• mHealth
  • eVisits create more visits

    Long before eHealth, the 18th century Scottish poet and farmer, Robert Burns, alerted us to the risks of projects having a mind of their own. His poem to a Mouse, a field mouse to be precise, gave us a permanent truth that "The best laid schemes o' mice an' men / Gang aft agley.” Since then, management and academic gurus have encapsulated it in more prosaic theories.

    Another human condition inspired by his field mouse was “I backward cast my e'e, On prospects drear!” A big advantage of retrospective evaluations is identifying unintended consequences. These can be extra benefits or extra costs. At an extreme, they can make a problem worse, such as Black Swan events, Nassim Nicholas Taleb’s concept, or unmitigated large-scale risks. Robert King Merton, a US sociologist awarded the National Medal of Science, promoted the concept. It’s important for eHealth strategists, planners and developers know if and when they’ve created any. Then, they need to fix any that are adverse, not rationalise them.

    A study published by Social Science Research Network (SSRN) found two unintended consequences arising from eVisits, a secure messaging service  between patients and providers. Generic goals are to improve healthcare quality and increase providers’ capacity. The team from Wisconsin University and Wharton School at Pennsylvania University found that eVisits create about 6% extra office visits by patients to their doctors. It also found mixed results on phone visits and patients’ health.

    The increased demand reduced capacity. It redeployed time allocated to phone visits, and 15% fewer new patients were accepted by doctors each month following their eVisits implementation. These results are from almost 100,000 patients over five years from 2008 to 2013, a period that includes eVisits’ rollout and diffusion.

    Taken together, the two findings may be good value for the 6% who may be accessing healthcare they need, but they might have delayed or foregone. It’s not good for the 15% who may have given up on healthcare they need.

    The adverse effect was more pronounced for healthcare organisations already at or near capacity. These seem like high priorities for eVisits’ potential. The study also reveals the difference between eHealth’s potential and its probable net benefits. Rarely, if ever, does eHealth operate at its full potential. A probable performance below this can create viable net benefits. Falling well short creates negative results.

    Africa’s health systems can test these unintended scenarios using effective business case methodologies. Risk adjustments that convert an ostensibly attractive project into a negative can reveal the scope for unintended consequences to come into play. It provides decision-takers an opportunity to deal with them prior to the event.  While another of Burns’ lines was sceptical about estimating. He thought “Foresight may be vain.”

    Maybe, but it’s better to model and test an unwelcome future than stumble into it.

  • Discover Africa’s plethora of eHealth opportunities at eHealthAFRO 2017 Use-case Bazaar

    Industry stakeholders are realising the opportunity for eHealth to help expand access to healthcare resources, improve patient outcomes, and increase efficiency of healthcare services. The eHealth space in Africa is experiencing an explosion of new ideas and technologies, which the eHealthAFRO 2017 conference will showcase. It takes place at Emperors Palace from 2-4 October 2017.

    Afternoon use-case bazaars on Tuesday and Wednesday will allow conference participants to explore 48 new ideas and technologies. These sessions will feature compelling eHealth solutions and implementations. The use-case bazaar themes extend from the conference theme: eHealth for Universal Health Care (eH4UHC) and includes mobile apps and devices, eHealth systems and architecture, and eHealth use-cases demonstrating on-the-ground successes.

    Participating organizations include HISP-SA, UCT's CIDER, Jembi Health Systems, SANAC's Focus for Impact project, the AitaHealth assisted community outreach project, HPCSA’s new eLogbook for interns and many more.

    See the expanding list on the eHealthAFRO website. Don’t miss this opportunity to engage with industry leaders, share your ideas and keep abreast of eHealth developments in Southern Africa.

    If you or your organization have an interesting eHealth solution or project, let it be shown where Africa meets for eHealth. There are still a few open slots for organizations that would like the opportunity to showcase their eHealth idea or technology. For more on this opportunity, contact the eHealthAFRO organizing committee here.

