eHealth a use of ICTs for effective healthcare service delivery

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eHealth a use of ICTs for effective healthcare
service delivery Vincent Sikakane Deputy
Director eHealth and Information
Technology KwaZulu Natal Department Of
Health eMail vincent.sikakane_at_kznhealth.gov.za No
vember 2014
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Content

• 1. Health systems strengthening
• 2. Challenges of health system
• 3. e-Health/telehealth/telemedicine/mHealth
• 4. Best practice in implementing e-Health
  innovation/initiatives
• 5. Costly failures of e-Health guidelines
  not stop sign.
• 6. KZN Dept. of Health e-Health initiatives

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1. Six components of health system need to be
strengthen to provide better health care
Telemedicine  
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Setting the Stage for Healthcare
Transformation Key Drivers
2.Challenges of Health system We are doing well
despite

• HIV AIDS and TB
• High Maternal and Child Mortality
• Non-Communicable Diseases and
• Violence and Injuries.

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Before
Paper Records
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Why do we have patients bypassing clinics and
CHCs to attend outpatients at district and
regional hospitals

• Staff shortages
• Patients seeking primary care
• To be treated by a doctor
• To collect medication
• To get an X-Ray
• To see a Specialist

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At your facilities

• Do you have an effective referral program?
• Do you have an effective in reach program?
• How often do you get specialists
• Do you have an effective outreach program?
• How often do you visit clinics
• Do medical officers view Lab results in their
  consulting rooms?
• Do medical officers view X-Rays in their
  consulting rooms?
• Do you have a digital X-Ray?
• Are your X-rays being reported by specialist
  radiologists?
• Turn around time for a patient visiting your
  facility?

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At your facilities

• Do you have enough doctors, nurses, Pharmacists
• Do have specialists
• Are your X-rays being reported by specialist
  radiologists?
• Do you have an effective referral program?
• Do you have an effective outreach program?
• Do medical officers view X-Rays in their
  consulting rooms?
• Do medical officers view Lab results in their
  consulting rooms?
• Turn around time for a patient

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Challenges faced on a daily basis

• Long waiting hours at our Health
  facilities-Patients get referred for minor
  ailments
• Medical officers leave a busy consultation room -
  To view X-Rays/To check lab results
• Most of the routine X-Rays are not being reported
  by specialist radiologists
• Time lost looking for the right patient
  information at the wrong workstation
• Duplicate tests and procedures when doctors share
  patients but not patient information
• A Patient gets a new folder and new folder number
  
• Open to litigation due to lack of complete
  information

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Aim

• Not to wait for patients to fall sick and come to
  health facilities
• Early detection of Diabetes, Hypertension, TB,
  and Counseling at an early stage.
• Reduce the number patients coming to Clinics
• Patients seen closer to where they live.
• Reduce number of referrals to the District
  hospitals
• Especially the unnecessary avoidable ones
• Reduce number of referrals to the Regional
  hospitals.
• Especially the unnecessary avoidable ones

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3. eHealth
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eHealth begins with a vision of

• connecting people to people,
• connecting resources to needs, and
• connecting healthcare problems to health care
  solutions

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4. Best practice

• Strategic Plan
• Constantly look at how healthcare services are
  rendered and identify those that can be delivered
  and or enhanced through telemedicine and
  ultimately achieve improvement in efficiency in
  service delivery

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Information management
HIS/HER Document Mx
Partnerships
Infrastructure
mHealth
Monitor Public health
Tele-health
Telemedicine
Capacity
Building
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What is eHealth?

• The World Health Organization defines eHealth as
  the use of information and communication
  technologies (ICTs) for health to,
• treats patients,
• pursue research,
• educate students,
• track diseases and
• monitor public health.

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What is mHealth?

• mHealth applications including
• education and awareness
• remote data collection
• remote monitoring
• communication and
• training for healthcare workers
• disease and epidemic outbreak tracking and
• diagnostic and treatment support.

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Putting eHealth into practice

• Physician outreach to remote clinics and
  facilities, especially where clinics are located
  in rural areas. The technology is used here to
  prevent travel of patients, doctors and
  specialists, saving time and improving
  efficiency.
• Remote patient assessment via video connectivity
  allows physicians to make remote initial
  assessments of patients, potentially preventing
  unnecessary transport of patients who do not
  require special care.
• Access to specialty physicians Since there is
  usually a dearth of specialists in remote areas,
  gaining access to such specialties as radiology,
  dermatology, cardiology and neurology can be a
  challenge.
• Outreach to school districts Placing video
  endpoints in schools allows physicians to consult
  with students without the students having to
  leave the school premises.
• Distance Learning (Continuing Education) Remote
  training via video connectivity provides
  increased learning capacity and saves significant
  time.

