical and Electronics Engineers (IEEE) identified nine top 2016 ICT trends. Its performance was reviewed in Computing Now. Some came to fruition in 2016. Others may reach critical development points this year. They were:

    1.     5G, promising unimaginable speeds

    2.     Virtual Reality (VA) and Augmented Reality (AR), with VR now available and AR expanding

    3.     Nonvolatile memory that can store more data at less cost and power

    4.     Cyber Physical Systems (CPS), used as the Internet of Things (IoT), its deeply embedded hardware and software in smart medical technologies

    5.     Data science, processes and systems to extract knowledge or insights from data in various forms, either structured or unstructured, and a continuation of some data analysis fields such as statistics, data mining, and predictive analytics

    6.     Capability-based security to provide finer grain protection and defences

    7.     Advanced machine learning, used in medical diagnosis, and exploring the construction of algorithms that can learn from and make predictions using data

    8.     Network Function Virtualization (NFV), an emerging technology providing virtualised infrastructure for the next-generation of cloud services

    9.     Containers that can deliver app faster and more efficiently.

    As the year progresses, how will Africa’s health systems evaluate and take decisions on these combined twelve ICT and eHealth trends? Ignoring them means falling behind. Assessing and adopting some of them means highly complex eHealth strategies. Maybe AI, 5G and analytics will be enough for now.

  • US eHealth IOp should focus on big impacts

    Interoperability (IOp) in eHealth isn’t an absolute state. Measuring it isn’t either. Sir William Osler, a Canadian doctor and one of four founding professors of Johns Hopkins Hospital, didn’t need to bother with eHealth IOp, but hinted at it in strategy when he said “In seeking absolute truth we aim at the unattainable and must be content with broken portions.”

    Challenges are how much, and which IOp measurement will achieve contentment without breaking it. An article in Fierce Health provide some indication. It sets out responses from five US organisations to the Office of the National Coordinator (ONC) report in the Proposed Interoperability Standards Measurement Framework, reported by eHNA in May.

    It has two main themes.  One’s measuring standards implementation. The other’s how end users can refine and customise standards to meet their needs. Most groups expressed some trepidation that new standards would result in an undue burden for providers. They want the ONC to focus on measurement areas with the biggest impact. Their advice is directly relevant for Africa’s IOp plans.

    The American Medical Informatics Association (AIMIA) supported the ONC’s framework in its response. It also asked the ONC to target “high-value standards” that offer the biggest impact. Specific requirements are functionalities for accessing drug databases and transmitting laboratory data. It wants the measurement framework to be automated too, so easier reporting mechanisms translate to higher participation.

    A combination of support and caution was part of the Health Information Management and Systems Society (HIMSS) contribution. It offers three main themes: 

    Limiting undue burden by leveraging the use of existing reporting frameworksStandards as the means, with the standards measured aligned to use cases critical to advancing IOp and better information exchangeIncluding all relevant stakeholders, including the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC).

    A sub group of HIMSS, the Electronic Health Record Association (EHRA) suggested a combination of standardised approaches with non-standard methods. It’s a focus on use cases with the biggest impact. It emphasised the potential burdens too.

    The College for Health Information Management Executives (CHIME) highlighted patient matching as one of the biggest IOp barriers. It says measurement standards are premature, and wants the ONC to:

    Develop standards for seamless communication between ICT systemsEnsure that data exchange identifies patients with 100% certaintyMake data exchange usable for clinicians before tackling IOp standards.

    CHIME proposed that if the measurement framework’s implemented, the ONC should work with stakeholders to prioritise cases and develop a granular set of standards.

    Health IT Now, a coalition of patient groups, healthcare organisations, employers and payers, recognises that measuring IOP’s necessary, and said a narrow focus on successful data transmissions devalue improvements in using data to improve care and defer the capability of health systems to exchange information. It wants collaboration with patients and patient advocates and private sector organisations that can contribute to identifying, developing, and deploying IOp standards for better information systems.

    These perspectives can inform Africa’s eHealth development. IOp and its choices are seldom off the eHealth agenda.

  • There’s a template for developing mHealth strategies

    With Africa’s score on the WHO results from its global eHealth survey approaching 60%, there’s still plenty to do. A survey by Spok offers some good practices for the next steps. The start point’s that there isn’t a single definition. Instead, organisations have different interpretations. Common purposes seem to be:

    Align mobile objectives with organisational goalsFeed the framework for all mHealth projectsAnswer questions such as:

    o   How can mHealth enhance patient care

    o   What strategic initiatives need including in plans for mobile enablement, such as shorter ED and inpatient discharge processes

    o   What integrations are needed meet the larger goals of the hospital, such as easier communication between healthcare teams

    o   How can mHealth improve health workers’ productivity.

