• Leadership
  • 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.

  • 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.

  • Acfee's think tank 2014 plans underway

    Over the few days spanning November and December, the African Centre for eHealth Excellence (Acfee) think tank will meet in Stellenbosch, South Africa. Its main themes build on the imperative to move eHealth ahead from its position where:

    eHealth in Africa lags behind other continents Sustainability is a constant challenge Two critical gaps are eHealth leadership and human capacity Support will help countries move ahead so eHealth reaches us all.

    Acfee is tinTree International eHealth’s specific initiative for eHealth in Africa. It’s developing a collaborative working relationship with Stellenbosch University’s Faculty of Medicine and Health Sciences. The goal is to support countries with initiatives that develop and expand their human capacity for eHealth.   Setting priorities for action is essential. No one can do everything. An important guide for this is Acfee’s Advisory Board of eleven health leaders from ten African countries. They will help to identify initiatives that build from Acfee’s and tinTree’s current resources of eHealth News Africa and its database of  eHealth initiatives, developments and countries, and soon to be available as an online resource.

    Acfee initiatives include:

    A university-based curriculum Research projects Workshops and events eLearning programmes Direct and specific help Membership.

    A firm plan will be available from 2 December. eHNA will report on its content.

  • Is the CIO a head geek or an eHealth leader?

    As eHealth expands with innovation, creating more opportunities, and sometimes more problems, how does CIOs keep up and develop their roles? Randy Davis, CIO and vice president of support services at CGH Medical Center in Illinois has a few ideas in an interview with Becker’s Health IT and CIO Review

    He says:

    The biggest challenge is putting the right team together. It’s about the people The budget for eHealth operations is about 4.1% of CGH’s total budget The budget percentage for data security and general securityis paltry at less than 0.5%, excluding security improvements embedded in upgrades and network replacements where data security is part of each eHealth project CIO’s should stop seeing themselves as the head geek and should be part of the clinical teams in identifying and anticipating the eHealth resources they need CIO’s should recruit the right people then agree explicit, clear goals with them Don’t use governmental regulations as an excuse for eHealth initiatives Leadership experience in healthcare is ther most important attribute for CIOs There’s not one greatest eHealth, there are several:  helping CEOs and boards understand the need for sustainable eHealth resources, implementing a coherent strategy to integrate  different systems to make life easier for clinicians, recruiting the right people, finding finance to meet users’ expectations CIOs need a broader knowledge of healthcare.

    How do you compare with Davis’s profile? Are you a head geek, eHealth leader, or a bit of both? Clinicians, executives and managers will still turn to CIOs and their teams for ICT and informatics knowledge and information. They’ll also need CIOs to lead them through the eHealth morass of choices and solutions as part of healthcare transformation. What they don’t want are CIOs who believe that “There are 10 types of people in the world: those who understand binary, and those who don’t.”

  • Dr Christine Kaseba Sata's ISfTeH eHealth Ambassador

    Zambia’s First Lady, Dr Christine Kaseba Sata, is now the eHealth Ambassador for the International Society for Telecommunications and Health (ISFTeH). She was decorated in the role by the UN as part of IISFTeH’s Global e-Health Ambassadors Programme (GeHAP).

    South Africa’s Noble Peace Prize winner Archbishop Desmond Tutu was the previous Ambassador.Since October 2012, Dr Sata has been WHO’s Goodwill Ambassador against Gender-based Violence, a two year role ending in October 2014. She is also a committed advocate to improving maternal and new born health. She brings her specialist medical experience to the role as one of the most recognized Zambian specialists in obstetrics and gynaecology. She’s also practiced as a physician at the University Teaching Hospital in Lusaka for more than 25 years, and lectured for the past 15 years at the University of Zambia School of Medicine.eHNA wishes her a successful term. It’s also looking forward to reporting on her achievements.

  • Mohammed Dalwai's global experience benefits Africa

    mHealth’s been around for a while, and it’s still expanding its impact and relevance for Africa. Lots of big names are stepping up, such as Apple with its various iHealth devices, Google’s aspirations with Glass, and Samsung with its wearables. Among the global throng, it’s important that entrepreneurs emerge who know both Africa and its health systems. This should help to create Apps that fit the role and perspective of African health workers. Even then, it’s still tricky and success can still be elusive.

