But in fact, many developing countries worldwide are investing in e-health to help increase access, improve affordability and boost care quality.
From telemedicine in Mongolia to e-pharmacy projects in Malaysia to low-cost electronic health records for HIV/AIDS patients in Kenya to Web-based communication tools to address maternal and child mortality in Peru, e-health applications are being used in many developing countries.
The February issue of the journal Health Affairs focuses on how e-health -- the use of information and communications technology to manage patient care -- is transforming health care in poor and low-income countries. The Rockefeller Foundation provided the journal with financial support for this month's issue, and many of the articles grew out of a 2008 Rockefeller Foundation conference on e-health at the foundation's Bellagio center in Italy.
At a Health Affairs briefing at the National Press Club in Washington, D.C., on Feb. 18, speakers discussed not only the promise of e-health technologies in developing countries but also the challenges and obstacles that remain.
Evidence of Benefits Needed
Hamish Fraser -- director of informatics and telemedicine at Partners In Health, an assistant professor of medicine at Harvard Medical School and an associate physician at Brigham and Women's Hospital in Boston -- discussed the need to evaluate e-health systems in developing countries.
Fraser co-wrote an article in the journal, titled "E-Health Technologies Show Promise in Developing Countries," that systematically reviewed evaluations of e-health implementations in developing countries. Fraser and his colleagues found that e-health systems in developing countries can:
- Improve communication between institutions;
- Assist in ordering and managing medications;
- Help monitor and detect patients who might abandon care; and
- Improve data collection timeliness and quality using mobile devices.
Fraser noted that PEPFAR spends an estimated $100 million annually on information systems and that other organizations, such as the Global Fund and the Bill & Melinda Gates Foundation, also provide significant funding for e-health in developing countries.
He said there is "a serious amount of money on the table" for e-health, but there have been few studies conducted to determine if we are getting value for our money.
According to Fraser, there have been insufficient studies on:
- Positive clinical impact;
- Cost-effectiveness;
- Improved process;
- Efficient use of staff time; and
- Safety.
Fraser said funding agencies should require evidence of the benefit of e-health systems based on evaluations during and post-implementation.
Interoperability Challenges Remain
Charles Jaffe -- CEO of Health Level 7, a global standards setting organization -- said that interoperability of e-health systems poses challenges both domestically and internationally. Jaffe defined interoperability as the:
- Sharing and (re)use of data across many sites, without the loss of information;
- Exchanging information without ambiguity of content, context and meaning; and
- Maintaining meaning for both the human reader and the computer.
Jaffe said that "one of the hurdles that we face in interoperability is [the] complexity" of medical language. Another hurdle is the host of legacy systems being used, he said. Jaffe said other issues that make interoperability challenging is that:
- Policy supervenes technology;
- Privacy and security often contravene simple interchange; and
- Data without context degrades information.
Jaffe added that without consumer trust, "any amount of technical capability will break down."
He said that the "United States hasn't always gotten it right" in terms of interoperability but that the developing world has an opportunity to get it right the first time.
Work Force Needs in Developing Countries
William Hersh -- professor and chair of the department of medical informatics & clinical epidemiology at the School of Medicine at Oregon Health & Science University in Portland, Oregon -- said there is an inadequate supply of health informatics workers in both developed and developing countries.
Hersh -- co-author of a Health Affairs article, titled "Building A Health Informatics Workface in Developing Countries" -- noted that recent studies have estimated that we'll need tens of thousands of more health informatics workers in English-speaking, developed countries. Hersh commended lawmakers for including funding in the 2009 federal economic stimulus package to help develop this new work force in the U.S.
However, he said that it still is unknown what kind of health informatics work force will be needed in developing countries. Hersh also said there is little information about best practices for training health informatics specialists.
According to Hersh, in order to build health informatics capacity, developing countries should:
- Focus on information, not technology;
- Use information to improve health, health care, public health and biomedical research;
- Be cognizant of workflow, organizational and cultural factors, local needs and capabilities;
- Partner with existing programs and institutions; and
- Nurture informatics professionalism and leadership that are essential to success.
E-Health Policy Toolkit in the Works
Ticia Gerber -- a senior program officer within the Health Metrics Network, or HMN, at the World Health Organization -- said she is leading a two-year HMN project to develop a policy toolkit for health information systems.
The policy toolkit will include:
- Policy landscape -- A comprehensive study of existing activities and efforts in health information system policy and an analysis of gaps that need to be addressed;
- Expert groups -- Expert multistakeholder groups will be established to discuss technical, legal, organizational and policy issues.
- Health information system legislative templates -- Ready-to-use legislative templates will guide countries in drafting and implementing policies; and
- Resource center -- The center will include implementation guides, technical resources and an online collaborating forum for users.
According to Gerber, coordination between efforts in different countries is "critical" to sharing new and quickly emerging intelligence. She added that while the HMN policy toolkit will focus on lower- and middle-income countries, the lessons learned from the project could be applied globally and could drive larger international policy discussions.
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Autor(en)/Author(s): Kate Ackerman
Quelle/Source: iHealthBeat, 19.02.2010
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