• Leadership
  • First African eHealth Forum meets in Cape Town

    Today sees the start of the first African eHealth Forum (AeF). It brings together the Advisory Board and some of the global partners of the African Centre for eHealth Excellence (Acfee). The Board will provide guidance for the Acfee team that will shape its action plans for the next year. It’ll also provide some of the content for the AeF annual report. eHealth themes that could be priorities for African countries could include how to:

    Develop human capacity, skills and knowledge needed for eHealth Work effectively with eHealth vendors and suppliers Construct a diverse, practical, rolling eHealth strategy Encourage, stimulate and roll out local mHealth innovation Deal with the long-standing issues of affordability, connectivity, architecture and standards Choose eHealth that offers good value for money Develop eHealth leadership.

    There’ll be many other themes too. The AeF report for the public domain is expected during the first week of August. At the same time, the Board members and partners will receive a wider, bespoke report for their own use.

  • Building blocks for an African eHealth Forum

    Next week, I’ll be at in Acfee’s inaugural Advisory Board meeting in Cape Town South Africa, in the company of eminent African health leaders from eleven countries. They are Acfee’s Advisory Board. Over three days, we’ll assess the status of eHealth in Africa, its challenges and its opportunities, and the board will guide and decide on practical ways of moving eHealth forward. The board’s main interest is seeing African health systems transform and strengthen. It’s not a technology focus, and they’re aware of both opportunities and obstacles to technology playing its supportive role.

    What are the main issues I expect we’ll find? There’s quite a range.

    They extend from human and ICT capacity constraints, sustainability, connectivity, moving from strategy to implementation, procurement and learning from lessons elsewhere. An important theme is that for many forms of eHealth, the costs and benefits are not always as they were envisaged at the outset. Showing how much eHealth matters is important too, as is ensuring that benefits are secured. Understanding each country’s reality needs careful review. The Advisory Board’s task is substantial: to provide guidance for the Acfee team that will shape its action plans for the next year.

    It’s a unique meeting that will form the foundation of Acfee’s annual African eHealth Forum (AeF). It’ll help to build the consensus, collaboration and capacity needed to move eHealth forwards in African countries. It’s about African countries taking ownership for sustainable eHealth strategies and investment. The rate of progress depends on practicalities.

  • Les pierres anglulaires d'un Forum de l'eSanté africain

    La semaine prochaine, je me trouverai à la première réunion du Conseil Consultatif d'Acfee au Cap, en Afrique du Sud, en compagnie d'éminents chefs de file africains en matière de santé venus de 11 pays. Ceux-ci constituent le Conseil consultatif d'Acfee. Pendant trois jours, nous étudierons le statut de l'eSanté en Afrique, nous nous pencherons sur les défis et les opportunités existants, et le Conseil fournira des directives et statutera sur les moyens pratiques permettant de faire progresser l'eSanté. L'intérêt principal du Conseil est de voir la transformation et renforcement des systèmes de santé africains. L'accent n'est pas mis sur la technologie, et les membres du Conseil sont conscients à la fois des opportunités et des obstacles à la technologie dans son rôle de soutien.

    Quels sont les principaux problèmes auxquels je m'attends à ce que nous découvrions ? L'éventail est relativement vaste.

    Il s'agit des contraintes associées aux capacités humaines et technologiques, de la durabilité, de la connectivité, du passage de la stratégie à la mise en oeuvre, de l'achat et de l'apprentissage issu des leçons reçues ailleurs. L'un des principaux thèmes est que pour de nombreuses forme d'eSanté, les coûts et bénéfices ne sont pas toujours tels qu'ils ont été envisagés au départ. Il est également important de montrer à quel point les questions d’eSanté sont également importantes, tout comme s'assurer que les bénéfices sont assurés. La compréhension de la réalité de chaque pays doit faire l'objet d'un examen soigné. La tâche du Conseil consultatif est substantielle : fournir des directives à l'équipe Acfee, qui donneront leur forme aux plans d'action pour l'année à venir.

    Il s'agit d'une réunion unique qui constituera le fondement du Forum annuel de l'eSanté africain d'Acfee (AeF). Elle contribuera à développer le consensus, la collaboration et la capacité nécessaires pour faire progresser l'eSanté sur le continent. Les pays d'Afrique doivent s'approprier la stratégie et l'investissement durable dans l'eSanté. La vitesse de progression dépend des aspects pratiques.

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    French translation provided by Murielle Jackson.

