Tom Jones

eHealth strategist, planner and evaluator

  • International SOS Foundation releases a teleconsultation guide

    The Medical Dictionary describes two types of teleconsultation. One is between doctors. The other’s between doctors and patients. It refers to networks and video links. Smartphone services such as Figure 1 is an example of a more modern version. It includes nurses too.


    Help in setting up and managing teleconsultation is available from the the International SOS Foundation. It’s launched a white paper on the topic, endorsed by the International Society for Telemedicine & eHealth (ISfTeH).


    Teleconsultation Services for the Mobile Workforce; Considerations & Guidelines for the Provision of Global Services in Compliance with Regulations & Best Practice Clinical Standards of Care provides insights into essential aspects needed to assess teleconsultation services. They include:

    • Country level review of legal requirements
    • Guidelines on clinical best practices, including local healthcare environment, clinical expertise of disease threats at patients’ locations and integration into the local healthcare systems
    • Case studies for corporate and educational sectors
    • Global best practices for assessing teleconsultation services.

    It can help Africa’s health systems to develop their telemedicine services towards broader teleconsultation services. Modern mHealth technology offers considerable opportunities.



  • ISfTeH’s next annual meeting’s in Portugal

    On 19 to 20 March 2019, the International Society for Telemedicine & eHealth (ISfTeH) conference will be underway in Lisbon, Portugal. Partners include the annual Portugal eHealth Summit which’s co-organised by ISfTeH’s institutional member, Centro Nacional TeleSaúde, part of the Shared Services of the Portuguese Ministry of Health (SPMS). The Portugal eHealth Summit is the largest eHealth event in Europe, bringing together some 10,000 stakeholders from the Portuguese National Health Service.


    It’s ISfTeH’s 24th International Conference. The range of topics is huge. They include:

    • Technology to:

    o   Monitor  vital signs for long term conditions

    o   Health management of service users with severe mental illness

    o   Facilitating integrated care in wider communities

    • Global Digital Health Index’s state of global digital health
    • Telemedicine’s potential for UHC in Portuguese-speaking Countries
    • Injecting the human side of telemedicine and eHealth
    • Economic evaluation of an new guideline of an online clinic in Japan
    • Considerations and guidelines for global teleconsultation
    • Physicians' experiences, attitudes and challenges in a paediatric telemedicine service
    • Algorithms for predictive medicine
    • AI for healthcare professionals
    • Big Data and tele-ECG
    •  eHealth data protection with GDPR
    • Effective digital tools for everyday practice
    • Portugal’s experience of telehomecare and telemonitoring
    • Putting IoT to work for caregivers
    • Is technology the solution for chronic disease management?
    • Tele-ECG network in Southern Brazil
    • AI and telemedicine for heart failure diagnostic support
    • Practice guidelines for primary and urgent care
    • Can telemedicine reflect healthcare system investment Needs?



    Details of the event will be available soon.


  • AMA has a structure for choosing EHR providers

    Procurement sits between EHR strategy and implementation. It’s a challenging process and needs a rigorous structure to assess providers and choose a few to move on to a procurement short list, The American Medical Association (AMA) has a checklist that helps to find a vendor worthy of a long-term partnership. It’s step 4 in the Part 2, the Pre-Game section of the American Medical Association® Digital Health Implementation Playbook.


    Selecting and Vendor Guide aims to find a long-term partner, not just an organisation to execute a set of transactions. Speaking with similar organisations or practices can provide valuable information and insights needed to construct shortlists of quality vendors. eHealth conferences can be another source.


    Discussions are not enough. Structured market research and activity’s needed too. AMA suggests: 


    • Build a Request for Proposal (RFP) that clearly outlines the goals that define success
    • Send RFPs to vendors that most closely align to these goals
    • Review RFP responses alongside key representatives from core and advisory teams
    • Ask for case studies and referrals
    • Schedule live vendor demonstrations with members of the core, advisory and implementation teams
    • Evaluate vendors across six critical factors:

    o   Business

    o   ICT

    o   Security

    o   Usability

    o   Customer service

    o   Efficacy and clinical validation

    • Narrow options to one or two preferred vendors in the pitch to leadership.


    Usability includes interoperability. Efficacy includes the vendors’ abilities to deliver organisational goals, metrics and Key Performance Indicators (KPI). For large-scale, strategic investment lick EHRs, three options may be more appropriate in revealing the differences between vendors’ technical services and cultures that are available. 


    AMA’s playbook can help Africa’s health systems to enhance the structure and sustainability of moving their EHR projects from investment decisions towards implementation. Procurement’s tough. Vendors are smart and used to the processes. AMA’s guidance helps to rebalance them.



