on Medical Informatics - IMIA · African Region eHealth resolution • Calls for member states to:...

MedInfo 2010 | 12 September 2010

MedInfo 2010:13th International Congress

on Medical Informatics

Cape Town, South Africa,

12 - 15 of September 2010


eHealth: a global perspective and responsibility

Najeeb Al-Shorbaji

World Health Organization

MedInfo 2010 | 12 September 20103 |

Introduction: African context

• MedInfo in Africa: the importance and significance;

• Africa and the MDGs: Africa still lags behind in terms of achievement of the Millennium Development Goals by 2015;

• The African Region of WHO still had the highest maternal, neonatal and under–five mortalities, estimated respectively at 900 deaths per 100 000 live births, 45 deaths per 1000 live births and 145 deaths per 1000 live births.



• Weakness of national health systems:• Governance issues;

• Inadequate financial and human resources in most countries of Africa;

• Limited access to quality essential medical products and technologies including essential medicines, clinical laboratory services and diagnostic imaging services;

• The shortage of the health workforce continued to be most acute in Africa, with the majority of countries facing critical human resources for health issues;

• Weakness in health information systems.



• African telecommunication indicators from the International Telecommunication Union:• 3.77% of the population has access to fixed

telephone lines;

• 27.48% has a mobile line subscription;

• 5.34% has internet access;

• 1.6% is the personal computer penetration rate in Africa while at a global level it is12.97%. This is compared to 34.04% in the Americas, Europe 29.24%, Asia 6.37%, Oceania 50.84.


Terminology

• Medical informatics

• Health informatics

• Tele-health

• eHealth

• Use of information and communication technology for health.

• The role of informatics as a tool for information management includes quantitative benefits, qualitative benefits and strategic benefits.


Benefits: can eHealth save lives?

• Yes: could be directly, could be indirectly, to the individual and to the society.

• Citizens, patients;

• Healthcare professionals;

• Healthcare providers;• Governments;

• To:• improve the quality of healthcare, patient safety• expand access and contribute to equity/universal access and• contribute to reduction of cost of health services.


eeee----LearningLearningLearningLearning

Training Course

eeeeeeee--------CareCareCareCareCareCareCareCare

Scope of eHealth applications and services

eeee----SurveillanceSurveillanceSurveillanceSurveillance

eeeeeeee--------ManagementManagementManagementManagementManagementManagementManagementManagement

eHealth eHealth eHealth eHealth GovernanceGovernanceGovernanceGovernance

PreventionPrevention

DiagnosticsDiagnostics

DermatologyDermatology

ObstetricsObstetrics//

GynaecologyGynaecology

RadiologyRadiologyPathologyPathology

Patients

Doctors

Nurses

Society

Websites

Pandemics

Emergencies

Disasters

HealthProfessionals

Research

Journals

Medicines Medicines

procurementprocurement

ReferralReferral

SystemsSystems

HospitalHospital

InformationInformation

SystemsSystems

HIS

IHR

ElectronicElectronic

HealthHealth

RecordsRecords


Global health and global eHealth

• Global health refers to health problems that transcend national borders—problems such as infectious and insect-borne diseases that can spread from one country to another. It also includes health problems that are of such magnitude that they have a global political and economic impact. http://www.familiesusa.org/issues/global-health/matters/

• "The Declaration of Primary Health Care and the goal of “Health for All in the Year 2000” advocated an “inter-sectoral” and multidimensional approach to health and socioeconomic development, emphasized the use of “appropriate technology,” and urged active community participation in health care and health education at every level" “Declaration of Alma-Ata.


Person-centered care

• Renewal of Health for All conference held in 2008 and the World health report 2008 emphasized the People-centered health care approach;

• Role of ICT in person-centered healthcare;

• Personal healthcare;

• Self medication;

• Access to health on the Internet.



• Health and eHealth are inseparable due to the

fact that health is an information intensive sector.

• Health is a global concern that is trans-border by

definition and affects the world population.

• Information technology and telecommunications

(ICT) is a global issue especially with the

emergence of the knowledge economy and the

information society.



• Access to the Internet, mobile phone penetration, global media, satellite communications, multilingual programmes, multinational ICT companies and partnerships and many other phenomena are characteristics of a globalized and interconnected world.

• This has required WHO to adopt global approaches to eHealth.


WHO and global health

• WHO has been recognized as the leader in global health through its work over the last 62 years as the UN specialized agency responsible for the health of the world's population.

• Other UN agencies share similar principles and manage activities to this end. The Millennium Development Goals (MDGs) are considered one of the most important global health and development initiatives.