  • Acfee's a beacon for the future

    The tremendous strides and benefits derived from modern technology over the last six decades have had far reaching effects and have greatly influenced and changed our ways of living and our activity on our planet. Relevant technology has had a much slower introduction and application to the healthcare sector over these decades. Healthcare is such a priority sector for most countries or populations and it is therefore no surprise that there is a concerted global interest and effort to see how the application of such technology, especially information and communication technology, can impact healthcare organization and delivery.

    eHealth is a challenge, but for too long, eHealth’s been too much of a challenge for African countries, possibly and partially explained by the association of technology with cost and complexity Fortunately, eHealth provides tools that can address issues such as access, cost, quality and organization of healthcare which are major considerations in any setting, poor or rich.  For modern healthcare, and for stretched healthcare in African countries, it provides an essential resource for patients, communities and all types of health workers. Selecting which eHealth to take forward, then how to implement it successfully and bask in its benefits is something that we can all learn from each other. 

    As a member of the Advisory Board for the African Centre for eHealth Excellence (Acfee), I work with my colleagues to help guide Acfee to provide a beacon for the future of African eHealth. It is only those of us who navigated and remember the dark and tortuous path of the not so distant past that can speak to that, and loudly! That said, it is also about sharing experiences in the search of a common path to solutions for our constantly increasing and complex health problems. Our (patients, health workers, and technicians) collective experiences and memories will remain our most important asset. The goals have to be to disseminate knowledge and ideas, develop the capacity of our patients and health workers to use eHealth to the full, and to develop our eHealth leaders.

    eHealth leaders aren’t the same as the people in the top posts and at universities. They spread across health systems and help to strengthen and transform healthcare in their local communities. As they expand in number and achievements, the whole health system will grow with them. Their knowledge and experience will be vital to the future of eHealth.

  • A medical Prof has a fresh eHealth vision

    Gurpreet Dhaliwal is Professor of Medicine at University of California, San Francisco. He’s also a physician at the San Francisco VA Medical Center. He’s described his different eHealth vision in the Wall Street Journal. It fits the way that African countries can approach their eHealth initiatives.

    It starts from his view that technology has a lot to offer doctors, but it’s different to the healthcare technology in the news, such as Big Data, EHRs and the connected patient. Improving and restoring health needs more than this physical capital. It needs investment in human capital too.

    First, Big Data using correlations in huge data sets seldom changes clinical and working practices. They’re more akin to preliminary research findings, so not ready to apply until they’re confirmed, scrutinized and distilled by conventional, rigorous testing. Clinicians need constant exposure to findings from high-quality studies and synopses. Twitter can disseminate these.

    EHRs are forensic document, billing and communication tools. They’re not learning tools. Patient lists and reminders are good, What’s needed now is a real time message service triggered by patients using healthcare, such as when they’ve had tests or outpatient attendance.

    Prof Dhaliwal wants a connected patient service where updates are from his patients. It needs routine use of SMS, text, email and videoconferencing follow-ups. Many doctors do it, so already have a foundation to build on.

    If African countries follow a more traditional eHealth route, it could diminish the benefits they realise. Building on Prof Dhaliwal’s vision can help them to achieve more.

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    Image from the New York Times

  • Now's time for an African eHealth Forum

    Over the last two years, eHNA’s been collecting examples of eHealth from across the continent.  It reveals three main themes:

    There are big eHealth differences between countries Some countries’ eHealth is building up a dynamic An emerging dual emphasis on big-scale EHRs and numerous mHealth programmes.

    These combine into the need for an African eHealth Forum that sets out the changing scenarios, opportunities, challenges and a range of directions ahead.

    At the end of July, Acfee’s Advisory Board will meet in Cape Town. It’ll launch the Annual African eHealth Forum. These health leaders from eleven countries and Acfee’s industry partners will look to the future and  identify Africa’s strategic directions for eHealth  agree a roadmap of activities for Acfee and its partners to roll out over the next year.

    We can expect the type of leadership that the AB members are well known for: focused, pragmatic initiatives, tightly tied to transforming the healthcare service experience for Africans, both patients and health workers. This’ll be good news. We’ll be catching up with them and hopefully, keeping up too.

  • How much does eHealth matter?

    It’s a good question. It’s also surprisingly difficult to answer. Typically, it depends. An answer starts from relatively simple aspects such as how much needs to be spent, what benefits it realises and what the health outcomes look like, and then moves into trickier areas such as what else is changing, who it’s changing for and how much of the change can be attributed to eHealth. Core themes for eHealth to matter are, does it help to:

    Strengthen healthcare Transform healthcare Improve health.

    From these, the challenge is to identify eHealth that contributes effectively to better health and healthcare. It needs a good framework to help deal with the complexity. Unfortunately there isn’t much available and the ones that exist use methodologies that are not well suited to the priorities and challenges eHealth faces in African countries. This is why Acfee believes it’s an important to begin building an appropriate framework for appraisal of eHealth Impact in Africa.

