• Informatics
  • China’s medical informatics plan has lessons for Africa

    Expanding eHealth needs a considerable investment in medical informatics (MI) as a pre-requisite for success. China’s 2010 health reform included a large MI investment. A study by a team in China, and with a US member, reported in the Journal of Medical Internet Research (JMIR), set out to evaluate this MI component. It compared China’s MI conferences with the US. The findings can guide Africa’s health systems plans too.

    Four events in China were reviewed:

    They were compared with two US events, the:

    The team summarised the scale, composition, and regional distribution of attendees, topics, and research fields for each conference. It found that China had a large deficit for the impact of MI conferences on continuing education. It may not be surprising given the longevity and scale of eHealth in the USA. For Africa’s health systems, it reveals a need to expand and support MI and eHealth conferences that enable sharing of MI information, challenges, experiences and successes.

    Learning from, and collaborating with, other countries are seen as vital by the team too. Africa’s regional groups already offer an existing context for these. An Acfee initiative’s a contribution to these goals with its eHealthALIVE Southern Africa 2017 conference on 2 to- 4 October 2017 at the Emperors Palace, Johannesburg.

    The event will be hosted by South Africa’s National Department of Health in collaboration with an Acfee-led consortium of leading eHealth organisations, including Health Information Systems Program,(HISP-SA) and the South African Health Informatics Association (SAHIA) and HealthEnabled. Plans are being developed for equivalent events in Africa’s other regions. 

  • Which is best, data repository or data warehouse?

    As Africa’s eHealth moves on, its health systems need to decide how to keep their new data. A choice’s between repositories and warehouses. A post by Tim Campbell in Health Catalyst says the belief in the value of data repositories can be overstated and limiting. Their functionalities are too narrow, being mainly just a place to put data, so they’re just databases. 

    Repositories’ roles in improving healthcare are often limited by their limited analytic functions and opportunities. Consequently, they can’t provide the depth of data needed to inform decisions on healthcare costs, quality and effectiveness, so support better healthcare across its continuum, an essential perspective.

    Healthcare’s wide-ranging complexity can often lead to several repositories, so data silos. Campbell proposes a better solution, a Late-Binding™ Data Warehouse (LDW). It enables data extraction and binding of data available for entire organisations. It’s quicker to pull and bind data. Its flexible architecture enables simple adjustments to meet users’ specific needs. LDW’s claim to reduce errors, so avoid wasted time, leading to increased efficiency and lower costs. These time-savings are put at 80%.

    These choices are essential for Africa’s health systems. A critical consideration’s investing in the analytic skills, so people, to enable the data to be used to good effect, whether it’s in a repository or a warehouse.

  • Which clinical databases do Africa’s health systems need?

    Extending eHealth across clinical services creates opportunities for investment in databases for research into perspectives such as clinical standards, practices, quality, cost-effectiveness and efficiency. Deciding which to pursue within Africa’s very constrained healthcare budgets isn’t easy. The choice’s considerable when it comes to research. 

    The US National Library of Medicine has 69 clinical databases supported by the National Institutes of Health (NIH). They extend over a wide range of topics. Examples from the NIH Data Sharing Repositories list are:

    The repositories, all supported by the NIH, provide data accessible for reuse. Some aggregate information about biomedical data and information sharing systems. The US approach shows that research findings are an important part of health systems’ repository services. Holding data just from eHealth services may not be enough for health systems. Findings from research that use eHealth data can offer benefits to wider health systems and other countries.

    It’s an opportunity for Africa’s health systems to develop and share research data. Maybe high priorities are communicable diseases, Non-communicable diseases (NCD) and antibiotic prescribing practices.

  • How can patients’ data follow them around health systems?

    Most patients are mobile. Their healthcare’s provided by different types of health professionals and other workers and organisations. In Africa, many people change towns and migrate from remote communities, so they access their healthcare in different districts and regions. It’s hard for their information to keep up, even between local clinics and hospitals.

    A major eHealth goal is to provide access to patients’ information wherever they turn up for their healthcare. A report from Health IT Analytics sets out a way to achieve it. Best Practices for Building an IT Infrastructure to Support Digital Transformation. It sets out five main steps:

    • Create an eHealth footprint focused on connectivity
    • Unlock data to move information securely across different systems
    • Eliminate data silos to enable secure data sharing
    • Engage patients electronically in a way that’s convenient and meaningful for them
    • Use analytics to optimise health data’s value. 

    It needs a significant parallel investment in the data itself. These eHealth programmes can be pursued in the context of the five goals. For Africa’s health systems, this may easier to construct than developed countries because of the current, limited legacy systems. It might be easier, but it’s not easy.

    The report sets out a hierarchy of eight steps moving from an integration foundation up toe ecosystem engagement:

    • Analytics
    • Mobile app development
    • Identity federation
    • Application Programming Interface (API) management
    • Extensible Markup Language (XML) and Service-Oriented Architecture (SOA) services
    • API integration
    • B2B Electronic Data Interchange (EDI) integration
    • Managed file transfer

    This perspective sets an eHealth horizon beyond information systems. It needs rigorous eHealth leadership. It needs considerable resources and eHealth capacity too. For Africa’s eHealth, the eight steps offer a long term direction. It’s still a direction that’s needed, and building blocks can be put in place in the short term.

  • eHealth skills and knowledge defined for health informaticians

    As eHealth drives forward, the skills and knowledge of health professionals dealing with informatics has to keep up. ”It's essential to keep moving, learning and evolving for as long as you're here and this world keeps spinning” says Rasheed Ogunlaru, a business coach. Sometimes eHealth seems it might be spinning too, as it expands from databases to analytics and into wider domains over the eHealth horizon. 

    It’s a big challenge, and the American Medical Informatics Association (AMIA) has shown a way ahead. Its Tasks Force report in Applied Clinical Informatics (ACI) sets out a comprehensive learning programme for the numerous types of health professionals dealing with clinical aspects of informatics. It offers an excellent template for Africa’s health systems to adopt

    The knowledge needed includes:

    • Understanding the science of informatics, the healthcare domain, clinical care processes, socio-technical challenges of care, communication, and clinical workflow
    • Understand how to communicate successfully with patients, citizens and clinicians about the impact and effects of eHealth on healthcare
    • Fundamentals are set out as clinical informatics and healthcare systems, clinical decision making, clinical care process improvement, clinical decision support, evidence-based patient care, clinical workflow analysis, process redesign, quality improvement, human factors engineering, eHealth systems and apps, clinical data standards, eHealth lifecycles, leading and managing change, project management, strategic and financial planning.

    There are many skills required. They include the ability to:

    • Guide EHR selection process
    • Define eHealth governance process
    • Engage senior executives in EHR culture and practice changes
    • Advise on implementation methodology and sequences of EHR modules
    • Identify eHealth value propositions and key performance indicators
    • Provide oversight of system design and implementation
    • Create implementation and key performance indicator score cards
    • Determine an enhancement request system and prioritisation process
    • Staff process improvement initiatives
    • eHealth education health and interplay with people and process changes, develop strong relationships with key stakeholders, including the other CCIOs.

    The considerable scope of these emphasises the life-long learning needed for these health professionals to succeed. A voracious capacity for it seems a prerequisite. Henry Ford revealed an incentive to succeed. “Anyone who stops learning is old, whether at twenty or eighty. Anyone who keeps learning stays young.”