• Telemedicine
  • A telemedicine toolkit from Novartis Foundation supported by CWCDH

    As telemedicine moves further into the mHealth environment, it can become more widespread. To help its expansion, Novartis Foundation, with the Commonwealth Centre for Digital Health (CWCDH) as a messanger, has have compiled a telemedicine toolkit.

    It covers a wide range:

    High-level overviewInteractive implementation guide Business continuity planCommunicationFact sheetFever overview, protocol and role play templates Postpartum haemorrhage overview and protocolReferencesRollout templateWhat to look out for.

    There are two videos:

    Ghana Telmed Toolkit Video 1Ghana Telmed Toolkit Video 2.

    Ghana Health Service and Ministry of Health are core collaborators. Ghana telemedicine has more background information.

    Two objectives for the toolkit are:

    Increased healthcare access for people in low- and middle-income countriesLeverage eHealth best practiced and benefits.

    It sees telemedicine as vital to connect Community Health Workers (CHW) to medical specialists in 24-hour tele-consultation centres. Doctors, nurses and midwives in the centres mentor, coach and advise CHWs in managing emergency cases that are beyond their capabilities. Ghana’s experience shows that telemedicine’s strengthened healthcare capacity can result in:

    Over half of tele-consultations can be solved directly by phone, so mHealth has a core roleHospital referrals can reduce by 31%Empowered CHWsBetter healthcare qualityReduced travel times and costs for patients.

    Developed in Africa, the telemedicine toolkit can help African countries' health systems expand towards a shared, successful model. This can lay a platform for sharing and developing the required eHealth regulation.

  • Rural India uses eHealth with containers

    Shipping containers re-appear in many guises, from roadside cafés to holiday homes. It should come as no surprise that they should have become part of the future of India’s eHealth network.

    A report in The Nation Online says in 2013, Dr. Anurag Agrawal, of the New Delhi-based Institute of Genomics and Integrative Biology (IGIB), saw the possibilities of including shipping containers’ versatility in his work towards a link between genes and lung disease. His plan was to use the movable containers to house and collate health records in rural areas so specialists could analyse the data to identify links between height, weight and predisposition for developing specific lung diseases. The analysis leads on to developing and delivering treatments.

    A container appeared in a village in Uttar Pradesh. Villagers soon had video access to a doctor and could see a paramedic in person. They could also leave blood samples and submit cardiograms.

    This initial success was hindered by IGIB’s link to government. It is one of India’s 39 state-funded Council for Scientific and Industrial Research laboratories, and is limited its scope to expand.

    Then IGIB partnered with the Indian hospital chain Narayana Health (NH) and Hewlett-Packard (HP) to install over 40 eHealth container centres across India. The service includes EMRs, bio-metric patient identification and integrated diagnostic devices. It’s a business model that could be appropriate for Africa’s drive towards UHC.

    India has one doctor for every 11,000 people, well below WHO’s recommended rate of one per 1,000lth. The eHealth container with HP cloud technology offered a dynamic solution. Clinical and administrative data is monitored and medical advice provided remotely.

    Dr Agrawal believes more benefits are available. Telemedicine has improved access to second opinions and international consultation in urban areas. It’s benefits in rural India may be more limited.

  • Texting between healthcare professionals and patients increases

    For Africa’s health systems, investment in mHealth could be laying the foundation for an increasing trend in relationships between healthcare professionals and patients. A survey by West Corporation, sponsored by Tele Vox Solutions, and available from mHealth Intelligence, says more patients are texting  with their healthcare providers.

    It’s gone beyond appointment reminders. Provider-Patient Texting Is Poised for Growth has identified five other activities that have a large texting component. Demand by patients is:

    Preventive care                                                    95%Chronic condition management                          87%Post-treatment instructions                                 85%Check-ins based on remote monitoring data      84%Co-payment information and reminders              83%Delays that impact appointments                        80%Appointment reminders                                       71%.

    In addition, 60% of patients say it is very or extremely important for their healthcare provider to text them about five other topics:

    Remote health monitoringPreventive careDisease managementBillingScheduling delays.

