Anna Adelof
Alvin Marcelo
Adesina Iluyemi
Peter Nyasulu
Vanessa Carter
Keith Househam
Sedick Isaacs
Richard Gakuba
Julius Awakame
Tom Jones
Miguel Peixoto
Onesmus Mwaura Kamau
Brenda Katwesigye
Babasile Daniel Osunyomi

Tom Jones

eHealth Person at eHealth News Africa
https://ehna.acfee.org/tom.jones/articles

As a small charity with a big vision, Vision for a Nation (VFAN) thinks everyone should be able to access eye care and affordable glasses. It started its work in 2012, helping over 90% of its 10.5 million people who had no access to local, affordable eye care. Over a million only needed a simple pair of glasses to see clearly again. Many more could benefit from eye drops administered on-the-spot or a referral to a hospital for specialist treatment to prevent potentially blinding conditions.

The project has lessons for managing and succeeding with all-Africa’s health and eHealth projects. The management model is an essential component that runs across project and operational management and benefits realisation.

VFAN’s response was an innovative programme, building and integrating local primary eye care into Rwanda’s national health system. It’s planned for completion later in 2017.

 The programme’s goals are ambitious. They include:

  1. Making primary eye care permanently available for services such as medication, reading glasses and innovative adjustable lens glasses and referrals for specialist treatment
  2. Through the country’s network of over 500 local health centres and with revenue generated from the sale of glasses at $1.50 each, but free for the poorest 20%, sustain the programme beyond 2017 when VFAN’s direct role has ended
  3. Nurturing local Rwandan talent, capacity and capability, extending from language skills to advanced degrees.

With over a million people already screened, VFAN’s this high impact approach enables it to screen an extra 1.5 million people by the end of 2017 and deal with the national backlog too. It’s succeeding because it thinks and operates like a successful business. It sees Return on Investment as critical, sets clear goals and measures outcomes against targets at every stage. Its founder, James Chen and major international institutions provide continuing support that enables financial flexibility and adaptability.

Rwanda’s Ministry of Health will assume full responsibility for new eye care services from January 2018. eHNA will be posting about the transformation and lessons from VFAN for other African projects and countries.

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Published: 2017-02-21 08:05:00
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Tom Jones

Like eHealth, there’s more than one definition of EHRs. Consequently, when it comes to procurement, it’s important to be specific about your definition and requirements. Dr Chrono has provided a checklist that can help Africa’s health systems with their eHealth strategies, plans and procure their EHRs. It has twelve components:

  1. Intelligent time-saving charting tools for operational efficiency, such as customisable medical templates, medical speech-to-text, dynamic photo charting and macros
  2. Customisation and flexibility, to tailor EHRs to practices and specialties
  3. Fully functional on mobile devices
  4. Integrated with laboratories so test  and imaging requests, provide referrals and send prescriptions are seamless, minimise paperwork and streamline administrative tasks
  5. Real time eligibility verification and billing
  6. Patient portal that’s user-friendly
  7. Flexible and simple patient admissions and check-ins
  8. Sharable patient educational material
  9. Available training and support for EHRs
  10. Regulatory compliance
  11. Data flexibility and portability
  12. Application Programming Interface (API) and third party integrations.

For Africa’s health systems, sustainable affordability’s a vital matter. Other sustainability requirements, such as connectivity, are essential too. With all these in place, they can concentrate on mitigating investment risks and benefits realisation. There’s always more work to follow on with eHealth.

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Published: 2017-02-21 08:00:00
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Tom Jones

Opportunities for eHealth to improve public health need developing and promoting by Public Health Associations (PHA). These are the conclusions of an article in the Journal of Public Health Policy, Digital technologies for population health and health equity gains: the perspective of public health associations, by an international team. How did it reach them?

The World Federation of Public Health Associations (WFPHA) conducted a semi-structured interview with its national PHA members about their eHealth use, their eHealth challenges, and their experiences and thoughts on how to assess its impact. There were 17 responses, with more detailed discussions with ten PHAs, including Cameroon and Uganda.

