Modern information and communications technology, or e-health, has already significantly transformed health care in the developed world. The way in which in e-health has also begun to transform health care in the developing world, and the potential for e-health to vastly expand in low- and middle-income countries, was the subject of a National Press Club briefing held Tuesday in Washington, D.C., by Health Affairs. Video and handouts from the briefing will be available soon on the Health Affairs Web site
In welcoming attendees, Health Affairs Editor in Chief Susan Dentzer cited important existing uses of e-health technologies around the world, such as the use of cell phone-based technologies to track receipt of HIV/AIDS medications in rural clinics in Rwanda. “These things are happening, none of them are imaginary or futuristic, but the potential of all of these technologies is much, much greater,” said Dentzer.
The briefing featured several authors from a cluster of articles on global e-health in the February Health Affairs issue, as well as other e-health experts. The Rockefeller Foundation supported the briefing and publication of the articles, which grew out of a 2008 conference in Bellagio, Italy, sponsored by the Foundation.
“This issue has a growing momentum,” said Ariel-Pablos-Mendez, a Managing Director of the Rockefeller Foundation. “In the 2008 Bellagio e-health ‘Call to Action,’ government, donors, industry, researchers, and civil society pledged to raise the profile of e-health and to promote the globalization of its benefits. The February issue of Health Affairs significantly contributes to this cause and to a better understanding of the complex multifaceted issue of e-health.” Pablos-Mendez also noted that the February Health Affairs issue marks another milestone in the journal’s increasing coverage of global health issues.
A primary theme of the conference was the need for rigorous evaluation of different uses of e-health. “As the old Scottish engineers might have said, ‘That’s all very well, but does it work?” Scotsman Hamish Fraser, Director of Informatics and Telemedicine at Partners in Health, and Assistant Professor of Medicine at Harvard Medical School, observed wryly.
Fraser related the findings of a systematic review of evaluations of e-health implementations in developing countries. He and colleagues Joaquin Blaya and Brian Holt found evidence supporting several types of e-health uses, including improving communications between institutions, such as getting information from laboratories to clinicians in remote areas; assisting in ordering and managing medications; monitoring and detecting patients who might abandon treatment; and improving the timeliness and quality of data collection using mobile devices.
Other Briefing Highlights
William Hersh, professor and chair of the Department of Medical Informatics & Clinical Epidemiology in the School of Medicine at Oregon Health and Science University, spoke about the challenges of building health informatics workforces in developing countries. In this area, “there is little data that we know about best practices: they’re not published well, we don’t know the right types of people to train,” Hersh observed, adding that “we can’t just train people in technology; they need to understand health care, organizational issues, and management – a whole variety of topics.” He also stressed the need to provide informatics professionals in the developing world with skills that complement the cultures and health systems in their home countries.
Hersh’s paper in Health Affairs lays out a model for assessing workforce needs and creating solutions appropriate to local needs in developing and developed countries. In his talk, Hersh highlighted the American Medical Informatics Asssociation’s “Ten by Ten” program, premised on the idea that there should be one physician and one nurse in every hospital trained in informatics. The program started in the United States but has expanded to include international students and now has reached 500 people across Latin America through a Spanish language version. He highlighted AMIA’s global partnership, which seeks to build informatics capacity in low-resource settings, and he commended the Rockefeller Foundation for its support of programs like the National Institute of Health’s Fogarty Center’s informatics and global health program.
Ticia Gerber painted a picture of a vigorous global e-health universe, where innovations are emerging from many different sources, including developing countries themselves, such as Paraguay and Belize. But she also lamented that stakeholders too often end up reinventing the wheel, unaware of ongoing e-health efforts elsewhere that would be applicable to their countries.
Gerber discussed efforts to better organize and disseminate e-health knowledge, such as those at the World Health Organization, where she works as a Senior Program Officer in the Health Metrics Network. WHO is working to develop a “policy toolkit” for health ministers in the developing world. One element of this is a “policy landscape” describing “what exists in terms of health information systems policy … in developing countries.” That leads into the next step of identifying critical questions and challenges, Gerber said. She added that the WHO is forming groups of global leaders on topics such as governance, confidentiality, capacity building, and data stewardship, to explore what consensus cross-border policies in these areas might look like.
“Most importantly, we’re creating an interactive resource center that countries, donors, and companies can access and see what’s happening across the world. They can search it by issue, by type of legislation, and by geography,” Gerber said. She expressed the hope that the policy landscape would be out in about 4 months, and she suggested that developing the resource center would take roughly two years.
Walter Curioso, Research Professor at the Universidad Peruana Cayetano in Peru and Affiliate Assistant Professor at the University of Washington, discussed the field of mobile health, or “m-health,” the use of cell phones and other portable devices in e-health applications. Curioso emphasized the importance of “South to South” collaborations, in which developing nations learn from each other.
To provide a sense of the potential for m-health in developing countries, Curioso pointed out that 80 percent of Peruvians have cell phones. He discussed the use of very inexpensive cell phones to track adverse events among Peruvian sex workers receiving medications to fight sexually transmitted diseases.
Charles Jaffe, Chief Executive Officer of Health Level 7, discussed the imperative of ensuring the interoperability of electronic health information generated by different sources. The issue of interoperability is discussed in an article in the February Health Affairs volume by Ed Hammond, Christopher Bailey, Philippe Boucher, Mark Spohr, and Patrick Whitaker. Hammond and his colleagues discuss five priority areas for achieving interoperability in health care applications: a patient identifier, semantic interoperability, data interchange standards, core data sets, and data quality.