    Countries need appropriate tools to help implementers with less experience and skills in economic evaluation to get started, grow, learn and progress to more complex techniques. It’ll also integrate economics with financial perspectives, so be able to deal with value for money and affordability. The dual view’s vital. eHealth affordabilitty’s a key obstacle for many African countries. Acfee’s building an eHealth investment framework to provide a structured appraisal to support countries’ business cases. It’s due for release in the second half of 2015, and has three components:

    Prospective evaluation of eHealth inititiatves, to identify the ones worth investing in Ongoing monitoring and evaluation of implementation, with a direct connection to the proposed benefits identfied in the initial evaluation Retrospective assessment, to extract lessons learned, to take back into planning and evaluation.

    If all goes well it might even help us provide a clear answer, the next time someone asks, “How much does eHealth matter”.

  • Meditech wins Frost & Sullivan 2015 Award

    Last week Frost & Sullivan awarded MEDITECH their 2015 Sub-Saharan Africa (SSA) award for Product Leadership. It’s based on recent analysis of the healthcare informatics product market and emphasises that the interoperability (IOp) of MEDITECH’s EHR platform offers significant value. Frost & Sullivan presents this award annually to a company that has an innovative product and gaining rapid acceptance in the market. It’s an important acknowledgement of MEDITECH’s SSA presence.

    MEDITECH’s African story emphasises the time and persistence required to succeed in this market. It started in South Africa in 1983, and it’s now in numerous countries including Botswana, Kenya, Mozambique, Namibia, Nigeria and Zambia.

    Over the last three decades it’s shown an ability to tailor its products to address SSA’s infrastructure and resource challenges and variability. Continuous investment in products has help it to address key SSA healthcare issues, such as connecting diverse facilities, from small clinics to large hosptals, and combating non-communicable diseases, enabling medical practitioners to deliver higher quality service to patients and facilitated improved communication between healthcare entities.

    “MEDITECH’s flagship solution consists of a high quality EHR platform with more than 40 administrative, clinical and managerial operating modules; a wider range of modules when compared to most of its competitors. This enables superior service in terms of tracking and monitoring of patients across the entire healthcare spectrum,” said Stephanie Craig, Frost & Sullivan Research Associate. “For example, the company developed HIV/AIDS and tuberculosis workflows, especially for clinics and treatment centres in South Africa, and ensures all its systems comply with country-specific financial requirements.”

    MEDITECH recognises the critical importance of dealing with IOp between data, people, and devices, across healthcare tiers and within organisations. Benefits are far reaching, including helping health workers to manage their workloads and use data already available to screen patients in primary healthcare and only refer to hospitals patients who need additional investigation or care. To support better IOp MEDITECH’s working to move to an open standard web-based interface that supports mobile technologies, and a more open database solution. These are not trivial endeavours, and show the company’s acknowledgement of their importance in SSA.

    “MEDITECH has also adapted its products to accommodate the limited infrastructure in SSA, particularly in terms of the low levels of Internet connectivity,” notes Craig. “In Botswana, where MEDITECH services medical outposts in very rural and remote areas, it works with the Ministry of Health to develop simplified versions of its electronic healthcare platform. These products can operate offline, and sync to the main database in Gaborone every few days. MEDITECH has achieved significant success in Botswana – the first country in Africa to have its entire public healthcare service sector running on one, integrated patient record.”

    Congratulations to MEDITECH. It’s moving Africa’s eHealth on.

  • What's healthcare transformation?

    Much is said about eHealth’s impact on transforming healthcare. Whatever it is, countries need to include it in their eHealth strategies that stretch towards the future. Achieving it needs effective eHealth leadership.

    There’s transformational leadership too. James McGregor Burns is a leadership expert. He introduced the concept in 1978 in his book, Leadership, which is still in print. He defined transformational leadership where "leaders and their followers raise one another to higher levels of morality and motivation." This is fine, but in healthcare, there are many other forces that are driving its transformation. It’s essential that leaders know what they are.

    One version is in the report on interoperability and medical devices by Frost & Sullivan. It’s in a ten-year time scale from 2015 to 2025, which may seem a bit short for African countries.

    The wide range and complexity of the change confirms the need for eHealth leadership that extends across clinical, executive and political leaders collaborating and acting in unison. It also shows that eHealth leaders are needed not only in top posts, but throughout healthcare and health ministries.

    One interpretation of the proposition is that healthcare may not transform, but may need both healthcare models alongside each other. Whatever the transformation envisaged, and eHealth contribution, it’s important that African countries are explicit about the transformations they envisage. The Frost & Sullivan model offers an excellent starting point for eHealth leadership and investment.

  • 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.