• Strategy
  • Future health data systems need more of these

    On March 14th I spoke at the ANOVA data summit in Johannesburg. I was asked to talk about the future of health data and its systems. Earlier that morning Stephen Hawking had passed away leaving the scientific community weighing the enormity of one man’s extraordinary contribution. Some of his famous words repeated in my mind, including his terse challenge, “The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge”, an apt warning for those of us in the information space.

    As health systems decisions become more data driven, demands for enough, quality data, and ways to make sense of it, increase too. Expectations are high.

    “It has become increasingly clear that Universal Health Coverage cannot be achieved without the support of eHealth” WHO suggested in the third global survey on eHealth and AMIA proposes that “access to broadband is, or soon will become, a social determinant of health”.

    In African countries, competition for resources is fuelled by smaller budgets trying to address substantial service gaps. Decisions to invest in eHealth and data need to be taken with considerable care, and must be economically sound, affordable, and evidence-based.

    Data systems should be built in steps that are sustainable and yield information that can be trusted. Emphasis should be on integration and consolidation and embracing emerging opportunities. It needs sound strategic planning too, with emphasis on:

    More substantive partnering among stakeholders Better agreement on architectural frameworks and evolving standardsMore opportunities for data collection from individuals, through mobile phones and other devices that become ubiquitousExploring new approaches to unique identifiers, including understanding the potential role of a medical blockchainIncorporating AI and machine learning to augment progress.

    Alongside these, cyber-security requires constant vigilance.

    Acfee is building a toolkit of good practice for help knowledge workers navigate these issues and make good choices.

    Talking about the future is fun but too often gratuitous. Hawking pointed out that “Intelligence is the ability to adapt to change”. The ability of our health data to provide value is also about our ability to adapt to health’s changing needs, to ensure that our efforts remain relevant and support impact.

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    Sean is CTO at HISP-SA and Chairperson of Acfee. HISP-SA supports the South African Department of Health in its efforts to build information systems that support health transformation.

    Acfee advances eHealth’s health strengthening and transformation role for Africa through the eHealth Network for Africa blog and eHealthAFRO stakeholder platforms, engagement with African Ministries of Health and other regional eHealth leadership groups, and the collection and sharing of knowledge and tools.

  • mPowering frontline health workers’ launches WASH health domain on ORB

    Exhortations to people to wash their hands frequently have a long history. Continuous, accessible reminders are still essential.  Handwashing’s the single most cost-effective intervention to prevent pneumonia and diarrhoea in children. It reduces infections during pregnancy and childbirth too.

    In the eHealth age, there are more sophisticated ways of disseminating the advice than numerous signs with lots of slogans. mPowering Frontline Health Workers is launching a new domain using on Object Request Broker (ORB) for Water, Sanitations and Hygiene (WASH). It contains training materials for health workers. ORB’s middleware that allows program calls from one computer to another. It relies on a computer networks.

    The need’s clear. In 2013, WHO and The Partnership for Maternal, Newborn & Child Health (PMNCH)  identified the challenge of diarrhoea. Diarrhoeal disease is the second leading cause of death and a leading cause of malnutrition in children under five. It’s in children under five years old

     years old. It is both preventable and treatable. There’s an estimated 1.7 billion cases of diarrhoeal disease every year, leading to about 760,000 children under five dying. A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene.

    Another report says an estimated 10-15% of maternal deaths are due to two causes. One’s infections linked to unhygienic conditions during labour. The other’s poor hygiene practices during six weeks after birth. 

    ORB’s WASH materials provide training and information on waste management, urban water supplies, sanitation planning, environmental health. All content’s quality assured to ensure accuracy and relevance for health workers. It’s accessible from mobile devices. 

    mPowering Frontline Health Workers is an initiative of USAID and the mHealth Alliance. It has six goals:

    Crowdsource innovative multi?media health contentCreate an online library of downloadable digital health content for organisations in developing countriesProduce a digital dictionary to enable integration and standardised reporting across several mHealth applicationsAccelerate the sustainable expansion of mHealth for frontline health workers in more than three developing countriesRigorously evaluate partnership impactShare experiences through a virtual global learning platform. 

    An estimate of 42% of global deaths from diarrhoea of children under five are in Africa. That’s about 320,000 children. mPowering Frontline Health Workers has an essential role.

  • Cape Town’s eHealth accelerator programme offers opportunities for graduates

    Many of us have good ideas. Turning them into action is often harder.  Cape Town's Accelerator Programmes aims to help. It offers opportunities for graduates to access finance and work experience to turn their ideas into a viable business.

    There are two pilot programmes. Accelerator two opens for applications on the 15th March 2018. Accelerator one has announced its eight finalists. They participate in a ten week online programme and have face to face interactions with their mentors. 

    Business coaches in eHealth started on the 23rd January 2018. The course extends over 10 weeks. There is one topic each week taking about ten hours. Finalists take part in discussions about health problems and solutions. Strategic planning, alignment to health-care environments, defining and marketing proposals are the main themes.  Discussions on topics relevant to running a profitable and beneficial eHealth business are included too.