A survey of the relative public health priorities showed:

This led onto three questions:

  1. How does eHealth facilitate the capacity of a PHA to achieve its mandate?
  2. How do PHAs use eHealth as a core element in their programmatic and advocacy activities?
  3. How do PHAs assess eHealth’s impact on population health and health equity?

How they use eHealth is:

These fulfil three main roles:

  1. Communicate with members
  2. Disseminate information about public health issues, best practices, and policies to members, stakeholders, and the general public
  3. Advocate, primarily to government representatives, policies and programmes to improve their country’s health system and have a positive impact on the public’s health.

Examples of PHAs eHealth use are:

  1. Governance
  2. Policy and advocacy
  3. Mobilising partnerships
  4. Identifying and solving health problems
  5. Informing, educating, and empowering people about health issues
  6. Analysing and investigating health problems and hazards
  7. Contributing to create and maintain a competent public health workforce
  8. Improving effectiveness, accessibility and quality of public health services.

Alongside these initiatives, advancing PHA’s eHealth has to address a long list of challenges and constraints that limit their capacity:

  1. Lack of qualified people to design and manage websites
  2. Lack of internal ICT competency in PHAs
  3. Internal human resource ICT capacity in PHAs is limited
  4. Using volunteers to design and manage their websites helps, but it’s insufficient
  5. Lack of resources, including donor funding, to support core operational costs
  6. While external funding can provide funds to start eHealth, it doesn’t extend to operating costs
  7. Some eHealth initiatives are specific to other projects and operate as long as funding is available
  8. Several projects share similar aims but use incompatible apps that can’t be scaled to national systems
  9. Lack of an explicit communications strategy that includes eHealth
  10. Need for leadership that encourages and supports change management to overcome internal resistance, experiments with new technologies, and improving effectiveness
  11. For PHAs in low income countries, problems with local infrastructure, Internet connectivity, low bandwidth capacity, interruptions in electricity supply, high costs of hardware and software maintenance, and inadequate real-time videoconferencing capability.

For Africa’s PHAs these are insurmountable on a significant scale in the short, and probably medium, term. Health systems also endure these constraints for their eHealth programmes.

A very encouraging consensus emerged from the survey. PHAs should include evaluation of eHealth impact on population health and health equity gains in their strategies’ communications components. This requires PHAs to use eHealth to identify all determinants that affect health and to explore how to exploit eHealth fully. Acfee’s working on frameworks and methodologies the help PHAs and health ministries to do this. It’s a welcome finding from the WFPHA.

The study suggests that PHAs should:

  1. Examine their eHealth’s impact
  2. Incorporate eHealth and allocate and reallocate resources for adoption and management into strategic and business plans and plans to assess eHealth’s impact the PHAs’ mandates and health and health equity
  3. Where PHAs have experiences using and assessing eHealth, mentor other PHAs and provide financial and technical assistance to help build eHealth capacity

WFPHA should:

  1. Put into place a programme to help PHAs, especially in middle and lower income countries, develop their capacity to use and assess eHealth
  2. Work with PHA members to develop an eHealth evaluation framework
  3. Customise and adapt methodologies and metrics to the needs of PHAs, including assessing inter-sectoral eHealth impact on health and building relationships with software developers

Host a session during the 15th World Congress on Public Health, bringing together PHAs, multilateral organisations, Canada’s International Development Research Centre (IDRC), and organisations outside of the health sector with experience in using and assessing eHealth impact, laying the groundwork for a global action plan on eHealth use and assessment of population health and health equity.

It’s a set of ambitious initiatives. As eHealth expands, these activities will have to expand with it.

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Published: 2017-02-20 08:00:00
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Tom Jones

As a criminal business, ransomware’s big. It’s set to be bigger. Jack Danahy, a Barkly co-founder, writing in Barkly’s blog says cyber-attackers will use three new methods in 2017.

