• mHealth
  • England’s mHealth has successes and challenges for African initiatives to learn from

    Strategies and plans for mHealth and mobile working stretch across most of Africa. A service from Digital Health can help the continent’s health systems to compare their performance with some of England’s NHS mHealth initiatives. Its Advisory Series, August 2017 deals with mobile and modern working. It has two perspectives, projects for clinical staff working in communities and mHealth that improves hospital care and to help non-clinical staff to be efficient.

    For mental health services, a goal’s to extend mobile access to EHRs for staff working mainly outside hospital. It includes logistics data such as patients’ locations and travel plans between them. mHealth benefits inpatient services too, where there are many routine tasks, such as therapeutic observations, and not similar to some community services that can involve complicated conversations that need recording. An mHealth solution from an in-house development enables health workers to use a range of phones or tablets that provide process-driven interfaces about patient care. mHealth can also replace traditional paper ward diaries with eLogistic  systems.

    Clinical audit and research can benefit from mHealth. An app can capture data about interactions with patients and match these against clinical guideline milestones. Instead of writing activities, doctors can tick boxes and data can be analysed and practices reviewed. Time saving and better quality healthcare are the results.

    South Gloucestershire Clinical Commissioning Group is another organisation which has found increased efficiency through greater use of mobile – simply by introducing the sort of electronic diary management abilities most take for granted in their private lives.

    Bring Your Own Device (BYOD) isn’t seen as viable for some NHS organisations. The extra complexities it brings can disrupt and a number of cultural changes to clinical and working practices are needed to realise mHealth’s benefits. These are the most challenging components of mHealth projects. They’re more significant than affordability challenges of devices, software, licences, connectivity and cyber-security. Mind-set changes and clinical leadership are essential for success. Clinical informatics champions, currently a small cadre, are helping to increase mHealth adoption.

    Africa’s mHealth programmes will have encountered many of these themes. There’s strong case for their leaders to share their experiences too.



  • Will the mHealth app market expand by 2020?

    Despite the hype around mHealth apps, the global mHealth app market is still niche. A report, mHealth App Market Sizing 2015 – 2020, by Research2Guidance believes it’ll change drastically over the next two years or so as mHealth app publishers refine their business models. Traditional apps store revenue sources like paid downloads, in-app purchase and in-app advertisement won’t be big enough to support the growing number of mHealth app publishers.


    The report focuses mainly on rich high-income clients, such as those in China, USA and France, all of which are in the top ten major country markets. Not surprisingly, no African country ranks in the top ten. This doesn’t mean that it’s not relevant for African countries.


    The report has five main parts:

    1.     Current market size, with  current mHealth market sizing in terms of app numbers, app downloads and app store revenues for all mHealth apps or by app category and identifying key app segments according to their current reach

    2.     Country mHealth markets, reviewing  the mHealth app markets of 56 countries. profiling ten countries which currently offer the best market potential for mHealth app publishers and information about the country mHealth app market characteristics, such as which platform leads in the country and required download numbers to enter a top five ranking position

    3.     Seventeen mHealth business models, describing of mHealth app publishers’ performance, their different monetisation strategies and the most commonly used business models for mHealth apps and  examples of best practice

    4.     Top mHealth app publishers, with their background and performance for the Health&Fitness and Medical app section and lists and descriptions of current, most successful Health&Fitness and Medical app publishers,  analysing their product portfolios and performance

    5.     mHealth market forecasts, with estimated market size and revenue until 2020, with  a detailed outlook on the demand and supply side of the mHealth app market, forecasting the number of mHealth app users, their platform preference and the number of downloads.


    Analysts, mHealth decision makers, mHealth app publishers and investors can all benefit from the insights in the report. It looks at important trends that African countries implementing mHealth solutions should be aware of. 


  • Kenya’s mHealth standards set out governance and policy rules

    Leadership’s seen as an underpinning component of mHealth governance and policy. Kenya Standards and Guidelines for mHealth Systems sets out the Ministry of Health approach to framework of strategies, plans, budgets, governance and policy.

    Kenya already has a governance framework. It integrates three stakeholder types, policy, suppliers and users. It fits into its institutional governance framework described in Kenya National eHealth Policy 2016 to 2030. Its mHealth governance arrangements fit within its three main policy stakeholder parts of policy, suppliers and users. Each one sets out stakeholders’ roles and responsibilities.

    Its regulation standards extend across:

    • A certification framework
    • Protection of privacy and confidentiality
    • Managing disclosures of health information
    • Source code and application ownership.

    Governance has four main parts:

    • Security
    • Validation
    • Accountability
    • Ownership.

    These are huge steps forward for all Africa’s eHealth. A possible trajectory for eHealth governance may be towards the standards released by the American Health Information Management Association (AHIMA). An eHNA post summarised these. COBIT 5 is an international for ICT governance in all economic sectors. Published by ISACA, It’s been adopted by AeHIN. As an extremely sophisticated governance model, it shows a possible destination of Africa’s eHealth governance.



  • Pocket mHealth's patient-centric and advances IOp

    Combining the synergy of patients, their mobiles and healthcare’s a growing ambition. Pocket mHealth likes the idea. It’s an app that brings EHRs to smartphones. The group is part of Atos Research & Innovation based in Atos Spain. It can fit Africa’s programmes for mHealth and EHRs.

    Validated by medical professionals, Pocket mHealth aims drives the paradigm shift needed for person-centric medical care. It provides access to EHRs so users can improve the way they take care of their health. An emphasis on Interoperability (IOp) and eHealth standards enabling integration of clinical data from heterogeneous Hospital Information Systems (HIS), it supports benefits such as better clinical efficiency, fewer medical errors and lower costs.

    Pocket mHealth’s underlying philosophies are:

    • Clinical data belongs to appropriate citizens
    • Users supervised by corresponding, responsible health professionals.

    These are achieved by Pocket mHealth’s validation by medical professionals. Other features include:

    • Improved diagnoses
    • Suppressing unneeded paper or DVD reports
    • Avoiding duplicate and redundant tests
    • EHRs are continuously updated and complete, enabling better health and quality of life decisions
    • Supporting patient mobility with accessible clinical data that enables better healthcare in rural or holidays locations
    • Cyber-security mechanisms that guarantee the privacy and data security.

    Both the vision and type of solution fit Africa’s needs. Its strategies and programmes for EHRs can incorporate secure IOp links to citizens’ smartphones. 


  • 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:

    • Planning
    • Landscape analysis
    • Local and national health priorities and needs
    • Target audience analysis
    • Project 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 development
    • Design, including technology, content, workflow impact and usability, a critical requirement for benefits realisation
    • Technology decisions
    • Creating message content
    • Testing message content
    • Prototype 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 targets
    • Benefits realisation models that follow on from project management and set baselines for the health benefits included in the standard’s M&E section
    • Applying WHO’s Monitoring and Evaluating Digital Health Interventions A practical guide to conducting research and assessment accessible from eHNA’s Resources
    • Distinguishing 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 SMSs
    • Standards for text messages, including device selections, risk assessments, development practices and training
    • PHI security guidelines
    • Risk 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 responsibilities
    • Guidelines for using eHealth and ICT to provide healthcare
    • What 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 choice
    • Authenticating ePrescriptions
    • Delivering ePrescribed drugs and medications and the role of pharmacists
    • ePrescribing 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 evaluation
    • Dynamic, to recognise and comprehend data changes in systems over time
    • Pragmatic, including modest AI
    • Semantic
    • Syntactic and workflow integration
    • Technical and integrated
    • None, 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.