  • An approach to regulating medical devices from the US FDA's now out

    Effective regulation’s a vital part of setting and maintaining high standards. In an article in Frontiers in Medicine, Tina Morrison and her colleagues describe an approach by the US Food and Drug Administration (FDA). Its Center for Devices and Radiological Health (CDRH) regulates medical devices, and emphases regulatory science with computational modelling for medical devices.

    Computational modelling is an increasingly powerful evaluation and regulatory tool for medical devices. Dealing with merging technologies resulting in novel products is one of the FDAs challenges. Using computational modelling can transform medical device design and evaluation. It can simulate treatment outcomes and clinical trials for imaging systems.

    The simplest and most common use of computational modelling for medical devices is simulating their performance under a variety of conditions that mimic aspects of clinical or use environments.  

    The primary use is for regulatory submissions is identifying appropriate bench testing configurations, such as worst-case or clinically challenging conditions, for cardiovascular, orthopaedic, and surgical implants. Its second common use is to provide evidence that supports safety assessments of patients with and without implanted devices when they’re exposed to radiofrequency (RF) fields of MR systems.

    Continuous development is underway too. A CDRH team is developing and validating a framework for streamlining the market entry of imaging systems relying solely on simulation instead of clinical trials.

    Using the approach to the increasing range of mHealth and wearables could close the knowledge gap. Directing users, especially clinical professionals to devices that do what the claim to do will be a huge step forward for Africa’s mHealth initiatives.


  • A playbook to help successful eHealth investment's from AMA

    Good practice is always a good idea. The American Medical Association (AMA) has combined a wide range of good practices for eHealth. American Medical Association® Digital Health Implementation Playbook is built from an assessment that:

    • Digital tools that enable new methods and modalities to improve health care, enable lifestyle change, and create efficiencies are proliferating quickly
    • Clinical integration of these tools is lacking, so needs changing.

    It’s a valuable guide for Africa’s health systems. The four parts:

    • Warm up
    • Pre-game
    • Game-time: remote patient monitoring
    • Post-game resources.

    The playbook addresses four key requirements as questions for doctors adopting eHealth:

    • Does it work?
    • Will I receive payment?
    • Will I be liable?
    • Will it work in practice?

    These underpin several eHealth perspectives:

    1. WARMUP

    • Introduction to eHealth implementation playbook
    • Introduction to eHealth solutions
    • What’s remote patient monitoring?
    • Remote patient monitoring in practice for hypertension
    • The implementation path

    2. Pre-game

    • Identifying needs
    • Forming teams
    • Defining success
    • Evaluating vendors
    • Making the case for eHealth
    • Contracting

    3. Game time for remote patient monitoring

    • Designing workflows
    • Preparing care teams
    • Partnering with patients
    • Implementation
    • Evaluating success
    • Scaling

    4. Post-game resources

    • Idea intake form as an idea prioritisation worksheet
    • Team structure framework
    • Team structure worksheet
    • When to engage teams
    • Using the quadruple aim to establish eHealth value
    • SMART goals overview
    • Selecting a vendor guide
    • Vendor information intake form
    • Cyber-security knowledge needed
    • Navigating digital medicine coding and payment
    • Key financial and legal documents
    • Key considerations for designing implementation workflows
    • Clinical roles and responsibilities
    • What if plans for patients
    • Lessons learned worksheet.

    All four parts contain an eHealth investment process for healthcare organisations. In defining the steps, their next job is to assemble the information to support each decision.

  • Research2Guidance publishes its eHealth connectivity report

    Working within ecosystems is increasingly important for eHealth. Research2Guidance third report of its mHealth Economics 2017/2018 program deals with connectivity. It sees mobile apps as the core of eHealth connectivity hubs. These extend connectivity to wearables, tracking sensors, medical devices, tools, access to third party aggregated health data and EHRs.


    The report is an introduction to mHealth connectivity in mobile health. It discusses the connectivity landscape too. Contents are: 


    • Tool usage
    • Connecting to health data via APIs
    • Connecting to sensors and wearables
    • Connecting to API aggregators
    • Connecting to electronic health records
    • Outlook on the future of connected devices. 


    These provide answers questions of:


    • What eHealth connectivity options exist?
    • To what extent are eHealth publishers connecting to sensors and wearables?
    • Which tools are mHealth app developers using?
    • Are mHealth app developers offering Application Programming Interfaces (API) for their apps?
    • To what extent do they use aggregated health data through APIs?
    • Which roles do EHRs play in eHealth?
    • How will connectivity to sensors change in the near future?


    It’ll provide a wide range of stakeholders with insights needed for mHealth strategies, plans and initiatives. As Africa’s health systems keep building on their mHealth investments, the report is helpful in moving them on.


  • Using drones in healthcare supply chains is now proven

    Healthcare for Africa’s rural and remote communities is demanding. Supply chains can be long and time-consuming. Drones can help, and while they may have been a bit fanciful as an idea, they’re now proven. Two companies are doing it.

