• Strategy
  • South Africa’s mHealth strategies expanding

    While many mHealth initiatives are local and spawned by enthusiasts, it’s essential that they have a strategic context. At this year’s eHealthALIVE conference, Peter Barron, mHealth Advisor to South Africa’s National Ministry of Health set this out for South Africa’s national health system. Five examples are:

    1. MomConnect, to promote the health of mothers and children
    2. NurseConnect, to support nurses’ knowledge and practices
    3. mHealth apps for clinicians
    4. Medicine adherence for patients
    5. Stock control for clinics to minimise stock-outs.

    MomConnect’s a two-way communication service. It sends regular, relevant information in the form of SMSs to pregnant women to help them take more responsibility for their and their babies’ health. Mothers can also provide feedback on services they’ve received that’s used to improve healthcare quality, so strengthen the health system. Feedback’s structured as:

    1. A service rating system for antenatal clinic visits
    2. A compliments system
    3. A complaints system for issues such as long waiting times, health workers’ inappropriate behaviour and drug and dietary supplement stock-outs.

    NurseConnect was piloted between January and March. Scale up started in May. It aims to support and empower nurses and midwives by:

    1. Allowing them to use their cell phones free of charge to receive relevant information to help them improve their performance in maternal and child health
    2. Enabling them to provide feedback and seek advice about their work and work environment
    3. Enabling them to set up learning and support networks.
    4. In four months, some 8,000 nurses have registered to use NurseConnect. The number of users’s expected to increase steadily.

    mHealth apps include:

    1. Primary Healthcare (PHC) guidelines, including TB
    2. Help clinicians treat patients correctly, safely and in compliance with best evidence available
    3. Algorithms to help clinicians who plug in variables.

    Medication adherence for patients:

    1. Allows patients to input their medication details
    2. Provides daily alarms as reminders to take medicines
    3. Keeps an overview of missed medication with green and red days
    4. Produces graphs of adherence
    5. Can link to a central database so that overall adherence is monitored remotely and provides information about overall compliance rates to direct compliance initiatives.

    Stock control at clinics is built on an mHealth app that minimises stock outs by:

    1. Allowing central monitoring of essential drugs at clinics
    2. Providing an early warning system of potential drug shortages
    3. Enabling drug stock transfers to ensure equitable distributions
    4. A learning experience about stock management for clinic staff.

    From this achievement, Peter Barron has considerable ambitions for the future. He sees progress so far as “Scratching the surface.” He sees big opportunities as people engage more with their mobile devices and spend more time interacting with them than they do with their partners. This opportunity’s enhanced by the younger generation who will always be much more techno sophisticated than their elders. As smart phones become the norm, and data and connectivity becomes cheaper and more readily available, Peter Barron’s personal ambition’s to be a fly on the wall in five years-time. Many of us would like to be on the same wall.

  • HISP’s a strategic partner for eHealth strengthening in Africa

    There’s a lot of eHealth innovation underway in African countries to transform our experience of healthcare and how we stay healthy. In my home country, South Africa, the Health Information Systems Programme of South Africa (HISP-SA) makes an important contribution, extending from its DHIS health data platform, now in use in 46 countries, to projects stretching from building mHealth apps, to training and support to help public health and facility managers take sound decisions.

    It’s a foundation for expanding eHealth’s health strengthening role for the future, which is a strategic goal for HISP-SA and HISP entities around the world. There’s regular collaboration between country teams to move this vision forward, with significant support from HISP-SA.

    HISP-SA meets a growing demand for eHealth expertise and services. In the last five years it’s expanded from a team of twelve people to now over one hundred. They cover a range of skills across public health, informatics, data management and computer science.

    I’ve been asked to help lead HISP’s ICT strategy and its implementation. It’s a Chief Technology Officer role with a team of analysts, software developers, data specialists and ICT infrastructure experts. Everyone in HISP-SA’s dynamic and experienced team has a valuable contribution to make to the way ahead and to guiding HISP-SA to grasp the numerous eHealth opportunities across Africa and deal with their challenges.

    I now work alongside well-known eHealth and public health personalities, such as Vincent Shaw, Gugulethu Ngubane, Calle Hedberg, Phumzile Zondo, Mohammed Jeena and Christa van den Bergh. An essential activity’s engaging closely with former colleagues and government eHealth leaders, including recently appointed National Director of Health Information Systems, eHealth stalwart Mr Mbulelo Cabuko, his colleague Julius Nkgapele, their Chief Director Ms Thulile Zondi and their teams.

