• Leadership
  • Is your digital health strategy delivering the health system changes you need? These three suggestions might help your 2020 planning.

    “Day’s sweetest moments are at dawn” wrote American poet Ella Wheeler Wilcox. It’s a time for fresh starts when almost anything seems possible. This new year feels a little like that for digital health, with technology maturing and unprecedented readiness of people and systems to use digital health to change how our health systems work.

    So, are we giving our users what they need to make big changes to the health system?

    Health workers have not always been keen to embrace digital tools, their position largely justified by poor usability and inadequate value-add, so the growing enthusiasm is encouraging. It should not be taken for granted, particularly as new techniques emerge to transform data, drive decisions and change the way both patients and health workers experience the health system. It is heightening the need to make sure we build solutions that really do respond to users' priorities and improve their lives, whether they are patients, health workers or citizens wanting to keep healthy.

    As we go into 2020 I have renewed optimism and humility as I look at the foundation of work that has been completed over the last few years. There's a sense of common purpose across the digital health community too, tangible at digital health events around the world. Our countries' health leaders have fuelled this, with overwhelming support for the rousing World Health Assembly 2018 digital health resolution, followed in 2019 by the WHO Recommendations on Digital Interventions for Health Systems Strengthening, summarised in this eHNA series.

    The Principles of Donor Alignment for Digital Health continue to gain supporters and we are approaching a consolidation of digital health peer networks, most recently seen at the Global Digital Health Forum gathering of friends and colleagues from Asia's AeHIN, Africa's Acfee, Central America's RECAINSA, and colleagues from a Pacific Islands network, Digital Square, RHINO, HISP-SA and others.

    WHO has been busy too. It has selected a new digital health Technical Advisory Group (TAG) to take over from the previous eHealth TAG established in 2013, which I was honoured to be part of, and initiated a round of global consultations on a draft global Digital Health Strategy set to be finalised in 2020. 

    On the African front there is a lot underway. An emerging digital health curriculum is being developed in partnership by WHO-AFRO and ITU with support from a number of global organisations. I have been thrilled to contribute to this work, along with many African digital health colleagues. This year I also had the privilege of joining writing teams for a number of new national digital health strategies. My home country, South Africa, has a new strategy available here, or you can read this short eHNA summary. New strategies for Namibia and Botswana are expected to be out in the first part of 2020. I have been humbled by the innovative work delivered by the tireless colleagues with whom I collaborate at WHO-AFRO, ITU, HISP-SA, Acfee, and many Ministries of Health across the African continent. I am sure you have had similar experiences too, with many more organisations.

    While this big global push builds a momentum that moves us forward towards maturity, on the implementation side, sober reflection reveals that our successes are proving hard to scale up and net health benefits remain largely elusive. There are lots of commentaries about how to improve readiness. As we take these steps, addressing all kinds of important issues from interoperability architectures and regulatory strengthening to data science, I believe we must focus more on what is happening with the people in the system. I have three suggestions for 2020:

    Let’s expand our circles of engagement. Patients are largely absent or extraneous to most digital health conversations and health workers at the coal face of clinical care remain peripheral too. Our talk of more user focused design and UxD needs to find a good footing to begin changing how we design systems, and in turn, the usability of what we produce for our users.We should examine how investments shape our local digital health communities and ecosystems and how they create meaningful, sustainable opportunities for people, whether academic, professional or commercial. While many of our countries struggle to raise adequate investment for ICTs, we see sparse resources further diluted by heavy licensing costs for underperforming applications, many of which use outdated design, architecture and technologies, misaligned with changing care pathways, to ultimately fail to contribute sufficiently to a sustainable local digital health ecosystem. This must be turned around with a deliberate local economic digital health investment approach.A new decade provides a chance to refresh our aspirations, ideals and motivation. It allows us to revisit our vision, re-galvanise our strategies around it, and help our teams embrace their parts in achieving it.

    Dawn can be a confusing time. No longer asleep yet not quite awake. These three suggestions may help enrich our numerous important activities, pushing hard towards the health systems transformation that we know is possible as we recommit to our teams, and our users, and launch into the new day. 

    I look forward to hearing about your 2020 successes.

    Happy new year everyone.

  • WHO launches digital health guideline, Wednesday 17 April

    Figuring out how to use digital health for health systems strengthening is an important task. Now World Health Organization (WHO) has a guideline document to help, launching 14:00 CEST, Wednesday 17 April 2019. Join the live stream here to be part of the launch and gain access to the guideline.

