E health stratigies & development in developing countirs
2013Hassan Rashid HassanLimkokwing University - PGCE-HEALTH STRATEGIES AND DEVELOPMENT INDEVELOPING COUNTRIES.
E-HEALTH STRATEGIES AND DEVELOPMENT INDEVELOPING COUNTRIES.1.0 INTRODUCTION:Technology is about meeting human needs through the creative process of designing andmaking. Technology capability is acquired through the two profile components of design andinnovation of a creative thinking, which if coupled with information is referred to informationtechnology. In this century most companies, organizations and government use this technologyand the efficient utilization of these technology always provide and ensures better services tothe public.Few countries around the world are generally regarded as “developed Nations”; the termdeveloped country is used to describe countries that have a high level of developmentaccording to some criteria. One of the main reasons responsible for their development, isadapting technology in their daily life. While on the other side we find most developingcountries must rely largely on imported technologies as sources of new productive knowledge.One of the critical point developing countries are facing is transforming government to e-government.E-Government (short for electronic government, also known as e-gov, digital government,online government or transformational government) is a diffused neologism used to refer tothe use of information and communications technologies to improve the efficiency,effectiveness, transparency and accountability of government, providing better services,transactions and interactions with citizens, businesses, and other arms of government.However this paper takes a closer look on the e-health sector of e-government.
1.1 WHAT IS AN E-HEALTH?The World Health Organization (WHO), defines e-health as “The use of information andcommunication technologies (ICTs) for health to, for example, treat patients, pursue research,educate students, track diseases and monitor public health”.1In practical terms, e-health is the use of secured electronic networks to support the delivery ofa quality and effective healthcare, by delivering reliable information to the right person at theright time.The Need for an E-Health:Currently in developing country, most of the hospitals keeps a paper based recorded of theirpatient, medicines and overall performance of the hospital, those data or information thengathered from across all hospitals in the country and send to the national health ministry foranalysis. This process takes months and the result at the end is mostly not to reflect the currenthealth status in the country since by the time the data gathered and analyzed is most likely tobe outdated data and not valid for any decision support.With time the amount of data will massively increased and analyzing them will become verydifficult if not impossible.With this in mind the need for effective electronic health system is more appreciated.The key benefits to be achieved through a comprehensive e-Health system and strategyinclude:- improved data and information to generate evidence to support timely and informed clinicaland non clinical decision as well as planning.- improve logistic and supply chain due enhanced management information system for medicaland non medical supplies.-improve financial management by improving accountability and financial accessibility tohealthcare services and cost reduction.- improve access and availability of healthcare services in remote or rural areas.-improve quality of care as result of reduction in wait times for medical treatment and surgicalprocedures.1 – http://www.who.int/topics/ehealth/en/
- enhance access to data and cases for researchers.- facilitate the adoption of eLearning system in the medical education and training fields.- Immediate alarm for national health tragedy.As a result for the key point listed above, e-Health will turn in improving patient healthoutcomes and an increase for life age average in the country.
PROBLEMS & CHALLENGES FACING E-HEALTH DEVELOPMENT IN DEVELOPINGCOUNTIES:The following quotation from NSDA 2010-20104 sums up the problem statement for e-Healthstrategy:“although large sums of money have been use to produce health ICT and HIS in south Africa inthe past, the ICT & HIS within the health system is not meeting the requirements to support thebusiness process if the health system thus rendering the healthcare system incapable ofadequately producing data and information for management and for monitoring and evaluatingthe performance of the national health system. This results from the lack of technologyregulations and a lack of policy frameworks for all aspects of infrastructure delivery.”This quotation was specifically made regarding the e-Health in South Africa, however it alsosuite most of the developing countries as well.One major challenge developing countries are facing is the lack if recourses, tools and common,reusable building blocks available to plan and create their own country specific enterprisearchitectures and solutions; as result, developing countries teemed to outsource their projectto another countries. In this case it’s mostly for the project to fail as result of badcommunication and requirement gathering issues. Each country is unique in its own way;therefore we strongly believe that such a national system should be build internally, helps fromother countries with a better experience in the field is very recommended, howeveroutsourcing the hall project may not likely to work.The following are specific challenges identified with respect to e-Health: Poor national e-Health Strategy:The lack of having clear structured plans for reaching e-Health maturity, also the issue of who isin charge of developing this plan; although the end benefiter of e-Health is Ministry of Health ,yet Ministry of Telecommunication & Information Technology or E-Government representedhave a huge impact on developing such a plan. Therefore all stakeholders in this project shouldwork together on developing a clear strategy in order to a chive e-Health system in the country. Widely different level of e-Health maturity:Different states and hospitals have different level of e-Health maturity, while some hospitalshave adopted an electronic system for keeping patient record, other are still using the normalpaper based system.