    As mobile technology and opportunities develop, healthcare’s mHealth strategies need to move on to match. This needs regularly updated policies. US experience is that mHealth strategies are quite fluid, with organisations amending them as needed:

    Shifting end users’ mobile needs

    44%

    New devices available

    35%

    New EHR provider capabilities

    36%

    Changed strategic goals

    23%

    Challenging strategy implementation

    21%

    Leadership changes

    16%

    Mobility strategy not updated

    7%

    A common feature’s that stated strategic goals aren’t embedded sufficiently or explicitly enough in mHealth strategic goals. Examples are:

    Communications between doctorsNurse to doctor communicationsCommunications between nursesCode team or rapid response team communicationsCommunication with health systems’ doctors networks and and other health professionalsManaging critical test resultsNurse call and patient monitoring alerts to mobile devicesPatient satisfaction scoresPatient throughputED and bed turnoverAlarm fatigue.

    Improving on these needs a range of engaged stakeholders. They include ICT, clinical leaders, telecommunication experts, all appropriate healthcare professionals and other health workers and the organisations’ executives. Setting them up as permanent mHealth strategy teams is a priority for Africa’s health systems.

  • Africa’s health ministers set a firm eHealth direction

    Health ministers at the African Ministerial Dialogue on Digital Health in Geneva, reported on eHNA, emphasised eHealth’s direction. A core component will be the eHealth report from the Broadband Commission on February 2017.

    Digital Health: A Call for Government Leadership and Cooperation between ICT and Health set out the role of governments and government leaders as playing a fundamental role in fostering eHealth’s enabling environment and resolving some of the challenges, such as unsustainable funding, high capital expenditures, limited workforce capacity, and poor collaboration between the health and ICT sectors. Governments can also help to avoid duplication of effort, adopting Interoperability (IOp) standards and coordinating stakeholders across public and private sectors. 

    Legislation and regulation are important too. Data protection and privacy measures, regulating medical devices and cyber-security are priorities.

    The report refers to the report from WHO that 73 of 116, 63%, of its member states have national eHealth strategies. Africa’s lagging behind at about 40%. There’s more to do. For national Health information System (HIS) policy and strategy, Africa’s above average at about 80% coverage. 

    There is one African member of the Broadband Commission. It’s Hon. Jean Philbert Nsengimana, from the Government of Rwanda.

  • More mHealth strategies are in place

    As mHealth expands across Africa, a report from Spok identifies an expansion of mHealth strategies. It’s improving, but there’s still plenty to do. From 2012 to 2017, healthcare organisations with mHealth strategies have increased from 34% to 65%. The Evolution of Mobile Strategies in Healthcare also identifies areas for improvement.

  • Senegal’s eHealth strategy has valuable lessons

    All African countries have valuable lessons to impart as they pursue their eHealth initiatives. Senegal’s have been complied into a case study with support from USAID and Knowledge for Health (K4H). Senegal’s Journey Toward an eHealth Strategy: Highlights from the Development Process sets out approaches to:

    Senegal’s methodsIts process to develop its eHealth strategic planEngaging stakeholdersDesk reviewsSituational analysisThe Drafting Committee activitiesFinancial resourcesCritical Success Factors (CSF)Challenges and barriersComparison to WHO/ITU eHealth GuidelineRecommendations to a useful eHealth Strategic Plan, successful implementation , monitoring implementation and for other countries’ eHealth strategies. 

    General lessons for other countries:

    Leadership by the health ministries of healthDevelopment of governance and co-ordination mechanismsHarmonise health and ICT experts contributionsIntegrate with existing initiatives, such as Rwanda’s electronic identity cards integrated with eHealth programmesEngage with and co-ordination stakeholdersIdentify  human and financial resources neededLook for ICT impacts of ICT rather than the technology itselfUse actors and systems already in placeProtect personal health data confidentialityBuild in measurement and evaluation.

    People who participated in the Senegal eHealth Strategy have concrete recommendations based on their personal and collective experiences:

    Allocate sufficient time to develop credible scientific documentsAnticipate the financial resources neededStart with a baseline evaluation or situational analysis that includes reviews of existing eHealth projects and playersApply a consultative, participatory approach where key players with diverse expertise are brought together for brainstormingRefer to countries that have an operational strategic plan and learn from their model while taking into account socio-economic factorsAssess infrastructureEnsure appropriate legal norms are in placeEstablish realistic activity calendarsSeek high-level support for strategiesRefer to the WHO/ITU toolkit.

    Acfee has identified other essential features for Africa’s eHealth. Two are an eHealth leadership triumvirate of clinical, political and executive personnel that permeates across all eHealth activities, and a considerable emphasis on benefits realisations through health and healthcare transformation.

