• Readiness
  • A playbook to help successful eHealth investment's from AMA

    Good practice is always a good idea. The American Medical Association (AMA) has combined a wide range of good practices for eHealth. American Medical Association® Digital Health Implementation Playbook is built from an assessment that:

    Digital tools that enable new methods and modalities to improve health care, enable lifestyle change, and create efficiencies are proliferating quicklyClinical integration of these tools is lacking, so needs changing.

    It’s a valuable guide for Africa’s health systems. The four parts:

    Warm upPre-gameGame-time: remote patient monitoringPost-game resources.

    The playbook addresses four key requirements as questions for doctors adopting eHealth:

    Does it work?Will I receive payment?Will I be liable?Will it work in practice?

    These underpin several eHealth perspectives:

    1. WARMUP

    Introduction to eHealth implementation playbook Introduction to eHealth solutionsWhat’s remote patient monitoring? Remote patient monitoring in practice for hypertension The implementation path

    2. Pre-game

    Identifying needsForming teamsDefining successEvaluating vendorsMaking the case for eHealthContracting

    3. Game time for remote patient monitoring

    Designing workflowsPreparing care teamsPartnering with patientsImplementationEvaluating successScaling

    4. Post-game resources

    Idea intake form as an idea prioritisation worksheetTeam structure frameworkTeam structure worksheetWhen to engage teamsUsing the quadruple aim to establish eHealth valueSMART goals overviewSelecting a vendor guideVendor information intake formCyber-security knowledge neededNavigating digital medicine coding and paymentKey financial and legal documentsKey considerations for designing implementation workflowsClinical roles and responsibilitiesWhat if plans for patientsLessons learned worksheet.

    All four parts contain an eHealth investment process for healthcare organisations. In defining the steps, their next job is to assemble the information to support each decision.

  • A Global Digital Health Index can help countries track their eHealth progress

    The eHealth landscape is evolving rapidly. So is the range of national and local initiatives under development. It can be difficult for countries and organisations to measure their own efforts against others, to benchmark their progress. The Global Digital Health Index (GDHI) has been developed to help.

    GDHI is an interactive digital resource that tracks, monitors, and evaluates the use of digital technology for health. It uses components of the WHO and ITU eHealth Strategy Toolkit. It was designed collaboratively with representatives from over 20 countries, and 50 international organisations. Online reports describe the consultations that took place in Cape Town November 2016 and Bellagio September 2017.

    GDHI’s three objectives are to empower, evaluate and motivate. GDHI website describes each as follows:

    Empower: The GDHI provides visibility into the status and historical progression of key digital health performance indicators at a national and global level. It empowers health ministries, funders, policy makers, and industry players to make intelligent and informed strategic decisions about why and where to allocate resourcesEvaluate: The GDHI benchmarks countries against standardized digital health criteria. It assesses the presence and quality of national policies and strategies, investment risks, and coverage of key digital health platforms while providing countries with a roadmap for maturing over timeMotivate: The GDHI helps countries track progress and identify weaknesses within their digital health initiatives. It incentivizes improvements in national digital health systems and more targeted investments globally. The GDHI helps facilitate the strategic use of digital health to accelerate and monitor the achievements of Sustainable Development Goal 3: Ensure healthy lives and wellbeing for all at all ages, through enhanced data use and visibility into health systems.

    As the tool develops, we hope to see more on health outputs.

    These types of initiatives are invaluable, particularly when they include deep and meaningful stakeholder consultations. Congratulations to all involved. 

    The initiative is co-facilitated by HealthEnabled and Global Development Incubator, with partners ThoughtWorks to develop the web-based index and Dalberg Design for design aspects of the index.

    Financial support is from Bill & Melinda Gates Foundation, Johnson&Johnson, Philips and HIMSS.

  • Is eHealth mature enough for healthcare?

    Two opposing views of eHealth could be optimism and cynicism. An article in Fierce Healthcare identifies a view in between. It sees eHealth as a maturing endeavour that’s in an adolescent stage. While it’s a view of US eHealth, if it’s right, it has implications for Africa’s eHealth strategies too/

    It starts from a position where basic ICT infrastructure’s in place, such as EHRs, analytics and population health tools. This has created lots of data, but healthcare organisations don’t seem to know what to do with it. They’re entering a phase of trying to pull it together into a cohesive unit. Doctors are taking a core role in this, such as the Integrated Health Model Initiative (IHMI) reported on eHNA. 

