eHealth Trends and the Use of St d d d G id liStandards and Guidelines

Mr Mark LandryHealth Information Technical Officer

World Health Organization, Regional Office of the Western Pacific

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 20111 |

OutlineOutline

IntroductionIntroduction

Trends in eHealth

eHealth:Using Information

Next steps: using enterprise hit t l h

gCommunication Technology (ICT) such as

t bil d iarchitectural approaches and adhering to standards

computers, mobile devices, and satellite communications – for

Future possibilities and potential impacts

communications for health services and information

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 20112 |

Health and eHealthHealth and eHealth

Health and eHealth are inseparable due to the fact that health is an information intensive sector.

Health is a global concern that is trans-border by definition and g yaffects the world population.

Information technology and telecommunications (ICT) is a globalInformation technology and telecommunications (ICT) is a global issue especially with the emergence of the knowledge economy and the information society.

This has required WHO to adopt global approaches to eHealth.

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 20113 |

Why eHealth?Why eHealth?yyHealth systems unable to deliver high-quality, affordable services with universal accessaffordable services with universal access

Increasing time and effort needed for acquiring information and data as well as forinformation and data as well as for administration and documentation

Critical health information buried in thick medical files and unsystematic data storage and retrieval system

Specialisation & Sub specialisationSpecialisation & Sub-specialisation

New Diseases

Increasing support to eHealth…the next breakthrough in health systems improvement

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Global Cellular SubscriptionsGlobal Cellular Subscriptions

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2010 Key Global Statistics2010 Key Global Statistics

mHealth Apps:

Hospitals:

yy

h Apps: 9,000Phone Apps:

270,000Midwives:

1.9 pp400,000 +

Tablets: 12 million +

million +

Hospital Beds: 20.9 million

Smartphones: 90 million

Health Workers: 40 million+

Feature Phones:4.4 billion

Households: 1.7 billion

Mobile Subscriptions:5.3 billion

Population: 6.7 billion

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 20116 |

Source: Courtesy to the mHealth Alliance for allowing WHO to reuse this graphic

WHO's ResponseWHO's Responsepp

Adoption of the World Health Assembly Resolution on eHealth (WHA58.21) i 2005 b WHO M b St tin 2005 by WHO Member States

The eHealth resolution gave legitimacy to the concept itself but also defined:defined:

– the scope of eHealth– the potential stakeholders– the role of governments and the private sectorthe role of governments and the private sector– the need for legal, ethical and regulatory frameworks for its implementation

Catalyzed recognition of the role of eHealth in:– strengthening health systems– improving health services– reaching out to remote communities– enhancing the capacity of health workforce– health promotion

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 20117 |

eHealth Global UptakeeHealth Global Uptakepp

eHealth Intelligence Report: h // h i / / hi / /http://www.who.int/goe/ehir/en/

WHO Global Observatory of eHealth: http://www.who.int/goe/en/

First Global eHealth survey, 2005:– Benchmarking, country comparisons, evidence on

progress

S d Gl b l H lth 2009Second Global eHealth survey, 2009:– More in-depth analysis: – Eight thematic areas: mHealth; Telemedicine; g

Management of patient information; Legal and ethical frameworks for eHealth; eHealth policies; eHealth foundation actions; eLearning and country profiles.

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 20118 |

Most Commonly Reported mHealth Initiatives in GOe

Most Commonly Reported mHealth Initiatives in GOeInitiatives in GOeInitiatives in GOe

50% in emergency/disaster situationsg y

50% in health call centre or healthcare telephone h l lihelpline

45% for surveillance programs45% for surveillance programs

40% for voice/text messages to achieve treatment licompliance

A number of countries highlighted using mHealthA number of countries highlighted using mHealth for HIV/AIDS and maternal health services

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 20119 |

eHealth Value StackeHealth Value Stack

TransformationExpert Systems

o vide

rs

IntegrationDecision Support Systems

Expert SystemsIntelligent cross‐platform 

solutions

efits

tots

/pro

v

TransactionManagement Systems

Decision Support SystemsEnhanced health, clinical and administrative 

decision‐making

Ben

eic

ipan

t

Interaction

Information Systems

g yIdentity, security, audit; payments; health 

systems management

Part

i

Information

Communication SystemsHealth and wellness content; messaging

Bi‐directional communication

Time/Maturity of Services

Health and wellness content; messaging

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 201110 |

Source: mHealth Alliance

The Grand Challenges to eHealthThe Grand Challenges to eHealthgg

Organizational and governance challengesg g g

Technical challenges

Financial challenges

Legal and ethical challenges

Local challenges based on differences in healthcareLocal challenges based on differences in healthcare systems, culture, economy, regulations, policies, ICT infrastructure and human resourcesinfrastructure, and human resources

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Scope of eHealth Services and Applications