    Zipline, a global drone company, has a regular service in Rwanda. It delivers drugs and vaccines to remote communities. The steps to delivery are:

    • Health workers use text message to the Zipline distribution centre to order the medical products they need
    • Items are pack and prepared for flight in a few minutes, maintaining cold-chain and product integrity
    • Confirmation to health workers that their order launches
    • Direct delivery at over 100 kmh, faster than other transport modes, delivered gently by parachute into a designated area the size of a few parking spaces, obviously with no pilot
    • Health workers receive a text message notifying them that a delivery is completed.

    In April 2018, the UPS Foundation announced it was expanding its work with Gavi, the Vaccine Alliance and Ziplineto to use drones to deliver blood and medicines to Rwandas’ remote communities. Since October 2016, the partnership has made over 4,000 drone deliveries of over 7,000 units of blood to remote hospitals across the country. UPS says it’s the world’s first national medical drone delivery network, and is being developed throughout Rwanda.

    In Tanzania, an article in UAS Vision says DHL, a global delivery services, has completed a trial using Wingcopter to deliver medicines over 60 km in 40 minutes from Mwanza to Nansio district hospital on the island of Ukerewe in Lake Victoria. Over 160 proving flights were completed. It takes about six hours to deliver by road.

    Now, 400,000 people living in Ukerewe District now have healthcare access in hours, not days. Three other districts are served too, totalling over 10 million people. It follows the success of DHL’s test to ensure reliability of deliveries beyond line-of-sight and the return of the drone.

    These services show that drones should be a routine component of Africa’s healthcare supply chains. While remote services are current priorities, urban areas will benefit too as drone technology develops.

    -------------------


    Image from dronebelow.com

  • WHO can help you keep up to date on global eHealth trends

    Awareness of eHealth achievements and dynamics from other users is crucial in framing eHealth strategies, investment decisions, benefits realisation and mitigating risk exposure. Finding the information’s often a challenge. A new publication from Johns Hopkins University Bloomberg School of Public Heath in collaboration with WHO can help.

    The first issue of Global Health: Science and Practice was supported by an Aetna Foundation grant. It deals with five themes:

    These themes fit into WHO’s eHealth themes of information and research, governance, financing, workforce and health services. Africa’s health systems can use the findings to support the sustainability and direction of their eHealth trajectories.

    Within these, it’s important to avoid strategic mistakes identified by Rosabeth Kanter:

    • Rejecting opportunities that initially seem too small
    • Assuming that new services and improved processes aren’t strategic goals
    • Launching too many minor service changes the confuse stakeholders and increase internal complexity.

    These are some of her innovation traps. Africa’s health systems don’t need them.


  • AeHIN says good eHealth governance methodology can transform health systems

    Information from eHealth investment’s reaches into many health and healthcare activities. Successful utilisation and benefits realisation needs effective governance.


    Asia eHealth Information Network (AeHIN), with support from the Asian Development Bank (ADB) and CC and C Solutions, an ICT training firm, has crafted a set of governance and architecture methodologies.  It aims to help health systems start the work needed to guide their eHealth projects at national scale.


    In a blog on Standards and Interoperability Lab Asia (SIL-Asia), Alvin Marcello says nine countries agreed to create the Health Information Governance and Architecture Framework (HIGAF). It’s based on a simplified Control Objectives for Information and Related Technologies 5 (COBIT 5) framework. 


    HIGAF helps developing countries address their health sector needs. It complements the Convergence Workshop for Ministry of Health national eHealth strategies. Many developing countries are accelerating their eHealth investment, but have yet to work out their governance approaches. 


    The governance initiative is part of a long-standing series of AeHIN initiatives that include: 



    AeHIN’s sustained focus and support is a collaborative model for Africa’s health systems. A challenge is the raising the finance to achieve.



  • Web sites need cyber-security too

    Malevolent hackers are smart. They know that many organisations’ websites are vulnerable to attacks. Akamai, a cloud security outfit, estimates that it costs attackers about US$40 to mount an attack, smaller than a peanut compared to the gains.


    Its infographic, Does my Enterprise Need  Web Application Security? is available from Health IT Security. It describes the threats and preventive measures. Most alarming’s its estimate that productivity losses of 98% arose from websites compromised in the last 12 months. About 86% have serious vulnerabilities. Most of the attacks are random, with robots searching for vulnerabilities.


    Akamai’s data shows the estimated range of attacks from Distributed Denial of Service (DDoS) activities were: 

    • Human - 8%
    • Servers - 30%
    • IoT - 62%




     A solution’s a Web Application Firewall (WAF). About 40% of websites have between none and two. The 6% have more than three. Agamai’s estimate is that a WAF needs three Full Time Equivalent (FTE) staff. 



    Africa’s health systems need these types of cyber-security measures in place for their website plans. Without them, the disruption will degrade their benefits.