  • Kenya’s mHealth standards set an implementation cycle

    Rigorous implementation standards are set out in Kenya Standards and Guidelines for mHealth Systems. The extensive content in the Ministry of Health report extends from planning to scaling up. The steps are:

    PlanningLandscape analysisLocal and national health priorities and needsTarget audience analysisProject management

    o   People’s roles, responsibilities, teams, communication and relationships

    o   Systems, from implementation to M&E

    o   Defined policies and procedures for data

    Partnership developmentDesign, including technology, content, workflow impact and usability, a critical requirement for benefits realisationTechnology decisionsCreating message contentTesting message contentPrototype and usability content

    o   Systems launch, including, Beta version process and creating user demand, including incentives and benefits

    M&E, including needs assessments, monitoring systems and outcomes

    o   mHealth system, including the WHO methodology mHealth Evaluation Reporting and Assessment (mERA)

    o   Compliance with the mHealth standards and guidelines

    Scaling up activities, including using the WHO model for mHealth Assessment and Planning for Scale (MAPS) and its six steps of groundwork, partnerships, financial health, technology and architecture, operations and M&E.

    Some implementation components are not emphasised explicitly in the standards and guidelines:

    Business cases, such as the Five Case Model, needed to identify optimal mHealth options for decision takers before mHealth projects begin and setting explicit probable, not potential, socio-economic goals measured by cost benefits or cost effectiveness, and affordability requirements, an essential component of sustainability and setting M&E baselines and performance targetsBenefits realisation models that follow on from project management and set baselines for the health benefits included in the standard’s M&E sectionApplying WHO’s Monitoring and Evaluating Digital Health Interventions A practical guide to conducting research and assessment accessible from eHNA’s ResourcesDistinguishing between mHealth’s economic and financial components, described in Defining a staged-based process for economic and financial evaluations of mHealth programs, also accessible from eHNA’s Resources.

    These added themes contribute to the standard’s goals of “Well thought-out planning … knowledgeable people … M&E.” It shows how demanding successful mHealth can be.

  • Kenya’s mHealth standards set SMS and ePrescribing practices

    Using SMS for health and healthcare’s an expanding initiative in Africa. Kenya’s Ministry of Health has set out a rigorous set of standards for it, and ePrescribing, in Kenya Standards and Guidelines for mHealth Systems. 

    As an effective communication tool for health in low-income countries, SMS need regulation and cyber-security standards that minimise the risk of privacy and confidentiality breaches. This extends across several activities. Kenya’s standards include:

    Risks of Personal Health Information (PHI) in SMSsStandards for text messages, including device selections, risk assessments, development practices and trainingPHI security guidelinesRisk management strategy, including password confidentiality and encryption.

    Standards for telephone and eConusltations deal with devices such as Interactive Voice and Video and Response (IVVR), mobile phones, teleconferencing, Voice over Internet Protocol (VoIP. It includes SMSs too. The themes are:

    Good medical practices, duties and responsibilitiesGuidelines for using eHealth and ICT to provide healthcareWhat to do in emergency situations. 

    ePrescribing extends from completing prescriptions, through delivery to pharmcists and on to dispensing to patients. Its goals include better quality healthcare, patient safety, accuracy and continuing care. The standards deal with:

    How to use ePrescribing, including patient choiceAuthenticating ePrescriptionsDelivering ePrescribed drugs and medications and the role of pharmacistsePrescribing data sets that include:

    o   Minimum patient demographics

    o   Prescription identifiers

    o   Product identification.

    While addressing current eHealth requirements, these standards lay a foundation for eHealth’s future scale and direction. It’s an opportunity to move eHealth regulation closer to project implementations, especially for ePrescribing.

  • Kenya’s mHealth standards are strong on IOp

    Kenya’s Ministry of Health has set a solid foundation for its next step in eHealth regulation and good practices. The second main section in Kenya Standards and Guidelines for mHealth Systems deals with information exchange and Interoperability (IOp). It has a seven stage model of IOp maturity, including level 0 for no maturity and three conventional IOp classifications of technical, syntactic and semantic. They’re:

    Conceptual, enabling other engineers to understand documentation and evaluationDynamic, to recognise and comprehend data changes in systems over timePragmatic, including modest AISemanticSyntactic and workflow integrationTechnical and integratedNone, so can be ignored.

