Commission on Information and Accountability for Women’s and Children’s Health

Recommendation 3 - Innovation and eHealthRecommendation 3 - Innovation and eHealth

Regional WorkshopGuatemala, 21- 23 October 2012

Dr Veronique ThouvenotDr Veronique Thouvenot

Innovation through IT for AccountabilityInnovation through IT for Accountability

Recommendation 3

“By 2015, all countries in the Global Strategy for Women's and Children's Health have integrated the use of Information and Communication Technologies in their national health information systems and health infrastructure.”

 

Indicators 

• 50 COIA Countries have developed a National eHealth Strategy and 25

countries have a National eHealth Plan in place.

• Web Based Reporting in place in all districts

 

Self-Assessment ToolSelf-Assessment ToolInnovation and eHealth Highly adequate Adequate Present but not

adequateNot adequate at all

  3 2 1 0

1 PolicyA national eHealth strategy or policy has been developed, including the use of ICT for MNCH

National eHealth strategy adopted; projects and priorities aligned; includes MNCH

National plan developed; projects are linked

National eHealth planning is at early stages; projects depend on sponsors

Planning specific to vertical projects, not led by MOH; projects depend on sponsors

2 InfrastructureThere are electronic communication channels (Internet, broadband, and mobile) available for health reporting in urban, district and rural areas

Broadband connectivity, fixed and mobile available in urban areas

Internet and mobile connectivity available, some high-speed

Mobile connectivity is available in district and some rural areas

Limited or no connectivity at district and rural levels

3 ServiceseHealth services and applications are used to improve measurement, reporting and performance of information systems (e.g., reporting on maternal mortality)

Information can be shared and consolidated at national level

Information systems coverage and data sharing is improved

There are multiple systems of reporting and feedback with limited data sharing

ICT supports specific projects or vertical programs, with no data sharing possible

4 StandardsThere are commonly agreed interoperability requirements or standards for eHealth services and applications

National standards coordination and compliance mechanisms are in place

Initial coordination mechanism established, some standards agreed 

Limited standards coordination; few standards agreed

No standards available

5 GovernanceThere is a national coordination mechanism for eHealth, with stakeholder involvement (health and non-health) in planning and implementation.

Active coordinating mechanism in place, with MOH leadership and stakeholder engagement

Coordinating committee exists, but not all stakeholders are represented and meetings are irregular

There is no formal committee, there are informal contacts between agencies to resolve problems 

There is no coordination leading to problems of inconsistency, duplication and inefficiencies

6 ProtectionData protection, legislation and regulatory frameworks exist for sharing health information.

Comprehensive legislation and policies exist for data protection and sharing; compliance is enforced 

Legislation and policies exist for data protection and sharing; compliance not enforced 

Legislation or policies exist, but incomplete and may constrain information sharing

Legislation or policies exist, but not specific to health

ITU Telecommunication Development BureauITU Telecommunication Development Bureau

International Telecommunication UnionInternational Telecommunication UnionUN Specialized Agency in Charge of ICTsUN Specialized Agency in Charge of ICTs

Presentation

ITU ICT Applications Strategies and

Resources

www.itu.int

5

e-Applications: A Priority for Development

Electrnic health (e-health) is : Electrnic health (e-health) is : • The ITU Plenipotentiary Conference 2010 in Guadalajara, Mexico adopted a new Resolution that

calls on ITU to give priority consideration to the expansion of telecommunication/ICT initiatives for e-

health. (Resolution PP-183, Guadalajara, 2010)

• A new Resolution on e-health was also adopted in 2010 at the World Telecommunication

Development Conference on Improving access to healthcare services by using information and

communication technologies. (Resolution WTDC-65, Hyderabad, 2010)

• Equity/Gender

Facilitating e-health infrastructure planning

6

• A report entitled Scaling e-Health services in step with ICT transformation was published to provide guidance to e-Health planners on which e-Health services can be deployed immediately with available infrastructure and which additional

services can be added as the infrastructure is transformed.

