• Strategy
  • 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

  • South Africa's new mHealth strategy's out

    There’s big news out of South Africa. The official mHealth Strategy 2015-2019 has been released by the National Department of Health. You can find it on eHNA's South Africa Resources page or download it here.

    The strategy’s been over a year in the writing, and after several iterations, is now finalised and approved by the Health Minister, Dr Aaron Motsoaledi and Director General, Ms Malebona Precious Matsoso. mHealth's evolution is an "opportunity to deliver improved health services" emphasises Dr Motsoaledi.

    The mission of the strategy is to 'apply mHealth as an integral part of delivery of health care services in order to meet information communication, health education and data management needs of the health system in South Africa.”

    Its aim is to provide a single harmoniszed and comprehensive mHealth strategy and implementation plan that:

    • Supports the priorities of the health sector
    • Addresses and meets the needs of:
      • Individuals, so they’re empowered to maintain and promote their own health and that of their families and communities
      • Providers of healthcare services
      • Managers and policy makers 
    • Paves the way for future public sector mHealth requirements.

    The strategy examines the current mHealth environment, research and piloting, and legal and policy framework. Like most countries, South Africa lacks an overarching legal framework for eHealth and mHealth. Nevertheless, South Africa has legislation to protect patients’ health records, a critical element. It’s provided for in the National Health Act (61 of 2003) that includes the electronic transmission of personal medical information networks.

    There's an mHealth Roadmap too, which has articulations with South Africa's National eHealth Strategy 2012.

    Challenges are discussed, the main ones encountered in South African being:

    • Lack of alignment and integration of the intervention into health plans, strategies and systems
    • Absence of government leadership and coordination
    • Poor documentation and learning from best practices
    • Lack of use of open source options
    • Absence of practical approaches to privacy and security
    • Lack of interoperability
    • Absence of a single framework within which to evaluate the role of mHealth and eHealth tools to strengthen the health system.

    As mHealth continues to expand across Africa, these challenges need addressing. These, and numerous others, were discussed in detail at Acfee’s African eHealth Forum, held in Cape Town last week. Some have simple solutions, others are more complex. Acfee believes that eHealth leadership and capacity building at all levels will play a major role in addressing many challenges. Another aspect highlighted was the need for better communication between countries regarding their mHealth experiences. Learning from each others successes, as well as failures, is crucial for successful eHealth. 

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    Image thanks to Amanda Tanner

  • How should you implement your mHealth strategy?

    Just because mHealth’s good for Africa doesn’t mean it’s easy. Converting strategies into action is always difficult, especially in Africa’s constrained ICT and healthcare environment. A white paper from Common Time sets out some steps that help to smooth the way. First, recognise the benefits. They include:

    • Better, smarter and more patient-centric healthcare
    • Reduced risk having the right information at the right time
    • Better data capture EHRs
    • Less worker downtime
    • Cost savings.

    From these, the challenges are then dealing with a daunting list of:

    • Selecting platforms, devices and types of app
    • Engaging users
    • Leveraging legacy ICT
    • Offline working
    • App development processes
    • Deployment pace
    • Adequate and skilled resources
    • Interoperability
    • Data management and manipulation
    • Data synchronisation
    • Multi-lingual capability
    • Infrastructure
    • Security.

    You then have software deployment choices of making it yourself, leveraging industry standards or taking a platform approach. With a platform, the report suggests the need for a Mobile Application Development Platform (MADP). It integrates management, development and collaboration. When it’s finished, you can use it to test your requirements. There are twelve questions, does the MADP:

    1. Support the development of single source apps using open standards?
    2. Support the development of apps for organisation to patient, organisation to supplier and organisation to public interfaces?
    3. Support distribution through an enterprise app store, third party app stores and Mobile Device Management (MDM) solutions?
    4. Provide a framework for user interface and experience design to create user-friendly apps?
    5. Enable organisational stakeholders to contribute to app development?
    6. Support open technologies so can leverage their existing skill-base?
    7. Enable developers to produce new software components and controls for re-use?
    8. Provide analytical and debugging tools for good software versioning control and auditing?
    9. Support offline and online working?
    10. Support flexible deployment options, such as cloud
    11. Support open integration to mobilise legacy and cloud enterprise systems?
    12. Support data management to facilitate interoperability?

    Creating successful mHealth’s a big job, and it doesn’t tell you how to make you mHealth programme affordable. Only you can do that.

