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.
- 832 views
- May 26, 2015
- Tom Jones
Namibia's President wins the Ibrahim Prize
Each year, the Ibrahim Foundation awards the Ibrahim Prize for Achievements in African Leadership to a worthy African president who’s about to retire. This year’s winner is Namibia's President Hifikepunye Pohamba.
The criteria are:Is a former African Executive Head of State or government Left office in the last three years Is democratically elected Has served his or her term as mandated by the constitution Has demonstrated exceptional leadership.
The Ibrahim Prize has three goals:Recognise and celebrate African leaders who have developed their countries, lifted people out of poverty and paved the way for sustainable and equitable prosperity Highlight exceptional role models for the continent Ensure that Africa continues to benefit from the experience and expertise of exceptional leaders when they leave national office by enabling them to continue in other public roles on the continent.
The President was elected in 2004, then again in 2009.
His terms extend across the period when Namibia introduced its Integrated Health Care Information Management System (IHCIMS). It started in 2011. In the same year, it opened its Information Communications Technology (ICT) Centre of Excellence at the University of Namibia in collaboration with Telecom Namibia.
eHNA and the African Centre for eHealth Excellence (Acfee) is delighted to add its congratulations to all the others that he will receive.
- 450 views
- March 04, 2015
- Peter Nyasulu
TOMPSA's Yaseen Khan is an mHealth leader
mHealth in Africa offers a bigger impact for citizens than in high-income countries with much bigger healthcare resources. With this opportunity, it’s important that Africa has its own entrepreneurs with a creative grasp of health and technology.
Dr Yaseen Khan fits this profile. He’s an enthusiastic medical practitioner and cofounder and director of the Open Medicine Project (TOMPSA) that is helping to improve patient care and strengthen healthcare systems by developing mHealth solutions that support healthcare providers. TOMPSA’s based in Cape Town, South Africa, is at the forefront of transforming healthcare in the country. It’s funded by the South African Medical Research Council, Strategic Health Innovation Partnership (SHIP) and is striving to continually enhance and develop products to improve services and save lives in South African Emergency Rooms.
It’s developed a number of mHealth solutions used in South Africa and 50 other developing countries, and it’s expanding. TOMPSA sees health workers as the most important agents in the system, and believe that by empowering them with access to relevant information and support, they’ll improve the health and lives of patients.
One of its mHealth solutions is its mTriage App. The app has been tested in local hospitals and results are showing a dramatic improvement in triage accuracy, waiting times and adoption by nurses. The app is evolving into a comprehensive decision support and patient management solution for local emergency centres. The vision for the app is clear. The team hopes that the app will continue to expand and that in the future every hospital on the continent will have a mobile, digital triage and Emergency Clinical Support solution in their Emergency Centres.
The Mobile Emergency Medicine guidelines (EMGuidance) is another innovation from TOMPSA. It has been published through the app stores and is used by over 15000 healthcare providers on their personal phones. This will eventually be integrated and adapted into the hospital solution, to ensure down the line decision support for doctors in hospitals, and will integrate with the hospital system.
Dr Khan has an MBChB (Bachelor of Medicine and Bachelor of Surgery) from the University of Stellenbosch. When his internship at GF Jooste Hospital in Cape Town ended, he took a keen interest in emergency medicine and gained a Diploma in Primary Emergency Care (Dip PEC). He’s committed to the role of evidence-based medicine in healthcare, which motivated him to pursue a Masters (MSc) in Clinical Epidemiology, again at the University of Stellenbosch. He has recently been selected as a fellow of the Youth Action Net, an initiative of the National Youth Foundation.
Yaseen is a proponent of bridging the gap between health workers and technology by developing innovative ways to help health workers to improve their effectiveness. He believes that innovation in healthcare will continue to have a profound and beneficial impact on patient care in the developing world if the solutions are directly relevant and easy to use.