    The title is WHO Guideline Recommendations on Digital Health Interventions for Health Systems Strengthening. This is the first WHO guideline on Digital Health Interventions. It provides evidence-based recommendations for ten ways that countries can use digital health to improve health services.

    eHNA will have more news on what the guideline contains and how we can use it productively for our African initiatives, after the launch.

  • Five strategies for your eHealth success in 2019

    Closing off 2018, I am struck by how much eHealth has grown up. It’s entering 2019 as a confident, enthusiastic adolescent, emerging almost abruptly from a precocious childhood. With eHealth’s latest pseudonym “digital health” gaining traction, it’s a timely herald of a viable, lucrative and sustainable digital health industry.

    If you are reading this, then securing a substantial piece of the expanding digital health pie is likely part of your organisation’s 2019 agenda. I’ve assembled five New Year’s resolutions to help:

    1.     There’s plenty to go around, and the spectrum of options is wide and growing, so find your niche and claim it

    2.     Take more time to identify and understand the needs and aspirations of your clients and stakeholders, then work with them closely to realise more health benefits

    3.     Use what you learn to develop a robust eHealth Impact Strategy that will provide a rudder for all your efforts through 2019 and beyond, locking onto core health benefits

    4.     Hire people who believe what you believe, then trust them and invest in them in line with your strategy

    5.    Find like-minded partners, growing your business through collaboration and cooperation, fulfilling your role as a unique member of the emerging global digital health community.

    Choosing one or more of these, and succeeding, will be enough to make a big difference.

    At African Centre for eHealth Excellence (Acfee) we have been monitoring the maturing eHealth landscape for more than a decade, examining the health-strengthening benefits, frustrated by the slowness of its arrival, and mindful that many critical foundation elements remained absent. Establishing the foundation more quickly has been a key focus of our work at Acfee, particularly:

    Developing eHealth leadershipBuilding eHealth capacityConstructing eHealth Strategies that create sustainable health impact.

    Now that progress is tangible, plenty of work remains to nurture and guide the fervent eHealth teenager, so Acfee’s focus on leadership, capacity and strategies will continue, expanding our efforts to meet demands. Priorities for 2019 include to:

    1.     Establish the eHealth Investment Model for Africa (eHIMA) and disseminate its use across African countries to assist Ministries of Health to take good decisions about their digital health investments.

    eHIMA is Acfee’s adaptation of the Digital Health Impact Framework (DHIF).  The DHIF is driven by the Asia eHealth Information Network (AeHIN) with support from the Asian Development Bank (ADB). Development of DHIF and eHIMA have been led by  Acfee’s Director of Strategy and Impact Tom Jones, providing a valuable bridge between Asian and African eHealth initiatives and challenges.

    2.     Expand eHealthAFRO, Acfee’s stakeholder engagement platform.

    We will build on the successes of eHealthAFRO 2017 in Johannesburg and the 2018 2nd EAC Regional eHealth and Telemedicine Ministerial Conference in Kigali, both covered in eHNA. eHA2019 will be in South Africa again. Keep an eye on eHNA for details to be confirmed later this month.

    3.     Grow Acfee’s existing capacity building initiatives:

    More support for academic programmes, such as:

    Rome Business School short courses on eHealth, including a DHIF short courseNew York University global public health master’s degree, which includes a collaboration with Acfee around a scholarship program to increase African participation Bespoke eHealth curriculum development for partnersAcfee’s eLearning and software development collaborations.

    More support for regional capacity building, such as the role I played alongside Acfee Director Ousmane Ly, and others, on the faculty of the first ITU/WHO AFRO Digital Health Workshop in Lesotho in November 2018.

    Re-launch of Acfee’s popular Future eHealth Leaders summer camps, to cultivate and advance the unique leadership skills and approaches needed for successful digital health.

    “Growing old is mandatory; growing up is optional” says 1960's Jamaican-American baseball player, Chili Davis. As eHealth moves into its teens, ensuring that we get it right will certainly be a collective effort. I look forward to working with each one of you, and all my African colleagues, to succeed in 2019. 

  • Acfee’s director supporting SIL-Asia

    eHealth proponents know the importance of standards and interoperability. In Asia, it has an effective regional umbrella. The Standards and Interoperability Lab – Asia (SIL-Asia)’s powered by the Asia eHealth Information Network (AeHIN). It has significant, sustained support from the Asian Development Bank (ADB) and co-sponsorship by the People's Republic of China Poverty Reduction and Regional Cooperation Fund (PRCF).

