Yuval Brodsky

eHNA Profile

  • Israeli start-ups are innovating for Africa

    Israel recently celebrated its mHealth week. Leaders and experts put their heads together to help solve global mHealth challenges. The week culminated on 18 February with the flagship event, the mHealth Israel conference.

    In a panel called Meet the new boss: Market leaders and the empowered healthcare consumer, Jeremy Sohn, Vice President and Head of Digital Business Development and Licensing at Novartis said, “Israel is a startup capital. I come here to be inspired really; Israel is constantly pushing the limits of innovation.” Sohn is not alone. Many eHealth and mHealth companies have R&D centres in Israel, and others flew in top level executives for the event.

    In line with this innovative and entrepreneurial spirit, the conference hosted an mHealth start-up contest, featuring the following finalists:

    • Biopmedical: Innovative device for screening cervical and other epithelial cancers.
    • Taliaz diagnostics: Personal tailoring of psychotropic medications based on an individual’s genetic profile
    • io: Using virtual reality for stroke patient rehabilitation
    • Intensix: Applying machine learning to big data to predict when critical care patients will deteriorate
    • 6 over 6: Using a smartphone to accurately diagnose vision problems
    • Datos Health: Data management solution for patient-generated data
    • MedAware: Using machine learning on big medical data to more accurately identify prescription errors in real-time, while mitigating ‘alert fatigue’

    Despite very tough competition, six claimed a first prize, and will receive an all expenses paid business development trip to Houston, Texas. There, they’ll exhibit at the Health Tech conference in Houston, meet C-level executives at the Texas Medical Center and the Houston Methodist Hospital, and be entered as finalists in two start-up contests: the Medica App Competition and the MedCity News INVEST .

    Another key feature of the conference was the 1x1 meetings session, organized by the Israel-Europe R&D Directorate (ISERD) and the Enterprise Europe Network (EEN). This is in line with the conference’s objective of strengthening collaborations between Israel and other eHealth markets and users. Attendees from Europe, Africa, Asia, and North America were in attendance, aiming to connect investors, entrepreneurs, and suppliers and users to forge meaningful cross-border partnerships.

    Private investors, venture capitalists, business angels, incubators, and accelerators constituted a major portion of the attendees, all in search of the next Israeli start-up to revolutionize the mHealth scene. Israel has a very strong track record of producing successful start-ups, boasting the highest per capita venture capitalist investment in the world. Some of the investors looking to bring these innovations to market see Africa and Asia as the most relevant markets. It will be important for them to ensure that they’re engaging African stakeholders throughout the development process, rather than simply bringing a finished product to African markets. Keep your eyes out for some of these and other Israeli mHealth services as they reach African users!

  • AeF: Africa's eHealth solutions are specific

    Too many simultaneous or large-scale eHealth solutions increase the risks of delay and unfulfilled benefits. It’s encouraging that the African eHealth Forum identified a fairly narrow band. It’s consistent with the African Centre for eHealth Excellence’s (Acfee) approach to finding an achievable fit to eHealth priorities. The AeF report Advancing eHealth in Africa sets out more details.

    It isn’t surprising that the range isn’t wide, with the tight sustainability and affordability constraints of African countries. The band includes:

    • Integrate health information and management information systems
    • Sharing data between health workers and health and healthcare organisations
    • EHRs, which can incorporate patient and medical records
    • mHealth, which extends across a wide range of health conditions
    • eSurveillance, given increased emphasis by the WHO  
    • Telemedicine, which can include telemonitoring
    • Supply chain management
    • District Health Information System (DHIS) 2
    • ICT collaboration
    • eLearning for a wide range of health workers, including eHealth and professional training. 

    Each of these carries different levels and relationships of risk and reward. EHRs can be seen as the Himalayas of eHealth. When they’re successful, the benefits are spectacular. Reaching this view is laden with risks, and not everyone achieves them, and in a few cases, they have to be abandoned.

    Other types of eHealth are lower risk, but the benefits are lower too. Reporting and management eHealth has perhaps the lowest risks and offer few benefits for patients, carers, communities and health workers, hence the need for a balance of investment between eHealth at points of care and management reporting. 

    Recent experience for Africa is that eSurveillance investment needs strengthening to achieve greater rewards. The investment risk is quite high, but the risks of insufficient investment are higher. eSureveillance’s priority is increasing. After the Ebola epidemic, it’s a must.

  • Are drones set for health in Africa?

    Going back over five thousand years, pigeons used to transport messages and light loads across distances with remarkable success. They were extensively used to carry post and in war exploits to carry messages. Their natural ability to return home even after long flights made them ideal couriers. This creative use of the bird’s abilities to meet people’s transportation and communication needs was clever and innovative for its time.