Yaseen sees his work with TOMPSA as initially successful, but with much more to come. He’ll be a major mHealth innovator in improving Africa’s healthcare. eHNA looks forward to posting about TOMPSA’s mHealth solutions in the future.
- 510 views
- February 21, 2015
- Lesley Dobson
What difference will eHealth make in SA over the next ten years?
In the film Terminator, the central character sent back from 2029 didn’t need much healthcare, but was packed with technology and the ability to change, two of the top requirements for successful eHealth. The current crop of eHealth initiatives needs to deliver more if they’re to have a big impact over the next ten years. It also needs supplementing with more innovative opportunities, such as health analytics, Big Data and the expanding Internet of Things (IoT). Many African countries are well along this journey and are changing the way they absorb eHealth as a core resource. In South Africa, the Government’s plans to establish a ministerial advisory committee on eHealth show foresight likely to step up the importance of eHealth and to move things in the right direction. Draft regulations are out for comment.
There are numerous claims that eHealth can transform our health and our healthcare systems and provide the means to cope with the increasing demands of an ageing population. If the claims are false, then they just increase the heap of fictional, hyperbolic and fanciful panaceas. If they’re true, immense changes are needed, and “change always brings strong opposition”. As many African countries look to South Africa to take an eHealth lead, internal leadership is always a key lever and has to extend across political, executive and clinical domains. This eHealth leadership isn’t quite the same as leadership in conventional entities where groups of stakeholders are less numerous.
Considerable attention accorded to benefits and their realisation will help to promote success, but it’s not enough. It’s vital when Africa’s healthcare resources are very scarce, that benefits exceed costs over time. This creates the more demanding goal of realising net socio-economic benefits. Then, realising benefits is integrated with control of investment, operating costs, obsolescence and risks.
When eHealth succeeds, the time horizons to net-benefits are long, approaching a decade for large-scale electronic health records (EHRs). Evidence for this exists in tinTree’s eHealth Impact Database, containing cost-benefit data of 60 initiatives from around the world. So, if a decade’s enough time to realise benefits, a reasonable question is what difference will eHealth make over the next ten years?
The answer is, it depends. Success factors extend across the value chain, including the vision for how citizens’ roles in health and healthcare can change, the way that health workers deal with patients, matching ICT with people and their needs, the scale of investment and the new skills and knowledge that people need.
eHealth in South Africa, also called ICT4Health, is on a steady trajectory, but is still patchy with much of the current emphasis on administrative data. The emphasis needs switching to health and healthcare delivery and quality. Since the government’s eHealth strategy was finalised in 2012, eHealth globally has seen several significant steps forward that offer bigger benefits than originally envisaged. Analytics and Big Data are topical examples, which South Africa now needs to incorporate into its eHealth strategy. In Africa, expanded mHealth may be one too as the number and use of smart-phones increases.
A key part of South Africa’s strategy aims to implement EHRs. It provides a sound platform for health worker teams to share patient and clinical information; they’re all up to date and can use the best clinical information to care for their patients. Health informatics can deal with most of the complexity of EHRs and clinical information. There are several examples from other continents that show that this approach is economically viable and achievable.
It’s now becoming clear that analytics offers the opportunity to make much more effective use of data in EHRs than envisaged some three or four years ago. An example is how it can be used to predict serious deterioration of patients’ health long before traditional diagnostics can see changes.
This recent surge in the use of analytics is not as well understood and may be the most exciting opportunity over the next decade. It can make health workers more productive and citizens and health workers more proactive, by providing information about changing conditions in people, patient cohorts and environments much faster than health workers can see from observation. An example from the USA is identifying patients with sepsis before health workers can see symptoms, so enabling interventions to avoid deaths in some cases. This leads through to an expanded healthcare model of managing patient cohorts proactively as well as providing direct healthcare.