    They combine into three categories, integration, IOp and composability for maximum interoperation. It’s a requirement that all Kenya’s mHealth complies with its IOp standards. These include Health Level (HL)7 version 3 for clinical messaging and International Classification of Diseases (ICD) 10, Systematized Nomenclature of Medicine (SNOMED) for coding, Logical Observation Identifiers Names and Codes (LOINC) and Rx Norm for pharmacies.

    Developers have to provide Standards for Applications Programming Interfaces (API) to define how their mHealth interacts with other systems. It fits into a Fast Health Interoperability Resources (FHIR) architecture. It complies with Integrating the Healthcare Enterprise (IHE) and HL7 standards

    While these apply to health and healthcare data, Kenya’s standards apply to social health determinants too. It’s an indicator of the breadth of its approach.

  • EMGuidance scales its eHealth platform across Africa

    After its success at Seedstar SA, EMGuidance next step’s to scale its clinical facilitation platform across Africa. It’s ready to release of a slim-line version in eleven countries.  

    An article in Disrupt Africa says its centralised, interactive digital access point equips local doctors with the latest information. It reduces inaccurate decisions when they deliver care and administer medicines. A team of in-house doctors, pharmacists and national network specialists developed the app. It’s Africa´s first free, interactive and consistently updated mHealth medicines resource, with over 800 active ingredients listed. By August this year, there’ll be 1,200 listed. 

    The eleven countries are Botswana, Egypt, Ghana, Kenya, Namibia, Tanzania, Uganda, Cameroon, Rwanda, Sudan and Zambia.  Its platform’s available on Android and iOS. Over 5,000 doctors have registered since its launch. It’s gone viral, with over 80% of growth coming through word of mouth. 

    Over 20 medical institutions use EMGuidance to publish their clinical guidelines. It seems that EMGuidance’s set to roll out right across Africa.

  • Kenya’s mHealth standards for documentation add clarity

    Covering a wide range of mHealth standards, Kenya’s Ministry of Health has set a firm foundation to step up its wide eHealth regulation and good practices. The first main section in Kenya Standards and Guidelines for mHealth Systems deals with development and functions. It’s comprehensive.

    Software development has to comply with a set of phases: 

    Requirement gatheringSystems analysisSystems designDevelopment and implementationSystems testingOperations and maintenanceSupportPost-implementation M&E.

    Documentation needed for these includes:

    ·       Systems Requirement Specification (SRS)

    ·       Software design documents, depending on the mHealth software design methodology, will include some of:

    o   Unified Modelling Language (UML) diagrams

    o   Data Flow Diagrams (DFD)

    o   Flow charts

    o   Entity relationship diagrams

    ·       Implementation plan, including:

    o   Implementation manual

    o   Training and capacity building manual

    ·       Test plans

    ·       Deployment procedures

    ·       M&E criteria.

    Three other required documents are:

    Technical manualDeveloper’s guideUser manual.

    Four requirements for data validation are included:

    First order, ensure valid data formats and values and prevent obvious data entry errorsSecond order, historical data comparisons for alerts for changesThird order assess data for consistency in specific forms and indicator setsFourth order, assess statistical outliers for validity. 

    These examples show the range and rigour of Kenya’s mHealth standards. They fit all types of eHealth too. It’s a considerable benchmark for all Africa’s health systems.

  • Indian Ministry of Health pilots mHealth services

    Indian Health Ministry has stepped up its mHealth and eHealth services. The programme currently focuses on two districts. Baglung and Ilam. mHealth uses mobile apps and text messaging services to track pregnant mother´s ante-natal visits.

    An article in the Kathmandu Post says Medic Mobile, an organisation operating in 23 countries, signed a Memorandum of Understanding (MoU) to scale up the programme in several districts. The MoU will strengthen health systems by promoting mHealth access, especially in isolated communities. Medic Mobile will also provide technical advice and support so eHealth and mHealth solutions are implemented and leveraged more effectively.

