• Governance
  • Technology’s healthcare transformation is core

    As their name implies, the two fictional robot clans of transformers were good at it. For healthcare, it’s a constant, striving ambition. A health policy statement from the American College of Cardiology (ACC) sees it as relying on successful adoption of technological innovations in big data analytics, precision medicine and eHealth. Published in the Journal of the American College of Cardiology, 2017 Roadmap for Innovation—ACC Health Policy Statement on Healthcare Transformation in the Era of Digital Health, Big Data, and Precision Health puts healthcare transformation as a product of a shared vision of a broad range of stakeholders. It has to establish healthcare delivery’s future and develop new patient-centred, evidence-driven models that reward value over volume.

    It sets out six steps that Africa’s health systems can adopt and adapt:

    Continuously engage a multidisciplinary group of stakeholders in an innovation collaborative to foster an understanding of how patient care guides the development and integration of new technologiesDrive patient-centric innovation by broadening patient access to health information, consumer empowerment and clinician activationSupport research into new innovations, including national and international academic activities, and incorporate rural and underserved populations in phases of device and precision-based clinical trialsDevelop a compact for human-centred design and a commitment to measuring the impact of new innovations on health, access, equity, costs, and outcomes through evidence generation and development of best practice modelsHarness the principles of evaluation, integration, patient and clinician engagement and measures of care efficiency as innovation platforms in an inclusive and iterative model to advance new technology development centred around factors important to patients, clinicians, and healthcare institutionsIdentify mile markers for innovation success, including new innovation groups to guide activities that represent types of clinician and professionals in training.

    These are rigorous activities. They can help Africa’s health systems move their eHealth services into a new phase with a firm strategic foundation.

     

     

  • Oracle has a supply chain system for healthcare

    Effective logistics are essential for efficient and effective healthcare. Oracle aims to provide this by transforming healthcare’s supply chains. Its white paper from Fierce Markets set out the steps: 

    Better automation and analyticsTighter integration between all stakeholders, including end users, supply chain, distributors, suppliers and Group Purchasing Organisations(GPO)Increased emphasis on sound inventory management and demand planning. 

    Care and Cost Drive Healthcare Supply Chain Revolution says these can overcome four core challenges:

    Master data management, such as item pricing and trackingManual processes and multiple hand-offs between stakeholdersLegacy technologyA reactive instead of proactive approach.

    A general savings estimate, claimed as conservative is 3% to 5% of supply costs. These are achieved by enhanced strategic sourcing that can weed out supply chain redundancies. Actual savings depend on the levels of efficiency that healthcare providers have already achieved. Further gains may be from better re-order quantities and minimum and maximum ordering and stockholding levels. IoT solutions can help too.

    Oracle’s solution relies on a cloud service. For Africa’s health systems, it could be a big step forward. Better spending on drugs and medicines and avoiding counterfeits are high-value objectives. Improving their costs and availability has a direct impact on healthcare quality and efficiency. The Supply Chain Management System from Management Sciences for Health ( MSH) and operating across much of sub-Saharan Africa has insights in the impact.

  • Lessons for Africa on making eHealth work

    Investing in the right eHealth then realising its benefits are global challenges. England’s NHS’s taking advice from the National Advisory Group on Health Information Technology  in England, chaired by

    Professor Robert Wachter Chair of University of California, San Francisco Department of Medicine. The report, Making IT work: harnessing the power of health information technology to improve care in England, sets out findings and recommendations that can inform Africa’s ehealth programmes too. The core perspective’s that while continuously changing healthcare’s a considerable challenge, eHealth that creates a fully digitised NHS important, will be the most sweeping and challenging.

    There are ten findings and principles:

    Digitise, so adopt eHealth, for the right reasonsIt’s better to have the right eHealth than quick eHealtheHealth’s Return on Investment (ROI) isn’t just financial, patient safety and healthcare quality are important tooDecisions on eHealth centralisation should learn, but not over-learn, the lessons of the National Progarmme for Information Technology (NpfIT) Interoperability (IOp) should be built in from the outsetBoth privacy and data sharing are very importanteHealth must embrace user-centered designThe end of implementation’s the beginning, not the endSuccessful eHealth strategies must be multi-faceted, requiring workforce developmenteHealth entails technical and adaptive change.

    For Africa’s eHealth, Acfee would add two other interacting principles. One is to adopt a business case methodology that enables rigorous, reliable eHealth investment decisions and lays a foundation for M&E. It leads on to the second principle; undertake M&E before, during and after implementation. The learning value is considerable, and leads to better business cases and investment decisions.

