1. Capacity-building for eHealth and Telemedicine: Strategies for Developing Countries Alvin B. Marcelo, MD University of the Philippines Manila National Telehealth Center

2. Outline

Definitions

Current situation

Inventory of resources

Gaps

Challenges

Strategies

Tips

3. Definitions

Developing country

• is not a developed country nor a failed state

• in the process of being a developed country

• low standard of living

• underdeveloped industrial base

• moderate to low Human Development Index (HDI) score

4. Our topic does not cover these scenarios. 5. We cover these. 6. Current health situation

Double burden

• high incidence

• • infectious diseases

• • chronic, lifestyle diseases

Inadequate compensation for health human resource pool

• migration

• • to other developed countries [external]

• • from rural to urban [internal]

7. Current health situation + = 8. Demands of the health system

Growing population requires more health professionals

Devolution of health care makes allocation of scarce resources more challenging

Lack of doctors makes staff training a hit-or-miss phenomenon

Documentation of services for reimbursement and compensation --> automation --> eHealth

9. Inventory of Existing Resources

Physicians

• medical schools

• residency training program

• continuing medical education

• professional board certification

10. Inventory of Existing Resources

Nurses

• nursing schools

• masters of arts in nursing

• continuing nursing education

• professional board certification

11. Inventory of Existing Resources

Allied Health Professionals/Midwifery

• respective schools

• professional board certification

12. Gaps

Not embedding in any curriculum the new knowledge and skills needed to maximize the benefits of IT for the profession

• Result: reluctant (recalcitrant) attitude towards IT-oriented enhancements to the workflow

13. Gaps

Teaching concepts that are not natural to the workflow of the health worker

• Example: teaching health workers word processing, spreadsheets, and presentation software

• Result: empowered trainee, but still unable to contribute to a better workflow environment

14. Gaps

Technology-centric training programs

• Example: mouse and keyboard, workstations

• Result: encumbered and harassed staff, bottlenecks in the workflow

15. Challenges

Teaching IT to staff who have not used computers all their lives

IT in areas with electricity only between 6pm and 12 midnight

Two hours by bus, then four hours by motorcycle, then one hour by foot

Islands in the middle of the typhoon belt

16. Strategies 17. Strategies 18. Strategy #1: Consolidate on EHR EMR 19. Strategy #2: Use Open Source

free or low-cost (license-free)

customizable

flexible

reusable

programmers abound

20. Strategy #3: Adopt Modular Framework

separation of logic and presentation

coding standards and convention

Lego block philosophy

21. Strategy #4: Build Concept Dictionary

Attempt to standardize the language and vocabulary (local)

Easier said than done

22. Strategy #5: Get Data Out Fast

Embedding reports in the data entry application may not be the shortest route

Be open to third-party report generation systems

Geographic information systems allow for more participation of community members (closes the loop)

23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. Training Tip#1

Never let the participants use the computer on the first day of training

• they are nervous and apprehensive

• they will project their fear onto your application

• they will have misconceptions that prevent thorough understanding of why they need to develop these new skills

45. Training Tip#2

Introduce the concepts of information systems using structured learning exercises/games

• allow them to verbalize the difficulties (in the SLEs)

• let them to identify their coping mechanisms

• map the SLE concepts to information systems

• this prepares the participant for the actual hands-on training

46. Training Tip#3

Eliminate the interface problem through the use of computer games

• solitaire

• tetris

• same game

• etc

47. Training Tip#4

Make sure the application is useful to their work

• documentation is part of their daily routine

• do not ask them to do word processing, build spreadsheets, make presentation slides if they won't be doing that when they return to work

• always revert back to the SLEs if you sense them having difficulties

48. Implementation Tip #5

Keep the design realistic and the budget small

• involve staff in design [open source makes that possible in an affordable way]

• let staff grow with the system [makes them think the system is their baby]

• prevents formation of prima donna attitudes such as expecting vendors to solve their problems [well you're paying them good money aren't you? why should we suffer?]

• close the loop by letting them act on their data (GIS)

49. CHITS is a Finalist in the 2006Stockholm Challenge www.stockholmchallenge.se 50.