    The Open Medicine Project (TOMPSA) is based in Cape Town. It’s an mHealth initiative with several successful projects that match technological innovations to practical challenges to health service delivery on the ground in South Arica and in other African countries. It’s shaping up to play its part in exploring mHealth’s contribution to African healthcare strengthening.

    One of the pioneering founders of TOMPSA is Dr. Mohammed K. Dalwai. He started TOMPSA with fellow doctor, Yaseen Khan. Like many medical practitioners working on healthcare’s front line, they have a first-hand experience of the shortcomings of South Africa’s healthcare system. The TOMPSA initiative was essentially born out of their frustrations with the limitations and inefficiencies of a paper environment and their determination to bring about change.

    TOMPSA develops mHealth tools and technological solutions, like mTriage App, Emergency Guidance App, HIV clinical guide and the MSF guidance app to meet health workers’ needs and improve healthcare. It’s a group of passionate healthcare workers and mobile technology designers and developers working together on projects to tackle specific health system problems. Their aim is to create innovative applications which improve patient care.

    Mohammed is a Bachelor of Medicine and Bachelor of Surgery (MBChB) from University of Stellenbosch and is passionate about medicine’s impact in the rural communities. He completed his Community Service at Manguzi in the Maputaland region of KwaZulu-Natal province. After that, he joined Medecins Sans Frontieres (MSF) the internationally regarded Doctors without Borders. It took him, as an ER doctor to numerous health environments including Pakistan, Libya and Syria. In 2012, Mohammed was recognized by South Africa’s Mail & Guardian as one of South Africa’s Top 200 young and most interesting people specifically for his ground-breaking work around the South African triage score and its implementation across Africa. He has been recognized as a 2014 TED fellow and given a TEDx talk on mobile devices changing healthcare in the developing world. He’s currently pursuing a PhD in Emergency Medicine.

    With his medical and technology backgrounds, he offers a big step forward for African mHealth. TOMPSA is already moving ahead with economic analyses for its mHealth product to provide the evidence for its efforts. And there’s more to come.

  • Warren Bennis: a leadership leader

    Leadership, what it is and how can it be better, has dominated business academia for decades. Warren Bennis was one of its protagonists, and he died on 31 July. One of his important perspectives is the distinction between leaders and managers. He encapsulated these with many neat aphorisms. “The manager has his eye on the bottom line; the leader has his eye on the horizon” is one of them.

    He promoted the concept that leaders are made, not born. It was based on leadership being a set of skills that leaders can learn. This model tends to place an emphasis on generic leadership skills that are transferrable between business entities. For eHealth leadership, there are some specific requirements that extend beyond the generic. But he still has some ideas that are relevant to eHealth. Three are:

    “Leaders must encourage their organisations to dance to forms of music yet to be heard.” “The manager accepts the status quo; the leader challenges it.” “Create a compelling vision, one that takes people to a new place, and then translate that vision into a reality.”

    These are valuable slogans with change as a common thread, but they’re not enough. Leadership needs them converting into results, and eHealth leadership into results in a context, and his ideas provide a point you can start from.

    He was at Massachusetts Institute of Technology, State University of New York, University of Cincinnati and the University of Southern California. Some of his publications are:

    Why Leaders Can’t Lead: The Unconscious Conspiracy Continues ISBN 1555421520 1997 Co-Leaders: The Power of Great Partnerships ISBN-13: 978-0471316350 1999 Managing People Is Like Herding Cats: Warren Bennis on Leadership ISBN 096349175X 1999 Managing the Dream: Reflections on Leadership and Change ISBN 0738203327 2000 Best Practices in Leadership Development ISBN 087952370 2000 Leaders: Strategies for Taking Charge ISBN 0887308392 2003

    They provide valuable constructs for a platform to develop eHealth leadership. One of these is that “Leadership is the wise use of power. Power is the capacity to translate intention into reality and sustain it.” Understanding the changing role of different types of power in organisations is a crucial step.

  • Clinicians can be disruptive, and It's probably helpful

    A US paediatrician created a stir in April when she wrote an open letter to Michelle Obama, telling her about a health app developed to target childhood obesity and inviting Mrs. Obama to attend the Health Datapalooza, an event at which the app would be showcased, along with hundreds of others.

    It’s a touching story of a motivated and passionate clinician, deeply concerned about her patients and eager to find innovative ways to use technology to improve their lives. It’s probably also about a passionate businesswoman using a smart tactic to promote her product.

