Research Topic A framework for designing and deploying e-health systems in developing countries Abdul Wahid Samadzai

1. Research Topic A framework for designing and deploying e-health systems in developing countries Abdul Wahid Samadzai PhD Student Institute of Informatics, Tallinn University 2014

2. Contents • Problem Area • Introduction & Related Definitions • Health information systems in the developing countries • Health Management Information System & ICT • The role of e-Health System in Information Society • Our Possible Contribution • Group Activity • References

3. Problem Area Health care system is one of the major issues for developing countries and thus the information technology is becoming progressively more important now a days. Health is one of the most important and valuable things in human life. Every nation is aware of its public health. Each year millions of people die from basic health care deficiencies.

4. Problem Area (Cont.) Most of the people in the rural area don’t even know much about the technological improvement over the world. Even the people who live in the rural areas are worried about the basic needs of their daily life; sometimes they depend on their local health facilitator who has no academic knowledge of medicine. Health care facilities available in the Government hospitals are having not enough seats for patients and there are always a lack of doctors, nurses, proper medical instruments and free medicines.

5. Problem Area(Cont.) Local pharmacies are selling medicine with or without prescription from the doctors. So the abuse of selling medicine that affects the general people suffering different diseases and young generations getting addicted which spread out over the country. Most of the doctors prescribe medicine on a hand written prescription paper and giving suggestion to make the laboratory test to the patients to verify their diseases.

6. Problem Area(Cont.) Mostly, patients lose their previous prescription and also the laboratory test report which will create problem to doctors to verify their previous diseases and to make decisions. At present in the cities, healthcare and diagnostic centers practice limited applications of electronic patient record mainly in the diagnostic services but having no share or access to their database in the local hospitals

7. Introduction • Health information technology (HIT) consists of set of technologies with a great diversion for transmitting and managing health data for the use of all stakeholders. • Stakeholders of health information include payer, providers and all other groups having interest in health and health system.

8. Health information technology Health information technology (HIT) means the use of computer in the form of physician digital assistance, electronic health records, computerized physician order entry system by doctors, patients, hospitals, laboratories, x-ray facilities and all other stake holders. Health information technology is very important part of constantly changing environment of health care system. With the use of HIT, health related information can be communicated well and can be used in evidence based decision making process .

9. Health management Health management is the intersection of information science, computer science, information technology and health. It deals with the resources, devices, and methods required in optimizing the acquisition, storage, retrieval, and use of information in health and biomedicine. This includes not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems.

10. Eelectronic Hhealth Record • A national health information system • A way for medical doctors to exchange health records • Access for the patient to his or her health records through a designated patient’s portal • Health care providers are able to enquire patients’ time-critical and general data • The system stores the patient’s medical history and is a vital information source for physicians

13. Digital Images • Electronic Health Records has separate links to analysis results • No need to make repeat analysis because of loss of images • (Foreign) experts can be easily included in medical procedures • More efficient use of analysis made with complex diagnostics equipment

14. Digital Registration • Overview of vacant reception times of all medical specialists of the given area and a possibility to book/cancel the reception time through a web portal • Registration systems of medical establishments continue to work in parallel • Enables to remind the patient about the reception time • Provides an objective and accurate survey of the length of treatment queues in health care establishments for health care management and national statistics

15. Health systems levels In order to improve the coordination between health systems levels, the flow of necessary information needs to be understood. The flow of health data from the lower level (primary health facilities) to higher level (secondary facilities) needs reliable data from the lower level. The upper levels where strategies and plans are made rely on the information collected from the lower level (operational level). Proper data collection methods allow regular monitoring of health information systems.

16. Levels of health care system and the data flow

17. Health information systems in the developing countries Health information systems(HIS) are the systems for collecting and processing health data from different sources. HIS have become a crucial component for strengthening the health systems in developing countries. There has been tremendous growth of these systems in recent years; this has been the result of advancement of technologies, which is taking place all over the world.

18. Health information systems in the developing countries(Cont.) Health information system emergence has therefore lead to shifting from paper based to computer-based ways of processing health information. This shift has increased the opportunities of manipulating patient data efficiently. However, it has also raised challenges of technological complexity in using the advanced tools of processing health data.The usage of health data is extended not only for patient care and administrative purpose but also for planning and decision making in improving health service

19. Health information systems in the developing countries(Cont.) The lack of shared standards in data collection methods cause the gaps in reporting health data as it might lead to important data not to be reported. Furthermore lack of coordination between health care system levels in reporting health data lead to poor utilization of the collected data which might therefore affect the quality of service that is offered by health management systems.

20. Information and communication Technology in Health Information and communication technologies (ICT) are being widely used in health management system. Rapid advancements in ICT in the last decade or so provide solutions to the problems in healthcare management systems. These include a wide spectrum of issues such as patient safety, dietary management, telemedicine, digital imaging and document management.

21. Information and communication Technology in Health(Cont.) The definition of healthcare system has changed due to the advancement in ICT. Quick and fast access to the medical data is available to all the stakeholders through internet and the developing countries may take advantage of it. Having said that, there is a financial constraint as well and most of the developing nations are not in a position to spend huge amount on healthcare projects.

22. Information and communication Technology in Health(Cont.) ICTs enable online communication about medical issues and diagnosis of complicated diseases by linking medical practitioners who are separated geographically. They have the potential to change the delivery of health services and patient care, as well as the management of health systems. e-health is an emerging field in the intersection of medical informatics, public health and business, with referral and information delivery enhanced through the Internet and related technologies.

23. Information and communication Technology in Health(Cont.) In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an approach, and a commitment for networked, global thinking to improve healthcare locally, regionally and worldwide by using information and communication technologies.