    Fast forward to the 21st century and another small bird holds potential to disrupt the transportation and courier industry as we know it today. While both birds share some characteristics such as flying on their own and returning home by themselves after long hours of flight, the new bird is man-made and comes in various shapes and sizes. The Unmanned Aerial Vehicle (UAV), or drone, comes in different designs touted for commercial use. They range from UAVs similar to very small aircrafts with horizontal take-off and landing, designs that have a combination of wings and rotors, unmanned small helicopters and the popular multi-copter design with multiple rotors. Multi-copters are low cost and easy to build with firmware needed for their operation, open-sourced and freely available online thanks to enthusiasts of the technology. A 2014 report by DHL Trend Research echoes the following UAV sentiments.“Some doubt that our skies will ever be filled with pilot-less aerial devices. Others say that this future will be ours very soon. In different ways, both opinions are close to the truth.”

    An  article by The Telegraph, a UK newspaper, highlights Rwanda’s plans to build the world’s first three drone ports by 2020 to overcome transportation infrastructure challenges in the hilly country’s healthcare system.

    UAVs have made headlines for all the wrong reasons. They’ve been used to carry out deadly military strikes leaving large numbers of civilian casualties, used to spy on people and public surveillance which has generated distrust and privacy concerns about their use, and have been flown irresponsibly and dangerously close to civil aviation traffic.

     They have recently been used for less sinister reasons. UAVs have been used by online retail giant, Amazon, to deliver items to customers, to shoot block buster movies in Hollywood, to deliver pizza in Russia and USA, to deliver cakes in China, and to prevent poaching of rhinos and elephants in South Africa. Many of these current uses have one thing in common; they’re part of proof of concept studies for commercial application of UAV technology.

    What Can Drones do for Healthcare in Africa?

    Just as mobile phones have allowed Africa to leap frog communication infrastructure challenges, drones can help Africa bypass transportation infrastructure challenges and improve health service delivery for the rapidly growing African population.

    UAVs have been shown to be successful in transportation of blood samples and other specimens to laboratories for testing. This is especially relevant for African healthcare systems where rural health facilities lack the capacity, equipment or reagents to perform many required patient laboratory tests. Most rural healthcare in Africa is based on clinical diagnoses due in part to these challenges. Providing the capability for rural health centres to access critical laboratory testing through UAVs can improve patient care outcomes, reduce referrals and treatment costs. The same UAVs can also be used to transport urgent blood for patients from blood banks or hospitals. The results from testing the lab samples can also be transported back to the requesting health centres using the same UAVs or transmitted electronically. Electronically will be quicker if connectivity and eHealth are in palce.

    UAVs can also be used to deliver vaccines and critical medicines to remote health centres. A UAV making a number of trips from a medicines warehouse to a remote health centre might be faster and cost less than a vehicle transporting the same drugs. The drugs can also be ordered more frequently by the health centre and delivered through the UAV which would minimise drug expiries in the healthcare system.

    UAVs can deliver health supplies to quarantined areas during disease outbreaks and quickly map affected geographic areas, minimising associated risks to health workers. For instance during outbreaks of highly contagious diseases. UAVs can deliver supplies close to patients’ bed-sides. They can be fitted with equipment to draw lab samples from quarantined patients and allow a tele-consultation using high resolution cameras and microphones between patients and clinicians.

    Currently, most of these uses will remain hypothetical until UAV concerns are addressed. These include UAV safety, country laws and regulations, technology maturity, payload capacity, privacy infringement, public trust, UAV airspace control, weather robustness of UAVs and anti-hacker capabilities. Until then, Africa’s skies will remain clear, but for how long?

  • What does Acfee do?

    eHealth in Africa offers lots of promise, but achieving it within healthcare’s resources is extremely challenging. Collaborating, sharing and developing supportive tools are ways to compensate. It’s in this context that the African Centre for eHealth Excellence (Acfee) aims to help to advance eHealth in Africa. Acfee’s dialogue with its Advisory Board and industry partners at the African eHealth Forum (AeF) is part of it and ensures that Acfee can:

    • Obtain guidance from eminent African health leaders to ensure that Acfee’s priorities are aligned to Africa’s health sector needs
    • Clarify priorities, goals and challenges for eHealth in Africa
    • Provide a mechanism to bring together leaders in health and eHealth in Africa.

