• Strategy
  • Lessons for Africa on making eHealth work

    Investing in the right eHealth then realising its benefits are global challenges. England’s NHS’s taking advice from the National Advisory Group on Health Information Technology  in England, chaired by

    Professor Robert Wachter Chair of University of California, San Francisco Department of Medicine. The report, Making IT work: harnessing the power of health information technology to improve care in England, sets out findings and recommendations that can inform Africa’s ehealth programmes too. The core perspective’s that while continuously changing healthcare’s a considerable challenge, eHealth that creates a fully digitised NHS important, will be the most sweeping and challenging.

    There are ten findings and principles:

    Digitise, so adopt eHealth, for the right reasonsIt’s better to have the right eHealth than quick eHealtheHealth’s Return on Investment (ROI) isn’t just financial, patient safety and healthcare quality are important tooDecisions on eHealth centralisation should learn, but not over-learn, the lessons of the National Progarmme for Information Technology (NpfIT) Interoperability (IOp) should be built in from the outsetBoth privacy and data sharing are very importanteHealth must embrace user-centered designThe end of implementation’s the beginning, not the endSuccessful eHealth strategies must be multi-faceted, requiring workforce developmenteHealth entails technical and adaptive change.

    For Africa’s eHealth, Acfee would add two other interacting principles. One is to adopt a business case methodology that enables rigorous, reliable eHealth investment decisions and lays a foundation for M&E. It leads on to the second principle; undertake M&E before, during and after implementation. The learning value is considerable, and leads to better business cases and investment decisions.

    Ten recommendations are:

    Complete a thoughtful, long-term national engagement strategyAppoint national chief clinical information officer with an effective roleDevelop a workforce of trained clinician-informaticists in hospitals, with appropriate resources and authorityStrengthen and grow the CCIO roles, others trained in clinical care and informatics and health ICT professionals Allocate national funding to help hospitals implement eHealth and maximise benefitsSet a time for substantial eHealth maturity when central financial support for hospitals can end and regulators deem those that have not achieved high eHealth levels as not compliant with quality and safety standardsLink national finance viable local implementation and improvement plansOrganise local and regional learning networks to support implementation and improvementEnsure IOp as a core eHealth component needed to promote better clinical care, innovation and researchSupport a robust, independent evaluation of eHealth strategies and act on the findings.

    Sustained investment in eHealth leadership across Africa’s healthcare’s needed too. Acfee proposes a triumvirate of clinical, political and executive eHealth leadership throughout healthcare. It’ll take time to reach a critical mass, so starting now’s essential. Future eHealth Leaders at eHealth ALIVE 2017 in October’s provides a step forward. 

    Appendix F’s an eHealth maturity index. Its self-assessment has three main themes:

    Readiness, strategic alignment, leadership, resourcing, governance and information governanceCapabilities of records, assessments and plans, transfers of care, orders and results management, medicines management and optimisation and remote and assistive care and standardsInfrastructure for WiFi, mobile devices, single sign-on and business continuity.

    Africa’s eHealth will benefit from a fourth component, benefits. It include benefits realisation and the timescales need to reach the critical mass to provide a socio-economic return on eHealth investment.

  • HISP’s global eHealth role expands

    As the global eHealth community matures, lessons and good practices are beginning to emerge. Some of these are about organisations and their business and software models. The Health Information Systems Programme (HISP) organisations provide a cogent example. They operate in numerous countries across global regions and are as different as they are similar.

    The differences are pronounced. The businesses range from informal, two to three-person teams, to large, formal company structures such as HISP-India and HISP-South Africa that have adopted robust business systems, employ experienced technical experts and managers, and enjoy long-term contracts.

    Where the differences end is when it comes to software. HISP entities share an almost ubiquitous commitment to the District Health Information System (DHIS) software platform. The latest version is DHIS2. It’s a success story for Free and Open Source Software (FOSS). It combines two essential components of successful FOSS:

    A highly customisable platformA highly professional core development team.

    The HISP network is developing and enhancing its role across several regions. The emerging HISP Partnership Organisation (HPO) is a collaborative effort to watch. Its members include HISP organisations in South Africa, Malawi, Namibia, Nigeria, Zambia, Zimbabwe, Rwanda, Côte d'Ivoire, West Africa, Bangladesh, India and the Philippines. Its founders are key personalities who’ve been closely associated with HISP entities and DHIS developments. They believe in collaboration and the need to build local capacity to ensure sustainability of DHIS implementations and broader health information management.

    Regional networks

    Regional networks are also taking notice of HISP and the DHIS. At the Asian eHealth Information Network (AeHIN) annual conference in Myanmar in March, DHIS2 was a hot topic of conversation in most sessions. The DHIS2 platform provides the foundation for many AeHIN countries' routine information systems.

    Africa’s AeHIN equivalent is growing too. It's the African Centre for eHealth Excellence (Acfee). The potential synergistic relationship between these regional networks and the HISP entities presents a substantial opportunity for cooperation and collaboration to move eHealth forward.

    Acfee supports local eHealth capacity building to develop the eHealth leadership and policy strengthening essential for sustainability. Learning from AeHIN's success is critical. The keynote address by AeHIN governing committee member Jai Ganesh Udayasankaran, at eHealthAFRO 2017 in Johannesburg 2-4 October 2017, provided tangible suggestions that will move the partnership into action. 

  • 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 neededHealth information that can be exchanged securelyHigh-quality data with a commonly understood meaning that can be used with confidenceBetter availability and access to prescriptions and medicines informationeHealth-enabled models of care that improve accessibility, quality, safety and efficiencyA workforce confidently using eHealth technologies to deliver health and healthcareA thriving eHealth industry delivering world-class innovationSafe, 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 assuranceCommitment, cooperation and collaboration across all governments to leverage existing assets and capabilities to avoid duplication and speed up benefits realisationEstablishing legislative, regulatory and policy frameworksStrong consumer and clinician engagement and governanceEffective governance and leadershipLearning 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 admissionsFewer adverse drug eventsReduced test duplicationBetter 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
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    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?

  • 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.