Tom Jones

eHealth strategist, planner and evaluator

  • ADB eHealth guidance says look at the forest and the trees

    Managing and investing in eHealth’s seen as similar to forest management. Both are complex ecosystems. A Peter Drury blog from the Standards and Interoperability Lab – Asia (SIL-Asia) emphasises the large number of dynamically, interacting elements that where. Each element in the system may not know about the behaviour of the whole system. 


    Five-year strategic visions and plans help. The WHO/ITU National eHealth Strategy Toolkit provides guidance for these, but they’re not enough. Managing a complex sets of real-time elements is a greater challenge. It’s the core of Guidance for Investing in Digital Health, an Asian Development Bank initiative. 


     It’s based on how stakeholders engage, or don’t engage, with current systems, and how well, or not, they’re supported by management, technical, and workforce foundations. Investment appraisals and decisions spring from these,


    Instead of a five-year cycle, eHealth policy-makers should:


    • Monitor progress
    • Adapt to emerging challenges and opportunities
    • Manage expectations and investment. 


    The ADB’s Digital Health Impact Framework User Manual, linked to the Guidance, provides a methodology for these activities. It too is iterative, and addresses short and long-term requirements. 


    Pressure for quick wins doesn’t help. To counter this, the Asia eHealth Information Network (AeHIN) and SIL-Asia support work on Digital Health Governance Architecture and the Mind the GAPS programme covering governance, architecture, programme management, standards and Interoperability.


    While these are Asian initiatives, Africa can begin to adopt them. Using components that fit each countrys’ health systems is the way to start. It’ll set them on a trajectory of proven good practices.



  • Medopad aims for doctors’ and patients’ information to reach beyond healthcare

    Based in London, the Medopad mission’s to build solutions that provide the right information to patients and doctors when patients are beyond healthcare settings. It says this’s 95% of the time. 



    Activities that its data support includes:

    • Better medical diagnoses
    • Enhanced treatments
    • Expanded professional knowledge
    • Empowered public
    • Faster and better collaboration of medical teams.

    It claims its services are used by the “world’s leading healthcare providers.” 

    Medopad’s examples include four major London Hospitals: 



    Its data range includes: 


    • Medication tracking
    • Blood glucose monitoring
    • SP O2 logs
    • Walk tests
    • Weight measurement
    • Symptom logs
    • After care videos
    • Support groups.


    These are for four main conditions:


    • Rare diseases
    • Metabolic diseases
    • Cardiovascular
    • Cancers.


    Health insurers use Medopad to reward policyholders for healthy behaviour. Benefits include increased retention, lower risk and bespoke policies.


    Pharma’s a development project. Three goal are to use Medopad’s real-time data to develop more effective drugs, accelerate medication trials and to close the gap between suppliers and hospital.


    How long will it be for Medopad to be used across Africa? Does its emphasis on tertiary hospitals and rich countries’ health insurance mean that Africa’ll be towards the bottom of its priorities?


  • A study designs a model to manage eHealth evaluation

    eHealth evaluation isn’t a common activity. A study in the Journal of Medical Internet Research, says the importance of evidence hasn’t been discussed as rigorously as the diverse research approaches and evaluation frameworks have been discussed.


    From this position, the team’s objective was to elucidate how evidence of eHealth effectiveness and efficiency can be generated through evaluation. It developed a model to help. Evidence in eHealth Evaluation comprises:

     

    It aims to show how evidence can be generated by evaluating certain aspects at each intervention phase. Assessing distinct aspects during distinct phases is a novel concept discussed in this study and requires further analysis.


    It’s consistent with Digital Health Impact Framework (DHIF) designed for the Asian Development Bank (ADB) and Standards and Interoperability Lab Asia (SIL-Asia). It also has some differences. DHIF. For example, DHIF includes optimism bias and risk exposure, and emphasises the different impacts, especially benefits, across a range of stakeholder types.


    The study implies an inconsistency between literary eHealth evaluation concepts and practices. It

    found that eHealth evaluation isn’t common in design and pretesting phases. Acfee’s view’s that it isn’t common before these, at the strategic and business case decisions stages that seek preferred options that commissions designs. It’s also rarely used at eHealth procurement stages. 


    It seems feasible to stretch Evidence in eHealth Evaluation model to include eHealth components on a wider timescale. Adding extra components within its timeline seems possible too. It is a conceptual model in its preliminary stages, so still being developed. It’s not a prescription, but a way to show a reliable progression of evidence in eHealth intervention. Africa’s health systems could build from it too.


  • AeHIN sets up its Community of Interoperable Labs (COIL)

    Six countries’ health systems have formed the Asia eHealth Information Network (AeHIN) Community of Interoperable Labs (COIL). The Standards and Interoperability Lab-Asia (SIL-Asia) is guiding the initiative. Viet Nam, Malaysia, Thailand, Philippines, Indonesia, and Taiwan commitment to interoperable health systems at the 6th Asia eHealth Information Network (AeHIN) General Meeting and Conference on Interoperability for Universal Healthcare Coverage (UHC).