Scope of eHealth Services and ApplicationsApplicationsApplications

DisastersHIS

e-Surveillance

Emergencies

DisastersHIS

IHR

eHealthDermatologyDermatology

Obstetrics/Obstetrics/GynaecologyGynaecology

Patients

Society Research

Journals

e-Learning

Training

ee--CareCareeHealth

Governance

RadiologyRadiology PathologyPathologyNurses

WebsitesHealth Training

CourseRadiologyRadiology PathologyPathologyProfessionals

ReferralReferralSystemsSystems

ElectronicElectronicHealth Health

RecordsRecordsee--ManagementManagement

RecordsRecords

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 201112 |

Technical Competenciesof Health Professionals

Technical Competenciesof Health Professionalsof Health Professionals of Health Professionals

Healthcare professionals usually do not receive ICT training. Their understanding of it comes late in their career.

ICT professionals are mainly hardware and software engineers p y gwith little orientation on biomedical applications.

Need for more in-service training, short-courses in the area ofNeed for more in service training, short courses in the area of health informatics.

Very few specialized health informatics programmesVery few specialized health informatics programmes.

Promote peer-to-peer learning and sharing within and between countries:countries:

– International Medical Informatics Association (IMIA): http://www.imia-medinfo.org

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 201113 |

Standardization and Systems Interoperability Challenges

Standardization and Systems Interoperability ChallengesChallengesChallenges

Fragmented efforts to develop eHealth applications in the absence of adequate governance, standards and national plans resulted in development of eHealthnational plans resulted in development of eHealth systems that cannot exchange data.

Th t i l t d l dThese systems are mainly standalone and disintegrated, lacking unified coding schemes, following different or no standards which resulted infollowing different or no standards which resulted in total lack of interoperability between them.

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 201114 |

Enterprise ArchitectureEnterprise Architecturepp Ministry of Health Health IT Vendors

Ministry of HealthLead

Health IT VendorsLead

Analyze Design Develop Deploy

Environment Needs

Specifications Standards

Iterative approach Development tools

Testing InstallationNeeds

Users Processes Requirements

StandardsData model Hardware/software Interfaces

Development toolsNetwork Databases Road maps

InstallationUser training Budget and staff Maintenance

Proper planning Expected solutions

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 201115 |

Two Examples:HL7 and SDMX HD

Two Examples:HL7 and SDMX HDHL7 and SDMX-HDHL7 and SDMX-HD

Health Level 7 (HL7)( )– Data exchange/messaging standard primarily for

patient-based transactional systems within a health systemEMR Laboratory Rx Billing Immunization– EMR, Laboratory, Rx, Billing, Immunization, maternal health, others

Statistical Data and Metadata Exchange—Health Domain (SDMX-HD)

– Intended to be part of national HIS and M&E infrastructure strengthening strategy, facilitating seamless flow of information from facility to district, national, and international levels

– Contains a data structure definition (DSD), which defines concepts, dimensions, attributes, code-lists and other artefacts necessary to describe the structure of datathe structure of data

– Defines attributes of a data items, which reduces the negotiation required to exchange data between information systems

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Future Possibilities in eHealthFuture Possibilities in eHealth

Innovative tools – remote diagnosis, medical g ,consultation, just-in-time training

– Hand-held ultrasound connected to phone– Holograms of blood cells using phone camera for malaria, HIV-

AIDS, anaemia, clean waterPhones that listen to heart and lung sounds cough– Phones that listen to heart and lung sounds, cough

– Transfer of images: cervical cancer diagnosis– “Serious games” via handsets for training CHWSerious games via handsets for training CHW

Disaster relief communications– Connect families– Assist emergency relief workers

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 201118 |

Future Possibilities (continued)Future Possibilities (continued)( )( )

Internet trends - peer to peer network, which allows individual computers to function as both server and client without central administrator

Clinical eHealth services -Clinical eHealth servicesreal-time medical consultations

Biotechnology andBiotechnology and Nanotechnology - decoding of human genome, storing and i t ti ti t ti dinterpreting genetic testing and evaluating treatment options

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 201119 |

Can eHealth Save Livesand Improve Health? YESCan eHealth Save Lives

and Improve Health? YESand Improve Health? YESand Improve Health? YESCould be directly could be indirectly to the individual and toCould be directly, could be indirectly, to the individual and to the society.

– Citizens, patients– Healthcare professionals, providers– Governments

Benefits are clear:– To improve the quality and efficiency of healthcare;p q y y ;– To expand access and contribute to equity/universal access; and– To contribute to reduction of cost of health services.

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 201120 |

Thank YouThank You

Mark LandryMark LandryWorld Health Organization, Regional Office of the Western Pacific

Asia-Pacific Advanced Network (APAN) 31st Meeting | February 23, 201121 |