WHO and global health

• Global health initiatives include malaria, HIV/AIDS, Tuberculosis, Polio, Tobacco, and other diseases.

• Target 18. (Goal 8: Develop a Global Partnership for Development) said "in cooperation with the private sector, make available the benefits of new technologies, especially information and communications technologies".


WHO's response

• The adoption of the World Health Assembly

resolution (WHA58.21) on eHealth in 2005 by

WHO member states came as a recognition of

the role of eHealth in:

• strengthening health systems,

• improving health services,

• reaching out to remote communities,

• enhancing the capacity of health workforce and

• health promotion.


WHA Resolution on eHealth

• The eHealth resolution did not only give legitimacy to the concept itself but also defined:

• the scope of ehealth

• the potential stakeholders,

• the role of governments and the private

sector,

• the need for legal, ethical and regulatory

frameworks for its implementation.


WHO Regional Director for Africa

• "eHealth can contribute to health systems strengthening in several ways by improving the availability, quality and use of information and evidence through strengthened health information systems and public health surveillance systems; developing the health workforce and improving performance by eliminating distance and time barriers through telemedicine and continuing medical education; improving access to existing global and local health information and knowledge; and fostering positive lifestyle changes to prevent and control common diseases."


The Regional Committee for WHO African Region eHealth resolution

• Calls for member states to:

• promote national political commitment to and

awareness of eHealth,

• develop a conducive policy environment

eHealth,

• developing national policies, strategies, norms

and appropriate governance mechanisms,

• build infrastructure and establish services for

eHealth,


The Regional Committee for WHO African Region eHealth resolution

• Calls for member states to:

• systematically develop human capacity for

eHealth,

• make the necessary investments in eHealth

infrastructure and services with the private

sector and

• establish monitoring and evaluation systems

to measure progress in the implementation of

the national eHealth strategic plans;


eHealth global uptake

• First Global eHealth survey, 2005:

• Benchmarking

• Comparison between countries

• Hard data and evidence on progress made.

• Second Global eHealth survey, 2009:

• More in-depth analysis

• Included eight thematic areas: mHealth, Telemedicine, Management of patient information, Legal and ethical

frameworks for eHealth, eHealth policies, eHealth foundation actions, eLearning and country profiles.


The grand challenges to eHealth

• Organizational challenges

• Technical challenges

• Financial challenges

• Legal and ethical challenges.

• Regions and countries have different challenges based on their healthcare systems, culture, economy, ICT infrastructure, human resources.


mHealth: Comparison of barriers:WHO African region and European region

0% 10% 20% 30% 40% 50% 60% 70%

Cost effectiveness

Demand

Infrastructure

Lack of knowledge

Legal

Operating costs

Policy

Priorities

Technical expertise

Other

% of Countries

Africa (n=20)

Europe (n=21)


Legal, ethical, governance and cultural

issues

• Different legal frameworks exit even within the same country. In other countries eHealth legislation is totally missing. Linguistic and cultural barriers limit the capacity for reusing some of the solutions or exchange of experience among countries. In many developing countries national policies and governance structure is not there. Issues concerning confidentiality of data (data protection acts) and ethical aspects of health on the Internet need to be addressed;


Awareness, access and attitudinal

problems among end users

• The value of ICT in health not fully recognized which has resulted in eHealth being not high on national health priorities. Evaluation of eHealth has been concentrating mainly on pilot projects in small settings. Coupled with all of this the attitude of many healthcare professionals as they resist ICT knowing of course that ICT is not for health by design. The communication gap between health and ICT professionals has resulted in a level of distrust in technology by healthcare professionals;


Technical competencies of staff at all levels

• As healthcare professionals do not receive ICT training as part of their undergraduate programmes their understanding of it comes late in their career. On the other hand ICT professionals are mainly hardware and software engineers with little orientation on biomedical applications. There is a need for in-service training and continuous education are missing in the area of health informatics. This is challenged by having very few specialized health informatics programmes;


Week public private partnerships in eHealth

• It has been noticed that private sector

healthcare institutions have their own ICT

implementation plans who work with the private

ICT sector. There is a need for private sector to

invest in ICT applications on behalf or in

collaboration with the public sector. This is

limited by the inability of the public sector to

allocate funds that can be sustained and to

attract the private investment in eHealth;


Financial support and sustainability

• eHealth is funded by donors in many places as research and/or pilot projects. Funding is provided for a specific component of eHealth applications in isolation of other elements which encourages vertical rather than horizontal implementation which by itself results in parallel systems in different institutions doing the same thing;


