September 2008

Making the eHealth Connection

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Not all problems have a technological answer, but when they do, that is the more lasting solution.- Andrew Grove, Founder of Intel Corporation

The Rockefeller Foundation held a conference series, Making the eHealth Connection: Global Partnerships, Local Solutions from 13 July to 8 August at the Bellagio Centre. The goal was to explore ways to use the recent proliferation of technology in developing countries to improve health, especially for the most vulnerable populations.

The aim of the Bellagio meeting was to “build support for access to health information in the Global South by:

  • Looking broadly at health information access solutions, experiences, and lessons learned
  • Highlighting knowledge about and evidence of the ability of health information access to improve patient safety, equity, and healthcare quality
  • Discussing state-of-the-art practices, tools, and avenues for further eHealth proliferation in the Global South
  • Examining barriers to access and publishing health quality information
  • Exploring the role of social networks, collaborative spaces, communities of practice, and virtual communities
  • Seeding global alliances and networks on e-information access and policies.

The conference series kicked off with a rousing keynote address by Dr. Tim Evans, Assistant Director-General for Information, Evidence and Research at the World Health Organisation. Tim put the four weeks of Making the eHealth Connection into context by talking about the current state of eHealth, the immense opportunities it offers, particularly for the Global South and the promise and responsibility the conference holds.

In the first week, the 'Path to Interoperability' session focussed on the challenges that the Global South faces. The other themes were Public Health Informatics and National Health Information Systems.

One of the most fruitful features were the break-out groups. Through these, the key messages were formulated. Some of the points of consensus were:

  • The need for an information and knowledge management system that is not another bureaucratic system defined to the local context and that addresses the demands of the different stakeholders/users, while allowing for contribution at the local level.
  • The importance of building on what already exists and ensuring that what is produced is available to all via standards including a space for the convergence of global collaborations where further development can take place.
  • The need to improve access to information and knowledge sharing highlighting that solutions should include a focus on improving human resource capacity, including the translation and localisation of information, free access to research and publishing to create a local knowledge base and well as some type of global virtual eHealth index.

Eight key issues are at the heart of advancing eHealth and improving health systems in the developing world's Global South region and these were a part of conference conversation:

  • The path to inter-operability
  • Public health informatics and national health information systems
  • Access to health information and knowledge-sharing
  • eHealth capacity building
  • Electronic health records
  • Mobile phones and telemedicine
  • Unlocking eHealth markets.

By gathering some of the world's foremost experts and centring conversations around these topics, new and actionable answers emerged about how to fund, design and deploy eHealth systems in the Global South and around the world.

In the second week, participants focussed on access to information and knowledge sharing organised by BIREME/PAHO/WHO paralleled by the conference on eHealth capacity (organised by the AMIA/IMIA). The “mHealth and Mobile Telemedicine” session gathered 25 private sector and public health leaders to explore the challenges, opportunities and way forward in building mHealth systems that can improve the access, efficiency and quality of health services in the developing world. The overarching goal of the Rockefeller Foundation conference is to develop a roadmap and global partnerships that support the use of emerging digital technologies to improve public health. mHealth session participants included representatives of Cisco, Google, Microsoft, Nokia, and Qualcomm, as well as the Earth Institute, Gates Foundation, MIT, and the UN World Health Organisation.

Africa and South Asia in particular have some of the worst health indicators in the world along with a dearth of information on healthcare, sanitation, best practices and the like. The conference focussed on health/medical professionals and policy makers. The most important recommendation was the “drafting of the health information policy,” which should be part of health policy. Once this health information policy is in place it can be adapted/used by any ministry.

Among the keynote speakers was President Paul Kagame of the Republic of Rwanda. In 2006 and 2007, President Kagame was awarded the ICT Africa Award, in recognition of his demonstrated excellence in promoting the use of ICTs for the overall development of the African continent.

Outcomes

The overarching goal of the conference was to develop support for workable solutions and to give new impetus for collaboratively funding, designing and deploying eHealth systems in the Global South and around the world. eHealth is increasingly employed to address health system challenges and improve services, particularly for poor and vulnerable populations. Yet a myriad of questions linger on the financial and incentive side of the equation regarding how to create viable and sustainable markets, adequate financing and incentives, and effective public-private sector partnerships for impact investment. eHealth markets are difficult to quantify due to their relatively undefined scope and constantly evolving technology offerings.

'Making the eHealth Connection' has prompted several debates and discussions in various fora. The Health Information for All (HIFA 2015) campaign saw eminent persons from the health domain debate issues and look for solutions to the lack of health-related 'knowledge' as Naina Pandita puts it. A lively debate on 'health information' versus 'health knowledge' continues. “One reason why medical professionals do not get access to the “right” information is because the 1st step they take is Google for it. We need to come up with solutions on how to re-package the information into meaningful knowledge that can be passed on further.





Nester Moyo from the Netherlands commented on how the worldwide shortage of nurses and midwives leaves the existing workforce overworked and even in the few instances when they do have access to literature/Internet resources to improve their skills, they do not have the time to do so. Liz Carrington from the UK raised the important issue of low-cost information dissemination strategies in developing countries. Week 2 saw some concrete proposals emerge. Some interesting suggestions include:

  • The need for an information and knowledge management system that is not another bureacratic system, defined to the local context and which addresses the demands of the different stakeholders.
  • The importance of building on what already exists and ensuring that what is produced is available for all.
  • The need to improve access to information and knowledge sharing

There were some grievances too. For example, there were no substantive comments on measuring the impact of information. As Siddharth Dutta puts it, “… sharing of unscientific data over net will have huge confounding problem to the mass. This must be peer-reviewed and scientific assessment done and then aired on net.” Professor Krishnan Ganapathy, Founder Member and Joint Secretary of the Telemedicine Society of India, and one of the conference organizers, said, “The conference's focus on the nexus of eHealth and the Global South is notable… We hope this will illuminate a path for others to follow.” Hopefully, the conference will set the stage for long-term sustainable collaboration in the field of eHealth.

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