  • AeHIN’s strategy has lessons for Africa’s eHealth

    Last week I returned from an Asian eHealth conference in Myanmar. The trip was extraordinary for a number of reasons: exploring places, people and cultures quite different to the African environment I call home, learning about our Asian colleagues' approach to eHealth leadership, and learning first-hand how ubiquitous the open source DHIS2 platform has become.

    As our African countries health systems move towards eHealth goals, looking at other global regions provides valuable insights.

    Set up in 2011, the Asian eHealth Information Network (AeHIN) provides an overview of eHealth in that part of the world. When it started, it identified a shared problem of, at best, minimal Interoperability (IOp) “Even within Ministries of Health.”

    AeHIN has a clear trajectory for its 25 country members. The Asia eHealth Information Network: Strategic Roadmap 2016-2020 sets out a wide array of initiatives to support national eHealth development in Asia. There are four strategic goals:

    Build eHealth capacity for Health Information Systems (HIS) and Civil Registration and Vital Statistics (CRVS)Effective networking to increase peer assistance and knowledge exchange and sharingPromote IOp in and between countriesEnhance leadership, sustainable governance and M&E.

    eHealth governance framework for enterprise ICT is based on COBIT5, from the Information Systems Audit and Control Association (ISACA). It’s an internationally recognised framework for ICT governance. Its three overarching themes are evaluate, direct and monitor. There are four main parts in AeHIN’s model:

    Align, plan and organiseBuild, acquire and implementDeliver, service and supportM&E and assess.

    AeHIN has eHealth blueprints for enterprise architecture. Its four components are business, data, application and technology. It also has a Regional Enterprise Architecture Council for Health (REACH). Its eHealth capacity framework has seven modules:

    eHealth service agreementsManagement, plans, policies and proceduresIOp profiles and terminology servicesHealth Information Exchange (HIE)National Standards and IOp frameworkeHealth governance frameworkNational eHealth action plans.

    Supporting these initiatives are special interest groups. They include:

    Geographic Information Systems (GIS) labRoutine HISsDistrict Health information Systems (DHIS) 2, implemented in twelve countriesResearch, with ten PhDs to work on AeHIN topicsCommunity of IOp labs.

    The African Centre for eHealth Excellence (Acfee) has much in common with AeHIN and its aspirations. A working relationship has been initiated between Acfee and AeHIN to begin sharing African and Asia lessons for mutual benefit.

    This structured approach offers a template for Africa’s eHealth. Modest, steady, sustained investment can start to achieve it.

  • Should Africa’s eHealth strategies include all healthcare, like Kerala’s?

    A goal of healthy Africans is neutral healthcare ownership. State, private, faith-based and company healthcare all share in the objective, but may not provide services to all patient groups. To achieve consistency of good practice and comprehensive public health data, is there a case for extending health ministries’ eHealth strategies across all healthcare?

    Kerala state health department in India thinks there is. The Times of India has reported that the state’s private healthcare sector may have to comply with its eHealth initiatives. About two thirds of patients in Kerala depend on private hospitals. Including them will ensure public health data collection will be complete. Currently, Kerala is rolling out its programme for EHRs, as eHNA posted previously.

    Extending it to other healthcare sectors will provide a full data set. How it’s done is important. The state government plans discussions with private hospitals. This builds on existing engagement where several private hospitals already co-operate with the state government under several schemes like Rashtriya Swasthya Bima Yojana (RSBY), a government health insurance scheme for people with low incomes.

    Success depends on engaging all types of healthcare providers from the outset. As public health promoters it makes sense for African countries to seek comprehensive eHealth coverage.

  • Will your eHealth New Year resolutions help secure better health for Africans?

    Happy New Year to everyone. Congratulations on your 2016 eHealth efforts. It's been quite a year, setting us up for an extraordinary African 2017.

    Thank you for reading our stories of Africa’s eHealth development. They reflect a small part of our passion to explore and support eHealth’s role in securing better health for Africans. They showcase some of the exceptional work already underway through you and our international eHealth colleagues.

    At the September African eHealth Forum (AeF), our Advisory Board set out African eHealth priorities. Details are in the AeF Report, Advancing eHealth 2016, and summarised in posts on eHNA.

    Acfee’s response will be delivered in the New Year. It will focus on bringing our five priorities to life in tangible ways that can help lead to healthier Africans.

