• Workforce
  • A medical Prof has a fresh eHealth vision

    Gurpreet Dhaliwal is Professor of Medicine at University of California, San Francisco. He’s also a physician at the San Francisco VA Medical Center. He’s described his different eHealth vision in the Wall Street Journal. It fits the way that African countries can approach their eHealth initiatives.

    It starts from his view that technology has a lot to offer doctors, but it’s different to the healthcare technology in the news, such as Big Data, EHRs and the connected patient. Improving and restoring health needs more than this physical capital. It needs investment in human capital too.

    First, Big Data using correlations in huge data sets seldom changes clinical and working practices. They’re more akin to preliminary research findings, so not ready to apply until they’re confirmed, scrutinized and distilled by conventional, rigorous testing. Clinicians need constant exposure to findings from high-quality studies and synopses. Twitter can disseminate these.

    EHRs are forensic document, billing and communication tools. They’re not learning tools. Patient lists and reminders are good, What’s needed now is a real time message service triggered by patients using healthcare, such as when they’ve had tests or outpatient attendance.

    Prof Dhaliwal wants a connected patient service where updates are from his patients. It needs routine use of SMS, text, email and videoconferencing follow-ups. Many doctors do it, so already have a foundation to build on.

    If African countries follow a more traditional eHealth route, it could diminish the benefits they realise. Building on Prof Dhaliwal’s vision can help them to achieve more.


    Image from the New York Times

  • EHRs may need extra staff

    A claim for EHRs, and eHealth in general, is that they save time. They may save some staff time, but they also need extra staff. A report in Market Place Health Care says “The medical scribe industry has been booming in recent years, fueled largely by hospitals around the county switching to electronic medical record systems.”

    It refers to Cheyenne Regional ER Doctor Amy Tortorich saying that EHRs are much more comprehensive than the paper files or computer spreadsheets the hospital used to use. They also take much longer, needing about 10 minutes per patient. She usually sees about 30 patients a day. “That’s an extra five hours charting. So half my shift, almost half my shift.”

    This is only part of the story. She also says she sees more patients, who usually leave happier, making medical scribes well worth their cost. From an African perspective, the increased EHR workforce results in affordability challenges that lead to productivity gains. This makes the benefits of EHRs harder to assess.

    An indication of the affordability challenge is from Scribe America, one of the biggest USA medical scribe companies. It’s tripled its growth in a year to almost 7,500 employees in 47 states. iHealth Beat says the American College of Medical Scribe Specialists estimates that the number of medical scribes in the U.S. will increase from about 20,000 today to about 100,000 by 2020. Their job includes entering patient data using medical terminology and billing codes and recording physicians’ notes during consultations.

    As Africa’s eHealth moves on, it’s important it knows how these features need building in. An optimal relationship between affordability and productivity’s not easy to find.

  • eHealth engagement means nurses too

    Nurses comprise the largest group of health workers. It is obvious that eHealth engagement strategies and arrangements must include them. In an interview for HIT Consultant, Elizabeth T. Jordan, Associate Professor University of South Florida College of Nursing, sets out why this is essential, but is not in place.

    She sees a generational divide in the way nurses use technology. Older nurses take longer than younger ones to adopt healthcare technology. This sounds familiar for all walks of life. Her main premise is that “Healthcare space is getting bigger, and nurses working on those units really rely on technology to be able to communicate.” The implications for the biggest workforce segment justify her proposition that she would like as part of the development and deployment stages of new technology.

    For African countries to maximise the use and benefits of their eHealth initiative, it is worth reviewing their engagement models.

  • An eHealth people shortage creates errors

    "A person who never made a mistake never tried anything new” as Albert Einstein said. It seems that in eHealth, the lack of people is creating mistakes, according to Professor Enrico Coiera, director of Australia’s $2.5 million National Health and Medical Research Council (NHMRC) Centre for Research Excellence in E-health and also at the University of New South Wales’ Australian Institute of Health Innovation. In an article in The Australian, he says that eHealth is prone to design mistakes because of a lack of expertise, and he says it is probably more of a problem in Australia.

    Instead of big-scale systems, he advocates lighter, smaller-scale touch and recognizing that social media could have a role in changing socially mediated diseases and health problems. This option is very relevant for African countries. It needs consideration as part of a solution to affordability and eHealth workforce constraints. There is already a strong emphasis on mHealth in Africa, and it offers a foundation for social media. It can also lead to a foundation for Big Data and analytics.

    For African countries, it may be that a lower-scale strategy is not sufficient. They still need to recruit, develop and retain people with health informatics, ICT and analytics skills and knowledge, and so expand the eHealth workforce to seek more benefits from more eHealth. This needs a human resources component in each eHealth strategy.

  • Post-2015 priority: healthcare workers

    Human resources shortages are a global challenge. Africa experiences it too, particularly in healthcare where competition is fierce for most resources. It is no surprise that the AfDB has flagged this issue as a key post-2015 priority.

    The Third Global Forum on Human Resources for Health (HRH) took place November 10-13 in Brazil. Some 2000 participants from 80 countries attend the event to encourage discussion and come up with innovative ideas on how to solve human resource shortages. The conference was followed by a Board meeting of the Global Health Workforce Alliance (GHWA) to set up the future health workforce agenda. Government officials, global health experts, AfDB and other key stakeholders discussed post-2015 development priorities.

    “The global community needs to change its traditional approach to health workforce in a fundamental way. This is particularly important to Africa with high disease burden and low density of health workforce,” said Ages Soucat, presenting AfDB’s vision for building African human capital over the next decade. Using innovative technologies to build human capital is at the heart of the AfDB’s Strategy 2013-2022.

    eHealth presents African countries with an opportunity to address the critical shortage of healthcare workers in a new way. Kenya is already experiencing the benefits of using eHealth to support development of nurses.