• IoT
  • Is FHIR a disruptor to help democratise the health information space?

    There are five disruptive technologies that healthcare organisations can embrace, according to Dennis Brown’s silicon republic article.  Robotics, virtual reality, automation, 3D printing and drones.  I agree with Brown, and I would add one more; the Fast Healthcare Interoperability Resources (FHIR) standard for exchanging electronic data.

    FHIR is a recent innovation of the Health Level Seven (HL7) internationally messaging standard. HL7 helps to create message structures for electronic exchange of patient information between systems, applications and compliant devices. HL7 is maintained by the sustained efforts of a large global community.

    FHIR is a highly flexible and can be found in a variety of electronic health information structures, such as the Electronic Health Record (EHR), Clinical Context Object (CCOW), Continuity of Care Document (CCD), Clinical Document Architecture (CDA), and Care Record Summary (CRS). FHIR is scalable, supporting information exchange within a single healthcare facility, a group of facilities or a multitude of electronic systems across a diversity of healthcare systems, facilities or services.

    FHIR provides a standardised messaging protocol for the communicating messages about a unique patient encounter. A FHIR server has unique characteristics:

    It is onlineIt is secureDefinitions are searchableIt can empower users, including patients, by shifting control of siloed proprietary data from individual vendors to an open, vendor-agnostic platformIt makes information available to authorised people, systems and devicesIt has substantial international support and investment.

    FHIR can help democratise the information space, level the playing fields, and spark healthy competition among information systems service providers, emphasising serving users’ needs, rather than data control.

  • IoT “in the wild” may help us manage stress better

    In his TEDx talk, Pablo Peredes makes a case for using the Internet of Things (IoT) to help humans manage stress. He points out that to be stress free, humans need more outdoor activity than our modern lives allow, and suggests that our “new” natural environment of homes, offices and cars can be more intuitive and responsive to support what we need. In his talk, he uses a book to explain our current stress-increasing predicament.

    Why Zebras don’t get ulcers is a book by biologist Robert M. Sapolsky. Sapolsky explains that for animals such as zebras, stress is typically episodic, such as when avoiding being eaten by a lion, and this stress is well managed by abundant opportunities for the free Zebra to engage in stress-relieving activities rambling around the savanna. In contrast, modern human stress is often chronic, such as worrying about losing a good job or how to survive a stressful one, and our natural environment is no longer the ubiquitous outdoors, but confined to homes, offices and cars, which offer too few opportunities for natural stress relief.

    Since we are unlikely to abandon our homes, offices and cars, Peredes suggests that IoT can help repurpose common household objects to make these devices able to help us manage our health better, transforming our homes, cars and workplaces into environments that identify and manage our stress. He suggests starting existing devices, avoiding the costs of adding new sensors. By collecting and analysing data from things we touch, such as a PC mouse, or a steering wheel in a car, Peredes says we can identify stress and do something about it.

    Peredes describes two reasons for people not managing stress: lack of willpower and lack of time. He suggests that we use the time available during our commute from home to office to diagnose stress levels and improve our stress management, such as making car seats talk us through breathing exercises, office chairs remind us to stand when we’ve been sitting too long, and adding imperceptible screen colour changes to adjust our breathing and heartrates.

    Peredes believes that the everyday devices around us should help us to manage stress. He calls it “stress management IOT in the wild” and invites us to share new design ideas via email.

    Many of our African homes are still connected to the natural environment, providing ample opportunities to blow off steam. Nevertheless, in Africa people are urbanising rapidly too, and it is reassuring to know that people like Peredes are thinking about how to make our modern environments more supportive. I look forward to writing more eHNA pieces about his IoT adventuring in the wild. 

  • How far into the future should eHealth strategies look?

