Tom Jones

eHealth strategist, planner and evaluator

  • Cyber-security has a smarter step up

    Chasing cyber-threats is a wearisome endeavour. A US healthcare provider’s relying on analytics to deal with some of the drudgery and anxiety. RWJBarnabas Health has twelve hospitals and some 250 clinics. A report in Fierce Healthcare says it’s halfway through a four year cyber-security upgrade that uses data analytics and network visualisation tools to track who’s accessing patient data and which devices are connected to the network. The aims are to detect and report threats and provide its system with more latitude to integrate mobile devices and step up mHealth.

    It’ll also improve the ICT department’s productivity to conduct manual network scans to identify new devices as they were connected. Now, it uses software to track devices in real-time and deploys monitoring tools to track the movement of patient data.

    It may be a benchmark for Africa’s health systems’ cyber-security trajectory. Balancing data sharing and network accessibility with privacy and security’s a challenging prospect with limited numbers cyber-security staff. Using analytics can be part of the solution. 

    The US healthcare systems are enduring sustained, and possibly increasing cyber-attacks. A recent report from Protenus Breach Barometer says almost three times more patient records were accessed in March compared with February and January combined. About a third of March’s 39 breaches were linked to hacking. Nearly 85% targeted hospital providers. These risks could increase as healthcare adopts more Internet of Things (IoT) initiatives and there reliance on networked devices.

  • mHealth good practices can reduce avoidable readmissions

    Many people don’t like the prospect of being admitted to hospital. It’s tolerable when it’s unavoidable. Being readmitted when it’s avoidable’s not a pleasant step, both for patients and their families and friends. A report from Mobile Smith, an app platform provider, says about 70% of the US’s hospital readmissions are avoidable. It’s hard to find equivalent numbers for Africa’s health systems.

    How Mobile Apps Can Reduce Preventable Readmissions sets out efficient app strategies that lead to quick impact on reducing avoidable readmissions. They’re:

    •  Effective discharge communication to minimise poor communication with patients and families members at discharge, a main reason for readmissions arising from confusion about follow-up care and prescribed medications
    •  Better discharge procedures that include education, communications with patients and families, support after discharge and fewer unresolved medical issues needing action after discharge, all of which result in lower readmission and improved patient outcomes
    • Use an app for post-discharge with interactive functions that includes promoting self-reliance, empowering patients to take charge of their health, connections to EHRs’ messages, managing appointments, access to educational articles and storing documents and notes
    •  Improving prescription adherence, including knowledge of the purposes of their medications and interactions, to improve health outcomes by tracking medication doses and intervals receiving medication reminders and recording reactions.

    There are six good practices:

    •  Research, know and understand target patient groups
    • Start simple and iterate often
    • Polish user interfaces and experiences
    • Keep apps fresh
    • Establish secure data exchanges
    • Embrace analytics to track utilisation and understand positives and negatives.

    These are valuable requirements for all mHealth initiatives. Africa’s developers and users can benefit by adopting them.

  • Sierra Leone sets up a National eHealth Coordination Hub

    Succeeding with eHealth’s complexities across national health systems invariably needs a core organisation. Sierra Leone’s Ministry of Health and Sanitation has set up its National eHealth Coordination Hub to co-ordinate and regulate eHealth. It’ll also support eHealth expansion across the country’s health system. The Ministry of Information and Communications is a leading part of the initiative too.

    A report in Awoko says support’s provided by UNICEF as part of a US$2 million project financed by the United States Agency for International Development (USAID) to strengthen Sierra Leone’s eHealth Management Information System in Sierra Leone. It’s part of the US Government’s commitment to strengthen health systems and services after Ebola. Laurie Meininger, Deputy Chief of Mission, said the Awoko that “Sierra Leone is taking a step in the right direction, recognizing the growing importance of health coordination for the future health and sustainable development goals in Sierra Leone.”

    The Hub has three main goals I supporting the government’s eHealth ambitions. They’re:

    • Co-ordination
    • Regulation
    • Improve alignment of data with national health system goals.

