e-Health in Developing Countries: What Can We Do as HI Professionals to Make a Difference?

In Canada where we enjoy universal healthcare and yet still see so much more that we can do to enable healthcare improvement, it can be difficult to imagine the huge challenges facing lower income and developing countries. High infant and maternal mortality rates, the
prevalence of communicable diseases such as HIV/AIDS and tuberculosis and lack of access to safe water, proper sanitation and basic health services are some of the hard realities for citizens in these nations.

What does this have to do with health informatics (HI) and our COACH community? A lot!  At our e-Health 2011 Conference, Stephen Lewis delivered an inspiring closing plenary, challenging us both individually and as a society, to improve the human condition of our fellow global citizens through a strengthened focus and investment in the most basic of public health services. He spoke to the role that e-Health could play in improving the human condition in this way and made a compelling call to us all for action.

We know that HI is a vital tool for enabling such improvements – both in the healthcare of individuals and the health status of entire communities – immunization for children and locally accessible prenatal care and follow-up for expectant mothers are just two examples where big gains can be achieved in many lower income countries. While the benefits of such basic interventions are widely recognized, the necessary infrastructure for them is often missing. In some African countries, for example, it can take up to 12 days to transport the paperwork for a vaccine. Information technology can bridge this yawning gap, and innovative low-cost solutions are emerging in communities using mobile phones for example. In countries where per capita healthcare expenditures may be as little as 1% of western nations, new and innovative HI practices can also play an essential long-term role in effective health system delivery and management by facilitating the data collection and analysis needed to plan for the future and target limited healthcare resources in the most effective way.

HI Passion in sub-Saharan Africa
This summer I was invited to deliver a keynote presentation and co-host a HI professionalism workshop at the Health Informatics South Africa (HISA) Conference, which was an excellent opportunity to actively contribute some of our Canadian experiences and insights. The experience was very inspiring and certainly caused me to reflect back on Steven’s address to those of us who were fortunate to hear him at e-Health 2011 in Toronto. The passion of the HISA Conference participants from the many sub-Saharan countries was evident – they were very open in sharing their stories with peers and I was struck by the barriers they were overcoming in creatively applying low-cost HI interventions in making a big difference in improving health in their countries. They were also extremely appreciative of the tools and advice we could provide them in helping to build more HI skills and capacity there and the lessons we could share from our e-Health experiences.

My Top 10 Lessons Learned on Canada’s e-Health Journey

  • e-Health is often a tough sell – cultivate strong sponsors.
  • Leadership, common vision & collaboration are important.
  • Have a common destination, architecture & standards – but multiple paths. (Be prepared to make course corrections!)
  • Use small steps, show results & continually learn & adjust.
  • Don’t drive change – enable it by supporting health system
    priorities & ensure strong provider & consumer/patient engagement.
  • Let’s not forget why we are doing this – better & safer health.
  • Focus on the information & business processes vs. the technology.
  • Change management, governance and project management are vital.
  • Manage expectations – achieving benefits requires sustained effort.
  • Don’t neglect the value of data for improving the health system.

HI capacity must be developed along the journey to ensure sustainability.

(From Neil Gardner’s Presentation at HISA South Africa Conference)

Developing countries are generally much earlier in their e-Health journey and often lack infrastructure, standards and the financial resources that we have, yet many of their challenges are not dissimilar to those that we faced as a country 15 or 20 years ago. Several of our COACH members are already engaged in work which is bringing together Canadian and international expertise gained during our collective e-Health journeys. As one example, Dr. Marion Lyver is Co-Chair of the ISO Public Health Task Force (PHTF) and a member of Canada’s delegation to ISO’s Technical Committee on HI (ISO/TC215). The PHTF experts are leading the development of a technical report which elaborates an architectural framework
and maturity model for the effective use of information and communication technology in support of health service delivery. It will provide low and middle-income countries with relevant guidance in developing their e-Health capability and assessing their progress toward its mature use. While there are many challenges, including ensuring interoperable e-solutions in nations experiencing a deluge of vendor offerings, Canada can also take a lesson in innovation from these countries. As Marion says, “Their resources may be limited, but they are often way ahead of the game when it comes to thinking outside the box around mobile, solar-powered and other ‘smart’ technologies.” With developing countries accounting for 77+ per cent of the world’s cell phone subscriptions, this technology is transforming the way local health workers and citizens can create, access, use and exchange healthcare information.