  1. An extra threat of doxxing, public disclosure of private records, either a file at a time or as a catastrophic dump to increase the chances of victims paying the ransom
  2. Ransomware infections will spread more quickly and easily
  3. Fileless ransomware will increase rapidly.

A Barkly survey reports only 5% of US organisations say they paid ransoms. Better back-ups and easier data recovery have reduced ransom attack’s effectiveness. Cyber-criminals are shifting their attacks to businesses instead of consumers to demand more. It means they’re increasing the potential damage and disruption of not paying. Other countries are seen as softer targets too. It’s a warning for Africa’s eHealth and healthcare.

Ransomware attacks will also increasingly bypasses scanners and signature-based anti-virus security. It raises the chances of infection for less sophisticated organisations. These’ll add to the more common technique of phishing emails with malicious attachments. Fileless attacks aren’t easy to identify using conventional endpoint security tools.

The lessons for Africa’s eHealth are stark. Two main themes are:

  1. Stepping up basic cyber-security measures rapidly, and not just to deal with ransomware
  2. Adopt more sophisticated cyber-security to deal with emerging new threats, especially ransomware threats.

Health systems will need investment in new cyber-security skills and solutions. They’ll need new eHealth strategies too.

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Published: 2017-02-17 08:05:00
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Tom Jones

While Africa’s mHealth initiatives scored highly in the 2015 WHO eHealth survey, a constant challenge for all countries is fitting them into the wider eHealth setting. A whitepaper by Athena Health, Going Mobile: Integrating Mobile to Enhance Patient Care and Practice Efficiency identifies how mHealth is used and how its strategic setting can be developed. mHealth Intelligence says healthcare leaders need a “thoughtful approach to integrate mobile health technology.”

The whitepaper says it includes: 

  1. Clinical decision support (CDS) by evaluating and selecting the best mHealth
  2. Workflow efficiencies, using mobile-enabled devices, services, and software to optimise data retrieval, documentation and healthcare transactions
  3. Communication and co-ordination by connecting and sharing information between providers to improve healthcare co-ordination
  4. Patient engagement to support population health, improve compliance, and engaging patients in their care
  5. Security and privacy and ensuring its effective for mHealth.

These present two challenges for healthcare organisations:

  1. Evaluating and selecting mHealth solutions that maximise support for clinical outcomes, co-ordinated healthcare, workflow efficiency, patient engagement, and population health
  2. Protecting the security and privacy of information shared using mHealth.

mHealth features that need assessing in these decisions include:

  1. Secure, and compliant with laws and regulations
  2. Focused on efficiency and measurable results
  3. Integrated with patient communication and EHRs
  4. Supporting CDS and better health outcomes
  5. Easy to use by clinicians and patients
  6. A strong platform for patient engagement
  7. Flexible, to accommodate mHealth innovations and changes.

These provide Africa’s health systems with an initial strategic structure to integrate and direct their current mHealth services and plans. A bigger challenge is evaluating a widening range of mHealth innovations and opportunities as a set of integrated business cases.

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Published: 2017-02-15 08:00:00
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Tom Jones

Like the term eHealth, EHRs are not strictly and unambiguously defined. A study in the Journal of Medical Internet Research (JMIR) has researched the literature and set about the task. It also identified concerns and challenges. The findings are essential for Africa’s health systems as they move their EHRs on.

Its Personal Health Record (PHR) taxonomy comprises three main categories:

  1. Structures, the main data types and standards used
  • Data types in PHRs
  • Standards that PHRs can adhere to
  1. Functions that depicts the main goals and features of PHRs
  • Users profiles and types that interact
  • Interactions of patient types with PHRs
  • Data sources and techniques for information input
  • Goals that represents PHRs’ aims
  1. Architectures types and scope
  • Descriptions of the main architecture models
  • Coverage as physical locations and divisions for data

There’s a wide range of challenges and concerns that need addressing. There are four main categories:

  1. Collaboration and communication
  • Context-aware computing
  • Wearable computing and IoT
  • Artificial Intelligence (AI) for health
  • Personalisation, usability, familiarity and comfort
  • Managing medications
  • Data generated by patients
  1. Privacy, security and trust
  • Confidentiality and integrity
  • Data repository ownership
  • Authorisation and access control technologies
  • Secure transport protocols
  1. Infrastructure
  • Portability between devices, equipment and hardware
  • Efficiency and scalability
  1. Integration
  • Patterns in collecting medical data
  • Terminology
  • Interoperability.