    Acfee’s regulations database has extending across 64 eHealth regulation topics shows Africa’s health systems trailing those on other continents. Catching up’s a big task that needs resources for regulation risk assessments, regulation decisions and compliance reviews. Selecting and implementing relevant and appropriate priorities are essential to expanding eHealth regulations.

    It’s an important achievement. For Africa’s health systems, affordable, sustainable eHealth decisions are tough to take. Creating the Hub provides Sierra Leone with a constructive way to take them. 

  • MapmyIndia and VISIT launch mHealth for Inida’s Swastha Bharat

    As mHealth moves towards more sophisticated services, collaboration between suppliers creates opportunities to move ahead. A report on India’s Outlook  news scroll says MapmyIndia, a digital map, GPS and tracking service, and VISIT Internet Services, provider of a range of getvisit apps are working together to support the government’s Swastha Bharat, a video and radio health magazine available through 30 regional kendras, types of charitable trusts. Doordarshan and All India Radio are the broadcasters. 

    It’s an mHealth service for people living in smart cities and, those with populations between 50,000 and 99.999, the tier-2 towns and villages. They’ll be able to access health services such as emergency ambulance services, finding nearby hospitals, clinics, labs and pharmacies, and a way to consult doctors and specialists by chatting, phoning and video.

    The new app’s powered by mapping technologies and AI-enabled telemedicine platform, respectively. VISIT developed the live chat service. It’s backed by India's top doctors who regularly review the information provided to users. It includes health recommendations about the most chatted issues, adjusted for users’ demographic data and past history. The aim’s to help them avoid health concerns. The chat assistant also provides updates on local epidemics and any preventive steps that users need to take. 

    It’s an mHealth initiative that Africa’s health systems could adopt for their towns and cities. From experiences in these locations, it may prove beneficial for some remote areas.

  • Will cyber-criminals go for medical devices next?

    Nothing on ICT landscape’s off limits for cyber-criminals. Attacking medical devices could be their next target. In the Rise of the Machines:  The Dyn Attack Was Just a Practice Run, the US Institute for Critical Infrastructure Technology (ICIT), a cyber-security think tank, says the Mirai Internet of Things (IoT) botnet has inspired more Distributed Denial of Service ( DDoS) botnet innovation. Its value’s enhanced by the lack of good practice cyber-security at design stages in the Internet and IoT devices. This harsh reality’s an opportunity for Africa’s eHealth to prepare for rigorous evaluations of IoT projects.

    Krebs on Security, a cyber-security news and investigation service, says  IOT’s botnet source code was responsible for the DDoS attack against it. A conclusion drawn from the incident by Kerbs is

    that the Internet will soon be flooded with threats and attacks from many new botnets powered by insecure routers, Internet protocol (IP) cameras, digital video cameras that can send and receive data with a computer network and the Internet, and used for surveillance, digital video recorders and other networked devices that are easy to hack. 

    ICIT provides a comprehensive and detailed analysis of the new threat. Stakeholders have been driven to recognise and accept the design security weakness and the prevalence of vulnerabilities inherent in IoT devices. Its report includes:

    •  A concise overview of the basic Internet structure, including key players and protocols of the International Organization for Standardization (ISO) Open Systems Interconnection (OSI) and Transmission Control Protocol/Internet Protocol (TCP/IP), used to govern computer systems’ connections to the Internet
    • DDoS anatomy,  including details on constructing botnets, conventional  botnets compared to IoT botnets and launching a DDoS attacks
    • An overview of the Mirai Incidents, including KrebsonSecurity, OVH cloud and  Internet Service Provider (ISP), Dyn, Liberia, Finland, the US Trump and Clinton presidential campaigns, WikiLeaks and Russian banks
    • Evolution of IoT malware, including profiles Linux.Darlloz, a worm, Aidra, QBot and Qakbot, BASHLITE, Lizkebab, Torlus, gafgyt and Mirai
    • A discussion on the sectors at greatest risk including healthcare
    • Recommendations and remediation to combat these threats.

    The ICIT report is essential reading for Africa’s health systems. It can help to prepare cyber-security plans for their forthcoming IoT initiatives.

