• Strategy
  • 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.

  • Strategies cybersante vont reussir en Afrique

    Avec la cybersanté en constante évolution avec de nouvelles initiatives telles que le nuage et de nombreux projets mHealth, comment les stratégies de cybersanté de l'Afrique maintenir? Peut-être de construire une stratégie qui intègre le cycle de cyberSanté où des changements dans la technologie et la santé les priorités changent le contenu et le contexte d'une première étape. De nouveaux services, comme le cloud computing et mHealth émerger et se développer, et de rendre les modèles précédents obsolètes. De nouveaux risques, comme les cyber-menaces, étendre, et de changer l'urgence et l'équilibre des priorités d'investissement. De nouvelles techniques, comme Big Data et d'analyse irruption sur la scène, offrant de nouvelles opportunités et de possibilités. Ces nouveaux horizons signifient que les stratégies de cybersanté et nécessité des investissements de mise à jour et de changer fréquemment.

    Les changements en matière de cybersanté sont reflétées dans la façon dont la cybersanté est défini, qui est notoirement difficile, avec aucun accord sur ce qui nous eHealth. Les systèmes de santé en Afrique peuvent définir pour correspondre à leurs propres priorités et défis. 

    Définition de l'OMS est un point de départ. Il est le transfert des ressources de santé et de soins de santé par des moyens électroniques, et englobe trois domaines principaux:

    • Livraison de l'information de santé pour les professionnels de la santé et des consommateurs de la santé par le biais de l'Internet et des télécommunications
    • Grâce à la puissance des TIC et le commerce électronique pour améliorer les services de santé publique, comme à travers l'éducation et la formation des travailleurs de la santé
    • Utilisation de pratiques de commerce électronique et e-business dans la gestion des systèmes de santé.

    Transmission de l'information de santé exige la capture d'informations aussi. Les trois thèmes impliquent des relations entre l'information, les TIC, les gens, le changement et les avantages. Ceux-ci mènent au changement organisationnel et des soins de santé re-engineering, avec un potentiel pour atteindre une transformation substantielle dans la manière de soins de santé dispensés et de la santé en charge.

    Partage de l'information rend ces changements possibles, mais ne suffit pas à garantir ses avantages. Les utilisateurs de cybersanté avoir à l'utiliser largement et à bon escient, et avec les nouvelles informations fournies par les nouveaux médias, et ils doivent modifier certaines de leurs pratiques cliniques et de travail aussi.

    Alors que les travailleurs de la santé peuvent utiliser la cybersanté pour améliorer leurs performances, et l'autonomisation des citoyens pour améliorer leur santé, il ne peut pas résoudre la pénurie de travailleurs de la santé en Afrique. D'autres stratégies sont nécessaires pour cela, et il est vital que les pays 'intégrer leurs stratégies et plans changeants de cybersanté et les travailleurs extension de santé.

  • eHNA's 2016 predictions for African eHealth

    New Year resolutions seldom see out the end of January. Some don’t sustain life after New Year’s Day. Instead of resolutions, a few predictions about African countries’ eHealth might be more valuable. They’ll need judging on 31 December 2016.

    What might happen:

    1. eHealth and mHealth initiatives will make Africans healthier
    2. Initiatives will focus more on integrating into and improving the daily lives of patients, citizens and health workers
    3. eSurveillance will improve its use of and reliance on eHealth
    4. Big Data will make a bigger contribution to African health
    5. More African countries will publish new, or revised National eHealth Strategies, better aligned to their goals for better health
    6. Countries will share more experiences, such as their successes, failures and challenges, to learn from one another, using stakeholder platforms such as Acfee’s African eHealth Forum, scheduled for 8, 9 September, shortly after eHealthALIVE Southern Africa taking place annually in Johannesburg from 6, 7 September 2016
    7. Investment in dealing with long-standing challenges, such as connectivity, will increase, with affordability improving as Africa’s economies and populations keep growing
    8. Health systems will be better at procuring eHealth by building the strategies needed to realise eHealth’s net benefits, then aligning procurement to them, making it easier for treasuries to make necessary resources available
    9. Universities will expand their health informatics and health science courses to include wider eHealth themes, along the lines of the curriculum development Acfee is already leading with ten African universities
    10. More eHealth leaders will emerge. 