    Ten recommendations are:

    Complete a thoughtful, long-term national engagement strategyAppoint national chief clinical information officer with an effective roleDevelop a workforce of trained clinician-informaticists in hospitals, with appropriate resources and authorityStrengthen and grow the CCIO roles, others trained in clinical care and informatics and health ICT professionals Allocate national funding to help hospitals implement eHealth and maximise benefitsSet a time for substantial eHealth maturity when central financial support for hospitals can end and regulators deem those that have not achieved high eHealth levels as not compliant with quality and safety standardsLink national finance viable local implementation and improvement plansOrganise local and regional learning networks to support implementation and improvementEnsure IOp as a core eHealth component needed to promote better clinical care, innovation and researchSupport a robust, independent evaluation of eHealth strategies and act on the findings.

    Sustained investment in eHealth leadership across Africa’s healthcare’s needed too. Acfee proposes a triumvirate of clinical, political and executive eHealth leadership throughout healthcare. It’ll take time to reach a critical mass, so starting now’s essential. Future eHealth Leaders at eHealth ALIVE 2017 in October’s provides a step forward. 

    Appendix F’s an eHealth maturity index. Its self-assessment has three main themes:

    Readiness, strategic alignment, leadership, resourcing, governance and information governanceCapabilities of records, assessments and plans, transfers of care, orders and results management, medicines management and optimisation and remote and assistive care and standardsInfrastructure for WiFi, mobile devices, single sign-on and business continuity.

    Africa’s eHealth will benefit from a fourth component, benefits. It include benefits realisation and the timescales need to reach the critical mass to provide a socio-economic return on eHealth investment.

  • Kenya’s mHealth standards are clear on compliance

    mHealth standards and guidelines are essential, but have to be applied. Like all regulations, effective compliance’s essential. Kenya Standards and Guidelines for mHealth Systems sets three main part of the Ministry of Health approach. They’re:

    Commitment at a senior level is a requirement for stakeholders, including an accountable resource either as an officer or managerImplementation that identifies the resources, including a person, needed for the design, development, implementation and monitoring stages and documenting compliance levels Audit, with a person assigned to provide an objective review of documentation and the compliance process to provide feedback and recommendations directly to management, especially for corrective action needed where compliance is weak or missing. 

    There’s a big stick too. Fines and penalties are part of a range of measures to encourage compliance. Building on Kenya National eHealth Policy 2016-2030, the mHealth standards are a huge step forward for eHealth regulation, not just for Kenya, but across Africa too.

  • AeHIN and Acfee to collaborate on supporting regional eHealth

    At today’s eHealthAFRO, Jai Ganesh Udayasankaran, Council Member of the Asian eHealth Information Network (AeHIN) presented his organisation’s history and successes. It plays a substantial catalytic role in supporting eHealth’s development in the Asian region.

    Mr Udayasankaran confirmed that AeHIN will collaborate with Africa’s emerging network, the Africa Centre for eHealth excellence (Acfee), on several aspects of eHealth that are priorities both for Africa and Asia. The main themes include:

    eHealth governanceeHealth regulationCyber-security.

    eHealth governance is well-developed in AeHIN. It promotes COBIT 5, a sophisticated standard. Most of Africa’s eHealth governance needs an initial entry point. Countries can use AeHIN’s experiences to see a trajectory of where their eHealth governance could lead.

    Acfee’s research on eHealth regulation in Africa reveals a significant deficit. The 2013 data are a few years out of date, though progress remains slow. They show an extensive reliance on telecommunications regulations, with little specific eHealth regulation, as shown below.

    These figures are well behind good practices. The deficit’s about 45% points, showing that progress is vital to avoid the African region falling further behind.

    Cyber-security has become increasingly critical. Acfee accumulates data on issues, priorities and guidance, much of which is posted on eHNA. Acfee’s basic cyber-security handbook for Africa sets out some features in what are rapidly changing and more effective cyber-threats.