    By definition, eHealth strategies are about investing in the future. They’re also about taking existing eHealth investments forward, either by switching, enhancing and rolling out further. In 2006, Rosabeth Kanter identified several lesson for innovation strategies. They included an “innovation pyramid” where:

    Not every innovation idea has to be a blockbusterSufficient numbers of small or incremental innovations can lead to big gainsBig bets at the top that get most of the investmentA portfolio of promising midrange ideas in test stageA broad base of early stage ideas or incremental innovations.

    The last one’s relevant for a perspective set out in an eBook from Oracle. Technology Takes Healthcare to Next Level proposes strategies for disruptive technologies of:


    Each one offers promise for healthcare. Combined, Oracle sees the sum of the parts as greater than the whole. Combining blockchain and IoT allows frictionless data exchange. AI and machine learning put data in motion with minimal human intervention. AI tools can study blockchain’s large volumes of data to find patterns that need responses

    For Africa’s health systems, investment in ICT foundations and patients’ clinical and demographic data’s needed to. The strategic challenge is to choose between sequential investment and progress in an innovation pyramid where these four technologies start their journey. While leaving the disruptive technologies into the future, it can defer the costs. It will also defer the benefits.


  • Saudi Arabia’s RAH@H aims to improve healthcare quality

    Connecting and integrating healthcare resources to improve quality’s a core eHealth goal. In Riyadh, the Remotely Accessible Healthcare at Home (RAH@H) initiative offers a daily, patient centric, connected health model to achieve it. Five themes are integrated: 


    Achieving these depends on RAH@H operating at the centre of a technological hub.

    Available both on Android and IOS, RAH@H uses modern technologies for telemedicine, webinars, and observations from medical devices to serve patients. Healthcare needs of vulnerable communities that don’t have ready access to services. They include pregnant women, especially with complications such as hypertension, gestational diabetes and cardiac conditions.

    Interventions include:

    Improved nutritionPrevention and protection against diseases and illness.

    These aim for outcomes of:

    Better life qualityCreating satisfied and empowered patientsIncreased treatment compliance.

    Based in Riyadh, RAH@H’s project custodian’s the Director General of Prince Naif Bin AbdulAziz Health Research Center at King Saud University in Riyadh. It's concept and technology can have a role in African countries and their vulnerable, underserved communities.

  • Voice recognition reduces Tanzania's patient waiting times

    Patients at the Muhimbili National Hospital in Dar es Salaam no longer have to endure long waiting times for their radiology results.  This is thanks to a new technology installation in the department.  Voice recognition or speech recognition technology is now being used to encode doctors notes on patients so that they can easily be transferred to the radiology department. 

    With this new technology, Tanzanian medical professionals are able to dictate into their computers, in the normal course of speaking and have the speech engine recognise what the clinician wants, and then apply the commands or structured words, respectively, to obtain a radiology report for a patient.  There has been some concern around the effect of speech accents on the technology, but this has posed no problems since implementing it at the hospital.  

    The speech engine is also capable of showing the cardiology report template populated with the name of the patient and other demographic data. By dictating the cardiology report narrative, the computer recognises the narrative context and intent and condenses a complete, correct, and structured document.

    This translates to shorter waiting times for patients, greater operational efficiency within the hospital and reduced workload on medical staff who are required to take notes of patient examinations and consultations.  The technology, which uses natural language processing, is constantly learning speech behaviour through repetitive exposure to terms and complex algorithms that organise speech patterns into recognisable behaviour. 

    This bold technology implementation in Tanzania could be a useful pilot for overburdened health care systems in Africa hoping to achieve the same benefits.

  • Verizon sees a bright IoT future, but…

    eHealth strategies should have a prime place for IoT.  It’s role’s expanding, but there are still several challenges that need addressing. A report from Verizon Enterprise set these out. State of the Market: Internet of Things 2017 Making way for the enterprise says IoT’s taking hold in almost every industry. An example’s where pharmaceutical companies use them to track and trace medicines from production to patients. eHNA has another example. 