Analytics and Big Data can change the way that agencies manage population health. Data from Wikipedia and Google have already provided faster information than the formal health agencies on the spread of flu epidemics in the USA. Twitter is doing the same with HIV. Structuring and transferring interoperable clinical and demographic data from EHRs into population health priorities creates an enormous database for analyses and risk assessment that can improve policies and responses, martialing resources better for better results. It also provides a source of health data for citizens, communities and patients that they can access with continuously improving smart phones.
If it’s this good, why isn’t it already underway? The answer’s simple. It needs a specific type of strong leadership, sustained investment and targeted change for a few more important pieces to fall into place.
One requirement is better standards and interoperability across multiple information systems. South Africa’s IOp framework provides an important start, which will need sustained support and development from the standards authority created under the new legislation.
Another urgent need is a sustained HR plan for investment in health informatics and analytics, with highly skilled people retained and developed further in South Africa: eHealth’s human capital. Supporting this is the need for a substantial, sustainable eHealth investment fund to finance human capital expansion and procure the modern ICT solutions and tools that can provide the information. The goal then is to deploy these to take South Africa’s healthcare forward for the benefit of its 51 million people. Like technology itself, it’s a never-ending quest.
The terminator was a cyborg-assassin with sinister intentions. Before we have to deal with him, we have to deal with cyber-criminals and their associated threats to the security of our health and healthcare data. Effective eHealth regulation and cyber-security are now essential, not optional eHealth costs. These need developing over the next ten years too.
- 242 views
- February 16, 2015
- Sean Broomhead
President Kagame's championing broadband development
Mr Paul Kagame, President of Rwanda has been honoured by the ITU for his leadership and dedication in promoting ICTs and broadband connectivity as a means of achieving sustainable development. The ITU has presented the World Telecommunication and Information Society Award to three eminent personalities including Mr Kagame. Ms Park Geun-hye, President of the Republic of Korea and Mr Carlos Slim and Chairman, Grupo Carso and President of the Carlos Slim Foundation were also recipients of the award.
ITU Secretary-General Hamadoun I. Touré, welcomed guests to the World Telecommunication and Information Society Day ceremony saying, “our distinguished laureates this year are among the greatest champions of ICT in the world. They have supported our work with tremendous zeal, and together we have accomplished a lot – particularly in highlighting the key role ICTs play in the global economy as well as in leveraging sustainable development.”
He went on to say that “Broadband connectivity is a critical element today in ensuring that ICTs are used as effective delivery vehicles for health, education, governance, trade and commerce in order to achieve sustainable socio-economic growth.”
President Kagame is certainly a role model for other African countries with Rwanda being an example of how ICT can help support sustainable growth. The country has not only seen strong economic growth but also development in the healthcare sector, which continues to benefit from its eHealth initiatives.
- 285 views
- February 13, 2015
- Lesley Dobson
Are these Africa's eHealth 2015 priorities?
eHealth in Africa moves on slowly. It’s good that it does. As the Ashanti say, “No one tests the depth of a river with both feet.” So, what does the eHealth river look like for 2015?
There are at least three strong currents. One is investing in African resources to support and secure Africa’s eHealth opportunities. The other two are mHealth, and lessons from other continents for big scale eHealth.
mHealth apps keep cropping up in many African countries, as eHNA has frequently posted. It’s likely to continue, so African countries can both ride and direct the current. They can set up an mHealth budget to identify mHealth that improves patients’ health and healthcare, and buy more of it. Simultaneously they can help to develop their national mHealth companies and start-ups, whose products can extend across a range from wearables for health and monitoring to triage and Clinical Decision Support (CDS) in Emergency Departments (ED) and other hospital services and a variety of community care services.
Decisions on deploying an mHealth budget need a strategic context, so countries need an mHealth strategy. This can set the priorities for mHealth investment that can translate into their budgets and medium term financial plans.
For big scale eHealth, explicit eHealth strategies, firmly embedded in health strategy, are essential. They help to specify eHealth priorities and scale, standards, architectures, interoperability and analytics endeavours.