    EHRs aren’t as communicative as they could be, and doctors don’t like the extra time they have to commit to eHealth’s demands. This extends to data entry too.

    Wearables can be full of potential for better health and healthcare. Unresolved challenges include designing effective service models and creating appropriate reimbursement arrangements. Reimbursement for telehealth remains elusive too, which doesn’t augur well for rising investment trajectories. It’s especially disappointing when over half of healthcare executives plan to expand their current programmes based on improved patient satisfaction and healthcare coordination achievements. 

    Recent huge global cyber-attacks, WannaCry  and Petya/NotPetya. revealed healthcare’s vulnerabilities. WannaCry breached several hospital systems in the UK’s NHS. For many weeks after the attack, the US Department of Health and Human Services was dealing with it’s operational aftermath for two multi-state health systems.


    Damaged a US-based drug companyForced a West Virginia hospital to replace its entire computer systemCost Nuance some US$68 million by shutting down it’s medical transcription services.

    Repairs weren’t confined to technical cyber-security matters. They had to address a severe lack of ICT security talent too. 

    In this setting, US eHealth investment’s up. For Africa, it’s eHealth strategies need recognise and deal with both the challenges and opportunities. A wide range of resources need deploying to drive through eHealth’s complexities that extend beyond ICT. 

  • Disaster and emergency preparedness may be needed for nine coastal African cities

    The Earth’s warming. There’s a consensus among Earth scientists that melting land ice contributes to Sea-Level Rise (SLR).  Research from the University Corporation for Atmospheric Research (UCAR) says future warming will exacerbate the risks to human civilization. Ice sheets, glaciers, and ice caps have melted during the 20th century leading to SLR. UCAR says it’s accelerating.

    A report from a team at the Jet Propulsion Laboratory, California Institute of Technology, Should coastal planners have concern over where land ice is melting? published in Science Magazine says the technique of Gradient Fingerprint Mapping (GFM) benefits long-term coastal planning. An appendix to the report identifies nine coastal African cities that could be affected. They’re:


    While the report deals with cities, other coastal communities will be affected too. If measures to reduce global warming succeed, it may not happen. If they’re too late or don’t work, it seems that it will.

    One response is building sea defences. Another’s to relocate communities. Doing nothing could mean emergencies and unplanned population migration. All have consequences for health and healthcare. The results from the study need factoring into the nine countries’ longer term disaster and emergency response and eHealth strategies and plans. Africa’s other coastal countries may need to start planning too.

  • eHealth has a role in equitable distributions

    Healthcare and chronic disease rates aren’t distributed evenly across Africa’s communities or countries burden. A report by a team from Aetna Foundation in the Journal of Public Health Policy, Population health-based approaches to utilizing digital technology: a strategy for equity may offer a way to use eHealth to even them up. More specifically, it proposes that mHealth can help.

    mHealth has a big role in engaging individuals and their communities in health and healthcare. It extends across accessing the Internet to find information about health conditions, monitoring health and fitness. Africa already has a wide range of mHealth services with plans for more. It’s 59% score on the WHO 2015 eHealth survey shows a respectable strategic foundation.

    Aetna Foundation takes a long-term, systematic view in making its grants. Its focus is promoting wellness, health and access to high quality healthcare. It evaluates bids for projects using “strong evidence-based criteria.” They include sustainability, scalability, potential for positive societal impact, leveraging available evidence such as population health data or healthcare data, and digital health technologies built on strong foundations of behavioural research or other applicable theories.

    This business case approach can help Africa’s health systems take good mHealth decisions. With a large mHealth evidence deficit, business cases enable rigorous assessments assumptions and estimates. They also support a switch away from seeking to achieve potential benefits to identifying more modest and realistic probable benefits. They also provide an analytical foundation for subsequent M&E, so adding to the current limited evidence pool.

    Acfee’s preparing guidelines for Africa’s health systems on using a proven methodology for preparing business cases. It also deals with the business case process as part of good eHealth governance. Both a methodology and a process are needed for business cases to fulfil their role in decision taking.

    Encouraging mHealth’s supply side’s important too. Aetna Foundation mentors mHealth innovators. Its approach to mHealth training that brings together leaders, behavioural sciences and clinical researchers offers lessons for Africa’s health system. Ministries of health, technology and economic development can collaborate to develop countries’ mHealth industries by setting clear mHealth priorities and working with local mHealth suppliers to develop and provide solutions and services.

    These themes combine into mHealth strategies that extend beyond healthcare and into the technology world of universities and business entities. This extended value chain offers a structure to expanding mHealth from the valuable progress achieved in Africa so far.

