Health InformationTechnology (HIT) inDeveloping CountriesCurrent Use, Obstacles, andFuture Development
Issues to be addressed by HIT indeveloping countriesHIT can help correct the health disparities anddisadvantages of low- to middle-incomecountries.4• Lack of health care providers• Increase of elderly population• Increased incidence of chronic andcommunicable diseases• Limited access and continuity of health care• Increase of communicable diseases
Benefits of HIT in developing countriesHIT will help resource-constrained countries in the followingways:• Improve patient care and outcomes5• Increase productivity5• More effectively manage resources5• Improve training of health care providers5• Reduce the need for clinic visits6• Prevent health care fraud2• Streamline finances to prevent losses and expeditepayments2• Improve sharing of information6• Overcome geographic limitations of rural areas1• Aid in the problems created by language barriers2
Types of HIT used in developingcountries• Voice technologies such as hotlines, voice over IP, etc.2• Text messaging between providers/patients, andprovider/provider to encourage compliance in treatmentprotocols6• PDAs to collect and organize data6• Videoconferencing for live consults with specialists orhigher-level providers in a different location4• Electronic health records7• Ancillary department information management systemsincluding laboratory and pharmacy 6• Patient registration, scheduling, patient tracking10• Clinical decision support7• GPS to track and find patients6
Main interestsof providers using HIT indeveloping countriesProviders are most interested in technologies that:• Improve communication with patients and otherproviders including education2• Extend geographical boundaries2• Improve quality of diagnosis and treatment2
CurrentutilizationsofHITindevelopingcountriesStrengths WeaknessesExtensive healthinformation managementsystem for refugee camps10Surveillance of services,conditions, and disease statesfor 1.5 million refugees in 85camps• Unable todistinguishrefugees fromnationals receivingcare• Language barriersof collection toolsvs. peoplecollecting dataHotlines for patients withchronic diseases4• Reduction of inpatientadmissions• Frequently usedText messaging, phonecalls to patients betweenpersonal contacts withhealth care providers6• Increased compliance ofpatients in medicationregimens and keepingappointments• Cost-effective• Improved patient outcomes• Language Barriers• Literacy Barriers
CurrentutilizationsofHITindeveloping countries(continued)Strengths WeaknessesGPS6 Ability to more quickly locateknown patientsPatient datamostlyunavailableVideoconferencing4 • Rapid and more economicalconsults with providersseparated by large distance.• High quality of care provided• Greater patient satisfactionCost oftechnology• PDAs for datacollection6• Electronic picturearchiving for radiology7• Portable• Doesn’t use resources in shortsupply (paper, ink, printers, etc.• High data qualityInternet healthinterventions for healthpromotion 8• smoking cessation• weight reduction• management of chronicmedical and mental healthconditions• Resource is readily available,convenient, and is not depletedas it is used• Cost-effective• Languagebarriers• Literacybarriers
CurrentutilizationsofHITindeveloping countries(continued)Strengths WeaknessesPharmacy and labinformation systems6• Reduction of errors• Speed of processing• Ability to accuratelyforecast needs forsuppliesClinical decision supporttools• Improved patientoutcomes• Not well researchedOpen medical recordsystem with access toprogramming codes forpersonnel to alter asneeded1• Flexibility• Encouragesindependentworkability• Allows insight intoneeds of differentenvironments
Barriers to HIT in developingcountries• Lack of HIT standards and policies(ethics, privacy of information, etc.)4• Inconsistent legalities from country to country(taxes, insurance issues, medicallegislation, etc.)4• Lack of interoperability of systems1• Insufficient data on use of HIT, needs, cost, etc.2• Unreliable infrastructure so that power andinternet access are intermittent7• Lack of dedicated financial and staffing support6
Futureof HIT in developingcountries• Organizations and events formed to offer authority,development and networking 4• The International Society for Telemedicine and eHealth• Med-e-Tel: yearly international conference• Points regarding formation of programs and technology• Systems need to be lightweight, portable, and practical in a crisis10• The humanitarian community should have input10• Plans for evaluation methods and data dissemination need to bebuilt into new systems1• Security measures must be considered3• Programs should be implemented gradually7• Live follow-up will need to be planned when interventions areautomated or over the internet5(Continued)
Futureof HIT in developingcountries(Cont.)• Policies and legislation formation• mutual recognition and reciprocity for providers between countries isnecessary3• Limits to medical licenses should be placed3• Guidelines for the HIT workforce11• Future research7• focus on the adaptability and relevance of technologies in a variety ofsettings• include participation of communities• smaller studies, although less definitive, are preferable as they areless expensive and produce quicker results• Increase data about financial impact of implementing newtechnologies
References1 Gerber, T., Olazabal, V., Brown, K., Pablos-Mendez, A. An agenda for action on global E-health.Health Aff. 2010; 29(2). 233-236.2 Lewis, T., Synowiec, C., Lagomarsino, G., Schweitzer, J. E-health in low- and middle-incomecountries: findings from the Center for Health Market Innovations. Bull World Health Organ. 2012;90(5):332-340. doi: 10.2471/BLT.11.099820.3 Mars, M., Scott, R. Global E-Health Policy: A Work in Progress. Health Aff. 2010; 29(2): 239-245.4 Jordanova M, Lievens F. Global Telemedicine and eHealth (A Synopsis). Proceedings of the 3rdInternational Conference on E-Health and Bioengineering. E-Health and Bioengineering Conference.2011; 1, 6, 24-26.http://ieeexplore.ieee.org.jproxy.lib.ecu.edu/stamp/stamp.jsp?tp=&arnumber=6150373&isnumber=6150308. Accessed 4/15/13.5 Vogel L, Perreault, L. Management of Information in Healthcare Organizations. In: Shortliffe E,Cimono J., eds. Biomedical Informatics: Computer Applications in Health Care and Biomedicine 3rdEdition. New York, NY: Springer Science + Business Media; 2006: 489-490.6Blaya,J., Fraser, H., Holt, B. E-Health Technologies Show Promise in Developing Countries. HealthAff. 2010; 29(2): 244-251.7 Piette, J., Lun,K., Moura,L., Fraser, H., Mechael, P., Powell, J., Khoja, S. Impacts of e-health on theoutcomes of care in low- and middle- income countries: where do we go from here? Bull WorldHealth Organ. 2012; 90(5): 365-372. doi: 10.2471/BLT.11.099069.8Geraghty, A., Toress, L., Leykin, Y., Perez-Stable, E., Munoz, R. Understanding attrition frominternational internet health interventions: a step towards global eHealth. Health Promot Int. 2012.doi: 10.1093/heapro/das029.9Sturgess,P., Philips,C. Enhancing internet literacy as a health promotion strategy for refugees andmigrants. Health Promotion Journal of Australia. 2009;20 (3):247.10 Haskew, C., Spiegel, P., Tomczyk, B., Cornier, N., Hering, H. A standardized health informationsystem for refugee settings: rationale, challenges, and the way forward. Bull World Health Organ.2010; 88: 792-794. doi: 10.2471/BLT.09.074096.11Dentzer, S. E-Health’s Promise for the Developing World. Health Aff. 2010; 29(2): 229. doi:10.1377/hlthaff.2010.0006
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