    Our relationship with provincial and district health is important too, to boost using information to improve health experiences at the point of care, for patients and health workers, and with key population groups.

    HISP-SA’s priority is to support South Africa government’s health information systems. They exist to secure and support how South Africa delivers better health for all. It’s an honour to be part of this endeavor. I look forward to what we will accomplish during our time together.

  • Rwanda and South Korea collaborate on eHealth

    It’s another eHealth step for Rwanda. An article in the New Times says Rwanda’s Ministry of Health has signed a Memorandum of Understanding (MoU) with the Republic of South Korea. The aim’s to improve technology in healthcare, including telemedicine, Hospital Information Systems (HIS) and ICT-based medical services. The MoU enables collaboration on eHealth between Korea Telecom (KT), Yonsei University Health System, including Severance Hospital, and University Teaching Hospital of Kigali (CHUK).

    At a media briefing, Kwon Deok-cheol, the visiting Korean Deputy Minister for Health and Welfare, said eHealth’s now an effective tool for sharing information needed for healthcare and controlling Non-Communicable Diseases (NCD). “eHealth would be very crucial in providing information, especially now that Rwanda has potential to expand modern health services across the country. Through working together, information between the two countries will be shared.”

    Rwanda’s Health Minister, Dr Agnes Binagwaho, said technology will be distributed across all levels of the health sector so everyone benefits. Her vision’s to “Use technology right from the rural areas to the national level that is how we can manage e-Health. Although we still have a long way to go in terms of improved management, access to information, advice from health personnel and distance towards health care facilities, this arrangement is one of the opportunities for us to improve.”

    As eHealth expands, it becomes more complex and challenging. Collaboration is an increasingly constructive approach. Rwanda’s collaborative strategy offers a model for all African countries.

  • Fresh eHealth strategies provide big opportunities

    African countries are producing National eHealth Strategies. In the last two years, announcements have come from Burundi, Mauritius and the Democratic Republic of Congo. Countries with strategies already in place include Egypt, Ghana, Kenya, South Africa, TanzaniaZimbabwe and others. Some have taken a step further and developed complementary strategies, such as South Africa's 2015 mHealth Strategy. You can follow the hyperlinks above to find a PDF of each document on the Resources tab of eHNA’s country pages.

    Having a strategy’s a big step forward. It fulfils resolutions made by ministers of health at the sixty-sixth World Health Assembly in 2013. It shows that the countries see a valuable role for eHealth in their health systems strengthening and mapping out a way forward to realise eHealth’s benefits.

    A good strategy goes further, recognising that health systems need more than strengthening to provide the health and care that citizens need. Despite limited resources, health systems need to transform by finding innovative ways to reverse trends of a rapidly rising curative burden and big, continuing population growth, perhaps as much as 3% a year.

    At Acfee’s African eHealth Forum (AeF) in July 2015, senior eHealth leaders from several countries identified more than 60 long-standing eHealth challenges that need fixing before eHealth can make a big impact. The list, described in Advancing eHealth in Africa, was longer, and more demanding than most people expected. These need addressing as part of an annual investment programme that initially stops the challenges expanding, and achieves a steady shrinking of their constraining impact.

    Expanded eHealth leadership, and eHealth capacity for skills and knowledge in the health workforce are important and continuing challenges. These we identified in 2009 by the Commonwealth Secretariat in its support programme for eHealth strategies. In a series of workshops, African countries working on their eHealth strategies showed that they needed to develop and achieve new organisational contexts to pursue their eHealth goals effectively. Without them, the important eHealth technicalities such as interoperability, architecture, standard and connectivity would not realise their benefits fully. There is still much more to do.

    Over the last few years, Acfee’s been helping Africa’s health systems to construct their organisational contexts. The AeF report confirmed that enhanced eHealth leadership and workforce capacity are essential. Their components extend across activities that include:

    • Engagement with health professionals
    • Realising benefits for healthy Africans and better healthcare
    • Transforming healthcare delivery and health systems
    • Sustainable health strategies
    • Rigorous business cases for eHealth investment decisions that implement strategies
    • Effective procurement
    • Sustainable financing models
    • eHealth regulation
    • Responding to growing challenges, such as cyber-threats
    • Responding to new eHealth opportunities and priorities, such as Big Data and surveillance.

    These are not easy to achieve. eHNA has numerous reports of countries that have struggled with many of these, and are still struggling. Putting the health ICT technicalities into the mix makes it even more demanding.