     

    A blog by SIL-Asia says the Regional Interoperability Workshop organised by the AeHIN at the the Global Health Research Forum in August 2015 was the genesis. SIL-Asia was set up as a regional health interoperability lab to meet the needs of Asian countries for a facility to benchmark emerging digital health technologies in the market. The benchmarking criteria are common international standards for interoperability or systems to exchange usable data and information.

     

    COIL is a community of Asian countries committed to establishing their own interoperability labs (IOL). These will focus on digital health interoperability and facilitate national health data and information exchange to support evidence-based healthcare.

     

    It’s a knowledge sharing community too. Each country is expected to share their lab technologies, artifacts and documents with one another to promote inter-country co-operation on standards and interoperability.

     

    Other countries can join COIL too. Teaming with SIL-Asia is the way in.

     

    SIL-Asia and COIL are models that can benefit Africa’s health systems and their eHealth initiatives. Which entities will provide the sustainable finance needed.  



  • Expect more cyber-attacks on healthcare

    The next cyber-attack never seems far away, and healthcare may be in criminals’ sights. A UK conference organised by The Guardian, a newspaper, and supported by technology company DXC, has some dark, ominous warnings for the UK’s NHS. They apply to healthcare everywhere.

    The report says some NHS employees expect another cyber-attack similar to WannaCry. In 2017, it caused widespread disruption to hospitals and GP surgeries. Not enough has changed to seek to avoid it.

    Poor leadership, budgetary constraints, deficient ICT systems and a lack of qualified staff combine to make the NHS vulnerable. A member of parliament and chair of the UK parliament’s public accounts committee commented that these limitations are exacerbated by:

    • No particular benefit for patients from good eHealth
    • eHealth isn’t a big enough issue
    • It’s not an instant win
    • Many NHS staff don’t trust their IT systems.

    Lack of clarity on patients’ benefits is another theme that needs attention. It reveals inappropriate eHealth investment.

    A report on the WannaCry incident by the National Audit Office (NAO) found that the attack could have been prevented by basic ICT practices. Cyber-security was weak too. An NHS Digital cyber-security assessment of 88 England’s NHS trusts, about 37%, before WannaCry found none passed. NHS Digital has no power to require action. Consequently, the NHS remained vulnerable.

    These commentaries and findings provide a vital checklist for all health systems’ cyber-security and eHealth investment activities and goals. Waiting for the next attack without preparation’s a high risk approach.

  • 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 overview
    • Interactive implementation guide
    • Business continuity plan
    • Communication
    • Fact sheet
    • Fever overview, protocol and role play templates
    • Postpartum haemorrhage overview and protocol
    • References
    • Rollout template
    • What to look out for.

    There are two videos:

    • Ghana Telmed Toolkit Video 1
    • Ghana 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 countries
    • Leverage 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 role
    • Hospital referrals can reduce by 31%
    • Empowered CHWs
    • Better healthcare quality
    • Reduced 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.


  • AI, blockchain, cold chain and motorbikes improve blood donations and save lives in Nigeria

    Blood shortages are common in many health systems. An initiative in Nigeria uses mHealth to create a community of voluntary blood donors, and connects hospitals with blood banks, and blood banks with donors. Life Bank, a Lagos start-up also provides a discovery platform on for hospitals to order blood

    LifeBank delivers requested blood in less than 45 minutes, in a WHO Blood Transfusion Safety compliant cold chain. An article in Disrupt Africa says it’ll add other medical products such as oxygen, vaccines and rare drugs to its services.

    Its founder, Giwa-Tubosun, began a non-profit service to encourage people to donate blood. She then moved on to address supply shortages and poor logistics. Two main goals are:

    • Increasing access to blood
    • Reducing the number of Nigerian women who die from birth complications.

    LifeBank’s resources include:

    • AI
    • Blockchain
    • Cold chain
    • mHealth
    • Motorbikes.

    These combine to provide information about blood availability and avoid health workers’ wasted time and frustration seeking blood products. They also minimise ineffective blood transports that result in bacteria proliferation and consequences of health complications.

    Supporters include:

    Its impact is considerable. To date, LifeBank’s delivered some 11,000 products for over 400 hospitals. Over 6,300 people are registered as voluntary blood donors, with over 20% donating blood in the last two years. The result: over 2,100 lives saved.

    A challenge is convincing blood bank partners to use LifeBank. As this is  overcome, it’s it easy to envisage LifeBank eventually operating across Africa.


  • Commonwealth Centre for Digital Health and ECH Alliance to launch their joint action plan

    Working and sharing with eHealth agencies offers mutual benefits. At the Digital Heath Week 2018 in Sri Lanka, the Commonwealth Centre for Digital Health (CWCDH) and the European Connected Health Alliance (ECH Alliance) met and agreed their joint action plan. It was originally envisaged in the partnership agreement announced in May 2018.


    The full action plan will be announced shortly. It will include:


    • On 20 November 2018, launch of an ecosystem in Malta, both a European and a Commonwealth country
    • Uganda’s ecosystem will be a nexus for collaboration across East Africa for CWCDH. Health
    • Organisation of a Commonwealth Digital Health Skills Summit early in 2019 to connect existing skills programmes with the needs of many Commonwealth countries
    • Launch of ecosystems in Sri Lanka and Uganda in early 2019. 