    What might not happen:

    1. eHealth won’t transform healthcare much, there’s not enough of it yet
    2. Interoperability will be a continuing challenge
    3. Information on the impact of Africa’s eHealth, and it’s economics, won’t improve much
    4. Specific eHealth regulation won’t develop much, if at all
    5. eHealth professionals will remain in short supply.

    A New Year action plan could include finding concrete ways to help move the items more likely to happen, forward. eHNA will be on the lookout for your successes.

    Happy New Year.

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    Image from newyearsstatus

  • Africa can keep up with eHealth changes

    With eHealth constantly changing with new initiatives such as the cloud and numerous mHealth projects, how can Africa’s eHealth strategies keep up? Maybe a first step’s to build a strategy that incorporates eHealth’s cycle where changes in technology and health priorities change the content and context.

    WHO and ITU have produced a toolkit for producing national eHealth strategies. It’s a useful starting point, though more is needed, and the developers are certainly well aware of it. A critical part of the tool for Africa is how it will help countries support their specific plans for healthier Africans with the best foundation for a range of rapidly emerging and changing opportunities.

    New services, like cloud computing and mHealth emerge and develop, and render previous models obsolete. New risks, like cyber-threats, expand, and change the urgency and balance of priorities for investment. New techniques, like Big Data and analytics burst on the scene, offering new opportunities and possibilities. These new horizons mean that eHealth strategies and investment need updating and changing frequently.  

    Changes in eHealth are reflected in how eHealth is defined, which is notoriously challenging, with no agreement on what eHealth is. Africa’s health systems can define it to match their own priorities and challenges.

    WHO‘s definition provides a starting point here too. It’s the transfer of health resources and healthcare by electronic means, and encompasses three main areas:

    • Delivery of health information for health professionals and health consumers through the Internet and telecommunications
    • Using the power of ICT and eCommerce to improve public health services, such as through the education and training of health workers
    • Using eCommerce and eBusiness practices in health systems management. 

    Delivering health information requires information capture too. The three themes imply relationships between information, ICT, people, change and benefits. These lead to organisational change and healthcare re-engineering, with a potential to achieve substantial transformation in the way healthcare’s provided and health supported.

    Sharing information makes these changes possible, but is not enough to secure its benefits. eHealth’s users have to use it extensively and to good effect, and with new information provided by new media, and they have to change some of their clinical and working practices too. 

    While health workers can use eHealth to improve their performance, and empower citizens to improve their health, it can’t solve Africa’s health worker shortage. Other strategies are needed for this, and it’s vital that countries’ integrate their changing eHealth and health workers expansion strategies and plans.

  • The USA's eHealth Plan's a model of good balance

    The inaugural meeting of the African Centre for eHealth Excellence's Advisory Board and African eHealth Forum set out how Africa’s eHealth strategies have to support health and healthcare goals and simultaneously show how countries will set about fixing their eHealth challenges. The USA’s Office of the National Coordinator for Health IT released its updated Federal Health IT Strategic Plan. It shows one way of doing this.

    Its main features are:

    • It looks five years ahead, from 2015 to 2020, despite 2015 being nearly 75% complete
    • It has a set of seven explicit values of:
      • Focus on value
      • Person-centred
      • Respect individual preferences
      • Build a culture of eHealth information access and use
      • Create an environment of continuous learning and improvement
      • Encourage innovation and competition
      • Responsible stewardship of the country’s money and trust

    It has four goals:

    1. Advance person-centred and self-managed health
      • Empower individual, family, and caregiver health management and engagement
      • Foster individual, provider, and community partnerships
    2. Transform healthcare delivery and community health
      • Improve healthcare quality, access, and experience through safe, timely, effective, efficient, equitable, and person-centred care
      • Support the delivery of high-value health care
      • Objective C: Protect and promote public health and healthy, resilient communities
    3. Foster research, scientific knowledge, and innovation
      • Increase access to and usability of high-quality eHealth information and services
      • Accelerate the development and commercialization of innovative technologies and solutions
      • Invest, disseminate, and translate research on how health IT can improve health and healthcare delivery
    4. Enhance Nation’s Health ICT Infrastructure
      • Finalise and implement the Nationwide Interoperability Roadmap
      • Protect the privacy and security of health information
      • Identify, prioritise, and advance technical standards to support secure and interoperable health information and health ICT
      • Increase user and market confidence in the safety and safe use of health ICT products, systems, and services
      • Advance a national communications infrastructure that supports health, safety, and healthcare delivery.