    What can Africa’s health systems expect from them? Verizon’s findings across economies are

    73% of executives are either researching or currently deploying IoT for the most important assets and processes 84% increase in IoT connections by manufacturers41% increase in transport and distribution industries40% increase in energy and utilities sectors19% increase in smart cities and communitiesIoT increases operational efficiencyImproved supply chain managementIt delivers unparalleled experiences to partners and customers.

    The big but’s that adoption’s slower than expected. Over 50% of executives say the reasons are a lack of:

    Industry-wide IoT standardsSecurityInteroperabilityAffordability.

    Both perspectives need to be included in eHealth strategies. Some of the inhibitors may be beyond health system’s direct control. Where they are, links to these initiatives need setting in place to monitor developments as part of investment plans.  One feature to keep on focus’s the changing supply side. Verizon says there are predictions of continuous market consolidation as larger providers acquire start-up and specialist IoT firms. 

  • India steps up certification training for medical device makers

    High quality medical devices are imperatives for healthcare. It may become more important as Africa’s health systems adopt more Internet of Things (IoT) initiatives. India’s first state-of-the-art medical devices manufacturing park in Visakhapatnam, the Andhra Pradesh MedTech Zone (AMTZ), organised a two-day industry training programme on quality certification. The aim’s to shorten the time and cost of achieving globally recognised quality certification for India’s medical device makers.

    A report in eHealth Magazine says the course was organised by Quality Council of India(QCI)  National Accreditation Board for Certification Bodies (NABCB) and Association of Indian Medical Device Industry. (AIMED). Medical device manufacturers, medical professionals and industry stakeholders were participants.

    There’s a need to fill the regulatory space in quality certification for India’s medical devices in the country.  The main themes included:

    ·       Interpretations and understanding of Conformité Européene (CE),  the European Commission (EC) the  labrynthine guidelines and regulations and product marking

    ·       Industry Indian Certification for Medical Devices (ICMED) certification 9000 and 13485

    ·       New Medical Device Rules 2017. 

    This could be a template for equivalent events for Africa’s device makers and users. As IoT expands, devices will have to keep up. Regulations and training are a vital ways to achieve it.

  • Finding the right mHealth and IoT needs a structure

    As mHealth and the Internet of Things (IoT) opportunities keep expanding, finding the right solutions for a health system becomes more challenging. A white paper from Insight, an ICT firm, sets out a ten-step approach to navigating the mushrooming landscape. 

    10 Best Practices for Discovering the Best Mobile and IoT Devices for Healthcare says healthcare organisations need a robust discovery process for acquiring and procuring mHealth and IoT devices.

    It offers a similar perspective to a concept from Marcel Proust, the 19th and 20th century French novelist. In Search of Lost Time, he said “The real voyage of discovery consists not in seeking new landscapes, but in having new eyes.”  The ten steps can help achieve it. They’re: 

    1.     Set up a cross-functional team

    2.     Seek the experience of independent advisers

    3.     Encourage exploratory thinking

    4.     Consider working with a group purchasing organisation

    5.     Create an mHealth and IoT policy leading to enterprise management

    6.     Create and use a scoring matrix

    7.     Assess existing infrastructure and mHealth and IoT use

    8.     Focus on cyber-security

    9.     Consider Choose Your Own Device (CYOD).

    10.  Explore device technology, including sensors and IoT.

    Cyber-security has several components:

    SeparateEncryptionmHealth and IoT compliance policyVirtual Desktop Infrastructure (VDI)Geofencing to limit accessSecurity softwareSecurity softwareMulti factor authorisationRole-based authenticationAutomatic Wi-Fi connections where cyber-security’s more important than convenienceRobust Virtual Private Networks (VPN)Mobile Device Management (MDM) and containmentRemote wipe to erase all data from a lost or stolen devices.

    Moving away from Bring Your Own Devices (BYOD) should be considered too. A better alternative’s Choose Your Own Devices (CYOD).