    So far, it’s been implemented by 83 Village Development Committees (VDC) in Gorkha and Dhading districts. Other districts will be able to build from the initial scale.  

    In Baglung, the Female Community Health Volunteers (FCHV) use mHealth to remind expecting mothers of their health facility schedules and visits. The service has been successful. The Family Health Division director, Dr Naresh Pratp KC, said the mHealth and SMS services “Have been effective to increase ante-natal visits.” 

    The service includes:

    Details of pregnant mothers are  entered onto an appReminders are forwarded periodically to FCHVsFCHVs are kept up to date of any complicated cases.

    Ante-natal care ensures a reduced risk of complications in pregnancy. However, irregular attendance by pregnant mothers on their mandatory four visits to health facilities’s an issue. Only 69% of women visited health facilities four times. It drops to 62% in rural areas. In urban areas, the figure’s 75%. 

    Bhogendra Dotel, the ministry spokesperson, said the mHealth services will soon be extended to track immunisation and disease surveillance. The initiative has important lessons for Africa’s health systems. Their maternity services share equivalent challenges and priorities.

  • Kenya launches app to protect health workers from HIV

    HIV’s still a big public health challenge for Africa’s health systems and their health workers. Many health workers see HIV+ patients every day, so exposed to cross-contamination risks, such as accidental pricks from contaminated needles and surgical blades and blood and other body fluid splashes that can result in contracting the HIV virus. Kenya's Ministry of Health (MoH) has partnered with Care for Carers (C4C), a carers’ platform, to provide an app to help healthcare workers have prompt medical care for accidental exposure to infections.

    It’ll provide a tool for health workers to ask for immediate attention says an article in Kenya Tech News. Post-Exposure Prophylaxis (PEP) drugs can reduce infection risk by over 80%, but have to be taken within three days of exposure. The dose’s needed for 28 days. They work by attacking and killing viruses before they cause HIV after they’ve multiplied. After the 28days, patients have to have two HIV done, each taking place after three months. Dr Martian Sirengo, head of the National Aids and STI Control Programme (Nascop), said “The time PEP is initiated, and the completion of the recommended dose is of great importance. And this new platform will help us with that.”

    Health workers have to log into the C4C platform and register. It then records information such as personal, employment, demographic data and any treatments. It then provides users with detailed procedural advice the MOH guidelines. The app also sends follow-up messages to encourage and advise practitioners to adhere to the requirements and provide information on PEP drug side effects.

    C4C enables county and national governments to monitor real time data on HIV exposure incidents in healthcare facilities. It also provides data on causes and risk exposure rates for locations. This can help to frame policies on safety in hospitals, creating safer working environments.

    M-health and Nascop helped developed the app. It’s currently used in Kisumu, Turkana, Meru, Embu and Murang'a counties.

    Kenya’ s not the only country struggling with these challenges. Other African countries need similar mHealth solutions to protect their healthcare workers. 

  • Kenya’s setting up new mHealth legislation

    Africa’s eHealth legislation and regulation needs considerable developed. Kenya’s stepping it up, eHealth experts have welcomed proposed eHealth legislation, including the Health Act 2017 and the Kenya Standard and Guidelines for mHealth Systems. They see the legislation as facilitating Interoperability (IOp) between private and public healthcare, and as guidelines to move wider eHealth on says an article in ITWEB Africa.

    The Health Act 2017 says within three years of its operation, the Ministry of Health (MoH) will implement management information banks. They’ll include an IOp framework for data interchange and security to improve personal health information management.

    Tony Wood, Managing Director at My Dawa, an online service for ordering prescription and wellness products, said he welcomed legislation that builds the eHealth ecosystem. "With everything, as you look at the world, technology is moving faster than regulation, governments and policy. More can now be done on how these are implemented going forward. I hope they are going to be implemented through open consultation where the public and private sector are working together." This seems like the next step.

    The 66-page guidelines are wide ranging. They set out definitions and extend across mHealth implantation, standards, governance and policy. The proposed legislation’s scheduled for debate in the national assembly. It’s a crucial stepping stone implementing successful and sustainable mHealth and wider eHealth.