A big challenge is converting strategies into action. eHNA’s posts on the lessons from other continents show that user requirements, usability, functionality, cyber-security and procurement are all eHealth components that are hard to do successfully. Examples from the USA are that EHRs often need more doctors’ time than envisaged, and cyber-security has elementary holes in it. African countries can’t afford to put both feet into this, so rigorous business cases that test out options and solutions for value for money, affordability and risk are vital while countries are still on the river bank, building strategies and implementation plans.
Birth and death registration remains a constant challenge. Big scale eHealth needs unique identification for citizens. Effective, complete and accurate registration is essential, so initiatives are needed that move it along.
The African Centre for eHealth Excellence (Acfee) has a programme for 2015 that supports these initiatives. It emphasises better knowledge about African countries’ eHealth development and support for building human resource capacity.
Acfee’s plans for a new eHNA release in February include access to eHNA’s knowledge database, the content of which will continue to expand as eHNA’s editorial team seek more eHealth experiences and events that add to the database range and content. Later in the year, Acfee’s eLearning apps will come on line, with courses that will build up during the year and beyond. Initial topics will include eHealth business cases, standards, procurement, cyber-security and economic and financial appraisal.
Acfee’s framework for appraising eHealth’s impact in Africa will support these, and is set for release in stages during 2015.
Underpinning these developments is support for eHealth leadership, a core needed for success. It’s two main themes are eHealth for healthcare transformation and support for eHealth start-ups. This will create an eHealth leadership bridge that connects and develops both sides of the eHealth river. A key challenge for many countries in 2015 might be not to fall in.
- 329 views
- January 01, 2015
- Sean Broomhead
Qu'en est-il des prioritÃ©s de l'Afrique en matiÃ©re de cyberSantÃ© pour 2015?
La cybersanté en Afrique progresse lentement. Et c’est une bonne chose. Comme le disent les Ashanti, « personne ne teste la profondeur d’un cours d’eau en y sautant à pieds joints. Alors, que nous réserve le fleuve de la cybersanté pour 2015 ?
Au moins trois courants majeurs sont observables. L’un est l’investissement dans les ressources africaines, afin d’appuyer et de promouvoir les opportunités qui sont offertes en matière de cybersanté en Afrique. Les deux autres sont la m-Santé, et les leçons que proposent les autres continents en termes de cybersanté à grande échelle.
De nouvelles applications de m-Santé font sans cesse leur apparition dans nombre de pays, comme eHNA a pu le documenter à plusieurs reprises. Une tendance qui devrait se poursuivre, de sorte que les pays d’Afrique peuvent à la fois se laisser porter par le courant et le diriger. Ils peuvent établir un budget pour la m-Santé, afin d’identifier les applications de m-Santé contribuant à améliorer la santé des patients et l’offre de soins, et en acheter davantage. En même temps, ils peuvent contribuer au développement de leurs propres entreprises de m-Santé nationales, dont les produits peuvent aller d’un large éventail d’appareils de m-Santé portables pour la santé et de suivi, aux systèmes de triage et d’aide à la décision clinique (ADC) dans les services d’urgences (SU) et autres services hospitaliers. La m-Santé est associée aux soins de santé.
Pour déployer un budget de m-Santé, la décision a besoin d’un contexte stratégique, les pays ont donc besoin d’une stratégie de m-Santé. Ceci permet de fixer les priorités en termes d’investissement dans la m-Santé pouvant se traduire dans leurs budgets.
Pour permettre une cybersanté à grande échelle, des stratégies explicites, fortement ancrées dans la stratégie de santé, sont essentielles. Elles permettent de spécifier les priorités et l’échelle de la cybersanté, ainsi que les normes, les architectures, l’interopérabilité et les efforts analytiques qui y sont associés.
