• Strategy
  • Safe, seamless, secure: Australia's digital health strategy

    There’s no doubt about Australia’s vision for its eHealth: safe, seamless and secure: evolving health and care to meet the country’s modern needs. Produced by the Australian Digital Health Agency  (ADHA), Australia's National Digital Health strategy up to 2022 has seven strategic priorities to support the option for every citizen to have their own “My Health Record”:

    • Health information available whenever and wherever it is needed
    • Health information that can be exchanged securely
    • High-quality data with a commonly understood meaning that can be used with confidence
    • Better availability and access to prescriptions and medicines information
    • eHealth-enabled models of care that improve accessibility, quality, safety and efficiency
    • A workforce confidently using eHealth technologies to deliver health and healthcare
    • A thriving eHealth industry delivering world-class innovation
    • Safe, seamless and secure: evolving health and health care to meet the needs of modern Australia.

    It sets out six Critical Success Factors (CSF) too:

    • Trust and security assurance
    • Commitment, cooperation and collaboration across all governments to leverage existing assets and capabilities to avoid duplication and speed up benefits realisation
    • Establishing legislative, regulatory and policy frameworks
    • Strong consumer and clinician engagement and governance
    • Effective governance and leadership
    • Learning from others.

    A core concept’s that eHealth’s information is the “bedrock of high quality healthcare.” Its five patient benefits are significant and compelling:

    • Avoided hospital admissions
    • Fewer adverse drug events
    • Reduced test duplication
    • Better care coordination for people with chronic and complex conditions
    • Better informed treatment decisions.

    The strategy builds on considerable eHealth progress. About 20% of the population have a “My Health Record.” An estimated 98% will have one in 2018. Many already access their health information from My Health Record using mobile apps.

    It will help to overcome the challenge of disjointed and hard to navigate care for people with chronic conditions. Developing new models of care are being constructed on their EHRs.

    A National Cancer Screening Register will create a single view for Australians participating in cervical and bowel cancer screening. It will integrate with GP clinical information systems to help GPs to identify patients’ screening eligibility and history to support real-time clinical decision-making.

    Recognition of the risk of uncoordinated eHealth investment may not meet a common set of standards shows the strategies realism. A combination of agreed priorities underpinned by standards is a signal to the market about the role of priorities of eHealth vendors.

    Enabling the exchange of high-quality data between healthcare providers and the systems is a core goal, so semantic interoperability (IOp) is a high priority. It includes co-ordination between people, organisations and systems. The goal is to preserve data’s meaning when it’s shared between people and systems and one context to another, so information is used and interpreted in the same way.

    The Global Open Data Index produced by Open Knowledge International (OKFN) recently ranked Australia number one in the world for its open data policies that create an IOp environment and using data assets as a national resource.

    There are many lessons for Africa’s eHealth, such as the way that new eHealth strategies can build on previous ones, lessons learned and approaches to implementation.


  • DG for Health Precious Matsoso to open eHealthAFRO 2017

    Ms Malebona Precious Matsoso will open eHealthAFRO 2017. She is passionate about eHealth's transformative potential and believes that achieving "UHC depends on effective, patient-centred eHealth". We are thrilled to confirm that she has accepted our invitation to open the conference with a personal address and perspective on eHealth in South Africa.


    Ms Matsoso is no stranger to eHealth, information systems and their role in transforming health and healthcare. She has led South Africa’s eHealth strategy and its current review. The overarching objectives that place eHealth in a core role to support Universal Health Coverage (UHC) are challenging to achieve. Her leadership is essential in securing these for the long term. Her vision sets the context for the provinces and local health services for their eHealth endeavours.



    Ms Matsoso drives the Ministerial Advisory Committee (MAC) that I have the honour of serving on, alongside ten South African eHealth leaders. She recognises that eHeath is essential to achieve better health for all and is leading the MAC to ensure that South Africa's eHealth will support health transformation, helping sustain the health of South Africans in line with international good practice.


    The conference theme “eHealth for UHC” emphasises UHC’s dependence on effective, patient-centred eHealth. Ms Matsoso sets the direction and a realistic timescales for successful eHealth.


    Ms Matsoso was appointed Director General of the National Department of Health (NDOH) by the President of South Africa on 08 June 2010. She serves under the Minister of Health, Dr Aaron Motsoaledi. 

    She holds a degree in Pharmacy, a Postgraduate Diploma in Health Management from the University of Cape Town, and a Masters degree in Law and Ethics (LLM) from the University of Dundee. Her career has included posts as Head of Medicines Control Council (MCC), member of the National Research Ethics Council of South Africa, and the Director of the Essential Drugs and Traditional Medicines Programme for the South African Health Department. She was a Director in Public Health Innovation and Intellectual Property (PHI) in the office of the Director General, of the World Health Organisation (WHO) serving as WHO Secretariat on Public Health, Innovation and Intellectual Property. She served as the Chair of the Executive Board at World Health Organization from 2015 to 2016.