    Where to start and what path to follow are good questions. The first step to success is recognising that it’s a long, slow road with no end. Health workers need new eHealth skills and knowledge that go beyond the health ICT technical skills that health informaticians need as specialists.

    The National eHealth Strategy Toolkit, published by WHO and ITU, provides an overall approach and lots of detail to help countries plan the way forward. 

    Acfee is developing programmes with eight African universities to begin the journey, and will be reviewing these with African health leaders at events such as the African Health Summit and the next African eHealth Forum.

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    Image from the Toolkit

     

  • Emergent strategy offers Africa's eHealth a refresh

    Africa’s health systems must address big challenges for its countries eHealth to catch up. At Acfee’s African eHealth Forum (AeF) in July 2015, senior eHealth leaders from several countries identified more than 60 long-standing eHealth challenges that need fixing before eHealth can make a big impact. The list, described in Advancing eHealth in Africa, was longer, and more demanding than most people expected.

    Since then, WHO’s 2015 eHealth Survey, reported in eHNA, found that out of 33 African countries, only one’s started to deal with Big Data. Other missing initiatives include investment in predictive analytics, both for surveillance and in clinical services, and the Internet of Things (IoT). Do these point to the need for countries to refresh their eHealth strategies and plans?

    Expanded eHealth leadership, and eHealth capacity for skills and knowledge in the health workforce, were important challenges. These we identified in 2009 by the Commonwealth Secretariat in its support programme for eHealth strategies. In a series of workshops, African countries working on their eHealth strategies showed that they needed to develop and achieve new organisational contexts to pursue their eHealth goals effectively. Without them, the important eHealth technicalities such as interoperability, architecture, standard and connectivity would not realise their benefits fully. There still much more to do. 

    eHNA’s reported that five-year eHealth strategies have a timescale that’s too short. eHealth needs a continuous process that stretches well beyond this horizon and allows for regular updates to address emerging issues.

    A first step for African countries to refresh their eHealth strategies is to recognise that it’s a long, slow road with no end. Health workers need new eHealth skills and knowledge that go beyond the health ICT technical skills of health informaticians. Acfee is developing programmes with African universities to deal with part of this journey.

    The expanding range of eHealth opportunities makes eHealth choices and affordability more challenging too. A segmented strategy and a combination of planned, deliberate and agile, emergent initiatives are needed. Henry Mintzberg’s credited with devising emergent strategy concepts. He sets out the deliberate, emergent choices on You Tube.

  • Forget five year eHealth strategies, try 30 years

    It seems that African countries with eHealth strategies look about five years ahead. In the USA, there’s an eHealth programme looking 30 years out. That’s about the length of a generation. 

    Health2047 has a goal to transform US healthcare over the next three decades, so one generation. It’s supported by the American Medical Association (AMA) mHealth is seen as a core component, so the approach may fit Africa’s mHealth ambitions. 

    In an interview with mHealthIntelligence.com, Health2047’s CEO, Dr Doug Given, an internist and infectious diseases doctor and entrepreneur who has founded or run five biotech companies describes his view of the future. He sees three main challenges in mHealth innovation. 

    1. Solutions being designed and piloted often end up bespoke to a single provider rather than scalable and generally useful with a national impact on healthcare, so instead, it should start from a system-level view to direct design
    2. mHealth innovators often don’t take into account regional differences so can’t offer the right market fit, failing to support a variety of use cases, requiring front-end work to understand the required market fit
    3. Variable and highly regulated healthcare creates complexity for mHealth innovators in driving meaningful system-level innovations, so mHealth technologists must collaborate closely with people who understand the depth of healthcare and mHealth’s complex dynamic.

    A reluctance by researchers and healthcare providers to trust data from wearables may slow down some of mHealth’s uptake. Bridging the gap between clinical apps and consumer-facing wearables is another challenge. Dr Given sees a solution in more integrated data models, measurable functional outcomes and interfaces that integrate and deliver data meaningfully to doctors, providers and users. These must replace the current point solutions that may be harmful; a dire warning.

    Does Health2047’s approach show that Africa’s health systems need to switch their current mHealth strategies? Instead of adopting a string of mHealth initiatives, should they be setting and applying the standards that will ensure scale up and a bigger impact for this, and the next, generation? It’s a quantum leap with big potential rewards.

  • Transformed health needs more than strengthening

    Health workers in African countries know a lot about facing challenges of all sizes. Sometimes they seem insurmountable. High disease burdens, resource limitations and structural issues can make it hard to move forward. Under these circumstances, it’s not surprising that they often feel ideas about strengthening health systems with eHealth don't do enough.