    These will comprise the beginnings of the Commonwealth Connected Health Alliance. Its aim will be exemplars for ecosystems across the Commonwealth. 


    Prof Dissanayake’s chair of CWCDH. He said “We decided to work together because we share the same mission and values and by joining forces we hoped we could deliver faster and do more better.” He is satisfied that considerable progress has been achieved in just a few months. The plan now’s to build on the value of the partnership with ECH Alliance and move forward with constructive activities as part of the commitment to work jointly with.


    COO of CWCDH, Anoop Singh said the partnership’s main goal’s to deliver real benefits, not to try to do everything. Bringing together eHealth stakeholders and collaborators from Europe, the Commonwealth and beyond will contribute to meeting numerous needs and opportunities.


    ECHAlliance chair Brian O’Connor is convinced that the collaboration will bring mutual benefits to everyone involved. His view’s based on discussions with people from over 40 Commonwealth countries. He sees their progress, innovations, determination and passion as a vital ingredient for future success.


    CWCDH will hold an event during the World Health Assembly (WHA) in Geneva in May 2019. The goal’s to obtain the commitment of Commonwealth governments to CWCDH’s planned activities. 


    Nineteen countries are Commonwealth members. If the benefits spill into the rest of Africa, the partnership will have proven its worth.

     


  • EHR’s financial benefits may be elusive


    Acfee’s stance on EHRs is that they’re an investment in health and healthcare, not an initiative to increase healthcare organisations’ income. The Acfee eHealth Impact Database contains over 60 evaluations. A common theme is that the extra cash needed for eHealth exceeds its cash savings. Healthcare quality and productivity are the main sources of benefits. The affordability planning and management lessons are clear for Africa’s health systems.


    It seems that US healthcare may see it differently. An article in Modern Healthcare says hospitals and health systems each spent millions and sometimes billions of dollars on EHRs. Examples are: 


    • Trinity Health reported a US$107.8 million asset impairment charge in 2018 to switch to a single version of Epic EHR and revenue cycle management software over four years and undisclosed costs
    • Mayo Clinic spent US$1.5 billion on Epic HER
    • Partners HealthCare spent $1.2 billion on an Epic HER
    • Scripps Health reporting weakened financial results when started an EHR conversion budgeted at US$300 million over ten years, with estimated operating costs of US$360.5 million, 20% more than the non-recurring costs
    • Banner’s US$45 million project contributed to a US$92 million hit to university delivery operations 2017 when it spent US$24.3 million on EHR conversion.


    Modern Healthcare says the promised clinical and financial benefits have been elusive. Some healthcare organisations have suffered financial problems when eHealth has worked against them. In particular, hospitals and health systems have faced financial stress when implementation costs drive up operating costs, a Capex Opex imbalance.


    Doctors and other clinicians have been wary of embracing eHealth too enthusiastically. Concerned that they may feel held back by it and causing clinician burnout.


    A literature review in the Journal of the American Medical Informatics Association said it revealed evidence that “Data entry requirements, inefficiently designed user interfaces, insufficient health information exchange from outside institutions, information overload, and interference with the patient–physician relationship are … factors associated with physician stress.”


    Some explanations are: 


    • There’s going to be some disruption when implementing EHRs so budgeting and financial planning, including contingencies helps to avoid financial crises
    • To ensure successful EHRs may need extra resources after implementation to mitigate financial risks
    • Looking at EHRs in the long-term, rather than two- or three-year returns, can be helpful
    • It’s inevitable that new eHealth, especially large-scale EHRs, will slow patient volume temporarily as providers learning to use them, so are less productive
    • Plan for eHealth complexities that diminish returns from EHRs, including procurement costs, deployment and increases in higher ICT operating costs, higher departmental operating costs and lower productivity and lower employee satisfaction. 


    Africa’s health systems can’t afford these outcomes. Rigorous business cases, an emphasis on health and healthcare benefits and top class eHealth leadership can help to avoid them.

     


  • Mongolia’s completing a big scale eHealth project

    Remote, large and sparsely populated; Mongolia offers a lesson on pursing a wide range of eHealth investment. Tucked in between Russia and China, it’s a country of about 3.1m people spread across 1.5m km. About half the population live in Ulaanbaatar, the capital.

    Dr Sereenen Enkhbold, Mongolia's eHealth Project Coordinator presented his country’s Role of E-Health Project in improving health information interoperability in Mongolia at Asia eHealth Information Network (AeHIN) 6th annual conference in Colombo, Sri Lanka. The objective’s to improve integration and utilisation of health information and eHealth solutions for better health service delivery. It’s about half way through four-year the project that started in 2016.

    The project, financed extensively by the World Bank incorporates:

    • Health sector enterprise architecture
    • Health data and information technology standards DICOM, LOINC and HL7
    • Health data dictionaries
    • HIE platform
    • Health statistics and dashboard
    • eHealth apps
    • Investments in primary healthcare facilities.

    The next phase includes benefits realisation and change management. Taken together, the project is a benchmark for Africa’s health systems.