    Ms Matsoso has a bold vision for health transformation and we look forward to her comments when she opens eHealthAFRO 2017.

    Get your tickets here.

    #eHA2017 #AreYouReady?




  • Call for Papers - six days to go

    Sharing eHealth experiences and research finding’s essential to progress. These are the main goals of the Health Informatics South Africa (HISA) Call for Papers (CfP) for its conference at eHealthAFRO 2017 on 2 to 4 October 2017 in Johannesburg. It’s hosted by the South African Health Informatics Association (SAHIA). The CfP has four topics. They are:

    • eHealth Strategy, governance and regulation
    • eHealth impact through routine health information
    • Cyber-security related to eHealth applications
    • eHealth systems related to public health and surveillance. 

    Papers on other relevant eHealth topics may be considered. Will extra papers include health informatics developments and research on eHealth futures, such as AI and health analytics?

    The timetable is: 

    • Full papers submitted to South African Computer Journal (SACJ), complying with SACJ’s submission guidelines, by Monday 28 August 2017    
    • Notification of paper acceptance on Friday, 15 September 2017
    • Final author registration by Friday, 22 September 2017
    • Final paper due Friday, 29 September.

    A special SACJ edition will published presented papers. They’ll comply with SACJ’s editorial process, so at the end of the submission form, comments to the editor should include “HISA Conference paper.”

    eHealthAFRO 2017 brings together researchers and practitioners active in health informatics. At least one author should register for eHealthAFRO and present the paper at the HISA Conference for the paper to be eligible for SACJ publication. SACJ charges ZAR6,000 for publication costs for accepted papers, but authors with no funding can apply for this to be waived.

    Prof Nicky Mostert-Phipps is the contact for submissions. She is a software development lecturer at the Nelson Mandela Metropolitan University Faculty of Engineering’s Built Environment and Information Technology, and can provide more information about HISA’s conference and preparing and submitting papers.

  • 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 computers
    • A shift from products to platforms that can scale investment
    • A 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: 

    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 systems
    • Ensure that data exchange identifies patients with 100% certainty
    • Make 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 goals
    • Feed the framework for all mHealth projects
    • Answer 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 doctors
    • Nurse to doctor communications
    • Communications between nurses
    • Code team or rapid response team communications
    • Communication with health systems’ doctors networks and and other health professionals
    • Managing critical test results
    • Nurse call and patient monitoring alerts to mobile devices
    • Patient satisfaction scores
    • Patient throughput
    • ED and bed turnover
    • Alarm 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 methods
    • Its process to develop its eHealth strategic plan
    • Engaging stakeholders
    • Desk reviews
    • Situational analysis
    • The Drafting Committee activities
    • Financial resources
    • Critical Success Factors (CSF)
    • Challenges and barriers
    • Comparison to WHO/ITU eHealth Guideline
    • Recommendations 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 health
    • Development of governance and co-ordination mechanisms
    • Harmonise health and ICT experts contributions
    • Integrate with existing initiatives, such as Rwanda’s electronic identity cards integrated with eHealth programmes
    • Engage with and co-ordination stakeholders
    • Identify  human and financial resources needed
    • Look for ICT impacts of ICT rather than the technology itself
    • Use actors and systems already in place
    • Protect personal health data confidentiality
    • Build 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 documents
    • Anticipate the financial resources needed
    • Start with a baseline evaluation or situational analysis that includes reviews of existing eHealth projects and players
    • Apply a consultative, participatory approach where key players with diverse expertise are brought together for brainstorming
    • Refer to countries that have an operational strategic plan and learn from their model while taking into account socio-economic factors
    • Assess infrastructure
    • Ensure appropriate legal norms are in place
    • Establish realistic activity calendars
    • Seek high-level support for strategies
    • Refer 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:

    1. Build eHealth capacity for Health Information Systems (HIS) and Civil Registration and Vital Statistics (CRVS)
    2. Effective networking to increase peer assistance and knowledge exchange and sharing
    3. Promote IOp in and between countries
    4. Enhance 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:

    1. Align, plan and organise
    2. Build, acquire and implement
    3. Deliver, service and support
    4. M&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:

    1. eHealth service agreements
    2. Management, plans, policies and procedures
    3. IOp profiles and terminology services
    4. Health Information Exchange (HIE)
    5. National Standards and IOp framework
    6. eHealth governance framework
    7. National eHealth action plans.

    Supporting these initiatives are special interest groups. They include:

    1. Geographic Information Systems (GIS) lab
    2. Routine HISs
    3. District Health information Systems (DHIS) 2, implemented in twelve countries
    4. Research, with ten PhDs to work on AeHIN topics
    5. Community 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.