    1. eHealth strategy

    Acfee’s research and support for African countries’ national eHealth strategies will expand. This includes a special focus on issues highlighted by the Acfee Advisory Board, including:

    Cloud computing: learn from global experiences of the challenges and opportunities and synthesise these for health ministries to revieweHealth surveillance: explore the contribution of Acfee’s eHealth impact and benefits realisation research and expertise for HISP’s planned eHealth surveillance initiative in West AfricaArchitecture: finalise the commentary on eHealth architecture to fit expanding mHealth and social media for health ministries to reviewInteroperability (IOp): seek finance to establish Acfee technical working groups for IOp and support an IOp workshop on a use case and a development programme in an African country in collaboration with Integrating the Healthcare Enterprise (IHE) to set the process of use case development in Africa

    2. eHealth governance

    Acfee’s review of start-up measures for health ministries will be published in an eBook, leading on to sophisticated arrangements as reported on eHNA.

    3. eHealth regulation

    Acfee will continue to develop affordable, sustainable approaches to eHealth regulation for health ministries to review.

    4. eHealth cyber-security

    Acfee’s on-going review of global threats, initiatives and actions will be synthesised in an expanding eBook for health ministries to use to combat cyber-threats, as reported on eHNA.

    5. eHealth impact

    Acfee will continue to develop sophisticated impact models appropriate to Africa’s needs, to help health ministries to select good initiatives, monitor and evaluate them and promote positive socioeconomic impact.

    The 2017 programme will include Acfee’s internal development, such as the internship programme to develop emerging professionals and future leaders and promote their contributions to eHealth’s advancement across Africa.

    Engagement of partners is critical too, such as professional bodies, with an important step being to work with Africa’s Public Health Associations (PHA). Developing Acfee’s eHealth curriculum will advance too with collaboration with Health Information Systems Program (HISP) and selected African and international universities, including New York University, Monash South Africa and Rome Business School for Masters degrees for Africans.

    Finally, Acfee’s two landmark events will continue, with the eHealthALIVE broad stakeholder forum planned to run in Southern Africa and the East African Community (EAC) in 2017. AEF meetings of Permanent Secretaries and other health leaders will follow these, to extract the lessons from the eHealthALIVE platform and channel them into decisions by ministries.

    Acfee’s relationships with African health ministries are growing, as are our efforts to collaborate with like-minded partners to expand stakeholder engagement to advance African eHealth.

    Our shared goal is healthier Africans, in 2017 and beyond.

  • African countries need more than good strategy – unpacking WHO's 3rd Global Survey on eHealth

    Chapter 1 of the WHO and Global Observatory for eHealth (GOe) publication Report of the third global survey on eHealth Global diffusion of eHealth: Making universal health coverage achievable says “It has become increasingly clear that UHC cannot be achieved without the support of eHealth.” It describes eHealth’s foundations and sees a national eHealth strategy as a core. That 58% of countries have a national eHealth strategy is an important start.

    Good components for these strategies are described as:

    What citizens value and understandThe context of the health prioritiesA visionA plan of action for delivering the visionMonitoring and evaluationStakeholder engagementGovernanceeHealth components of standards, legislation, technical and service delivery solutionsFinanceHuman resources to deliver them.

    Acfee’s African eHealth Forum (AeF) report in 2015, Advancing eHealth in Africa, identified some 60 long-standing eHealth challenges that need addressing too. These included connectivity, improving dependencies beyond healthcare, such as registration of births and deaths, integration with research, procurement, better risk management and cyber-crime. In 2015, the AeF concluded that “African countries’ successful, expanded eHealth investment depends on dealing with long-standing eHealth challenges.” Solutions are seen as comprising thirteen measures:

    StrategiesHuman eHealth capacityLeading and managing complex change                          Relationships with suppliersSustainabilityeHealth performanceHealth informaticsBusiness casesBenefits realisationRegulation and governanceProcurementMedical EducationCountry scale.

    Evidence of eHealth’s performance and net benefits is sparse. eHNA has referred to numerous evaluations that show a range of studies with incompatible findings that range across eHealth’s success, its unexpected extra costs, modest benefits and financial disasters.

    This year’s AeF report, Advancing eHealth 2016, identified five themes, one of which is National eHealth Strategies, and set out seven priorities as:

    Cyber-securityCloud computingeHealth surveillanceEstablish technical working groups for Interoperability (IOp) and support an IOp workshop and development programmeDevelop eHealth curriculaEngage professional bodiesCollaborate with regional bodies.

    Progress is underway and Africa’s regional bodies have an important role to play in eHealth’s development. They will need to expand their views beyond the WHO report contents to consider recent challenges to eHealth development, such as the growth in cybercrime and the need for countries to take effective countermeasures. For Africa, this will put extra strain on already stretched resourcing for eHealth foundations. National eHealth Strategies will need to be agile and well supported across local stakeholders to fulfill their important foundational role. 

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    Image from the global eHealth observatory report