  • eHealth SME start-ups aren’t booming yet

    As a relatively new and constantly changing industry, eHealth can expect the role of Small to Medium-sized Enterprises (SME) to provide a significant contribution. Africa’s eHealth success could depend on them. An EU survey of over 300 European eHealth SMEs by eHealth Hub produced some surprises that highlight issues for Africa’s eHealth.

    About 39% of eHealth SMEs are in pre-revenue stages. Some 43% have revenues below €100,000. Taken together, that’s 82% in early development stages.

    These point to an EU market that’s still maturing. While this may be the state of the SMEs, their solutions may be further ahead. Pascal Lardier, executive director at Health 2.0 says demonstration apps for Health 2.0 Europe have shown a consistent maturity over several years. His conclusion’s that the supply side is maturing faster than demand by consumers and healthcare.

    He’s also surprised that most SMEs, almost an even split for a total of about two thirds, work on B2B or B2B2C solutions:

    The EU differs from the US where the bulk of investment’s for B2C solutions. In the EU, it’s about 8%. It may be that the EU’s investment flow may be greater if B2C initiatives were stronger, with Europeans spending more as health consumers?

    83% of SMEs surveyed stated they were currently looking for funding. Their investors’ most important criterion remains commercial traction. About 37% of these start-ups also said they’d already raised a round of external capital, with 38% of that subset having raised over €1 million. Indicating that raising investment money without revenues is viable.

    Finding the right investors needs a combination of the right idea with the right plan to turn it into a successful business, Pascal Lardier’s advice’s to adopt an old “Ask for money and you'll get advice, ask for advice and you'll get money." Will this work for Africa’s eHealth SMEs?

  • Smart dashboards are essential for eHealth benefits

    Realising benefits depends extensively on maximising the number of users. It also depends on them using the data effectively. This, in turn depends on meeting their requirements. There are two main parts to this, the information they need and having in a format, style and presentation that they can use for faster decision taking.

    Tableau, a dashboard supplier, has a white paper saying there are four main ways to use data to improve healthcare:

    • Using analytics for better  population health management
    • Using real-time analytics to increase productivity
    • Aggregating and blending data to reveal and fix supply chain inefficiencies
    • Automating ad hoc visual analysis for better revenue cycle management.

    Providing more data doesn’t always help. The first step’s to simplify data that’s already available. It might easier said than done. In a hospital organisation, there can be a thousand or more health workers. Common themes for simplification include: 

    • Use data visualisation so users can quickly automate processes rapidly
    • Enable users to visualise and assimilate data the way their minds work
    • Helps users see and understand their healthcare data no matter how big it is, or how many systems it is stored in
    • Connect quickly to any data, analyse it and share insights to reveal opportunities to benefit patients, health workers and healthcare organisations.

    As Africa’s eHealth expands, it’s vital that these concepts are in place too. Maximising eHealth’s benefits depend on it. 

  • There’s an mHealth generation gap

    Technology adoption’s becoming shorter. Larry D Rosen said technologies that used to take dozens of years to become mainstream now achieve it in three to five years. Radio took 38 years to reach an audience of 50 million. Television took 13 years. Personal computers took 16 years. The Internet took a mere five years. Within these changes, different generations use technologies in different ways. Their questions, choices and web navigations aren’t the same. 

    Research in the Journal of Medical Internet Research (JMIR) aimed to learn more in the context of chronic conditions, an increasing challenge for people and healthcare systems. Smartphones and health apps are promising tools to change health-related behaviours and manage chronic conditions, but they may have different roles across generations. The study explored:

    •  The extent of smartphone and health app use
    • Socio-demographic, medical and behavioural correlations of smartphone and health app use
    • Associations of app uses and characteristics with actual health behaviours.

    A survey of 4,144 Germans aged 35 and older identified socio-demographics, presence of chronic conditions, health behaviours, quality of life, health literacy and the use of the Internet, smartphones and health apps.

    About 61% of the sample were smartphone users. Younger users undertook more Internet research net, were more likely to work full-time, have a university degree, engage more in physical activity, ate low fat diets and have a higher health-related quality of life and literacy.

    Almost 21% of smartphone users also used health apps. They were younger, less likely to be native German speakers, undertook more research on the Internet, more likely to report chronic conditions, engaged more in physical activity, ate low fat diets and were more health literate than people who used only smartphones.