    In the letter Dr. Natalie Hodge tells of her experience working as a paediatrician. She explains how she has been troubled by childhood obesity, how she believes the problem can’t be addressed without working with parents and children together, and how she teamed up with business partners to develop a “kid and adult friendly health game that is rooted in evidence-based medicine.”

    The incident emphasizes that successful eHealth needs different types of leaders and opportunities for meaningful engagement across a wide variety of stakeholders. eHealth NGO tinTree describes three important eHealth leadership types: political, executive and clinical, with emphasis on the clinical leaders. Dr. Hodge is a clinical leader. She found executive leaders to work with, but noticed that the political role in her eHealth initiative was missing, so she reached out to try to fill it.

    It’s not clear whether Mrs. Obama attended the Health Datapalooza or not, but that’s probably not the point. For African eHealth it’s a useful reminder of the importance of including all three eHealth leadership types in our initiatives and creating productive opportunities for engagement.

  • Why is good eHealth leadership so elusive?

    Excellent leadership is hard to do. It seems that eHealth leadership might be harder. A report in Australia’s Financial Review says that Australia continues to struggle with eHealth, and that several health sector stakeholders share the blame. It’s a message from the Big Data in Healthcare roundtable, an event hosted by The Australian Financial Review and GE in Sydney.

    Part of the problem is seen a lack of vision for healthcare. In addition, it’s suggested that no one is explaining and selling Big Data’s potential value. While data is developing, its links need improving. These don’t help when they’re put alongside the claim that there’s a lack of strong, informed, insightful leaders in the health system. It posed an important message of eHealth being about a better system and leadership.

    These are common themes stretching back several years and from several countries. It confirms that good eHealth leadership is hard to do, sustaining it is challenging, and eHealth leaders are scarce. Constant striving is part of the solution, but isn’t sustainable without good eHealth results and success stories.

    According to Denis Waitley, a US management motivator and former sailor, “The most splendid achievement of all is the constant striving.” It’s not very splendid when eHealth projects struggle. It can become a strain, so eHealth leaders need to deal effortlessly with it. If the Financial Review is right, and there’s an eHealth leadership vacuum, then eHealth leaders need to create a constructive, conducive atmosphere before they run out of breath.

  • What's in a name when it's eHealth?

    It seems odd that an activity built extensively on semantic interoperability doesn’t have one definition of eHealth or one way to spell It. It’s origins may go back to 1999. Eysenbach attempted to define it in 2001, and called it e-health. He identified ten types of e:

    Efficiency Enhancing quality Evidence based Empowerment Encouragement Education Enabling Extending Ethics Equity.

    In its Strategy 2004-2007: eHealth for health care delivery, WHO defined eHealth as transmitting and exchanging health data and information securely and cost-effectively. This focus on functionality says nothing about the quality or impact of the data and information. It then went on to define it in eHealth resolution 2005 as the cost-effective and secure use of ICT to support of health and health-related fields. These include healthcare, health surveillance, health literature, and health education, knowledge and research.

    Harrison and Lee had a go at defining e-Health in 2006. It said that eHealth will empower consumers to use health ICT to enhance their knowledge of disease processes and improve their health, and that the role of eHealth is to support the relationship between patients and their healthcare providers. It didn’t see eHealth as a substitute for the personal interaction between patients and providers.

    In 2011, Jolly provided Australia’s Parliament with a list of different definitions. She concluded that however it’s defined and whichever of its components are stressed e health, as she called it, is a catalyst for a radical new approach to health, and it is has the potential to change the way health is delivered and the attitudes of those who provide and benefit from health services. Realising the potential depends on a “myriad of factors”. They include the types of technologies, the extent to which patients and practitioners trust them technologies and how successful governments are in managing system reforms.

    Two things emerge from these attempts at definition. One is that eHealth comprises a vast array of different types of initiatives. The other, like Jolly says, successful reforms are essential to benefits realisation. eHealth has these two main parts, ICT and change. She also points to shining examples and others verging on disaster. This provides an undertone that fits ICT and change, and that’s risk.

    eHNA’s founder, Acfee, uses the definition of eHealth that combines ICT and change to create better health and healthcare. It’s a cornerstone of Acfee's work with African Universities and includes building a curriculum that is responsive to the need to expand human capacity and take the opportunities for eHealth to strengthen health.

    A human is a creative contradiction “who needs order yet yearns for change”, said US educator Freda Adler. It’s probably true about the nature of eHealth too.