    There’s a mismatch between supply and demand. For example, for preventive care patients demand 95% and providers text 25%, and chronic condition management patients demand 87% and providers text 31%. A similar trend is found across services such as post-treatment instructions (85% vs 7%), check-ins based on remote monitoring data (84% vs 6%), co-payment information and reminders (83% vs 6%), and delays that impact appointments (80% vs 49%).

    It seems that USA patients are more mobile-savvy than their healthcare providers. The findings indicate that Africa’s health systems may have an opportunity to build on their mHealth investment and expand their direct connections and engagements with their patients.  

  • Telemedicine can help patients with opioid dependencies

    Addiction isn’t pleasant. Trying to reverse its impact is always challenging. An issue brief from Polycom, a global communications firm, and available from mHealth Intelligence, says opiod addiction’s an epidemic, so inevitably, can stretch across all sectors of society. 

    Enabling Providers to Address the Opioid Epidemic with Telemedicine describes how Circle Park Behavioral Health Services, a US provider in rural South Carolina, uses telemedicine to support people dealing with opioid addiction. Prescribing Medication-assisted Treatment (MAT) has to comply with strict legal controls, including numbers of patients who can access MAT. Polycom’s platform helps healthcare professionals to match patients need MAT with providers who have the waiver space to treat them.

    Providers can connect with patients at times and places of their choosing too. Fitting consultations in daily time commitment and giving patients comfortable place to communicate rather than doctors’  offices all help with the journey that can leave addiction behind. These frequent contacts give healthcare professionals opportunities to assess patients’ daily routines, issues and progress.

    While MAT’s the main telemedicine role, it’s not the only one. Addicts often have to deal with chronic health issues such as high blood pressure, diabetes and heart failure. The telemedicine initiative’s seen as an opportunity to connect with patients outside the office on these and other care management and co-ordination activities.

    Africa’s priorities for telemedicine should be showing equivalent benefits. Establishing the impact of these provides valuable knowledge to justify more investment.

  • Saudi Arabia’s RAH@H aims to improve healthcare quality
      

    Connecting and integrating healthcare resources to improve quality’s a core eHealth goal. In Riyadh, the Remotely Accessible Healthcare at Home (RAH@H) initiative offers a daily, patient centric, connected health model to achieve it. Five themes are integrated: 

    EducatingEmpoweringInfluencingMonitoringTreating. 

    Achieving these depends on RAH@H operating at the centre of a technological hub.

    Available both on Android and IOS, RAH@H uses modern technologies for telemedicine, webinars, and observations from medical devices to serve patients. Healthcare needs of vulnerable communities that don’t have ready access to services. They include pregnant women, especially with complications such as hypertension, gestational diabetes and cardiac conditions.

    Interventions include:

    Improved nutritionPrevention and protection against diseases and illness.

    These aim for outcomes of:

    Better life qualityCreating satisfied and empowered patientsIncreased treatment compliance.

    Based in Riyadh, RAH@H’s project custodian’s the Director General of Prince Naif Bin AbdulAziz Health Research Center at King Saud University in Riyadh. It's concept and technology can have a role in African countries and their vulnerable, underserved communities.

  • Intermountain Healthcare integrates telehealth and mHealth in a connected care platform

    Information silos are huge obstacles to integrated healthcare. And integrated care is the kind most of us want for ourselves and for our loved ones. It's a key eHealth challenge.

    In a report in Research Information, research platform outfit Dimensions says they’re usually created unintentionally, and are a phenomenon to “escape” from.

    Intermountain Healthcare, based on Salt Lake City, US, seems to be free of these troubles. A report in mHealth Intelligence says it’s integrated 35 different telehealth and mHealth services into Connect Care Pro, a single connected care platform. Objectives are to improve care coordination and keep care in communities, both of which could be good for patients and health systems. It took five years to plan. 

    The services it supports include: 

    Virtual or tele-programmesTelestrokeTelehealth programmes for behavioural healthTelehealth programmes for newborn critical careTelepharmacy serviceseHealth services using connected health devices.

    The legacy was a history of launches of several telehealth and mHealth programs and pilots that didn’t integrate easily. Intermountain sees their integration initiative as the next telehealth phase.