Un défi de taille est la conversion des stratégies en action. Les communications de l’eHNA consacrées aux leçons des autres continents montrent que les exigences des utilisateurs, la fonctionnalité, la cybersécurité et l’approvisionnement sont tous des composantes de l’e-Santé qu’il est difficile de réaliser avec succès. Des exemples tirés de l’expérience américaine quant aux dossiers électroniques médicaux indiquent souvent que les médecins y consacrent plus de temps que ce qui est initialement envisagé, et la cybersécurité est aussi un défi majeur. Les pays d’Afrique ne peuvent se permettent d’y sauter à pieds joints, par conséquent, des analyses de cas rigoureuses étudiant les options et solutions en termes de rentabilité, d’accessibilité et de risque sont essentielles quand les pays ne sont encore que sur les berges du cours d’eau, afin d’élaborer des stratégies et des plans de mise en œuvre.
L’enregistrement des naissances et des décès reste un défi permanent. L’e-Santé à grande échelle exige que chaque citoyen soit identifié. Un enregistrement efficace, complet et précis est essentiel, par conséquent, des initiatives sont nécessaires afin de pouvoir progresser sur cette voie.
Le Centre Africain d’Excellence pour la Cybersanté (Acfee) dispose d’un programme pour 2015 appuyant ces initiatives, notamment de meilleures connaissances sur le développement de la cybersanté dans les pays d’Afrique et l’appui au développement des ressources humaines.
L’Acfee prévoit une nouvelle publication de l’eHNA en février, incluant l’accès à la base de données de connaissances de l’eHNA, dont le contenu continuera à être développé, à mesure que l’équipe rédactionnelle de l’eHNA aura davantage d’expériences et d’événements relatifs à la cybersanté à ajouter au contenu de la base de données. Plus tard au cours de l’année, des applications d’e-apprentissage seront accessibles en ligne, avec des formations qui seront développées au cours de l’année et au-delà. Les premiers sujets couverts seront les études de cas en cybersanté, les normes, l’approvisionnement, la cybersécurité et l’évaluation économique et financière.
Le cadre de l’Acfee pour évaluer l’impact de la cybersanté en Afrique viendra les étayer, et devrait être diffusé par étapes au cours de l’année 2015.
Le soutien au développement du leadership dans la cybersanté, un élément essentiel à la réussite, viendra étayer ces développements. Ses deux principaux thèmes sont les soins de santé et l’appui aux startups de cybersanté. Ceci créera une passerelle pour le leadership dans la cybersanté, qui reliera et appuiera les startups de cybersanté. Un défi clé pour nombre de pays en 2015 pourrait être de ne pas chuter.
- 323 views
- January 01, 2015
- Ousmane Ly
Acfee appoints its directors
After the first think tank of the African Centre for eHealth Excellence (Acfee) in Stellenbosch, South Africa, Acfee has appointed its first three directors:Dr Sean Broomhead from South Africa Dr Ousmane Ly from Mali Professor Peter Nyasulu, from Malawi, now living in South Africa
All three are clinicians. Sean Broomhead is also a member of WHO’s eHealth technical advisory group, and regularly posts for eHNA. Ousmane Ly is a physician and Mali’s Director General of Telehealth and an eHNA guest editor. Professor Peter Nyasulu is an epidemiologist teaching at four Universities, Stellenbosch, Monash SA, UCT and Wits and is an eHNA editor.
Having three directors from Africa is consistent with Acfee’s values of expanding Africa’s eHealth leadership and capacity with African initiatives. They have a shared vision of eHealth as a tool for transforming citizens’ and health workers’ health and healthcare experiences. There’s no need for more formal directors at this stage of Acfee’s development.
Taken in Stellenbosch 01-12-2014. From left to right: Back row: Mr Tom Jones, Mr Yuval Brodsky. Front Row: Dr Sean Broomhead, Mrs Lesley Dobson, Dr Ousmane Ly, Mr Mats Larson, Prof Peter Nyasulu, Prof Peter Drury.
- 371 views
- December 04, 2014
- Lesley Dobson
What are Africa's eHealth priorities?