    African health workers hope for, and many strive for, a fundamental change in how health systems work. The change is about addressing numerous precursors to poor health and disease and shifting the balance of power and responsibility towards citizens before they become patients and every step along the way in partnership with health workers once they are.

    This deals with helping people engage in their personal health choices, supporting their health seeking decisions, influencing them towards constructive choices, nurturing their good habits, and building relationships with trust and power balances that will continue to bear fruit. 

    It’s not a new public health concept, but perhaps here’s a new perspective. This transformation will not be possible without embracing a fundamental, intrinsic role for a wide range of ICT-enabled opportunities, stretching across initiatives such as EHRs, telemedicine and mHealth. This shift, to recognise the role for eHealth’s role or citizens and CHWs, is essential. Next is to realise how hard it is to get right and how much can be done to promote success.

    Acfee’s work with African countries' health systems reveals readiness to engage in this. It’s a long road with lots of challenges, such as over 60 identified at Acfee’s African eHealth Forum (AeF) in July 2015. The list is described in Advancing eHealth in Africa.

    It needs new leaders in African health systems who recognise eHealth’s power to support transformation, acknowledge the challenges and risks, and move forward anyway with smart, step-wise decisions that move their health systems along the road to better health. 

    Acfee’s doing it’s bit to help African countries tackle some of these steps. One is strengthening national eHealth strategies. Alongside we’re matching those strategies with a skills development programme in collaboration with eight African universities. We’re also running leadership development events, like the annual African eHealth Forum for health‘s decision makers and the annual eHealthALIVE conferences, the first if which, for Southern Africa, launches in Johannesburg in September.

    We’re at the African Health Summit this week to discuss these ideas with our partners. Join the conversation live on-site or via our Twitter, Facebook and LinkedIn channels. African eHealth is on the move. What part are you playing?

  • eHealth strategies take longer than eHealth exhortation

    Many eHealth strategies have horizons of fulfilled potential and Utopian healthcare. Eduardo Galeano, the Uruguayan journalist, summed it up as “Utopia is on the horizon. I move two steps closer; it moves two steps further away. I walk another ten steps and the horizon runs ten steps further away”. A challenge for Africa’s eHealth’s to deal with this as a normal.

    England’s NHS shows a harsh reality of horizons. It started its EHR journey in the late 1990s. The end’s still not it sight. After the Connecting for Health debacle, the Secretary of State set a new EHR goal in a speech to the Policy Exchange in January 2013.

    A five-year horizon was set for an extensively paperless NHS in England, and by 2018, included:

    • Clear plans in place to enable secure linking of EHRs and care records wherever they’re held, so there’s as complete a record as possible of the care someone receives
    • Clear plans in place for records to follow individuals, with their consent, to any part of the NHS or social care system
    • By April 2018, digital information to be fully available across NHS and social care services, barring any individual opt outs
    • A clear expectation that hospitals should plan to make information digitally and securely available by 2014/15.

    The benefits were summed up by the Minister as “Only with world class information systems will the NHS deliver world class care.” There was also a goal to “save billions.”

    Subsequently, the Minister set a longer timescale. The NHS Five Year Forward View said out “the overarching objective of harnessing the information revolution is to make the NHS paperless by 2020.” This vision is encompassed in the National Information Board’s Personalised Health and Care 2020 Framework.”

    With a budget of £4 billion for EHRs and online appointments, prescriptions and consultations, it’s now being reinforced as an achievable horizon two years further away, along with objectives of:

    • Faster diagnoses
    • At least 10% of patients use computers, tablets or smartphones to access GP services by March 2017
    • By 2020, 25% of patients with long-term conditions such as hypertension, diabetes and cancer, can monitor their health remotely
    • Free Wi-Fi in all NHS buildings, but no deadline’s set.

    Africa’s eHealth strategies and programmes can learn from this. It’s more important to put in place the sustained resources and organisation needed for continuous eHealth investment priorities rather than set out a Utopian eHealth endpoint that inevitably slips further away.

    Eduardo Galeano went on to say “As much as I may walk, I'll never reach it. So what's the point of utopia? The point is this: to keep walking.”

  • Has Ebola energised Africa's eHealth strategies?