Also among hospitals which adopted more electronic approach for keeping patient record, wefind that each hospital has chosen a totally different system with different technologies andstructures than the others. The lack of strong information governance:Having strong information governance will ensure compliance with the necessary standards andprocedures for, and appropriate use of, health information. The lack or absence of Medical coding system:Not having a unique code for each disease, medicine and medical procedure makes it very hardif not impossible to gather all data from hospitals and analysis it. A very good example ofmedical coding system is International Statistical Classification of Diseases and Related HealthProblems ICD -10, which developed by the WHO and been adopted widely and internationally. Human Capacity Building:Opportunity for education in e-Health are currently limited, most available courses are either apost graduate programs or a small short training programs. Additionally there are no cleardefined career path fir e-Health professionals. Funding:In developing countries, the priority in the health sector is to invest in direct services such asprocurement of drugs, vaccines and medical supplies, while e-Health programs typically requirelarge sustained investment over five to ten years, which is not very attractive funding candidatefor most of the donors. Broadband connectivity is expensive and out of reach of many.
PRINCIPLE OF DEVELOPING NATIONAL E-HEALTH STRATEGYHaving a well function e-Health system will have it huge impact needed for improving thehealth of our community, especially for those in the rural areas. However an immediatedevelopment of e-Health system without developing e-Health strategy will lead to a negativeresult.This is a very common case scenario when it comes to development countries, the country willimmediately rush into the implementation of e-Health system without having a reference orguideline. Achieving a fully integrated mature e-Health system must start from the very basic byhaving a clear vision & mission of the e-Health and developing a strategy.The strategy should provide a clear framework for the design and roll out of e-Health in thehealth sector. It addresses the issues of standers and inter-operability and mechanisms forcoordination that will help to minimize the frequent failures usually encountered in theadoption of e-Health solution.In the Summary of Australian Health Ministers’ conference – December 2008, seven strategicPrinciples were underlined, in which we will be discussing in dept:NATIONAL INFRASTRUCTURE:While developing a national e-Health strategy, a wild observation of the current available ITinfrastructure within the country should be made and analysis for better understanding of thecurrent status and how it can be used for delivering e-Health system. Also future country plansin developing IT infrastructure should be closely studied for matching it with the developmentof the national e-Health system timeline making it more effective to deliver core elements ofenabling national e-Health infrastructure once, rather than duplicating development efforts andincreasing the likelihood of rework and duplications.STAKEHOLDER ENGAGEMENT:The engagement of stakeholder in any project is essential for any project success, however inmany cases and for different reasons we find that only less than 50% of the project stakeholderare actually engaged with the development plans, therefore the project actually get buildwithout taken their requirements in consideration. National e-Health system stakeholderincludes but not limited to: Ministry of Health. Ministry of IT & Telecommunication. E-Government presenter. Hospital Managers.