In the USA, the eHealth Initiative is a group of organisations that takes an overview of eHealth and sets out scenarios for its direction. The latest is its 2020 Roadmap as the initial step for transforming healthcare with data exchange and eHealth. Its components include:Reaching a consensus on a framework to measure and track interoperability (IOp) Work with federal agencies to ensure that requirements support (IOp) and build goals for better patient outcomes and better healthcare efficiency Leading a national effort to help identify best practices in using a wide range of eHealth tools Coordinate trade associations and professional bodies to develop a toolkit of resources for clinicians to engage better with their patients Work with federal agencies to identify minimum data requirements for population health management Work with vendors to harmonise applications that increase adoption and patient engagement Gather and provide recommendations to ICT vendors to help develop IOp tools and applications that promote preventive care and engage patients in their healthcare Create a private sector process for standards development and testing for data to follow patients and providers to use for clinical and health purposes Define national IOp that should be universally available.
With the addition of patient registries, patient cohort management and surveillance, and greater emphasis on mHealth, African countries would benefit by collaborating on these topics too. For Africa, it needs collaboration between several entities, like the African Centre for eHealth Excellence (Acfee) and the African Network for Digital Health (ANDH) to take it forward.
- 228 views
- November 28, 2014
- Tom Jones
eHealth leadership's much more than strategy
Steve Jobs said that “Innovation distinguishes between a leader and a follower.” It may be true, but it’s not enough for eHealth on a tight budget, where strategies have to shift into tactics, implementation, operation, realising benefits and managing risks through each stage: the whole eHealth spectrum.
Many advisors recommend a national eHealth Strategy as a good starting point for countries wanting to move their eHealth on. It’s good advice. There’s lots of support for those who do, including from WHO with its toolkit, and there’s pressure on those who don’t. Having the strategy, though, isn’t a good indicator that eHealth will fulfill its potential to help to create stronger health systems, or make the difficult task of implementation and realising eHealth benefits any easier.
tinTree’s absorbed by these questions across the whole profile. The wrong answers can break a good eHealth strategy. A tinTree study is identifying what helps countries move forward, what obstacles need to be overcome and what makes the biggest, affordable difference. Some of this is in tinTree’s African eHealth Readiness Index. The result is what appears to be an optimal position between solving problems and taking new opportunities, dealing adequately with affordability and capacity, and ensuring the right leaders are in place across the eHealth spectrum. These are essential for a good start. They’re the strategic priorities and before success is tasted, eHealth needs them converted into initiatives that are driven directly by stakeholder spreading throughout the health system.
A recent report covered by eHNA, says that only 4% of US hospitals have ICT infrastructure ready for integrating types of eHealth. It’s a surprise to many of us. The US is known for its strong strategies and ICT investment, particularly around integration, but somehow the strategies didn’t convert into the eHealth spectrum that needs expanded ICT capacity. The reasons are numerous. One could be leadership.
Some laudable parts of a good strategy might not deal adequately with the dynamic and complex pressures experienced by implementers, who have their own goals and strategies and ideas about how best to achieve them. If they are not sufficiently involved in the high level strategic choices, there could be a mismatch of priorities that constrict progress.
eHealth leadership is a bigger challenge than previously thought. It’s always been an eHealth Strategy topic, a box to be ticked, but its obstacles are often underestimated. The skills, knowledge, attributes, tools and data needed for good leadership and its decisions are substantial. To expose the eHealth choices to be weighed and considered with stakeholders, leaders need rigorous eHealth impact models and appraisals that identify the various paths likely to achieve buy-in, secure benefits, and deliver a positive impact.
A witty Malawian proverb offers advice. “He who thinks he is leading and has no one following him is only taking a walk.” This is the critical test for eHealth leaders moving from strategy to implementation.
- 648 views
- November 27, 2014
- Sean Broomhead
Rome Business School eHealth Masters
Better managers for a better world
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