    This substantial support has enabled SIL-Asia to provide a wide range of services to its members. Its Tooling page includes:

    Investing in Digital Health: Digital Health Impact Framework (DHIF)Guidance on Investing in Digital HealthDigital Health Terminology GuideTransforming Health Systems with Good Digital Health Governance: Health Governance Architecture FrameworkHealth Enterprise Architecture FrameworkSIL-Asia Cloud Set-upSIL-Asia FHIR Service.

    Countries can use SIL-Asia’s tools for their digital health implementation programmes. There’s more to come, including :

    A technology benchmarking frameworkInteroperability toolkitImplementation guide.

    SIL-Asia’s assets for countries’ use include:

    RxBox, a telemedicine device OpenMRSCHITS, an OpenMRS EMRBahmni,a HIS based on OpenMRSZato.io, a python based Enterprise Service BusWSO2, a Java-based, open source enterprise service busMedicCR, a Master Patient Index (MPI) developed by Mohawk LabOpenHIM, a JS-based mediator developed by Jembi Lab. OpenEMPI, a Java-based MPIOpenInfoMan, a health worker and facility registryDHIS2.

    Having completed his initial work on the DHIF, Acfee’s Tom Jones has taken on the role as a SIL-Asia partner. As Acfee’s Director of Strategy and Impact, it will provide a valuable bridge between Asian and African eHealth initiatives and challenges. Acfee envisages that Africa’s health systems will benefit considerably.

  • Asian Development Bank presents eHealth guidance at AeHIN conference

    Weak eHealth strategies lead to weak digital health investment. Maximising success and minimizing failure’s a core ADB eHealth theme. It sees effective eHealth strategies as requirement, and it presented its Guidance for Investing in Digital Health to the Asia eHealth Information Network (AeHIN) 6th annual conference this week in Colombo, Sri Lanka

    The guidance describes the healthcare context that’s needed for eHealth strategies. Peter Drury, the project lead, then set out essential issues that included identifying and engaging with stakeholders and pursuing digital health strategies that are drawn from health and healthcare strategies and that achieve a balance between value for money and affordability.

    He sees strategies as only part of the process, and similar to his word association of fish and chips and bacon and egg. For eHealth, it’s strategies and investment. Sharing experiences of the two are important.  There are examples of effective strategies that he’s seen across Asia available from AeHIN’s Standards and Interoperability Lab (SILA). These provide valuable insights for Africa’s health systems and for African countries contemplating new national eHealth strategies. 

  • Mongolia’s completing a big scale eHealth project

    Remote, large and sparsely populated; Mongolia offers a lesson on pursing a wide range of eHealth investment. Tucked in between Russia and China, it’s a country of about 3.1m people spread across 1.5m km. About half the population live in Ulaanbaatar, the capital.

    Dr Sereenen Enkhbold, Mongolia's eHealth Project Coordinator presented his country’s Role of E-Health Project in improving health information interoperability in Mongolia at Asia eHealth Information Network (AeHIN) 6th annual conference in Colombo, Sri Lanka. The objective’s to improve integration and utilisation of health information and eHealth solutions for better health service delivery. It’s about half way through four-year the project that started in 2016.

    The project, financed extensively by the World Bank incorporates:

    Health sector enterprise architectureHealth data and information technology standards DICOM, LOINC and HL7Health data dictionariesHIE platformHealth statistics and dashboardeHealth appsInvestments in primary healthcare facilities.

    The next phase includes benefits realisation and change management. Taken together, the project is a benchmark for Africa’s health systems.

  • Sri Lanka’s eHealth story stretches over 20 years

    The reputation of Sri Lanka’s continuing eHealth story is considerable. At the Asia eHealth Information Network (AeHIN) conference in Colombo, Prof Vajira Dissanayake of the Health Informatics Society of Sri Lanka (HISSL) described the from1998 to 2108 and beyond.

    It’s set out in Digital Health in Sri Lanka. This describes the sustainable implementation of digital health solutions through local capacity building. The lessons for Africa’s health systems are essential reading. It extends over 17 topics, including:

    Strategic planningPersonal health numbers and master patient indexElectronic indoor Morbidity and Mortality Register (eIMMR)Hospital Health Information Management System (HHIMS)HIMSElectronic Patient Information Management System of the National Programme for Tuberculosis and Respiratory DisordersElectronic Reproductive Health Information Management System (eRHIMS)Electronic Non Communicable Diseases System (eNCD)Registering and Verification of the Electronic Health Information SystemsSuwasariya telehealth programmeStroke Clinical RegistryEssential Drug Stock Alert Tracker Sri Lank Journal of Biomedical Informatics (SLBMI)HISSLS’s short history.