For Africa’s health systems, these range from long-standing eHealth challenges to new challenges coming with constant eHealth innovations. They’re demanding to deal with, and increase with complexity the longer they’re left.

Three common requirements to progress are affordability, benefits realisation and health systems human eHealth capacity and capabilities. They need adding to the list.

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Published: 2017-02-14 08:00:00
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Tom Jones

An ambitious eHealth project has started in India. It offers an investment model that could fit Africa’s health systems. Kerala State Government has launched its project, supported by the World Bank. Its goals are:

  1. EHRs for its population
  2. End-to-end automation of all government healthcare organisations
  3. Integration of an electronic demographic database.    

In its report on the initiative, The Hindu says it builds on a pilot in twelve locations in Thiruvananthapuram district. The new project scales it up across the State and will link with all Health Management Information Systems (HMIS). There are two main components, a public health module and a hospital automation module. The public health module will be launched across the State immediately. The latter is planned for scale up in seven districts in three months as Phase 1.

The seven locations are Thiruvantheapuram, Kollam, Alappuzha, Idukki, Ernakulam, Kararagod and Malapuram. Eventually, all health organisations will connect to the State Data Centre using the Kerala State Wide Area Network. Institutional networks will rely on services from Bharat Sanchar Nigam Limited (BSNL), the Indian state telecommunications company based in New Delhi.

The consortium’s led by Hewlett Packard Enterprise. Hardware’s procured by Keltron, India's first and largest electronics corporation in the State sector. Kelara State IT Mission has the role of technical support.

Not all Africa’s health systems can start as such large-scale eHealth projects. For these, Kerala’s initiative provides a clear profile of an eHealth future that Africa’s health systems can move towards.

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Published: 2017-02-13 08:05:00
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Tom Jones

Two stark statistics from Nigeria are “Each day in Nigeria, 109 women lose their lives due to pregnancy-related issues and 660 newborns die from preventable causes.” MamaYe has a clear goal to improve it by making “Life-saving change for mothers and babies in Nigeria.” It’s one of six countries in the Evidence for Action (E4A) programme, E4A-MamaYe. The other five are Ethiopia, Ghana, Malawi, Sierra Leone and Tanzania. The initiative aims to use better information, advocacy and accountability to save lives. It’s financed by the Gates Foundation

Five project reports are published in the International Journal of Gynecology and Obstetrics. They describe accountability arrangements and publicise E4A-MamaYe experiences and achievements in Maternal and Neonatal Health (MNH) that are essential to achieve Sustainable Development Goal (SDG) 3

The first paper provides a review of the MNH accountability mechanisms in sub-Saharan Africa that have been implemented and assessed. It offers a conceptual framework to guide discussion.

The second paper discusses political accountability using a review of three global and regional mechanisms used to monitor and track MNH progress. It draws on how global and regional commitments have impacted national responses, as shown in the E4A countries.

The third paper deals with performance and accountability of Maternal Death Surveillance and Response (MDSR) systems, especially response and action components. It includes describe describes the E4A-MamaYe country experiences in implementing MDSR systems.

The fourth paper sets out a case study on a pilot for social accountability to improve MNH services in Ghana. The project uses scorecards and engaging stakeholders in districts.

The fifth paper provides another case study on how evidence supported a campaign on budget advocacy in Sierra Leone. It advocates financial and budget monitoring to ensure financial commitments for MNH are sustained.

MDSR Technical Guidance proposes several actions to increase effectiveness and sustainability. They include:

  1. A supportive institutional culture fostering a learning environment
  2. Multidisciplinary teams at different health system levels to review, communicate and act on findings
  3. Leadership and commitment of government and healthcare staff
  4. Aggregate data from facility and community to higher levels to provide a deeper understanding of gaps in care quality and system-wide challenges
  5. Recognising that local and less resource-intensive solutions can save lives.