    The initiative has valuable lessons for our African countries' mHealth and telehealth programmes. It makes sense to start constructing equivalent platforms without delay. It’ll be easier and cheaper than waiting until more silos need integrating. Even more important, it’ll bring extra patient and healthcare benefits, sooner, for our patients, our families and ourselves. 

  • Computer aided detection for TB (CAD4TB) installed across Ghana

    A target of sustainable development goals (SDGs) is to end tuberculosis (TB) globally by 2030.  Effective prevention, detection and treatment is necessary to achieve this goal.  Ghana is in the global high burden list for TB, but is tackling this burden using eHealth innovations. 

    In collaboration with Delft Imaging Systems, they have successfully installed 51 X-ray systems in facilities, containers and TB screening mobile clinics across the country.  These mobile X-ray systems are self sustainable, employing solar technology to power them, even in the remotest of locations.  All X-ray systems have been equipped with computer aided detection (CAD4TB) software that makes use of machine learning to detect TB in X-rays.  Additionally, tele-radiology technology is used to interlink all images to a central platform that allows healthcare providers across connected facilities and units to access images.

    The innovation allows healthcare providers to screen up to 200 images per day.  When the images reveal a high CAD4TB score, patients are referred for the standard and more expensive GeneExpert tests.  This makes detecting TB in poorer communities very effective. 

    It is eHealth innovations like this that will strengthen health systems in Ghana and other African countries, while still being conservative of the constrained health budgets in Africa.

  • Telehealth providers have five trends

    As Africa’s mHealth initiatives move on, opportunities to include telehealth are expanding. Options for health systems can follow five provider trends. MDLIVE has described these in Wellness Gone Wireless:Top 5 Trends Driving Telehealth in 2018, available from Fierce Markets. 

    The trends are: 

    Expansion of cloud-based smartphone technology and health and wellness wearables, creating more engaged consumersAI innovation enabling more refined data analytics and personalised patients’ experiencesReduced reliance on reimbursement models, expanding providers and patients populationsConsumer satisfaction driving more demand and lower costsDisciplined focus on data security, driving increased consumer confidence and suppliers’ oversight. 

    Removing barriers to access telemedicine’s part of these trends. It can improve healthcare quality and removes geographic limitations on access. It’s becoming easier to match providers to community needs.

    These are encouraging signs for Africa’s telehealth priorities.

  • Ghana prioritises telemedicine for universal health coverage

    The Novartis Foundation and the Ghana Health Service have announced the successful integration and scale-up of a pilot telemedicine programme started in the Ashanti Region in 2011.  Full national coverage of telemedicine services is expected to be possible by 2019. 

    The telemedicine programme strengthens healthcare capacity by empowering community health workers, while also improving the quality of their care.  Additionally, this avoids unnecessary referrals, thereby reducing transport costs for patients. 

    Community health workers make use of mobile technology to connect to health professionals and specialists via a tele-consultation centre.  Doctors, nurses and midwives in the tele-consultation centres instruct community health workers and advise on the treatment of their patients, particularly in emergency care. 

    The success of the telemedicine model has prompted Ghana Health Service to implement the programme across the nation as part of its national e-health strategy to improve healthcare delivery.  With sustained government leadership, this initiative could transform healthcare for years to come.

  • Ghana will have a national telemedicine service next year

    Pilotitis become a phenomenon a few years ago as scaling-up eHealth pilots became too challenging. Good scale-up news is the recent  telemedicine initiative by Ghana Health Service and The Novartis Foundation, They’ve announced the successful integration and scale-up of a telemedicine service. National coverage’s planned for 2019. 

    The 24-hour telemedicine service uses mHealth for community health workers to consult specialist health professionals at teleconsultation centres on a range of health topics, including emergencies. It builds from the telemedicine pilot started in 2011 in the Ashanti Region’s Amansie West District.

    An important lesson for other African countries’s the timescale. Seven years may seem like a long time, but eHealth does take time to come to fruition. Over the period, telemedicine has encountered some specific changes. mHealth opportunities have replaced conventional conferencing technology, now obsolete and looking a bit clumsy and chunky.

    Ghana may have set a standard for other African countries to follow. It represents a considerable technological achievement in modernising and transforming healthcare.