    The profile of their health apps was:

    ·       Planning                            51%

    ·       Smoking cessation           44%

    ·       Healthy diets                     39%

    ·       Weight loss                        23%

    ·       Reminders                         36%

    ·       Prompting motivation        34%

    ·       Providing information         34%.

    There were significant associations between planning, health behaviour and physical activity. Equivalent links were found between feedback or monitoring and physical activity, and between feedback or monitoring and adherence to doctors’ advice.

    Two overall findings emerged. One’s that there were many smartphone and health app users. The other’s that a substantial proportion of the population was not engaged. The difference is attributed to age, socio-economics, health literacy and health disparities in mHealth use. A recommendation’s that health app developers and researchers should include the needs of older people, people with low health literacy and chronic conditions in their innovative endeavours. As Africa’s population increases and the demographics slowly change, this will be important to maximise the benefits.

  • eHealth for consultations can reduce hospital waiting times

    It’s inevitable that appointments with hospital specialists have waiting times. eHealth that provides online consultations can reduce them. A report in the New England Journal of Medicine (NEJM) Catalyst says NYC Health + Hospitals, an integrated healthcare system of hospitals, neighbourhood health centres, long-term care, nursing homes, and home care, has built an eConsult services that improves access to specialty care and reduces patients’ waiting times.

    It offers fast review of clinic referrals for specialists to provide clinical guidance to some referring providers. The initial pilot found 30% of referrals were either appropriate for management by the referring provider or needed extra work before patients were seen by specialists. Transforming these clinical and working practices has three lessons that Africa’s health systems can consider for their eHealth strategies and plans: 

    1.     Learn the unique needs and limitations of health systems’ referral processes so eConsult’s aligned specific needs

    2.     Specialty clinics must prepare for an appropriate eConsult workflow by designating a specialist reviewer who can triage each referral and allocate resources for patient communications and scheduling

    3.     Specialty providers must collaborate on the best care plan each patient and set clear expectations on communications and shared management. 

    The greatest waiting time reduction was a pilot clinics third next available appointments dropping from 37 days to eight days in the first six months, about an 80% improvement. Achieving an equivalent for Africa’s health systems can improve productivity and liberate some of their overstretched healthcare resources for redeployment to other patients, and minimise costly journeys for patients and save them time.

    Los Angeles County Department of Health Services provides acute and rehabilitative services with 19 integrated health centres. Fierce Healthcare has reported that its eConsult service achieved similar benefits. About 25% of patients resolve their health issues without visiting specialists.

  • eHealth could avoid and improve prescribed drugs

    As a concept, eHealth that can improve people’s health as much as a drug can, but without the same cost and side-effects, is good. Andreessen Horowitz, a venture firm, says it’ll work. It predicts digital drugs, will become medicine’s third phase, the successor to chemical and protein drugs we have now, but without the cost of bringing them to market. In the US, digital therapeutics don’t usually need Food and Drug Administration (FDA) approval, especially where they promote low-risk lifestyle or dietary changes.

    It’s part of eTherapies, or digital therapeutics. There are two types, medication augmentation and medication replacement. The report says several peer-reviewed studies show that the outcomes are better than drugs alone. About a dozen start-ups are working on it. The apps are different from wellness apps, such as activity monitors, smart scales and sleep trackers. However, eTherapies can include tracking sensors, coaching material and cognitive behavioural therapy.

    A distinguishing feature’s that eTherapies have big ambitions. An example’s Virta Health, based in San Francisco. It aims to reverse diabetes without drugs or surgery using online coaching to encourage people to adhere to a special diet high in fats and low on carbohydrates. Research in 2011 found that “Normalisation of both beta cell function and hepatic insulin sensitivity in type 2 diabetes was achieved by dietary energy restriction alone.”  It took about eight weeks.

    Propeller Health works with GlaxoSmithKline (GSK) to combine GSK’s asthma medications with sensors that patients attach to their inhalers to monitor when they’re used. Patients using the app’s feedback use the medication less often. 

    For Africa, these nascent initiatives are worth watching. It’s too early for the continents health systems to include them in their eHealth plans. As soon as they’re up to scale, Africa can take them.