• Interoperability
  • An ITU/WHO “how to” guide for building interoperable digital health infrastructure

    As we strengthen African national eHealth strategies, interoperability is gathering momentum too. It's a critical component of our national eHealth programmes. We are looking for a common, comprehensive framework, incorporating all data sources and information flows, both electronic and paper-based, providing a clear development and consolidation path for all components, along a digital development maturity model.

    Fortunately, there’s a handbook about how to do it: Digital Health Platform: Building a Digital Information Infrastructure (Infostructure) for Health, published by the International Telecommunications Union (ITU) in collaboration with the World Health Organization.

    The figure below provides a high level overview of the Digital Health Platform (DHP) concept, its components, and how users interact with it. 

    Figure: How a DHP interacts with external applications and users

    The handbook suggests that a well-designed DHP will help countries to achieve the following priorities:

    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 DHP Handbook illustrates how DHP components are derived from the National eHealth Strategy. It is a detailed guide including illustrative case studies from Liberia, Estonia, Canada, India and Norway. It’s essential reading for African countries’ as we invest in our national eHealth programmes.

  • 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.  

  • Zanzibar’s eHealth aims to connect its 24 hospitals

    Zanzibar, a semi-autonomous Tanzian region in the Indian Ocean, has successfully installed a national ICT programme. It’s the backbone of social services digitisation. A report in IPP Media says it’ll provide broadband to its citizens across the archipelago and connect all 24 hospitals in region. 

    The government has set up a data centre to house medical information. It supports the eHealth objective of improving delivery of a range of social services.

    It also provides a platform to develop eHealth programmes to:

    Share patient informationRemote interpretation of test resultsRemote diagnosis.

    The plan’s to use the expanded connectivity to improve healthcare and social services quality. There’s a more sophisticated objective too. It’s to stimulate economic growth by unlocking entrepreneurial potential. This can create exponential eHealth investment trajectory that all Africa’s health systems could replicate.

  • 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.

  • Asian Development Bank presents eHealth guidance at AeHIN conference

    Weak eHealth strategies lead to weak digital health investment. Maximising success and minimizing failure’s a core ADB eHealth theme. It sees effective eHealth strategies as requirement, and it presented its Guidance for Investing in Digital Health to the Asia eHealth Information Network (AeHIN) 6th annual conference this week in Colombo, Sri Lanka

    The guidance describes the healthcare context that’s needed for eHealth strategies. Peter Drury, the project lead, then set out essential issues that included identifying and engaging with stakeholders and pursuing digital health strategies that are drawn from health and healthcare strategies and that achieve a balance between value for money and affordability.

    He sees strategies as only part of the process, and similar to his word association of fish and chips and bacon and egg. For eHealth, it’s strategies and investment. Sharing experiences of the two are important.  There are examples of effective strategies that he’s seen across Asia available from AeHIN’s Standards and Interoperability Lab (SILA). These provide valuable insights for Africa’s health systems and for African countries contemplating new national eHealth strategies. 

  • 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.

  • Interoperability across all healthcare’s needed

    Unlike most organisations, healthcare’s an huge array of integrated services. Ensuring that its information in interoperable across the range’s a daunting task. A white paper from Verato, a patient matching service, says comprehensive and effective healthcare needs a new architecture for patient identity interoperability (IOp).

    Its thesis has four themes:

    Healthcare involves extensive co-ordination across the healthcare continuumAccessing patient information’s the cornerstone of co-ordinationResolving patient identities across disparate systems and enterprises is critical to accessing informationExisting Master Patient Index (MPI) technologies can’t resolve patient identities consistently enough or well enough to support emerging needs.

    The task’s easier is if each citizen or visitor has a unique national patient ID number (UPI). These should be assigned at birth or on entry into countries. Issuing and maintaining UPI’s is challenging and needs sustained resources.

    Where these aren’t in place, MPI technologies are used but may be obsolete. Verato says they may not cope successfully with routine factors such as maiden names, old addresses, second home addresses, misspellings, default entries such as 1/1/1900 for birthdates and hyphenated names. Probabilistic matching fills in the gaps.