    Beyond 2018, other initiatives are coming through. Partners include UNICEF and Bloomberg Philanthropies. UNICEF provided finance for the app District Nutrition Monitoring System. Children’s nutrition won the prize for the best early stage app in South Asia.

    The sequence reveals a continuing strategic eHealth trajectory. Equivalents for Africa will be valuable in learning from the past and setting strategic trajectories, road maps and investment plans.

  • Asian Development Bank presents its Digital Health Impact Framework at AeHIN conference

    eHealth investment decisions usually end up by balancing value for money with affordability. It’s a regular end point for business cases for eHealth and a core ADB eHealth theme for its Digital Health Impact Framework (DHIF). It presented this and other components to the Asia eHealth Information Network (AeHIN) 6th annual conference this week in Colombo, Sri Lanka

    DHIF is a methodology for estimating and analysing socio-economic costs and benefits over time to identifying value for money and how long it takes to achieve it. Then it converts these into financial and accounting estimates to assess affordability. Tom Jones, the project lead, set out these issues that included:

    Deriving eHealth benefit requirements for health and healthcare strategiesIdentifying and engaging with stakeholdersManaging assumptions and estimateseHealth leadership, change management and new business models.

    The methodology has ten steps, but modellers and decision takers using DHIF for the time should choose only those components that are critical to the immediate decisions. From these, they can build up expertise and move towards using the full set.

    Risk is a constant in eHealth investment. DHIF can be used to estimate risk exposure that leads on to risk mitigation plans.

    Optimism is also common. DHIF provides adjustments for optimism bias, which can increase cost estimates with a range of lower than 40% up to 200%.

    Other material from the presentation is available from AeHIN’s Standards andInteroperability Lab (SILA). They can help Africa’s health systems improve their Health decisions, especially where parallel investment is needs in healthcare resources and new business models.

  • Digital Health Week (DHW) 2018 starts 7 October in Sri Lanka

    A full week on eHealth’s coming up in Sri Lanka. DHW combines an array of initiatives:

    Commonwealth Digital Health AwardsBiennial Conference of the Asia Pacific Association for Medical Informatics (APAMI)International Medical Information Association (IMIA) Global TelehealthAsia eHealth Information Network (AeHIN). 

    The first day includes the AeHIN’s 6th General Assembly. Its main theme’s interoperable digital health for UHC. There’s an AeHin pre-conference event too. It includes presentations on Asian Development Bank (ADB) initiatives:

    Guidance for Investing in Digital HealthDigital Health Impact FrameworkCurrently in draft format and scheduled for completion in September.

    Other pre-conference topics include

    the Standards and Interoperability Lab for Asia (SIL-Asia) project HIE Implementation Costing ToolData science for the SDGs and UHCVarious M&E methods for national eHealth programmesDHIS2 Knowledge Exchange And Latest UpdatesGlobal public goods from the Health Data Collaborative.

    The main DHW theme’s Transforming Healthcare through Digital Health Innovation. The wide range of eHealth perspectives should provide everyone with sufficient takeaways to step up sharing and convert ideas into practice.

  • Ada Lovelace’s 19th century computer book sold at auction

    The first female computer expert translated and expanded the Sketch of the Analytical Engine, published in 1843. She worked with Charles Babbage who invented the Analytical Engine, a mechanical calculator. It had four components that match modern computers. They were: 

    Mill, the calculating unit, the equivalent of the Central Processing Unit (CPU)Store, where data was held before processingReader, an input functionPrinter, an output function. 

    He unveiled his machine at a seminar at University of Turin in 1840. Italian military engineer and mathematician LF Menabrea, subsequently a prime minister, reported on the presentation. Babbage encouraged Lovelace to translate it into English. She added her own, substantial explanatory notes, which more than doubled the length of Menabrea's article and included an Analytic Engine’s algorithm.

    A report in the Antiques Trade Gazette say the book sold for auction in England for £95,000 (US$124,000). It’s one of seven known copies. It’s significant because she was the first person to recognise that the machine had applications beyond pure calculation, and published the first algorithm. She’s referred to as the Countess of Computing, reflecting her social standing and formal, title of Lady Lovelace, and the World’s First Computer Programmer, recognising her pioneering role in computer programming. When it was published, she was not credited as author. In 1848, she was, four years before her death, aged 36. 

    Her father was the poet Lord Byron. Her mother, Lady Byron, was educated in science and mathematics. It may be that inherited traits such as creativity and analysis combined in Ada Lovelace with a resultant impact on computer science and creation of the Ada Lovelace Institute.   

    How much will these abilities reflected in manuals of modern algorithms sell for in about 180 years from now? Presumably they’ll be in an eBook.