• Leadership
  • 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.

  • Sedick Isaacs Award seeks nominations

    Prof Sedick Isaacs was a founder member of the South African Medical Informatics Group, later the South African Health Informatics Association (SAHIA). He was SAHIA President, and President of the International Medical Informatics Association (IMIA) Health Informatics in Africa (HELINA) region.

    He was an anti-apartheid activist, member of the African National Congress, and imprisoned on Robben Island for 13 years. His ingenuity resulted in notoriety with officials when he was found in possession of a key that he’d fashioned to fit all the locks in the prison. I remember him most though for unlocking knowledge and for igniting a passion for health informatics with his fierce, dry humour and poignant anecdotes.

    It’s time for the 2014 nominations for the Sedick Isaacs Award. It recognises the lasting contribution to health and medical informatics in Africa by Dr Isaacs. The (IMIA) funds the award and administers it jointly with HELINA. The primary criterion for a Sedick Isaacs Award is to recognise “an individual whose personal commitment and dedication to medical informatics has made a lasting contribution to medicine and healthcare within Africa, through her or his achievements in research, education, development or application in the field of medical informatics.” The secondary criterion is that the person receiving the Award should live and work in Africa.

    The Award presentation is at the HELINA2014 conference in Accra, Ghana on 11-15 October 2014. The winner will have an opportunity to make a keynote presentation at a plenary of the HELINA conference. The Journal of Health Informatics in Africa will publish a version of the presentation.

    The Award does not have a monetary value, but IMIA will cover travel costs within Africa to the HELINA2014 conference. It will also pay for up to three nights’ accommodation at the conference.

    Nominations should be sent to the IMIA Office by email: imia@imia-services.org no later than 15 August, 2014.

    Sedick Isaacs image from International Film Festival of India.

  • Clinical eHealth leaders are essential

    The late Peter Drucker is still a global leadership guru. He distinguished it from management in his pithy quote “Management is doing things right; leadership is doing the right things.” For eHealth, tinTree sees the need for a triumvirate of clinical, political and executive leadership. It’s not surprising that the study in the International Journal of Medical Informatics confirmed the essential contribution of clinical leadership in successful eHealth.

    A team of Australian and Norwegian researchers analysed 32 peer-reviewed research articles published between January 2000 and May 2013. It found clear associations between clinical leaders who value ICT implementation and achieved positive organisational outcomes. It says the findings are important for the education, recruitment and training of clinical managers and directors. They’re also important to develop the relationship with the other two types of leaders, political and executive.

    eHealth leaders who have technical health ICT expertise at the outset are most likely to be committed to using ICT to improve processes and care quality. Their confidence in the value of ICT motivates them to remain stable through periods of change, resistance and adversity as ICT’s implemented and adopted. Previous experience with ICT project management is another factor helping clinical leaders to develop partnerships with ICT professionals. This teamwork is essential for success.

    Another vital role for leaders is guiding the behaviour and performance of clinicians and their support staff through their use of ICT. It extends to changing some of their clinical and working practices.

    The study’s authors identified seven factors associated with positive outcomes:

    Clear communication of visions and goals Providing leadership support Establishing a governance structure Training Identifying and appointing champions Changing work processes Follow-ups.

    It’d be good to see the equivalent findings for political and executive leaders, and match them with the clinical leaders findings. They should match up to another of Drucker’s aphorisms: “Whenever you see a successful business, someone once made a courageous decision.” For eHealth, it’s at least three people.

  • eHealth leadership is continuous learning

    Peter Drucker said that “leadership is doing the right things, management is doing things right.” As 2013 approached its place in history, Forbes  published their take on it. The Top 10 Qualities That Make a Great Leader are

    1   Honesty

    2   Ability to delegate

    3   Communication

    4   Sense of humour

    5   Confidence

    6   Commitment

    7   Positive attitude

    8   Creativity

    9   Intuition

    10 Ability to inspire.

    These ten-factor checklists are valuable for highlighting the boundary with other factors from other lists, such as the one from ex-New York Mayor Giuliani’s book with the uncomplicated title “Leadership” published by Hyperion in 2002.

    For eHealth, all these are good for eHealth leaders in healthcare and in suppliers. But check-lists rarely say how leaders can learn to be leaders. Learning leadership is more valuable than leadership teaching. This is the Future eHealth Leaders model where action learning sets a context where eHealth leaders can design their own approach to learning, developing and applying leadership continuously. Two of its concepts are learning to know when to stop and change direction, then, keep leading in a new context. With leadership being about change, this is probably the hardest change of all.

    Ten-factor checklists have a place. Continuous leadership learning has a better place in doing the right things.