Yunkap Kwankam, Executive Director, ISfTeH, Switzerland

1. Going Digital and to Scale:
Prof. S. Yunkap Kwankam, PhD
Executive Director, International Society for Telemedicine and eHealth
(ISfTeH)
CEO, Global eHealth Consultants, Switzerland
Addressing the Digital Health Grand
Challenges

2. Outline
Digital health priority action areas – not much change in a decade
Benefits of digital health well understood – but benefits limited by
critical factors: review of Digital Health Grand Challenges
Examples of scale limitations - application areas and enabling actions
Scale effects: application areas and enabling actions
Suggestions for a way forward
Conclusions

3. WHO eHealth priority actin areas (2006)
! " # $ % & ' ( )* " + , - )& ' ( $ , ' * $ . " % & / / " ' * , - )& ' (
. & , * / , 0 $ 1 & + $ 2 " 3" / " * )% )' "
!
" # $ !% &' ( ) &!* + ' , &$ - % $ !. ' / / ' + 0 !1 ' 2 !3+ + ' 4 ) " 3' + 0 !3+ !
# $ ) &" # 5!6 !7 89 : 6 8!; < = 9 >?@9 ; A!6 B C!DB 9 E 8< C 7 < !>F 6 ; ?B 7 != 86 G 9 ; H !
rity mHealth application areas (W H O ’06)
• eLearning
• MOOCs
• BCC
• Rapid SMS
• EHR/PHR
• HIS
• Telemedicine
modalities
• DSS
Service
delivery
Access to
info
Workforce
Dev.
Health
promotion
Priority mH ealth enabling actions (W H O
•SDOs
•Interoperability
•IHE; C.A.
•MAMA, ZMD
•ZMD
•Who?
•What?
•Where?
•Lessons
•Legal issues
•Ethical considerations
•Policies
•Strategies
Policy &
Regulatory
Environment
Business
Inteligence
Norms &
Stds;
Interop.
PPPs, ICT
R&D for
Health
Application areas
Enabling actions

4. The Digital Health Landscape
ICT – the third pillar of the health care industry
http://medcitynews.com/2014/08/often-consumers-use-digital-health-tools-graph-will-
show/

5. Creating knowledge commons for
Digital Health
Going to scale with Digital Health
interventions – commensurate with the
scale of problems
Creating integrated eHealth systems
Transforming all health workers into
ePractitioners
ICT to support health production
ICT for the health system of the future
Digital Health Grand Challenges

6. Going to scale with digital health
What to scale – the need for evidence
How to scale – the need for information and knowledge
sharing (The Global Knowledge Commons)

7. Examples of scale limitations
Most glaring hurdles are in information intensive digital
health applications – HIS; EMR/EHR – adoption by some
but not others
Health facilities
Health districts
Build resistance to digital health adoption – the equivalent
of MDR-or XDR-TB

8. Framework 1: ADA white paper

9. Framework 2: PMNCH workbook
Purpose inter-alia to:
Identify obstacles to scale-up
Guide exchange of ideas
12 specific mHealth applications
and 9 themes structured to
guide the dialog

10. Framework 3: ITU process
Purpose:
Propose a six-step process for
scaling eHealth interventions in
step with advances in ICT
developments.
Scalinge-Health Servicesin step with ICTTransformation
Mappingclient platform and connectivity requirementsof ane-Health system
Method: This study has adopted the methodology suggested in (17) and customized it as illustrated
in flowchart of figure (1). Initially, several real-life scenarios in preventive, curative and palliative care
delivery was surveyed covering 26 major e-health initiatives from a mix of private, government and
NGO organizations addressing over 200000 patients across India. These e-health networks
aggregated the skills and facilities of primary, secondary and tertiary care from rural villages and
urban cities, from several thousands of entities (hospitals, clinics, diagnostic labs, insurance claims
administrators, medical colleges, call centres, pharmacies, etc.,) across India. India was chosen for its
wide spectrum of technological, economic, social, linguistic and cultural diversity and number of
pioneering initiatives already underway (18). From their publications, site visits and in some cases
interviews with the staff, various usage models and infrastructure at the point-of-care were studied
to identify adoption pattern of connectivity and end-user platform technologies in their activities (for
details refer (19)).
FIGURE1: Stepsused in thisstudy
Survey Health care
initiatives and identify
care activities
Identify possible
transactions within
such activities
Categorize nature of
information exchange
events within
transactions
Map user platform &
communication
requirements for
information events
Group information
events with similar
requirements in
various transactions
Remap and group
information events as
a function of
infrastructure

11. Regulatory interoperability
Issues of mutual recognition and fee
waiver for cross-jurisdictional practice in
states within a country
Legal instruments for cross-border
activities among countries, such as in
the European single market
All WHO member countries – 194
18,721 separate bilateral
agreements, or
1,198,144 tri-lateral agreements,
or
1 all-party accord
Examples: IHR-2005; Framework convention on
Tobacco

12. Dimensions of the GKC
Who is doing what, where; how well is it working; what
can we learn and what can we use from it?