    Following on from the Wilton Park event, (Re)building health systems in West Africa: what role for ICT and mobile technologies, there’s plenty of enthusiasm for expanding eHealth’s role after the Ebola crises. A report in mPowering summarise the key findings as:

    • ICT and mobile are a critical part of rebuilding health systems, but must be interoperable, integrated logically and responds to the actual, not perceived health workers needs
    • Data and information sharing can enable rapid responses to emergencies, but only if the most relevant data is collected and used
    • There’s a role and responsibility for all sectors that must work together with common objectives
    • Efforts need to be government-led
    • Moving from fragmented, project-based activities needs new kinds of collaborations with clear roles and shared responsibilities to support resilient health systems
    • Aid and investment must support countries to develop the infrastructure, infostructure and skilled health workforces needed to respond to future health emergencies.

    Pape Amadou Gaye, President and CEO of IntraHealth International, set out his views on the foundations for more and better eHealth. These underpin the changes identified at the conference, and aim to deal with the challenge of the advent of digital solutions that has improved data collection techniques and quality that has not yet liberated data too often lying dormant in government databases and left to departments that may not be prepared to use or disseminate them properly.

    Taking full advantage of eHealth’s promise of building stronger health systems, three challenges need addressing:

    • Governance, information management and behaviour-change training to address the remaining cultural and bureaucratic bottlenecks and encourage the adoption and creation of new governance platforms for mHealth and ICT that will help build trust, instil transparency, and move forward effectively
    • Culture for using and sharing data can be improved and be part of routine practice, training, and mentality, so cultivate data use, and foster greater sharing and collaboration
    • Infrastructure, where the simplicity and wide availability of mobile phones offer ample opportunities for mHealth and global information-sharing, but there are still limitations to overcome, including countries needing sufficient networks, bandwidth, and electricity to harness mHealth’s real power.

    All these are vital components of eHealth strategies. Is the core message from the event that Africa’s health systems need to reset their eHealth strategies?

  • NSW develops its way of doing eHealth

    As eHealth strategies are rolled over, lessons from previous strategies provide valuable insights about what needs reshaping. New South Wales (NSW) in Australia’s A Blueprint for eHealth in NSW is good example. It builds on its significant eHealth investment, and changes the way it manages its next wave. Four changes are: 

    • Setting up eHealth NSW as a separate entity within NSW Health, and provide state-wide leadership on the shape, delivery and management of ICT-led healthcare
    • Establish an eHealth Executive Council to set overall state-wide strategic direction and liaise with the NSW Government ICT Board
    • Adopt a federated governance approach for eHealth NSW
    • Appoint a Chief Clinical Information Officer (CCIO)

    The eHealth Executive Council will be chaired by the Director General, NSW Health. Members include the Ministry of Health, eHealth NSW, HealthShare NSW, Local Health District, Pillar and clinician membership. It’ll be supported by an eHealth Architecture Executive with representation from Local Health Districts (LHD) and eHealth users to provide state-wide technical direction to guide decision-making on eHealth investments. LHDs will establish formal eHealth governance structures to both engage clinicians and connect with eHealth NSW. 

    This new management model will steer several main eHealth initiatives.

    • Clinical care
      • Electronic Medical Records (EMR) that include test ordering, surgery scheduling and discharge summaries
      • Picture Archiving Communication System (PACS)
      • Radiology Information Systems (RIS)
      • Enterprise Imaging Repository (EIR)
      • Electronic Imaging System (EIS) library
      • HealtheNet and the National eHealth Record (NeHR), also known as the Personally Controlled Electronic Health Record (PCEHR)
      • HealtheNet that connects NSW public hospitals and community services
      • Pharmaceutical Benefits Scheme (PBS)
      • Australian Organ Donor Register information
      • Australian Childhood Immunisation Register (ACIR)
      • Medicare Benefits Schedule (MBS)
      • Medicare and the Department of Veterans’ Affairs benefits
      • Advanced Care Directive Custodian Record
      • The eBlue Book, an electronic version of a paper based version that documents health and development checks and immunisation details for babies and children
      • Several eHealth business, back of house solutions to manage health services effectively and efficiently
    • Corporate building blocks
      • Data warehousing and Patient Flow Portal
      • StaffLink, a Human Resource Information System (HRIS) with payroll
      • Food Services
    • Infrastructure backup
      • Statewide Information System (SWIS), Phase 1
      • Health Wide Area Network (HWAN), Phases 1 and 2.

    This is a considerable eHealth array. As Africa’s health systems move their eHealth on, it will eventually reach an equivalent position. It makes sense to start moving in this direction now.