    Finalists are :

    Petrus Van Niekerk :  Udok allows doctors to interact with patients who are far away as well as administer treatment and monitor patient careDr William Mapham : Vula Mobile is a system which allows doctors to refer patients to specialists in tertiary hospitals Dr Anuschka Coovadia : HealthAtHome is a company that will provide patients with the best care from the comfortability of their homes at an affordable price. Brighton Khumalo : ConnecTB is an online tool which allows health care providers to register and monitor TB patientsNicole Van Der Merwe : GeneCare Molecular Genetics will provide patients with access to customised diet plans as well as exercise programmes which will be accompanied by educational video coachingDr Musaed Abrahams : Aviro Health has developed an app that will mentor nurses in primary health care to efficiently treat patients with HIVSuretha Erasmus : GC Network  has developed a pregnancy screening app that educates pregnant mother of their individual risk for a chromosome abnormality as well as provides detailed information regarding available prenatal testing which will help the mothers make informed decisionsVere Shaba : RAR Group VRHEALTH is a company that created a virtual yet realistic world for substance abuse patients who have been placed in a rehabilitation to develop new behavioral patterns through the virtual world Is the programme a model for Africa’s other health systems? It offers a smart way to encourage and develop Africa’s budding eHealth entrepreneurs. 

  • eHealth for mental health needs more intelligence

    Cinderella never thought that her success would attach her name to parts of healthcare. Countries’ mental health service is one of them, and its eHealth investment is being held back too. A study in the Journal of Medical Internet Research (JMIR) sets out to explain why. It investigated individual characteristics that influence both preferences and intentions to use eHealth for mental health in Australia. It identifies factors that might inhibit or enable eHealth.

    It found low reported preferences for eHealth for mental health services. Despite this, intentions to access these services are higher. This raises the challenge of how to translate these intentions into activities that use eHealth services. It found that strategies designed to enhance confidence and familiarity and ease people into new Internet-based mental health service programs may be important for increasing the chances of sustainable use. But, will users return to eHealth later? 

    It’s a worthy goal, but the study found that most respondents, almost 86%, prefer face-to-face services. The scope to engage eHealth users was found to be up to 40%. It’s a significant user base that needs supporting.

    Acfee identifies several factors that needed in eHealth to secure benefits. They include:

    Stakeholder engagementMeeting users’ information requirementsEasy to useHigh level of utilisation. 

    Putting these in place for the 40% will increase the chances of sustainable use and benefits realisation. For Africa, with its limited healthcare resource base, supporting up 40% mental health patients with eHealth access offers a valuable way to expand mental health services at minimal cost. It’s an opportunity. It’s not easy to achieve.

  • Can Africa adopt a modern master patient index?

    Paper patient administration and medical records can be unreliable in sustaining patient identification. Overcoming their limitations needs a sound Master Patient Index (MPI) and effective patient identification as a foundation for dependable eHealth. A white paper from Verato, an MPI vendor, describes a way to do it.

    A thesis in The Future of Healthcare Depends on a New Architecture for Patient Identity Interoperability has five components:

    Healthcare will involve extensive co-ordination across the full care continuumThe ability to access patient information is the cornerstone of co-ordinationResolving patient identities across disparate systems and enterprises is critical to accessing informationCurrent MPI technologies can’t resolve patient identities consistently enough or well enough to support emerging information needsMPIs patient identity resolution technology must support the new needs as part of a highly accurate, national patient identity resolution service.

    Africa’s health systems can apply these criteria to their strategic and procurement choices. They apply to all types of eHealth, not just EHRs. It’s a core requirement for improving healthcare efficiency. It supports a shift from point-in-time service towards effective healthcare co-ordination too.

    Three themes are needed for effective access to patient information: 

     Agreed rules and policies for sharing patient dataStandardised access protocols and content in EMRs and EHRsPatient identity matching.

    A unique national patient ID number is seen as supporting these. But Verato sees this as logistically

    Impossible, politically untenable because of privacy implications and would not help link people to pre-existing medical records. Relying on basic demographic identifiers such as name, address, birthdate, gender, phone, email, and social security numbers aren’t a solution because they’re prone to error when patients register at receptions and can change over time. About 8 to 12% of people may have more than one identity in any given hospital system, with actual medical histories spread randomly across them.

    MPI matching techniques was invented in 1969, and obsolete. Verato sees the solution as a pre-built, cloud-based, nationwide MPI that healthcare organisations  can plug into. It can avoid the need for extensive algorithm tuning, data standardisation, data governance, data cleansing, or data stewardship. It can help to achieve better compliance with data standards. 

    As Africa’s eHealth moves on, the concept can be assessed as an investment option. If it’s not, then an option to deal with the limitations of conventional MPIs may be needed.

  • Taiwan’s eHealth success has important lessons

    Health and healthcare challenges for Taiwan are being addressed with eHealth. Success with ageing populations and advanced eHealth has lessons for other countries. These were elicited with a qualitative methodology in 90-minute semi-structured interviews with 38 stakeholders, including focus groups. Published in the Journal for Medical Internet research (JMIR), their views are:

    eHealth can enable seamless patient careClinical benefits include flexibility in time managementLeaders’ visions, authority, and management skills might influence health care innovation successBoth internal and external organisational governance are relevant for implementing eHealth innovation in health care.