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eHealth Strategy South Africa

• The principles are
• Get the basics right infrastructure,
  connectivity, basic ICT literacy, human resources
  and affordability planning.
• Take an incremental approach build on what
  exists already in both the public and private
  sectors and fill the gaps where necessary.
• Look for early wins in implementations and
  benefits to build the confidence of health
  professionals, patients and the public in
  eHealth.
• Advocate the benefits of care enabled by eHealth
  and ensure that these benefits are realized.
• Constantly evaluate eHealth initiatives and
  measure improvements in health outcomes in order
  to build an evidence base that demonstrates the
  net benefits over time of eHealth and guides
  planning and decision-making.
• Establish national co-ordination on all
  initiatives in order to improve the effectiveness
  of eHealth at all levels.

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5. Costly failures
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Why is eHealth so Important in Our Healthcare
System?

• eHealth is emerging as a critical component of
  the healthcare crisis solution.
• eHealth holds the promise to significantly impact
  some of the most challenging problems of our
  current healthcare system
• access to care,
• cost effective delivery, and
• distribution of limited providers.

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eHealth increases access to healthcare

• Remote patients can more easily obtain clinical
  services.
• Remote hospitals can provide emergency and
  intensive care services. 

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eHealth improves health outcomes

• Patients diagnosed and treated earlier often have
  improved outcomes and less costly treatments.
• Patients with eHealth supported ICUs have
  substantially reduced mortality rates, reduced
  complications, and reduced hospital stays.
•  

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eHealth reduces healthcare costs

• Home monitoring programs can reduce high cost
  hospital visits.
• High cost patient transfers for stroke and other
  emergencies are reduced.

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eHealth assists in addressing shortages and
misdistribution of healthcare providers

• Specialists can serve more patients using eHealth
  technologies.
• Nursing shortages can be addressed using eHealth
  technologies. 

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eHealth supports clinical education programs

• Rural clinicians can more easily obtain
  continuing education.
• Rural clinicians can more easily consult with
  specialists.

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eHealth improves support for patients and
families

• Patients can stay in their local communities and,
  when hospitalized away from home, can keep in
  contact with family and friends.
• Many eHealth applications empower patients to
  play an active role in their healthcare. 

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eHealth encompasses four distinct domains of
applications.
These are commonly known as Live
Videoconferencing (Synchronous) Live, two-way
interaction between a person and a provider using
audiovisual telecommunications technology.
Store-and-Forward (Asynchronous) Transmission of
recorded health history through anelectronic
communications system to a practitioner, usually
a specialist, who uses the information to
evaluate the case or render a service outside of
a real-time or live interaction. Remote Patient
Monitoring (RPM) Personal health and medical
data collection from an individual in one
location via electronic communication
technologies, which is transmitted to a provider
in a dierent location for use in care and
related support. Mobile Health (mHealth)
Health care and public health practice and
education supported by mobile communication
devices such as cell phones, tablet computers,
and PDAs. Applications can range from targeted
text messages that promote healthy behavior to
wide-scale alerts about disease outbreaks, to
name a few examples.
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KZN Department of Health Case studies
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Telemedicine initiative TeleRadiology
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TeleRadiology Network
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Problem statement information collected by CCG
as part of OSS there is a backlog of 6-8 months
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• ICT Solution Data collection

• Benefits

• Pilot at Gcumisa clinic using mHealth technology
• Using digital pen Cellular phone Web based
  software to collect information from households
  by community care givers based at Gcumisa clinic.
• 17 CCGs have been trained to uses the Digital pen
• 400 households information has been captured

• It takes about 10 seconds after completion of the
  form for information to go into a web based
  solution.
• Reports can be generated for statistics screening
  and management purposes

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CPSI Awards 2014
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Problem statement Patients referred to a
psychiatric hospital before proper
assessmentQuality of service is being
compromised in facilities that do not have a
Psychiatrists
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• ICT Solution for telePsychiatry

• Benefits

• The use of videoconferencing technology to
  facilitate the provision of health care for
  persons with mental health issues
• VC equipment
• Board room setting
• Consulting room

• Medical officers can discuss with Psychiatrists
  in real time.
• Counselling sessions using Video confernecing
• Access to specialised care by disadvantaged
  communities
• Quality of care and outcomes are improved
• Cuts down travel time and costs
• Opportunity for training and education for health
  care workers
• Reduces professional isolation

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Problem statement Pharmacy stock-out can have
severe negative effects on patient care,
especially in the case of complex, chronic
diseases like HIV and TB when poor outcomes, such
as drug resistance and death, can often result.
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ICT Solution for stock management in PHC

• mHealth as a tool to combat pharmacy stock-out in
  Primary Health Care facilities in KwaZulu Natal

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Tele-education initiatives
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Conclusion
It is important to emphasize that eHealth is not
substitute for face-to-face medical practice, but
rather it is a tool to compliment the current
health care delivery in South Africa
From the Initial Telemedicine Evaluation Report
for the year 2000
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Thank You!
Vincent Sikakane Deputy Director eHealth
Information Technology KwaZulu Natal Department
Of Health Contact Us eMail vincent.sikakane_at_kznhe
alth.gov.za Cell 072 371 7081 Telephone 033
8467116