National Medicine Suppliers. National Department of Drugs. Private Sector presenters. Medical Universities. Doctors, Specialist, Nurses, Pharmacist, etc.INCREMENTAL APPROACHBuilding long term national e-Health capability in an incremental and pragmatic manner,focusing initial investment in those areas that deliver the greatest benefits for consumer, careprovider and health care managers.RECOGNIZING DIFFERENT STARTING POINTSSince there are different e-health maturity levels across the country, it must be taken inconsecration there are different starting point for each level. Therefore we must have abalancing support level between care providers will less developed capability and others withmore advance participants to progress.LEVERAGEMore effectively leverage and scale e-Health activity across the country. Meaning developmentof e-Health shouldn’t be centralized or limited to a specific part of the country, thedevelopment should be leverage across the hall country. Even if each part is not actually at thesame level of maturity yet, the plan should cover the hall country.BALANCING ALIGNMENT & INDEPENDENCYDeveloping a national e-Health system in the country, doesn’t mean limiting the ability forhealthcare providers to implement their local system. However the strategy must cover a typeof mechanism allowing linking those systems to the national e-Health system. The strategymust also include specific standers that must be followed by all healthcare providers if theywished to implement their local system.RELEVANT SKILLSEnsuring enough number of skilled practitioners is available to support the delivery of nationale-health strategy.
Other than those seven listed by the Australian Health Ministers’ Conference, there are quitefew others worth mentioning such as: Establishing national co-ordination on all initiatives in order to improve theaddictiveness of e-Health at all levels. Encouraging a collaborative approach by leveraging partnerships. Increase e-Health reliability and trust by looking for the early wings in implementationsand benefits to build the confidence of health professionals.Among developing a national e-Health strategy, there are six points been listed by Institute ofMedicine (IOM) for achieving healthcare quality which must be taken on consideration. Safety:Avoiding any type of harm to patients from the care that is intended to help them.In e-health, safety may also include patients’ information safety and security. Effectiveness:Providing service based on scientific knowledge to all who could benefit and refrainingfrom providing services to those not likely to benefit from.In e-health, effectiveness may means providing the right information to the right person withthe right permission at the right time. Patient – centeredness:Providing care that is respectful of and responsive to individual patient preferences,need and values and ensuring that patient values guide all clinical decisions. Timeliness:Reducing waiting times and potentially harm delays for both those who receive andthose who give healthcare. Efficiency:Avoiding any type of west; including west of equipment, supplies, information, energyand time. Equitability:Providing an equal healthcare services to all public regardless of their gender, ethnicity,geographic location, and socioeconomic status.
E-HEALTH STANDARDSFor successful implementation of an e-Health strategy, technical standards are required toensure national and international compatibility, interoperability, open architecture, modularityand capacity for upgrade.Nationally adopted standards should enable the procurement and implementation ofaffordable, cost effective and accessible technology that complies with these standards.While internationally a wide range of e-Health standards developed by standards developmentorganizations like ISO and CEN are available, very few of these have been localised and formallyadopted by South Africa.Two that have been adopted by the South Africa Bureau of Standards (SABS) are ISO/TS18308:2004 (SANS18308 Health Informatics - Requirement for an EHR Architecture) and ISO/TR 20514:2005 (SANS20514 Health informatics - EHR – Definition, scope and context).Current work by an active group of experts on the localization of ISO 21549: Patient HealthcareData is nearing completion. This work is coordinated by the SABS and the local standard will bereferred to as SANS 828-2 Health informatics – Health smart (HS) card.However, in general, there is limited work done in the country on the localization ofinternational standards for developing countries setting. Advocacy and adoption is also limited.The implementation of the e-health Strategy needs to be handled with care as different sectorshave invested substantial resources in developing the existing systems, hence constructiveengagement between the private and the public sector will be very important. The areas offocus for this process are the following:• Pharmaceutical Coding.• Diagnostic Coding Schema.• Procedural Coding Schema.• Diagnostic Related Groups (DRGs).• Standards for Clinical Content.There is an active Private Healthcare Information Standards Committee (PHISC) which aims tomaximize cooperation in e-Health standards across the country. PHISC provides “an importantforum for debate and consensus on health information standards issues for the private sectorwith the overall aim of identifyingAppropriate common standards applicable to both the public and private sectors.”South Africa requires an e-Health Standards Board or similar body to address some of thecurrent risks and deficiencies. The country does not currently have participant (“P”) status andas an observer (“O”) is unable to vote on the development and maintenance of international e-Health standards.