    These are outlined in Advancing eHealth in Africa, the report of Acfee’s first African eHealth Summit. You can access if from a link in the left panel of eHNA’s Home page. Underpinning this is Acfee’s set of three main perspectives, discover, learn and lead:

    1.     DISCOVER:

    • Share knowledge
    • Disseminate information
    • Share cost effective measures
    • Identify opportunities and challenges

    2.     LEARN:

    • Develop capacity of eHealth’s human capital
    • Collect and understand findings on good and weak practices

    3.     LEAD:

    • Advocate for eHealth resources
    • Promote recognised eHealth standards and norms
    • Develop eHealth leadership
    • Expand human eHealth capacity
    • Share best practice
    • Help to improve eHealth strategies
    • Encourage communication.

    This provides structure and direction for generic tools and methodologies for African countries to use in their eHealth endeavours. The dialogue at Acfee’s AeF helps to assess and review the model and its priorities. AeF 2015 identified several new themes to extend Acfee’s service. These’ll be summarised in subsequent eHNA posts.  

  • Is eHealth vulnerable to Outer Space Events?

    After Google’s four strikes and you’re not out, what other natural phenomena can affect eHealth? Are there Outer Space Events (OSEs) that disaster recovery should prepare for? A post on Gizmodo says there are.

    The Sun’s flare ups, Coronal Mass Ejections (CMEs) shoot giant clouds of magnetised plasma into space. They’re a bit pedestrian. If the Earth’s in their paths, after about twelve hours, and sometimes several days, they can reach us. If they do, they interact with Earth’s magnetosphere, triggering geomagnetic storms.

    Two alluring affects are at the poles. Aurorae Borealis and Australis light up the sky at their poles in pretty colours and patterns, and attract tourists. Less attractive are the effects on power grids. Some big solar storms can reach the Earth’s surface and result in power surges that power stations feed into grids, which they can’t cope with.

    Geomagnetic storms vary in strength. They’re measured by Disturbance Storm Time (DST). Routine low DSTs are for the Aurorae. In 1989, a high DST storm knocked out power across Quebec. The worst on record was the Carrington Event in 1859. If we have one like it now, it could bring disaster. The CME was visible without magnifying aids. It electrified telegraph lines and caused power cuts.

    Because of our reliance on electricity, a lot of which relies on networked underground assets, the effect would be direct and widespread. Copper wires could melt. Tablets, laptops, desktops and mobiles connected to the power supply could cop it. Server farms could take a direct hit. The Internet would cease. GPS wouldn’t work.

    It seems some of these big scale CMEs might have come close to Earth since 1859. Sooner or later, another Carrington’ll happen. Luckily, meteorology services can see them coming at their cosmologically slow pace. Disaster recovery systems might just work, provided they can be unplugged and don’t touch the ground. Can it be done?

  • Benin uses SATMED for better healthcare access

    Achieving more access to healthcare is challenging across Africa. Benin is improving its position by using SES Techcom Services’ eHealth platform SATMED. SES says it aims to help Benin with its priority to improve childbirth services at the Maternité Hospital in Ahozonnoude. From there, it provides remote consultation and monitoring for effective communications between the maternity hospital, the hospital in Cotonou, the capital, and a third hospital in Allada.

    Transport links between the three locations are often inaccessible due to flooding during the rainy season. eHealth is the only reliable daily link. With continuing training delivered online, midwives and health workers have their new skills and performance monitored and evaluated by an assigned physician. The result is better local, regional and national healthcare. Fondation Follereau Luxembourg (FFL), an NGO, helped with the installation and achieving better medical knowledge by using remote consultation and monitoring.

    On a wider geographical perspective, SES managing director Gerhard Bethscheider said “We are very pleased with the way SATMED is overcoming the barriers often faced in deployment of health services across Africa, where terrestrial infrastructures may be lacking or even non-existent. Thanks to satellite technology, we are now in a position to assist in improving both the speed and quality of healthcare services in rural and remote regions, contributing to change on a much wider scale.”

    SATMED’s a collaboration of several technical and medical universities and research institutes in Europe, Asia and Africa. It combines expertise from eHealth, telecommunication and cloud services. It’s tailored to the needs of the global health community by NGO’s active involvement. The Luxembourg government has a vital leadership role. It’s a prime example of the benefits to Africa of global collaboration. 

  • BoFiNet shares its ambitions

    On 9 March 2015, Botswana Fibre Networks Ltd (BoFiNet) hosted a stakeholder breakfast seminar to bring their community up to speed on two of their flagship initiatives: Fibre-to-the-X (FTTx) and Wholesale-WiFi.