  • Acfee's eHealth Readiness Index updated

    African countries have marked differences in their eHealth readiness. Acfee’s updated eHealth Readiness Index shows that for some countries, it’s changing over time too. The index now includes data from WHO’s 2015 eHealth Survey, produced by the Global eHealth Observatory.

    Other data’s been updated too. The latest numbers for healthcare spending and the latest Ibrahim Index scores have been added. While some countries are shuffling around Acfee’s Index over the last few years, some have been reasonably consistent, especially those with high and low scores.

    These differences point to the need for different, bespoke eHealth initiatives. They can range from updating strategies to deal with new events, such as increasing cyber-crime, to an emphasis on low cost, high value mHealth investment. 

    Affordability is a common thread. Rigorous financial plans and business cases for eHealth are needed by every country. Acfee’ Index shows that all countries have to deal with eHealth financing constraints with a need to break out of short-term financial log-jams.

    If you’d like to discuss the implications for your country, you can contact Acfee. An email setting out your perspective can start a dialogue and help you start to develop further options to your eHealth strategy and programme.

  • How do African countries match readiness criteria for mHealth?

    A survey of EU countries’ mHealth readiness for research2guidance lists five countries with the highest readiness score, and with mature markets. They’re Denmark, Finland, The Netherlands, Sweden, with the UK at the top because 55% of mHealth practitioners saying it’s due to its openness and positive attitude of many doctors in the UK for new technology and integrating mHealth solutions into patient treatments.

    The survey is part of the mHealth App Developer Economics research programme.There were five readiness dimensions, each with a set of criteria. There are 26 of these in total. African countries can test how they rate on the five readiness dimensions including:

    eHealth adoption Level of digitalisation mHealth market potential Regulation Ease of starting a business. eHealth adoption: GPs transfer prescriptions to pharmacists electronically Patients making an appointment using a website GPs exchanging medical patient data with other  healthcare providers and professionals Internet users seeking online health information  Digitalisation: Smartphone penetration Tablet penetration Average number of apps in use Mobile Internet use Regular Internet users  mHealth market potential: Population Number of doctors and nurses Number of hospitals Health expenditure by population’s out of pocket National health expenditure Health expenditure per head Regulatory: Acceptance of ePrescriptions Implementation of EHRs Standards on EHR interoperability Permission for secondary uses of EHR data Permission of remote treatment Existence of e and mHealth guidelines Acceptance of health data transfer Restrictions on mHealth data storage  Ease of starting a business: Time needed to start businesses Number of procedures needed Taxes.

    A modest correlation is between market readiness and mHealth adoption and practitioner’s perspectives. It occurred in half the countries.

    That means that mHealth companies have a realistic view on the mHealth market conditions in these countries. The survey also found a wide spread of results. For Africa, where will your country fit?

  • Can eHealth readiness be measured?

    It’s well known that eHealth is more developed in high-income countries. A report available from the Electronic Journal of Information Systems in Developing Countries (EJISDC) reviews the position, especially eHealth’s integration, into the health systems of developing countries. It takes eHealth readiness as its perspective, and confirms the essential role of a readiness assessment.

    The researchers, Billy M. Kalema and Mmamolefe R. Kgasi, both from Tshwane University of Technology in South Africa, propose an eHealth readiness model with several parts:

    Core readiness, that identifies the core attributes of the target population that lead to the need for change, such as identifying needs, dissatisfaction and eHealth awareness Structural readiness, for attributes related to institutional and human resources Societal readiness, for the preparedness of health institutions and staff to participate in the networked world collaborative working and data sharing Government readiness, where the nation state and government are prepared, committed and have a legal and regulatory infrastructure for eHealth Acceptance and Use readiness, where medical and other health professionals are prepared to commit their time to eHealth for subsequent benefits.

    The report sees core readiness as the most important for eHealth in developing countries. It also identifies several factors that need to be in place for eHealth to succeed:

    Identifying eHealth suitability, appropriateness and affordability Institutional preparedness to finance the costs of equipment, installation, training, maintenance and provision of support Capacity building and human resource development to ensure sustained support and training Identification of suitable legal and regulatory frameworks that are conducive to eHealth Investment in high level preventive health and ensuring trust of health systems to the users and citizens.

    They could’ve added dealing with obsolescence and the rapid emergence of new solutions and opportunities, such as Big Data and mHealth. The impact in Africa is different, and may be more important than in developed countries.