• mHealth
  • 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.

  • 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 gathering
    • Systems analysis
    • Systems design
    • Development and implementation
    • Systems testing
    • Operations and maintenance
    • Support
    • Post-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 manual
    • Developer’s guide
    • User manual.

    Four requirements for data validation are included:

    • First order, ensure valid data formats and values and prevent obvious data entry errors
    • Second order, historical data comparisons for alerts for changes
    • Third order assess data for consistency in specific forms and indicator sets
    • Fourth 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 app
    • Reminders are forwarded periodically to FCHVs
    • FCHVs 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.

  • Finding the right mHealth and IoT needs a structure

    As mHealth and the Internet of Things (IoT) opportunities keep expanding, finding the right solutions for a health system becomes more challenging. A white paper from Insight, an ICT firm, sets out a ten-step approach to navigating the mushrooming landscape. 

    10 Best Practices for Discovering the Best Mobile and IoT Devices for Healthcare says healthcare organisations need a robust discovery process for acquiring and procuring mHealth and IoT devices.

    It offers a similar perspective to a concept from Marcel Proust, the 19th and 20th century French novelist. In Search of Lost Time, he said “The real voyage of discovery consists not in seeking new landscapes, but in having new eyes.”  The ten steps can help achieve it. They’re: 

    1.     Set up a cross-functional team

    2.     Seek the experience of independent advisers

    3.     Encourage exploratory thinking

    4.     Consider working with a group purchasing organisation

    5.     Create an mHealth and IoT policy leading to enterprise management

    6.     Create and use a scoring matrix

    7.     Assess existing infrastructure and mHealth and IoT use

    8.     Focus on cyber-security

    9.     Consider Choose Your Own Device (CYOD).

    10.  Explore device technology, including sensors and IoT.

    Cyber-security has several components:

    • Separate
    • Encryption
    • mHealth and IoT compliance policy
    • Virtual Desktop Infrastructure (VDI)
    • Geofencing to limit access
    • Security software
    • Security software
    • Multi factor authorisation
    • Role-based authentication
    • Automatic Wi-Fi connections where cyber-security’s more important than convenience
    • Robust Virtual Private Networks (VPN)
    • Mobile Device Management (MDM) and containment
    • Remote wipe to erase all data from a lost or stolen devices.

    Moving away from Bring Your Own Devices (BYOD) should be considered too. A better alternative’s Choose Your Own Devices (CYOD).

    These offer Africa’s health systems a firm start to managing their new mHealth and IoT programmes. It can help to mix new mHealteh and IoT visions with a dose of caution. “People wish to learn to swim and at the same time to keep one foot on the ground,” as Proust observed.

  • An SMS service improves HIV mothers’ and babies health

    The UN’s SDG 3 has two goals to improve health and wellbeing for pregnant women and babies. A study reported in Taylor and Francis Online shows that SMSs can help to improve these.

    An international research team from the University of Witwatersrand, the Karolinska Institutet, Johns Hopkins University, Princeton University and the United Nations Foundation evaluated the effectiveness of an SMS service aiming to improve the maternal health and HIV outcomes of HIV+ pregnant women. 

    Twice a week, SMSs were sent to 235 HIV+ pregnant women. They continued until their children’s first birthday. Content included maternal health advice and HIV support information.

    Outcomes were measured as Ante-Natal Care (ANC) visits, birth outcomes and infant HIV testing. They were compared to a control group of 586 HIV+ pregnant women who received no SMSs. Results showed marked benefits. Intervention group women attended more than 31% more ANC visits, and were more likely to attend at least the recommended four ANC visits.

    Birth outcomes of the intervention group improved too. The women had an increased chance of a normal vaginal delivery and a lower risk of a low-birth weight baby. 

    The intervention group had a trend towards higher infant polymerase chain reaction (PCR) testing for HIV within six weeks of birth. It also had a lower mean infant age in weeks for HIV PCR tests.

    The team concluded that its results add to the growing evidence that mHealth can have a positive impact on health outcomes. It should be scaled nationally after comprehensive evaluation. For a large-scale mHealth programme, Africa’s health systems may have to invest in extra ANC and PCR testing capacity.

  • KardioPro helps to tackle cardiometabolic disease

    Cardiometabolic disease, a cluster of inter-related risk factors that can lead to atherosclerotic vascular disease and type 2 diabetes, is the world’s leading cause of morbidity and mortality. It kills more people than AIDS and malaria combined and places tremendous strain on healthcare resources and costs. Currently, the epidemic of cardiometabolic disease worldwide is being diagnosed, treated and managed in separate silos. Healthcare systems rely on repetitive, duplicated tests and services, which inevitably leads to reduced patient outcomes and increased costs. To address this challenge, the Kardiogroup, a connected health company, has developed the first comprehensive cardiovascular risk reduction and treatment approach.