    As a rolled over plan, it builds on a subset of existing initiatives, such as the National Interoperability Roadmap. eHNA has reported on the continuing dialogue. Africa’s health systems will have a different set and mix of priorities, but the overall concept of an effective balance between health, healthcare, eHealth and health ICT’s still needed. Implementing it’s a lot more demanding.

  • Acfee's African eHealth Forum report's out

    Towards the end of July, the African eHealth Forum (AeF) met for its first time in Cape Town. Its report was published today. You can access it by clicking the link in the left panel of eHNA's Home page.

    The Forum is where the African Centre for eHealth Excellence’s (Acfee) management team consults with its Advisory Board, industry partners and other stakeholders, to exchange their experiences of eHealth in Africa to seek better ways ahead. Advancing eHealth in Africa summarises the dialogue and proceedings.

    Its analysis is constructed around a process of:

    • Health priorities
    • Healthcare priorities
    • eHealth contributions
    • eHealth challenges
    • eHealth solutions
    • Acfee’s action plan.

    The core theme out of the Forum was that for African countries, successful, expanded eHealth investment depends on dealing with long-standing eHealth challenges.

    There are two sets of findings. One’s for countries; the others for Acfee’s medium-term action plan for its priorities and activities. For countries, the most important health goal is seen as saving lives, so eHealth has to contribute directly to this, and countries’ other health and healthcare goals.

    Achieving it needs countries to rebalance their eHealth strategies and plans in three ways.

    • First, increase investment in meeting their eHealth challenges, not just investing in new eHealth applications
    • Second, invest in a larger number of smaller-scale eHealth initiatives, not just large projects
    • Third invest more in information at healthcare’s numerous points of care that benefit patients and health workers directly, rather than the current dominance of reporting and management information.

    Acfee thanks the members of its Advisory Board for the commitment and inspiration provided as we begin this journey of action 
for advancing eHealth in Africa together.

    eHNA will be summarising the report in a series of posts over the next few days.

  • Burundi eHealth strategy's out

    As the African eHealth Forum was assembling its long schedule of eHealth opportunities and challenges at the end of July, Burundi’s Health Ministry was finalising its Plan National de Développement de l'Informatique Sanitaire (PNDIS), available on the Resources tab of eHNA’s Burundi page. It sets out its eHealth challenges and health information strategy for the next five years. It’s a substantial document and important contribution to Africa’s eHealth. It builds on its Plan Stratégique du Système National d’Information Sanitaire 2011 - 2015, and it’s ambitious.

    It includes the use of standards, including:

    • International Classification of Diseases Tenth Revision, Classification Internationale des Maladie (CIM 10),
    • Classification of Primary Care, La Classification Internationale des Soins Primaires (CISP-2)
    • Diagnostic and Statistical Manual of Mental Disorders, Le Manuel Diagnostique et Statistique des Troubles Mentaux (DSM)
    • Bilingual Bi-classified Terminology (3BT) thesaurus
    • Logical Observation Identifiers Names and Codes (LOINC)
    • Anatomical Therapeutic Chemical Classification, Le Système de Classification Anatomique (ATC).

    It assesses architecture in two parts. They’re first, information systems and applications, second, technology strategy.

    Burundi sees its eHealth challenges as including:

    • eHealth fragmentation
    • Over-reliance on donor funding
    • Low uptake of ICT projects in the health sector
    • Sustainability
    • Limited government leadership
    • No ICT framework.

    The total estimated spending on PNDIS is more than €18 million, over €3m for each of the next five years. Nearly €7m of the total’s for Priority 1 projects.

    When the strategy and plan’s finally approved, it’ll be a big step forward for Burundi. It may well extend beyond a five year horizon.

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    Image from the strategy's cover