What difference will eHealth make in South Africa over the next ten years?
In the film Terminator, the central character sent back from 2029 didn’t need much healthcare, but was packed with technology and the ability to change, two of the top requirements for successful eHealth. The current crop of eHealth initiatives needs to deliver more if they’re to have a big impact over the next ten years. It also needs supplementing with more innovative opportunities, such as health analytics, Big Data and the expanding Internet of Things (IoT). Many African countries are well along this journey and are changing the way they absorb eHealth as a core resource. In South Africa, the Government’s plans to establish a ministerial advisory committee on eHealth show foresight likely to step up the importance of eHealth and to move things in the right direction. Draft regulations are out for comment.
There are numerous claims that eHealth can transform our health and our healthcare systems and provide the means to cope with the increasing demands of an ageing population. If the claims are false, then they just increase the heap of fictional, hyperbolic and fanciful panaceas. If they’re true, immense changes are needed, and “change always brings strong opposition”. As much as many African countries look to South Africa to take an eHealth lead, internal leadership is always a key lever and has to extend across political, executive and clinical domains. This eHealth leadership isn’t quite the same as leadership in conventional entities where groups of stakeholders are less numerous.
Considerable attention accorded to benefits and their realisation will help to promote success, but it’s not enough. It’s vital when Africa’s healthcare resources are very scarce, that benefits exceed costs over time. This creates the more demanding goal of realising net socio-economic benefits. Then, realising benefits is integrated with control of investment, operating costs, obsolescence and risks.
When eHealth succeeds, the time horizons to net-benefits are long, approaching a decade for large-scale electronic health records (EHRs). Evidence for this exists in tinTree’s eHealth Impact Database, containing cost-benefit data of 60 initiatives from around the world. So, if a decade’s enough time to realise benefits, a reasonable question is what difference will eHealth make over the next ten years?
The answer is, it depends. Success factors extend across the value chain, including the vision for how citizens’ roles in health and healthcare can change, the way that health workers deal with patients, matching ICT with people and their needs, the scale of investment and the new skills and knowledge that people need.
eHealth in South Africa, also called ICT4Health, is on a steady trajectory, but is still patchy with much of the current emphasis on administrative data. The emphasis needs switching to health and healthcare delivery and quality. Since the government’s eHealth strategy was finalised in 2012, eHealth globally has seen several significant steps forward that offer bigger benefits than originally envisaged. Analytics and Big Data are topical examples, which South Africa now needs to incorporate into its eHealth strategy. In Africa, expanded mHealth may be one too as the number and use of smart-phones increases.
A key part of South Africa’s strategy aims to implement EHRs. It provides a sound platform for health worker teams to share patient and clinical information; they’re all up to date and can use the best clinical information to care for their patients. Health informatics can deal with most of the complexity of EHRs and clinical information. There are several examples from other continents that show that this approach is economically viable and achievable.
It’s now becoming clear that analytics offers the opportunity to make much more effective use of data in EHRs than envisaged some three or four years ago. An example is how it can be used to predict serious deterioration of patients’ health long before traditional diagnostics can see changes.
This recent surge in the use of analytics is not as well understood and may be the most exciting opportunity over the next decade. It can make health workers more productive and citizens and health workers more proactive, by providing information about changing conditions in people, patient cohorts and environments much faster than health workers can see from observation. An example from the USA is identifying patients with sepsis before health workers can see symptoms, so enabling interventions to avoid deaths in some cases. This leads through to an expanded healthcare model of managing patient cohorts proactively as well as providing direct healthcare.
Analytics and Big Data can change the way that agencies manage population health. Data fromWikipedia and Google have already provided faster information than the formal health agencies on the spread of flu epidemics in the USA. Twitter is doing the same with HIV. Structuring and transferring interoperable clinical and demographic data from EHRs into population health priorities creates an enormous database for analyses and risk assessment that can improve policies and responses, martialing resources better for better results. It also provides a source of health data for citizens, communities and patients that they can access with continuously improving smart phones.
If it’s this good, why isn’t it already underway? The answer’s simple. It needs a specific type of strong leadership, sustained investment and targeted change for a few more important pieces to fall into place.
One requirement is better standards and interoperability across multiple information systems. South Africa’s IOp framework provides an important start, which will need sustained support and development from the standards authority created under the new legislation.
Another urgent need is a sustained HR plan for investment in health informatics and analytics, with highly skilled people retained and developed further in South Africa: eHealth’s human capital. Supporting this is the need for a substantial, sustainable eHealth investment fund to finance human capital expansion and procure the modern ICT solutions and tools that can provide the information. The goal then is to deploy these to take South Africa’s healthcare forward for the benefit of its 51 million people. Like technology itself, it’s a never-ending quest.
The terminator was a cyborg-assassin with sinister intentions. Before we have to deal with him, we have to deal with cyber-criminals and their associated threats to the security of our health and healthcare data. Effective eHealth regulation and cyber-security are now essential, not optional eHealth costs. These need developing over the next ten years too.
Dr Sean Broomhead is a member of the WHO’s eHealth Technical Advisory Group (eTAG) and co-chair of it’s eHealth Strategy working group. He’s chairperson of tinTree International eHealth, an NGO specialising in leadership, strategy and development to support eHealth in African countries and other entities that want to make a meaningful contribution to Africa’s eHealth future.