    The Kardio Ecosystem links connected health devices as a Technology Enabled Care (TEC) to validated Point of Care (POC) blood tests. It provides accurate and validated risk analyses, links to emergency care and access to treatment protocols informed by local and international guidelines.

     

    KardioPro, an mHeath app, is part of the ecosystem. It integrates with diagnostic tools, including a cardiolabs to measure patients’ blood pressure and Ankle-Brachial Index (ABI), a pulse oximeter, a professional wireless core body scale, and a glucometer.  Path Pro’s part of the configuration too. It provides the Alere Affinion Machine and the Abbott Istat POC pathology diagnostic equipment.

    Healthcare workers can use KardioPro to take measurements, connect to the KardioPro app from iPads or Androids, then visualise, track and share the results. It performs tests in 15 – 20 minutes, stores and organises results, simplifies patient monitoring and edits reports in PDF format so they can be shared by treatment teams. It also helps with the interaction of healthcare workers and patients to:

     

       Improve adherence

       Reassess treatments

       Reassure patients and explain to them the evolution of their health status

       Fix goals for patients

     

    The App:

       Is simple and easy to use

       Provides accurate risk analysis

       Has multi step reporting

       Provides treatment suggestions based on guidelines

       Delivers secure cloud based data capturing

     

    Tests performed by the app includes:

    1. HBA1C - Glycated Haemoglobin - This is used to test the 3 month average glucose of patients. It is used for screening for diabetes and used to monitor diabetic patients. 
    2.  Lipogram - This is a full cholesterol panel which is one of the important components in cardiovascular disease. It measures the different types of cholesterol in the body which is important in assessing cardiovascular risk in patients
    3. Crp - known as C-Reactive Protein - This is an inflammatory marker test can be used to determine if antibiotic therapy is required in patients who are ill.
    4. Urine ACR - known as Albumin to Creatinine Ratio - These are the two key markers to test for chronic kidney disease. 
    5. U&E - Urea and Electrolytes - This is an important and common type of biochemistry test. It is used to assess Renal Function in Diabetic patients and are important screening test for patients with hypertension.
     

    All health data generated by the device is secured and stored in an approved secure healthcare database. This is increasingly important with the rise in cyber-security threats.

    KardioPro is currently being used by 40 practitioners in South Africa. The solution has the potential to benefit resource poor communities across the continent. KardioPro is looking to expand internationally with interest to collaborate with international partners. 

  • Whatsapp helps to demystify cancer in Tanzania

    Cancer rates are soaring in Africa and people are taking note. The answer to why the disease is spreading so rapidly on the continent is not straightforward. Doctors and health workers attribute the spike to poor health education, environmental changes, high HIV rates, improved diagnostics and the fact that people are simply living longer.

    WHO has recently warned that Non-Communicable Diseases (NCD) are likely to kill more people in Africa than infectious disease. It set these out as a forecast by 2030. Cancer’s a major contributor.

    The Ocean Road Cancer Institute (ORCI), Tanzania’s major cancer centre, has estimated that the country’s heading for 30,000 new cancer cases a year. The diseases’s a huge public health concern.

    Combating the increase in misleading cancer information is part of Tanzania’s contributing. An article in allAfrica says it includes false cancer cures claims and alarming stories on social media linking some foods and human behaviour with cancer. Experts are trying to demystify the disease by curbing this damaging information.  

    Radiotherapists in Tanzania say WhatsApp, the cross-platform instant messaging service for smartphones, can help to tackle the problem. In February, radiotherapists formed Saratani.info a set of WhatsApp groups to disseminate cancer awareness. Currently, there are five groups. Each one has 251 members, so 1,255 people have so far joined. Each group has five educators, including radiotherapists, doctors and nurses.

    Mr Franklin Mtei, Saratani.info’s founder, and managing director of the Tanzanian Cancer Society (Tacaso), formed in 2014, leads the team of educators.  They’re expected to become future cancer ambassadors. Other group members included people from the general public, the private sector, public officials, students, entrepreneurs, professionals and non-professionals.

    The groups were formed by adding the WhatsApp users that the radiologists already had in their own phone books. Other people were invited through Facebook. People can join and leave any of the groups voluntarily through their Facebook Page.

    A co-founder of Tacaso, Mr Ally Idris, a radiotherapist, says people's perception about cancer in Tanzania has been wrong for many years. Society’s information gap is huge. Many people believe that cancer is contagious, while others think that treatment by radiations causes more cancer.

    The founders want their initiative to provide services beyond the WhatsApp groups. They plan to expand across Tanzania, targeting vulnerable people who lack information about cancer, its causes, prevention and how to access treatment. It’s an initiative that could benefit all Africa.