    These offer Africa’s health systems a firm start to managing their new mHealth and IoT programmes. It can help to mix new mHealteh and IoT visions with a dose of caution. “People wish to learn to swim and at the same time to keep one foot on the ground,” as Proust observed.

  • IoT might have two inconsistent scenarios

    Africa’s eHealth plans tend to have limited requirements for the Internet of Things (IoT). As health systems mull over their IoT strategies, it’s worth considering two scenarios identified in an article in MIT Technology Review. It seems that IoT might help improve patient care by making data-sharing easier. It might also put patients at risk, especially from cyber-security challenges. A solution has a dilemma too. Some want more government oversight and regulation. Others say this approach could stifle innovation that’s crucial to IoT’s trajectory.

    The article says prominent computer security experts recently told the US Congress that the “Growing mass of poorly secured devices on the Internet of things represents a serious risk to life and property, and the government must intervene to mitigate it.”  A graphic example of the catastrophic risk was the Denial of Service (DoS) attack on Dyn, an Internet infrastructure provider. Cyber-criminals found ways in with a botnet that hacked webcams, camcorders and baby monitors. It shows that the Internet alone can’t support critical systems safely.

    A case’s made that IoT manufacturers lack incentives to assign a high priority to security. Regulation’s seen as the solution by many, but precisely how’s a matter of intense debate. Business groups such as the US Chamber of Commerce and the Consumer Technology Association say new IoT regulations could hinder innovation. A challenge seems to be to either reconcile these views or take one side.

    As eHNA posted, Africa’s eHealth regulation deficit needs a boost. Countries’ eHealth regulation start to catch up with developed countries before IoT regulation can be introduced. A better option may be for countries to start to introduce IoT regulation as a single, integrated exercise across all sectors. It can be vehicle for both IoT investment and innovation in healthcare.

  • Africa's IoT revolution's underway

    The number of connected devices around the world continues to multiply, with International Data Corporation (IDC) expecting that the worldwide market will reach a total value of $1,7-trillion in 2020, says an article in IT Online. The firm believes that the Internet of Things (IoT) opportunity in Africa is enormous, with the continent likely to house around 1-billion connected devices by the turn of the decade. 

    George Kalebaila, senior research manager at IDC Sub-Saharan Africa, believes that “the opportunities are endless, with the spread of IoT enabling smart industry, smart health, smart living, smart energy, smart transport, smart buildings, smart cities, and an overall smarter planet. Indeed, the only forces restricting the application of IoT are our imaginations and the rate at which policy frameworks can catch up to regulate the industry.” 

    IoT dependens on understanding and interpreting data for actionable insights. Without data and analytics, IoT won’t deliver its intended value. “IoT is not a technology but an ecosystem consisting of software vendors, IT services providers, systems integrators, cloud providers, and network providers,” Kalebaila adds. “These industry players have the opportunity to optimise the potential value of IoT by partnering with each other to provide end-to-end solutions. Simply put, when IoT-based products and solutions become connected, their value increases exponentially and the number of potential use cases explodes.” 

    Recent ICD research shows that 33% of enterprises in South Africa are planning significant IoT investment over the next three years. It’s being driven by the pursuit for lower operational costs, improved process efficiency, and heightened levels of product and service innovation aimed at addressing overall needs. 

    While the potential benefits are clear, the continent faces a number of challenges which it will need to overcome in order to reap the benefits. One of the current challenges is the lack of consolidated standards. There are also concerns around the security and privacy of the data being collected, as well as maturity of the regulatory frameworks. Other challenges impacting Africa’s IoT landscape include IT budgets and priorities, the dependence on stakeholders, and the shift in mindset that is required to drive digital transformation on the continent.

    These challenges are vast and need to be addressed for healthcare and eHealth to evolve. GE has already committed 2 billion to develop IoT capacity across all its customers’ machines, including healthcare. It seems that eHealth with IoT in Africa has exciting possibilities ahead.