    Collaboration with AeHIN will move further ahead this year. Progress will be reported at next year’s eHealthAFRO 2018 and in eHNA

  • There are twelve trends in identity governance and access management

    Imaginative innovation underpins eHealth. While it’s like Hollywood film director Frank Capra’s concept of “Don't follow trends, start trends,” it still has trends that many health systems need to follow:  Ponemon Institute set out its findings in Global Trends in Identity Governance & Access Management, sponsored by Micro Focus. Its aim’s to understand two ICT themes. One’s organisations’ capacity to protect access to sensitive and confidential information. The other’s to identify what they believe’s needed to improve protection and security. It identified twelve trends:

    Employees are frustrated with access rights processes, and ICT security’s seen as a bottleneckResponding to requests for access is considered slowControl over access management is decentralisedSome technologies are important in meeting ID governance and access management requirementsA single-factor authentication approach isn’t effective nowIntegrating machine learning within ID governance solutions’s critical for 64% of respondentsEnforcing access policies consistently across all information resources is most difficult information taskEnd users have more access than they needMigrating to mobile platforms affects access managementNew threats created by disruptive ICT reduces organisations’ ability to mitigate governance and access management risksManaging access in the Internet of Things (IoT) is a concern.Effective ID governance and access management across the enterprise is achievable.

    These comprise components of eHealth strategies and governance. Africa’s health systems’ eHealth governance boards should consider each of these, provide an assessment of their implications and requirements and convert them into eHealth project plans. It’s important to catch a trend before it disappears over the horizon.

  • Good eHealth governance takes time

    If good eHealth governance’s tedium, arduous, drudgery, painstaking diligence a seemingly endless chore, as an article in Healthcare IT News says, why should Africa’s health systems bother with it? A team from University of Mississippi Medical Center (UMMC,) Dartmouth-Hitchcock Medical Center  (DHMC), RelayHealth and Dartmouth Analytics Institute explains why at length. Both perspectives are important for developing Africa’s eHealth governance.

    First, it’s the most important analytics strategy for healthcare. It’s a view most notably from people who’ve succeeded with it.

    Since eHealth governance was set up, UMMC’s eHealth team’s productivity increased enormously. Over some 14 months, five report writers have produced 40 data visual apps. It’s been achieved because eHealth governance set their working rule explicitly and clearly, so removed the need for them to seek a stream of clarifications about their projects.

    Good eHealth governance also enables organisations to take the steps needed to transform data into actionable insights from across the whole health and healthcare spectrum. Despite this considerable benefit, eHealth governance’s still immature. It’s stuck at the formation of committees that work as think tanks to devise analytics strategies. The committee model’s often seen as good eHealth governance, but there are many challenges it can’t address because it operates as an ICT subcommittees, not a core part of an organisational information strategy. This approach won’t progress until healthcare executives see data as a strategic asset and a value chain instead of an ICT by-product.

    A benchmark for developing good eHealth governance in the US health system’s 18 months. Africa’s different. It has different eHealth priorities and resources. It’ll take longer, so a stepped process is more appropriate where modest eHealth governance starts to take hold. To reach good eHealth governance, It’s vital that the evaluation jogs along, so doesn’t become extinct, which is a considerable risk. Carl Sagan, the astronomer and cosmologist, said “Extinction is the rule. Survival is the exception.” For the effort expended needed for Africa’ eHealth Governance, survival goes hand in hand with success.

  • South Africa’s moving on IOp polices and governance

    In its eHealth Strategy stretching from 2012 to this year, Dr Aaron Motsoaledi, South Africa’s Minister of Health, was clear. “Historically, health information systems in South Africa have been characterised by fragmentation and lack of coordination, prevalence of manual systems and lack of automation, and where automation existed, there was a lack of interoperability between different systems.” In a masterclass at this year’s eHealth ALIVE conference, Matthew Chetty from South Africa’s Council for Scientific and Industrial Research (CSIR) set out the Interoperability (IOp) policies and governance as part of the solution.

    Five levels are:

    Political context, with co-operating partners with compatible visions, aligned priorities and focused objectivesLegal IOp, needing aligned legislation so exchanged data’s accorded proper legal weightOrganisational IOp, needing co-ordinated processes so organisations achieve a previously agreed and mutually beneficial goalSemantic IOp alignment so precise meanings of exchanged information’s preserved and understood by all partiesTechnical IOp for interaction and transport so planning technical issues to link computer systems and services.

    Four sequential steps are needed to achieve these. They’re:

    Analyse the landscape and assess Health Information Systems (HIS) to define the IOp problemEstablish a set eHealth IOp standards, the National Health Normative Standards Framework for Interoperability in eHealth (HNSF)Establish a regime for IOp testing and certification, the National eHealth Interoperability LabEstablish the foundational ICT Infrastructure needed for IOp.