13. ! "#$%&' () &*+,-. ' - (/ 0&0' -1 -&2(34$2-1 $(5(6- 7*$#2*8#-$(
5/$6. /!7, $8 /' ( 9' !: $2 2 $, &!
"/. 1$#2 !<#*+-)' *)3#' !!
: ' , )' #!=$#!>' . /)+!
? . #@' )!A, , $B. C$, !
>-, 9D!
5E? <!2 >' . /)+!
F#. *@' #! G!
HAE: I J KL! <MMI F<FK! : I I LHAM<FK!! : I NN<OI L<FK! E><LK!
(((((((((((() &*+,-. ' - (9*1 1 *&$(3-8: #;- (<=3>( (F. P$, $2 Q!!!!!!A, ( ' P-, 9!!!!!!<99#' 9. C$, !!!!!!EQ, ( -*. C$, !!!!!!H-&*$B' #Q!!!!!: +. , 9' !: $, )#$/!!!!G!!!!
) &*+,- . ' - (9*1 1 *&$(?8-$-&20%*&(@04-8(
7, $8 /' ( 9' !
: $2 2 $, &!
7, $8 /' ( 9' !
: $2 2 $, &! 7, $8 /' ( 9' !
: $2 2 $, &!
' >K<NF>!
: $2 2 $, &!
J ALFR<N!NAOL<LS! EI : A<N!!
MKF4 I L7!
: REFI ? !
I MFI NI 5S!
: I ? ? RMAFS!
? <M<5K? KMF!
5NI O<N!!
LK5AEFLS!
) &*+,- . ' -(9*1 1 *&$(<A$#&-$$(@*' #;(@04- 8!
!
!I T -, ' !: /-' , )!

14. First decade-and-a-half of the 21st
century
has seen major advances in digital health
At policy level
In national programs
Technological advances – with industry
rediscovering health as a market
Local capacity for digital health in countries
Conclusions - 1

15. Conclusions - 2
To further consolidate gains and plan for the future, we
must
1. Focus on the big picture
Emphasis on overall economic development. Paradigm shift.
ICT4H  ICT4D
2. Strategic and Tactical
Creation of pull structures for sustainability
Emphasis on health and wellbeing
Address the Digital Health Grand Challenges, especially the
GKC for Digital Health innovation
! "#$%&'&( )"*+,&-+. -"/"%0)&%1++
+
2 $30+#3%+4"+5&%"+0&+. -"/"%0+. "&. '"+*6,,"-)%( +,-&7 +#$-&%)#+#&%5)0)&%*+,-&
5"/"'&. )%( +'&%( 80"-7 +#&7 . ')#30)&%*9+
+
2 $30+#3%+4"+5&%"+0&+. -"/"%0+0$&*"+. "&. '"+,-&7 +5"/"'&. )%( +#$-&%)#+
#&%5)0)&%*+)%+0$"+,)-*0+. '3#"9+
+
: )*#6**1+
• 0"#$%&'&( )"*+4"$)%5+. -"/"%030)/"+#3-"
o ; -)7 3-<+. -"/"%0)&%
o ="#&%53-<+. -"/"%0)&%
o !"-0)3-<+. -"/"%0)&%
• 4"*0+. -3#0)#"*+>+*<*0"7 *+0$30+#3. 06-"+. $"%&0<. "+5303
o -"0)%&( -3. $<?+. 3-0)#6'3-'<+,&-+5)34"0)#*
o 2 "3-34'"+"'"#0-&%)#*+3%5+@&5<+A-"3+B"0C &-D*+E@AB*F
!
eHealth Corps
eHealth Steering
Committee
eHealth
Center/Network of
Excellence -
Resource Ctr
National eHealth
Council
!
!
! !
National eHealth Society
! ! !
The GeHCs-ISfTeH Framework

16. Thank You
16
ykwankam@gehcs.com
ykwankam@isfteh.net