    The FTTx project intends to bring fibre broadband connections to end-users around Botswana. According to BizTech Africa, the ‘X’ in Fibre-to-the-X refers to end user facilities, including hospitals, petrol stations, shopping malls, commercial areas, airports, government facilities, and office parks. The Wholesale-WiFi project will complement FTTx in selected areas, providing WiFi connectivity to nearby users.

    Together these projects aim to help reduce the digital divide in Botswana, and will be key enablers for government and businesses. This is an important strategic decision by the Government, showing its commitment to improving the quality of life for the Batswana through access to information.

    Strengthening national ICT infrastructure can benefit all countries in Africa, however, specific implementations may differ. Each country has different ICT regulations, infrastructures, policies, and providers. While the fibre solution may well serve Botswana, alternatives, such as satellite communications, should be explored in other countries for affordability.

    Regardless how it is achieved, strengthening communications infrastructure is indeed to be undertaken, or at least catalysed, by national governments, and is certain to create a wealth of opportunities for eHealth services.

    BoFiNet was established in 2012 by the Government of Botswana. It remains its sole owner.

  • eHealth in action at Argentina’s El Chaltén health post

    Mr Yuval Brodsky (tinTree) with Dr. Ana Clara Galvan, Mr. Adolfo Collazo, Ms. Liliana Renda, Dr. Dante Ardenghi (El Chaltén) from left to right

    Nestled in the Patagonian Andes of Argentina, El Chaltén is a climber’s and adventurer’s mecca, home to a population of 1,200, and without mobile connectivity. It’s strongly reminiscent of an old colonial town frozen in time; though this illusion is only a small part of the charm of Argentina’s newest town, established in 1985 to stake the nation’s claim to those lands in a border dispute with neighbouring Chile.

    Despite the constant pummelling winds, the town attracts upwards of 60,000 adventurers each summer to its beautiful river valley, serving as an exploration hub for the fabled Fitz Roy Massif and its crowning jewel Cerro Fitz Roy, rising up to 3,441m. This ebb and flow of tourists is one of the many challenges faced by the Puesto Sanitario El Chaltén Health Post which sees close to 15,000 patients annually.

    Telecommunications in the town are a complex issue to begin with, due to its remote location and harsh geography. In a country with a fairly advanced healthcare system, El Chaltén was at risk of being left behind. Satellite internet may have presented a viable solution, as in the nearby town of Tres Lagos. It was once attempted, but the receiver wasn’t installed high enough and the signal was blocked by the surrounding mountains. As such, the health post currently makes do with a 128 mb/s Internet connection, leaving lots to be desired. This connection comes from El Calafate via microwave, which in turn is served by a fiber optic connection.

    Our major capital is human,” says Dr. Dante Ardenghi, who goes on to explain that despite the hardships of providing healthcare in rural communities, a strong team on the ground can be resourceful enough to meet the challenge.

    eHealth does play an important role in the health post’s operation, says Dr. Ana Clara Galvan, speaking on behalf of Director Dr. Carolina Codo.”We often engage in teleconsultations with our colleagues at the hospital in El Calafate Since we have a very good relationship with them, these are often informal phone calls.” El Calafate is some 220 km away, so a serious undertaking in this terrain.

    “The clinic uses the same eHealth system as the rest of the Santa Cruz province, called SCA4, and has been using it for eight years,” explains Mr. Adolfo Collazo, the health post’s administrator. The system is currently used for booking appointments, both locally and with specialists in El Calafate and Rio Gallegos, billing, and consulting electronic patient records. These are updated in the other cities, but not yet in El Chaltén, where staff training for electronic data entry is underway.

    When a patient requires treatment or drugs not available in El Chaltén, they are referred to El Calafate, or sent there in one of the town’s two ambulances. They may be treated there, or sent as far as Rio Gallegos, about 455 km away, for diagnostics like MRIs, or neo-natal ICU. If their condition is critical, they’re flown from Rio Gallegos to the nation’s capital, Buenos Aires. Specialists do come from El Calafate once a month to minimize travel time for patients.

    When asked what resources would be most helpful moving forward, the entire staff agreed: “A faster Internet connection would be nice, but what we really need is more space.” This is understandable given that the health post provides dental, psychological, trauma, orthopaedic, gynaecologic, x-rays, basic laboratory services and numerous other treatments and services.

    The El Chaltén health post is a sterling example of eHealth in action; strengthening,- but by no means substituting a strong team of diligent healthcare providers.

  • Vitals monitoring conceived in Egypt for Mars

    The concept of diagnosing a medical problem prior to its treatment has been tested through the ages, ever since the Ancient Egyptian physician Imhotep first applied the method around 1500 BCE. He is commonly credited with being the first modern physician and for writing the Edwin Smith papyrus, the first known medical manuscript on trauma, which notably did not contain any magical thinking.