    A common thread across these is that eHealth helps healthcare teams to work smarter, not harder. This sits on Taiwan’s history of advanced medical and technological innovation. This’s an important aspect to reflect in assessing Taiwan’s lessons for Africa’s health systems. 

    Identified lessons include:

    Telehealth is essential, and how it’s used can make a differencePersonal information security must be addressed before designing eHealth care systemsWhen benefits can outweigh security concerns, these systems may become as popular as online banking and shoppingSecuring personal medical data should not be seen as an insurmountable problem that prevents telecare’s adoption and developmentElectronic data can be easily integrated with an existing HIS and can ultimately contribute to by decreasing financial burdensSystematic and integrated patient records can be developed to offer better health services, decrease diagnostic errors and ensure quality and cost-effective benefitseHealth’s a crucial tool for connecting people, not replacing themeHealth can help to bridge gaps in isolation between older and younger generations and rural and urban societiesClinicians were concerned about biometric data accuracy while they say they can collect more accurate data than hospitalsCost of adapting eHealth might initially pose challenges because of growth, but upgrading and renewal costs become more cost-effective in the long termUltimately, eHealth systems’ benefits will outweigh any potential problems in the long term. 

    These are encouraging insights for Africa’s eHealth. Affordability for Taiwan’s health systems may not be as challenging as Africa’s.

  • How eHealth will support healthier Africans in 2018

    Contemplating my New Year's resolutions recently, I thought about Africa's eHealth journey over the last decade. It's moved from a largely disputed, nebulous term, to a fledgling industry with remarkable potential to transform our African health landscape. While eHealth is better understood now and showing some progress, the potential has not been translated into tangible African health benefits at scale.

    Numerous key issues need to be addressed. They constitute the contents page of many new National eHealth Strategies. An issue that is frequently underestimated though, is how to create better ways for the numerous eHealth stakeholder types to participate constructively. To be effective, this engagement needs to extend across a wide value chain, along timescales beyond most strategic plans. Only then, can it secure eHealth's role in achieving Healthy Africans.

    Improving engagement, building capacity and developing eHealth leaders is essential and why we created the African Centre for eHealth Excellence (Acfee). Our growing list of initiatives are starting to move this forward, such as the eHealth Network for Africa (eHNA) blog, the eHealthAFRO regional events, the African eHealth Forum including Acfee's Advisory Board of eminent African health advisers and the Acfee Awards for Outstanding eHealth Leadership. All these contribute to Acfee's work to collect data about Africa’s eHealth initiatives, engage African stakeholders, build capacity, develop eHealth's leaders and support countries’ national eHealth strategies.

    Acfee's 2018 plans include new contributions on strategy, leadership and curricula, guides on cyber-security, governance, regulation and impact, a much anticipated eHNA v5 release, and other technology assets that will provide our network of African eHealth experts with better tools to advance African eHealth. The successful eHA2017 in Johannesburg will continue annually. Additionally, eHA2018 will launch an East African event, in partnership with the East African Science and Technology Commission (EASTECO).

    Many hands make Acfee's work possible. Thank you for being part of this journey, whether you work with us, challenge us, or simply participate in an Acfee initiative. Together, 2018 will be the best Acfee chapter yet, for eHealth and for Healthy Africans.

  • BYOD needs to sit on a strategy

    With mHealth, comes Bring Your Own Device (BYOD). It can be haphazard, random and uncontrolled, and can stretch across all eHealth. It’s best to avoid these high-risk scenarios. A white paper from MobileIron, an enterprise mobility service provider, describes an approach. The Ultimate Guide to BYOD deals with:

    Building a programmeRolling it outSustaining its security and performance.

    The overarching strategy’s using BYOD to drive transformation in a mobile enterprise. It fits Africa’s eHealth. MobileIron’s sequence of three BYOD maturity steps are:

    Prepare the organisationSet a risk tolerance level and impact for a BYOD programmeEngage stakeholders early to define programme goalsSurvey and communicate with employeesIdentify mobile and ICT capabilitiesUpgrade ICT infrastructure to support BYODInclude eight Components of a successful BYOD strategy:> Trust, the strategic core> Device choice> Liability> Internal marketing> App design and governance> User experience and privacy> Economics and financeSoft launch BYOD programmesDeploy programmes and training services.

    From this maturity stage, the desired result’s satisfactory cruising. It leads onto a culture of user independence comprising: 

    Self-registration of new devices, monitoring and managing current devices and retiring redundant devicesSelf-remediating hardware, software, application and compliance issues using explicit notifications and resolution instructionsContinuous productivity, efficiency and cyber-security compliance.

    From this second stage of maturity, the third’s:

    Incrementally add more devices, systems and appsEnsure safe and effective device retirementMeasure and demonstrate BYOD valueTake the measures needed to achieve mobile transformation. 

    These offer Africa’s eHealth a way to a sound BYOD strategy. It carries a financial cost. So does unfettered freedom.

  • 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.