Information and communication technology penetration and infrastructure

• In addition to absence of broadband connections at national level, healthcare institutions are not on the priority list for computerization due to weak national information infrastructure. In most developing countries ICT services are very expensive and under monopoly by the government. This has resulted in vicious circle of weak private sector, less investment, lacking quality and eventually low internet penetration rate in general and in health sector in particular;


Standardization and interoperability

• Fragmented efforts to develop eHealth applications in the absence of proper governance, standards and national plans resulted in development of eHealth systems that cannot exchange data. These systems are mainly standalone and disintegrated, lacking unified coding schemes, following different or no standards which resulted in total lack of interoperability between them;


Trans-border data flow, data ownership

and personal rights

• Typical issues that require global solutions relate to access to personal data stored in one country by professionals in another country. Access to and use of health information over the internet when data generated in one country and used/utilized in another;

• Ex: a company implementing an electronic health record in a country while servers and systems are hosted in another country


Open source software vs. off the shelf

commercial packages

• Choice between the different options in many cases is not in the hands of the national government. Multinational vendors, donors, companies, alliances, partnerships and associations have infrequence on the choice.

• Ex: in the absence of national policies countries may accept "donation" by a private company which then pulls out or stop technical support.


Six important areas that have global dimensions and impact


Broadband Commission

• Countries in North America and the European Union

account for more than 50% of the world's 1 billion fixed and mobile broadband subscriptions, but South Asia and

Sub-Saharan Africa together account for less than 3%;

• UN Secretary General established the Broadband

Commission in 2010;

• The Commission met in Geneva in July 2010;

• The Commission is co-Chaired by H.E. President of Rwanda;

• The Commission will launch its report at the MDG

Summit on 21 September in New York.


Mobile health (mHealth)

• mHealth is the use of mobile communication technologies as an integral part of healthcare delivery.

• mHealth is part of eHealth and therefore it carries all of its promises and concerns-plus. mHealth has to be part of an architecture and not another silo in the eHealth arena. mHealth has to set over eHealth infrastructure;

• Mobile phone is one of the fastest growing telecom infrastructure at both national and global levels. ITU predicted an estimate of 4.6 billion subscriptions globally by end of 2009. It is expected that 45 % of traffic on mobile networks will be data.


Mobile health (mHealth)

• mHealth aims to improve healthcare delivery through eCare, eServices, eSurveillance and eLearning.

• Issues related to mHealth include cost, ownership of data, confidentiality and equity.


The most commonly reported mHealth initiatives in GOe

• 50% in emergency/disaster situations;

• 50% in health call centre or healthcare telephone helpline;

• 45% for surveillance programs;

• 40% for voice/text messages to achieve treatment compliance;

• A number of countries highlighted using mHealth for HIV/AIDS.


Public-Private Partnerships

• Goal 8: Target 18: of the MDGs calls for a Global Partnership for Development;

• The World Health Assembly in May 2005 adopted a resolution on rules of engagement with the private sector;

• It is strongly believed the private sector has a major role to play in innovation, funding and implementation of eHealth systems;

• At a national level stakeholders include the government, the private sector, the academia, the NGO who have to work together;

• Medinfo 2010 under the theme of Partnerships for effective e-Health is very timely and fitting.


eHealth Economic Models

• A high level consultation was held in Geneva on 6 and 7 September to discuss this issue;

• Participation from governments, the UN, EU, the donor community, the NGOs, the academia/research;

• No one model can apply to all situations and countries;

• Health as a development sector is the prime concern;

• Return on investment need to be calculated based on the socio-economic values in addition to the monetary cost;

• A plan was developed for further work by the participating agencies;

• Report of the meeting will be shared at the UN MDG Summit in New York.


Global governance of eHealth

• Code of ethics;

• Standardization

• Interoperability;

• Human resources development;

• Charters and frameworks;

• Collaboration and partnerships.


IMIA as an NGOs in official relations with WHO

• The objectives of WHO's collaboration with NGOs is, inter alia, to promote, the policies and strategies derived from the decisions of the governing bodies of WHO. Unless otherwise indicated, the agreed activities are intended to contribute to the achievement of the following:

• WHO Strategic Objective(s):

• Implementation of the action plan of the 2005 eHealth Resolution;

• Realize the potential of IT for the strengthening of the Global Healthcare Workforce.


IMIA as an NGOs in official relations with WHO

• Specific proposals for collaboration:

• Agreement on IMIA/WHO fellowship fund;

• Active role and participation in the scientific programme of the future IMIA Conferences;

• Joint development of guidelines;

• Convening of partnerships especially with IMIA

academic members;

• Assistance to countries in establishment of national

societies for eHealth, health/medical informatics;

• Networking and knowledge sharing joint events.


Thank you

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