    A national database that healthcare organisations can access is seen as a better option. It can be managed effectively and updated regularly more efficiently than each healthcare organisation can achieve.

    The model offers Africa’s health systems an option in improving their UPIs. While many of these may be in their infancy, it creates an opportunity to set up a reliable way ahead to set up IOp rather than switch at a later stage of maturity.

  • Intermountain Healthcare integrates telehealth and mHealth in a connected care platform

    Information silos are huge obstacles to integrated healthcare. And integrated care is the kind most of us want for ourselves and for our loved ones. It's a key eHealth challenge.

    In a report in Research Information, research platform outfit Dimensions says they’re usually created unintentionally, and are a phenomenon to “escape” from.

    Intermountain Healthcare, based on Salt Lake City, US, seems to be free of these troubles. A report in mHealth Intelligence says it’s integrated 35 different telehealth and mHealth services into Connect Care Pro, a single connected care platform. Objectives are to improve care coordination and keep care in communities, both of which could be good for patients and health systems. It took five years to plan. 

    The services it supports include: 

    Virtual or tele-programmesTelestrokeTelehealth programmes for behavioural healthTelehealth programmes for newborn critical careTelepharmacy serviceseHealth services using connected health devices.

    The legacy was a history of launches of several telehealth and mHealth programs and pilots that didn’t integrate easily. Intermountain sees their integration initiative as the next telehealth phase.

    The initiative has valuable lessons for our African countries' mHealth and telehealth programmes. It makes sense to start constructing equivalent platforms without delay. It’ll be easier and cheaper than waiting until more silos need integrating. Even more important, it’ll bring extra patient and healthcare benefits, sooner, for our patients, our families and ourselves. 

  • Limited IOp’s a drag on benefits

    For several years, health informaticians and other eHealth’s ICT experts have recognised the link for effective Interoperability (IOp) and eHealth benefits. Now, US finance executives have added to the case for more IOp.

    A US Healthcare Financial Management Association (HFMA) survey of 117 financial executives identified their views. It found an increasing need for an increased IOp priority, slightly up to from 68% in 2015 to over 70%. Almost a quarter, 24%, said their organisations can’t share data effectively with other providers and payers.

    Their views extended to external and internal IOp. Both are seen as a combined, upcoming primary focus of healthcare providers. Three drivers are:

    Current shortcomingsAnticipated future needIncreasing demand for access to numerous data sources.

    While the survey may not have revealed much that’s new about IOp, it’s a valuable reminder that progress is slow. For Africa’s health systems, it confirms the long timescales needed to reach high IOp levels. If it’s taking the rich US health systems so long, Africa’s can’t expect rapid results. Slow, steady and sustained seem to be their IOp plan.

  • Healthcare enters the blockchain ecosystem

    Over the last few years, healthcare has seen a record number of security breaches involving healthcare data.  This has prompted several start-ups to realise the work that needs to be done on the cyber-security front to make healthcare data secure.  Blockchain offers one potential solution to this challenge. Other solutions offered by blockchain include interoperability and the ability to connect data silos for more seamless systems and improved patient safety.

    SimplyVital Health is one of those start-ups experimenting with blockchain technology to give the healthcare industry a facelift. The company has developed a decentralised open-source protocol that will enable frictional-less sharing of healthcare data.  Their Health Nexus is a public-permissioned blockchain. It provides a platform to build advanced healthcare applications while maintaining the privacy and security required in the healthcare industry. 

    The developer tools on the Health Nexus are open source and available for free.  Members are able to build and deploy distributed apps utilising the blockchain protocol for transactions, identity and smart contracts, and a distributed hash table (DHT) for data storage, managed by a governance system. This will allow developers to create valuable solutions for pharmacies, healthcare providers, insurers, clinical researchers or patients.  

    Blockchain is certainly paving opportunities for new business models in healthcare.  The trajectory it will follow in the coming years, however, is an unmapped terrain waiting to be explored.  The road ahead for blockchain and healthcare will also require substantial intra-industry cooperation as well as dialogues between the public and private sectors regarding standards and regulatory frameworks.