  • Five ways to transform healthcare

    At the African Centre for eHealth Excellence (Acfee), eHealth’s seen as a combination of people, health ICT and healthcare transformation. This view’s developed further at the 4th European Forum on Health Policy and Management: Innovation & Implementation in Berlin, where they’ve been discussing transformation needed for successful innovation. They identified five challenges:

    • Beyond technology, because healthcare needs social innovations that lie beyond the technological and clinical
    • Population health that successfully manages the health needs of large populations
    • Professional buy-in that grows with innovation’s increasing pace
    • Deciphering evidence, including ethnographic questions about populations, such as who are they, how do they live, how do they see health and health care and what are their problems?
    • A new generation seeking personalised medicine, health information from the Internet, keen to share decision-making with providers, anxious about information privacy and intrigued by wellness and technical medical innovation, but alongside communities in poverty, illiteracy, stigma, and personal and social disorganisation who remain beyond innovation’s reach.

    These themes fit Africa’s eHealth challenges. They offer a start to develop eHealth’s clinical, executive and political leaders to develop a toolkit to help them transform and improve the health of their communities and the services provided by their healthcare systems.

  • Why are eHealth strategies hard to implement? Lesson 4

    In his book On War, Carl von Clausewitz, the 19th century military strategist said “Everything in strategy is very simple, but that does not mean that everything is very easy…. But great strength of character, as well as great lucidity and firmness of mind, is required in order to follow through steadily, to carry out the plan, and not to be thrown off course by thousands of diversions.”

    eHealth’s similar. Its strategies set out directions for investment in development such as new health ICT systems, architecture, interoperability, standards, resources and benefits. Converting them into action seems to prove more demanding than strategies envisage. African countries are not alone in this quest, so what are the lessons?

    First, many eHealth strategies have many initiatives that fit into a relatively short time scale of some three to five years. There are two inbuilt constraints. One is that there’s often too many. The other is that some of the initiatives have much longer timescales. An example is the USA’s national interoperability road map. It has a ten year timescale, as posted on eHNA. It seems realistic, so can’t fit into a strategy with a horizon of five years or less. The lesson is, either extend your strategies timescale, or shrink the initiatives to fit.

    Implementation needs different skills to strategies. Guru’s often invoke leadership components. Examples are:

    • Three Cs of Implementing Strategy by Scott Edinger in Forbes, who says it needs you to clarify, communicate and cascade your strategy
    • Managing Performance Execution & Implementation Process By Shannon Sage in On Strategy, who says:
      • 90% of organisations fail to implement their strategies
      • 60% link strategy to budgeting
      • 75% don’t link employee incentives to strategy
      • 86% send less than one hour per month discussing strategy
      • 95% of a typical workforce doesn’t understand their organization’s strategy.

    She proposes a leaders’ self-assessment test:

    • How committed are you to implementing your strategy?
    • How do you plan to communicate it?
    • Are there sufficient people with buy-in to drive it on?
    • How are you going to motivate your people?
    • Have you identified the internal processes you need to drive it forward?
    • Are you going to commit money, resources, and time to support it?
    • What are the roadblocks to implementation and support?
    • How will you take available resources and achieve maximum results?

    With implementation skills different to strategic skills, you have to have to right human capacity and capabilities in place. These include health workers who can release time for engagement, project management broads, project managers, informatics teams, ICT support teams, procurement teams, trainers and training time, devolved budgets, accountability links, a devolvement plan for corrective decisions.

    The scale and scope of these will determine progress. As these are scarce resources, scale and scope is likely to be limited. An assessment of these can as part of formulating an eHealth strategy help to integrate implementation and strategy and ensure realism for both. One way to do this is to have an eHealth strategy that sets out the initiatives needed, but without a timescale. It then becomes the source of actions for selection to transfer into a rolling three to five-year plan. This is appropriate for countries with constrained resources, so can fit Africa’s healthcare.

    Perhaps the most demanding part of implementation is securing the changes to clinical and working practices and healthcare transformations needed for success. An example is eHNA’s post on EHRs need new healthcare models. It shows that eHealth is much more than health ICT. Implementing eHealth is much harder than implementing ICT systems. Realising eHealth’s benefits must be part of implementation. Clausewitz view on this is that “The relations between material factors are all very simple, what is more difficult to grasp are the intellectual factors involved.” This is why implementation is so challenging, and not just for African countries.