    Recommending eHealth standards for South Africa isn’t developing eHealth standards from scratch. It’s selecting the most appropriate set of standards from the range available from international standards organisations to support South Africa’s health system. The HNSF includes a process of reviewing eHealth base standards and selecting a stack that fits South Africa’s health systems requirements and health functions. Seven selection criteria are scalability, implementability, testable, cost, maturity, extendibility and flexibility. Six IOp components fit into a template of:

    Process for functional group and functionsTechnical, for Integrating the Healthcare Enterprise (IHE) profiles, general ICT standards, transfer and messaging standardsSemantic, for coding and terminology, content and structure and EHR standardsSecurity standards.

    Steady progress is underway. There’ll be much learning on route as standards are applied in eHealth investment decisions using the HNSF as a firm foundation

  • Acfee to publish reviews of cyber-security and eHealth governance

    To priority topics to come out of the eHealthALIVE week in September were eHealth governance and cyber-security. Acfee’s taking action on both.

    At eHealthALIVE, several presenters said that successful larger-scale eHealth depends on effective eHealth governance. While there are generic components, such as accountability, there’s a need to develop and implement bespoke eHealth governance to fit each countries’ situation. An important aspect’s that it should fit the corporate and political governance arrangements. Consequently, Acfee’s eHealth governance document’s a basic guide for Africa’s health systems to build from. It’s not a recipe.

    After eHealthALIVE, Acfee’s African eHealth Forum met. It’s combination of Acfee’s advisory board members and selected, invited eHealth vendors. Cyber-security was identified as an essential eHealth component with minimal advice and commentaries for Africa’s health systems.

    eHNA monitors global cyber-security information, research and advice and Acfee is summarising some themes from its database of posts for Africa’s health systems. Cyber-threats are becoming more sophisticated, matched by new research, so the document’ll be followed with updates. These do not comprise cyber-security advice, but identifies actions from other continents for Africa’s health systems and eHealth leaders to consider as they develop their cyber-security policies, strategies and measures. 

  • AHIMA releases its Information Governance Framework

    Every country needs to ensure effective Information Governance (IG). This means that it has to be based on sound principles. The USA’s taken a big step forward, from which we can all learn. The American Health Information Management Association (AHIMA) has released its Information Governance Principles for Healthcare. You can access it through Fierce Health IT.

    The framework is part of AHIMA’s continuing strategy to emphasise the importance and value of information governance. It sees effective governance as essential to achieving the goals of patient care and ensuring regulatory compliance. The framework has eight principles:

    Accountability, where an accountable leader oversees the IG programme Transparency, with IG processes and activities documented  openly and verifiably Integrity, with information  managed to provide a reasonable guarantee of reliability Protection, with appropriate security to prevent breaches, corruption and loss Compliance, with the IG programme complying with applicable laws, standards and organisational policies Availability, with information managed to ensure timely, accurate, and efficient retrieval Retention, with data kept for appropriate periods to meet legal, regulatory and other relevant requirements Disposition, with data that is no longer required, disposed of appropriately and securely manner.

    FierceHealthIT says that AHIMA adapted its IG framework from the American Records Management Association, ARMA International’s publication Generally Accepted Recordkeeping Principles. This deals with quality improvement, risk management, compliance, privacy and security. It’s eight principles for IG programmes are:

    Accountability: an organisation shall assign a senior executive to oversee the IG programme, delegate program responsibility to appropriate individuals, adopt policies and processes to guide staff, and ensure program auditability Integrity: an IG programme shall be constructed so the records and information generated or managed by or for the organisation have a reasonable and suitable guarantee of authenticity and reliability Protection: an IG programme shall be constructed to ensure a reasonable level of protection to information that is personal or that otherwise requires protection Compliance: an IG programme shall be constructed to comply with applicable laws and other binding authorities, as well as the organisation’s policies Availability: an organisation shall maintain its information in a manner that ensures timely, efficient, and accurate retrieval of its information Retention: an organisation shall retain its information for an appropriate time, taking into account all operational, legal, regulatory and fiscal requirements, and those of all relevant binding authorities Disposition: an organisation shall provide secure and appropriate disposition of information in accordance with its policies, and, applicable laws, regulations and other binding authorities Transparency: an organisation shall document its policies, processes and activities, including its information governance program, in a manner that is available to and understood by staff and appropriate interested parties.

    AMRA’s Maturity Model embedded in its framework goes beyond the restatement of the principles. It defines IG’s characteristics at three levels of maturity, completeness, and effectiveness. For each principle, the Maturity Model describes characteristics as sub-standard, in development and essential.

    These documents are essential starting points for African countries expanding their eHealth initiatives, IG and regulation.