“There are things we Canadians are REALLY good at: satellite telecommunications, space robotics and hockey come immediately to mind. As it happens, we also enjoy a truly well-deserved international reputation for excellence and leadership in HI,” says COACH member Derek Ritz, based on his international experience with ISO/TC215, the PHTF and a number of national e-Health infrastructure projects in Southern Africa and South East Asia. “For the six billion people living in low and medium income countries, that excellence in HI can help…and help a lot. For example, the advocacy work presently led by COACH and COACH members regarding e-Health standards, governance and HI professionalism is having a huge positive impact and should be supported and strengthened.”

My recent opportunity to participate in the HISA conference in South Africa reinforced for me the high degree of respect that our counterparts in other countries have for both our Canadian health system and our e-Health achievements, and their interest in quickly leveraging, adapting and learning from both our failures and our successes.

“Even though many developing countries are half a world away, we share many similarities when it comes down to the basic ingredients necessary to enable improved health through the effective use of available information and technologies.”

As we prepare for our new three-year COACH Strategic Plan and reflect on the progress we’ve made towards our vision of Taking Health Informatics Mainstream, I can’t help but think about how we might better support our colleagues in less fortunate countries in meeting the major health challenges they face through the innovative use of technology. Even though many developing countries are half a world away, we share many similarities when it comes down to the basic ingredients necessary to enable improved health through the effective use of available information and technologies.

Sharing knowledge and experience, both as an association and individual members, could be a good first step. For example, our HIP® resources – Core Competencies 3.0, Role Profiles, Career Matrix, Career Navigator and CPHIMS-CA credential – are vital starting points in building the local capacity necessary to successfully adapt and sustain good practical e-Health solutions. Sharing COACH’s experience about the knowledge, abilities, skills and judgements needed to be a competent professional gives other countries a leg-up on putting the necessary people in place. We are seeing countries at relatively more advanced stages in the e-Health journey leveraging our work in areas such as HI professionalism and practices.

Australia and Brazil, for example, have already been able to accelerate their credentialing and related professionalism initiatives, building on COACH assets and expertise. So I think we should explore further what we could do in collaboration with other national and international organizations to make this knowledge more available and adaptable for lower income countries and help build their HI skills and capacity.

The Challenge: Committing Your Time & Energy
So what do you think?  Is the opportunity to better support e-Health adoption and skill development in developing countries that see e Health as an important enabler for improving health something that you are willing to commit some time and energy to? Are you perhaps involved in such an international effort now? If so, I’d like to learn more about it and see if we could lend support as a community if that would be beneficial.

How do you think COACH and you, as a HI professional, can become more involved and make a difference internationally?  What insights and
innovative ideas can we also gain in doing so? Through COACH, we’ve had an International Telehealth Special Interest Group for a number of years and we could re-tool and build on this by creating an International HI Community of Interest (COI). What areas of interest do you think a COACH-sponsored COI should cover and are you willing to get involved!?

As always, I welcome your questions and comments, and in this case I would especially like to hear your ideas about what we could do to address the challenge that Stephen Lewis laid before us.

Please email me via the COACH office at info@coachorg.com or tweet me at@COACH_HI. I would be delighted to hear from you.

To learn more about supporting HI in developing countries, download Neil’s HISA South Africa presentation, “The Need for Health Informatics (HI) Professionals” from the COACH site at http://www.coachorg.com/en/resourcecentre/Presentations.asp

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