These are relevant for Africa’s eHealth governance. An example is Nigeria’s Commission on Information and Accountability (COIA) tracking progress on maternal and child health. It reviews MNH features such as the latest MNH numbers, their variations between urban and rural areas, and impact of education on young women using contraception. There’s much more evidence on MamYe’s progress that provide benchmarks and lessons for all Africa.

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Published: 2017-02-10 08:00:00
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Tom Jones

A common feature of cyber-security’s its general lag behind cyber-threats. Data Breach Incident Response Workbook, from AllClear ID, a cyber-security company, provides general guidance and assistance in developing security standards. It’s essential for Africa’s eHealth.

Health IT Security says it provides an outline and recommendations for a start to planning well-orchestrated responses to a data compromises. The next step’s engaging external stakeholders. An essential theme’s ensuring plans are recorded and tested thoroughly to achieve effective financial and operational responses to cyber-attacks.

Its contents include:

  1. The cyber-threat world and operational and reputational damage
  2. Anatomy of a data breach
  3. Preparing for a data breach
  4. Building a strong internal response team
  5. Data breach checklist
  6. Data breach notifications
  7. The Incident Response Plan Guide.

Incident response teams shouldn’t be just from ICT teams. They should draw and appoint an incident lead from:

  1. Executive management
  2. ICT
  3. Customer and patient services
  4. Risk management and security
  5. Compliance and audit
  6. Legal
  7. Privacy
  8. Public relations.

The checklist should document everything that happens and is discovered. Prompt action’s vital, so every action needs fitting into a timeline. Actions include:

  1. Implement the data breach incident response plan
  2. Specify the information needed for reporting summaries
  3. Identify the problem
  4. Start the incident reporting process
  5. If the data breach could harm a person or business, contact local police
  6. Create an incident summary report for executives
  7. Create a technical incident summary report.

The Incident Response Plan checklist’s comprehensive. It includes important advice: “Continuously update the information in the contact lists and other documents – don’t get caught in an emergency with outdated information.” It’s obvious, but an elementary error to avoid.

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Published: 2017-02-09 08:05:00
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Tom Jones

At the core of eHealth sits EHRs. The WHO Global Survey 2015 and Capter 5 of the  WHO and Global Observatory for eHealth (GOe) publication eHealth Report of the third global survey on eHealth Global diffusion of eHealth: Making universal health coverage achievable, say there’s been steady growth in adopting national EHRs over the last 15 years. It’s’ jumped by 46% in the last five years. Africa has much more to do.

More than 50% of upper middle and high-income countries have adopted national EHRs. The rate in poorer countries is 15% and 35%. Africa’s average’s at the lower end.

EHRs depend on other eHealth for much of their data. Most, over 70%, national EHRs integrate with laboratory and pharmacy information systems. About 56% integrate with Picture Archiving and Communications Systems (PACS). African countries trail the global average on these too. Their investment’s about a third of the global average. Catching up on EHRs needs investment in these systems too, so a considerable resource, affordability requirement and undertaking.

WHO identified lack of funding, infrastructure, capacity and legal frameworks as investment barriers. eHNA has posted on numerous others. They’re mainly parallel investments needed to maximise benefits. Examples are cyber-security, ID management, an example in a recent post, and ferreting out and quelling undesirable “digital dystopia” of ineffective EHRs that doesn’t improve health, healthcare or make it more efficient, posted on the snake oil speech at the American Medical Association.

Africa’s need for more investment in EHRs and related eHealth and overcoming the barriers points to the important role of rigorous eHealth business cases. These lead to better eHealth investment decisions, so better eHealth, including EHRs. Healthier Africans is the overarching goal. EHRs are an important part of achieving, but only a part, and a part with significant dependencies that need to be in place too.

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Published: 2017-02-09 08:00:00
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Tom Jones