24. Mobile technologies in health systems The dramatic advancement of mobile technology has geared new opportunities of improving social lives in developing countries. The societies are now becoming mobile oriented and therefore, there is an increased pressure on the efforts of exploiting this technology in improving social services. Usage of mobile technologies in developing countries could now be able to handle many existing problems of their health systems; data collection process is one of the aspects that can be fuelled by exploiting mobile technology as enabling technology in improving the accuracy and efficiency of the process as whole.

25. Central Health Database Management System of e-Health Card The Central Health Database Management System explores the connectivity with different service center, where the physician and other service units will have the rights to use on customer data through the e-Health card system. The platform performs several stages to provide a better e-Health card service to the citizens.

26. e-Health Card Service Center Connectivity Unit The e-Health card service center will help the citizens to learn the advantages of different type of health care services for the patients. The e-Health card service center will give the facilities to the citizens about their health literacy. From this health service center people will know how they are working behind the technology and their connectivity with each other, and their responsibilities of different healthcare units.

27. e-Health Card Service Center Connectivity Unit(Cont) However, e-Health card information service center will provide the information to assist in accessing various public health resources. This service will make sure a better and secure health service for every citizen.

28. Verifying National ID Card After arriving at the e-Health card service center, the patients will be verified personally with his National ID card and proceeded to continue his/her queries regarding e-Health care services. After verification of the patient, e-Health card of the patient will be issued and made an appointment with the doctor for his/her treatment.

29. The role of e-Health System in Information Society People, as part of the society, form the core of health systems. They use health services, contribute finances, are care givers and have a role in developing health policies and in shaping health systems. In all these respects, there is growing pressure for public accountability and increased response to inputs from civil society. The manner in which the state responds to these changes, and the extent to which society actors are recognized and included in health policies and programs, are some of the critical factors determining the course of public health today.

30. The role of e-Health System in Information Society(Cont.) society has a long history of involvement in public health. Early public health actions to clean up American cities in the 1800s, for example, were led by well known public figures supported by women's’ groups. However, the recognition of civil society’s contribution to health has varied over time. One of the most significant developments in the recent past has been the 1978 Alma Ata declaration, which is considered a landmark for recognizing people’s participation in health systems as central to Primary Health Care and for recognizing the role that organized social action plays in securing health gains.

31. The role of e-Health System in Information Society(Cont.) • Patient Portal – access by one’s ID card to his or her medical data regardless of time and place • Patient no longer needs to carry papers between different physicians • Physicians have an objective and accurate overview of the patient’s health history • In collecting data to the electronic health record it is no longer necessary to recall earlier diseases or drugs • Better overview of the health history improves the medical quality

32. The role of e-Health System in Information Society(Cont.) • Improves and speeds up exchange of information • between doctors of different specialisation • between specialised and family doctors for mutual counselling, considering second opinions • The system provides and overview of time-critical data of the patient • A more comprehensive and faster overview of the medical history • earlier visits and diagnoses • results of research and analyses • issued prescriptions

33. Our Possible Contribution • My research possible contribution to the e-health system is to develop and evaluate an approach for designing and deploying e-health systems in developing countries. • This is the goal of my research in the broad area of e-Health system.

34. Research questions • The main question of the research is: How to support developing countries in development of health management systems? • In order to answer to the main question, we need to answer to following sub-questions: • To learn how does a health Information Systems Work already in developed countries? • What practices from such scenarios can be applied for developing countries and what cannot?

35. Research questions(Cont.) • What the main obstacles are exists in developing countries for introduction of solutions that are exists in developed countries? • What are the critical issues affecting the introduction of a health management information system in hospitals on the district level?

36. Research Methods We will use the qualitative research approach. In this case we will conduct the research work in the following stages: • Data Collection: In this research, relevant research data will be collected. New data sources allow us to learn from and improve with each patient’s interaction with the health care system.

37. Research Methods(Cont.) • Data Analysis: Collected data has been further analyzed to resolve the existing problems in the healthcare system. Data that is collected and available does not on its own support better care, improve system performance or inform health policies. As noted, the volume of health data being collected and made available is increasing, and its nature is changing; this is transforming how data is analyzed and used.

38. Group Activity Group of 4-5 persons List the challenges of e-Health system in developing countries. (15 Minutes) Present your findings. (4 Minutes)

39. References [1] M. Aanestad, E. Monteiro, H. Kimaro, E. Macombe, G. Macueve, F. Mukama, H. Muquingue, L.J Nhampossa, and J. Lungo, Strategies for development and integration of health information systems: coping with historicity and heterogeneity. Working paper, University of Oslo 2005 [2] Oladosu J. B. (2011). Framework For A Service-Oriented Mobile E-health Infrastructure For Rural and Suburban Healthcare; A Ph.D. Thesis in the Department of Computer Science and Engineering, LadokeAkintola University of Technology, Ogbomoso, Nigeria. [3] Chetley, A. (2006), Improving Health, Connecting People: The role of ICT in the Health Sectors of developing countries. A framework paper. InfoDev. [4] Heywood, A. (2005). The Vietnam Health Management Information System, Health Metrics Network (HMN).

40. References [5]Brender J, Ammenwerth E, Nykanen P, Talmon J. Factors influencing success and failure of health informatics systems—a pilot Delphistudy. Methods Inf Med. 2006;45 (1):125–36. [6]UNESCAP (2010). E-Health in Asia and the Pacific, Challenges and opportunities. [7] Dr. Muga R., Dr. Kizito P., Mr. Mbayah and et al.,(2011). Chapter 2: Overview of the Health system in Kenya.

41. Thank you!