    The monitoring of vital signs is among the most basic yet effective methods of detecting medical issues in near-real time. This is no secret, and is frequently used to monitor people at higher risk of having acute medical issues, such as elderly populations and those operating in extreme environments. Space is one of the more extreme environments in which humans live and work, enhancing the importance of health monitoring.

    Earlier this month, the Italian Mars Society conducted its first virtual Mars mission simulation called V-ERAS 1, where many different technologies were tested and demonstrated in an effort to increase humanity’s readiness for a real mission to the Red Planet. The mission was conducted in Madonna di Campiglio, Italy between 7 and 14 December.

    Among the technologies tested was a health monitoring sensor suite, providing the vital signs of the virtual astronauts in real-time, and recording them for further scientific study after the mission. Intelligent algorithms were used to alert Mission Support of any anomalies in the astronauts’ vital signs during all of their activities. This was a critical part of ensuring the safety of all participants, since they were immersed in a Virtual Reality environment and using an omni-directional treadmill with Mars gravity simulation; the combination of which has not yet been tested before, along with its effects on human physiology.

    Implementing health monitoring in African countries presents both opportunities and challenges. Wearable sensors enhance the reach and ease-of-use of health monitoring systems and provide a useful synergy. A trend is to rely more on wearables to gather vital signs information. Conversely, countries need to carefully consider the effects of telemonitoring on health workers’ workloads before implemenation.

    This technology is effective, relatively simple, mature, and quite low-cost. It has all the right ingredients to play an important role in telemonitoring for remote African communities, where high-risk patients can have their vital signs monitored from their homes, with warnings being activated both in the home and with patients’ healthcare providers in the event of an emergency.

    Image: Italian Mars Society virtual astronaut Vito Gentile is connected to vital signs monitoring sensors.

  • Telementoring works in Africa and on Mars

    A mission to Mars and a remote rural village in Africa may have more in common than initially meets the eye. While they can be separated by as much as 400 million km, they share the characteristic of physical separation between a patient and the medical care they may require. While both may have someone able to deliver basic medical interventions, that person is often not trained to manage complex medical emergencies.

    Telementoring is a technique used by physicians and surgeons, where a specialist can guide a less experienced colleague performing a complex procedure in real-time. This guidance is best provided through a two-way video link with real-time data transfer, although in some cases only voice or one-way video may be sufficient.

    In its first virtual Mars mission simulation called V-ERAS 1, the Italian Mars Society conducted a telementoring experiment, where four of its virtual astronauts were faced with a simulated medical emergency. The exercise consisted of two other virtual astronauts involved in an accident on a simulated spacewalk on the virtual surface of Mars, and arrived at the base seeking medical attention. The injuries encountered were above the virtual astronauts’ level of training, so they established a telemedicine link with the African Centre for eHealth Excellence (Acfee) with Dr. Sean Broomhead, playing the role of a physician at another surface base on the Martian surface. The simulation took place in Madonna di Campiglio, Italy, while Dr. Broomhead was located in Kimberley, South Africa; a separation of over 8,400 km.

    In the simulation, Dr. Broomhead successfully guided the virtual astronauts through the execution of complex medical procedures, including reducing an anterior shoulder dislocation and decompressing a tension pneumothorax, saving the lives of the simulated patients. Of course, such a link could hardly be established between Earth and Mars, due to the communications delay introduced by the great distance between the two. This was rather a simulation of communications between two Mars surface bases.  Where near-real time communications are impossible, video mentoring may play an important role.

    While this type of communication exists in many places world-wide, this was a powerful demonstration of its effectiveness. Not all rural communities in Africa can physically have a slew of experts in all medical disciplines, but they can benefit from their virtual presences. Telementoring can be valuable in many settings and infrastructures.

    Telementoring can make use of:

    • Landlines
    • Mobile phones
    • Video links
    • Data links.

    At the most basic level, it can consist of a voice connection facilitating a telementoring consultation between two experts in different medical centres. With increasing infrastructure, video and data streams can be integrated to provide a better telementoring experience.

    The implementation of telementoring in African healthcare centres is an example of an organizational change that can be implemented with or without any additional infrastructure. It is a solution whose simple implementation can have big impacts; and this type of low-hanging fruit should be a starting point in African nations’ eHealth strategies. It is low-budget, high-impact, rapid implementation, and low risk, and would enable medical experts from one centre to assist local healthcare providers with a wide range of their clinical needs.

    Photo courtesy of the Acfee - Dr Sean Broomhead performing a teleconsultation.