• The report is available at: http://www.itu.int/ITU-D/cyb/app/e-health.html

Facilitating e-health Standardization

7

• ITU’s Standardization Sector has released a Technology Watch Report that looks to the

future of e-health.

• The report observes that e-health development will require more universal e-health

interoperability standards, and strategies to overcome technical infrastructure barriers and

address privacy, security, and other legal requirements.

• The report is available: http://www.itu.int/en/ITU-T/techwatch/Pages/ehealth-standards.aspx

Technical countries assistance

8

• Conducted a “Country Assessment and Feasibility study” in Nepal to

identify potential scalable and sustainable Mobile e-Health

(mHealth) services for improved health outcomes from 25th April-7th

May 2011.

• 3 concept notes were proposed for possible mHealth projects

eHealth and InnovationeHealth and InnovationWhat TechnologiesWhat Technologies?

• Radios

• TV

• PC - Internet

• Mobiles: mHealth

• GIS

• Cloud Solutions

• Nanotechnologies

Mobile-cellular subscriptions, 2011Mobile-cellular subscriptions, 2011

Fixed (wired)-Broadband subscriptions Fixed (wired)-Broadband subscriptions per 100 inhabitants, 2011per 100 inhabitants, 2011

Technologies?Technologies?

????????

Innovation through IT for AccountabilityInnovation through IT for Accountability

Current situation and main gaps

Current situation Main gaps• The promise of ICT has not been realized to

create health benefit • Lack of coherent strategies/roadmaps

• There are multiple small activities, pilot projects

• Inadequate sharing of information • Limited development of lessons learned • Poor guidance for countries wishing to

accelerate ICT innovations

• eHealth and mHealth are fragmented • Lack of interoperability

• eHealth is multidisciplinary and bigger than the health sector

• Lack of multi-stakeholder integration

Way to move forward Multi-sector engagement to develop strategies

e.g. mobile phone and internet service providers, ministries of ICT, ministries of finance, national statistics offices, national broadband networks, telecommunication regulatory authorities, health insurance , product developers, private sector...

Consolidated WHO – ITU - IWG WorkplanConsolidated WHO – ITU - IWG Workplan

Priority Activity I Catalysing development and dissemination of ICT tools that will accelerate the

implementation of the recommendations of the Commission

• Propose readily-usable ICT tools and services for MNCH

• Technical Report on ICT tools and services for MNCH

• Facilitate technical assistance in response to countries' request/needs for project support

• MNCH ICT Experts Roster• Expertise provided for replication and reuse of

existing tools and knowledgePriority Activity II

Bringing together multiple stakeholders across sectors to develop country led “national eHealth strategies” and mobilize resources to implement them

• Develop tools, supporting materials, experts roster, to

support National eHealth Strategies development

• Assessment Checklist Tool• WHO-ITU National eHealth Strategy

Toolkit• Supporting materials on Interoperability • Learning materials on national eHealth Planning• Expertise for national eHealth Planning• National eHealth Planning Portal

Priority Activity IIIDevelop mechanism for fast tracking innovations and sharing with other countries with

special focus on South-South cooperation

• Develop an MNCH ICT Knowledge Management Platform

• e-Repository of MNCH projects, tools and best practices

• Facilitate Knowledge Sharing of ICT MNCH tools • Virtual MNCH ICT Information Sharing Group and Webinars

Consolidated WHO – ITU - IWG WorkplanConsolidated WHO – ITU - IWG Workplan

WHO-ITU National eHealth Strategy ToolkitWHO-ITU National eHealth Strategy ToolkitDecember 2011December 2011

• Technical Report on ICT tools and services for MNCHTechnical Report on ICT tools and services for MNCHDecember 2012December 2012

• e-Repository e-Repository of MNCH eHealth projects, tools and best of MNCH eHealth projects, tools and best practices practices

2013 - 20142013 - 2014

National eHealth Strategy ToolkitNational eHealth Strategy Toolkit

The “National eHealth Strategy Toolkit” is a resource for developing or revitalizing a country’s eHealth strategy.

The Toolkit provides a framework and method for the development of a national eHealth vision, action plan and monitoring framework.

Available at: http://www.itu.int/ITU-D/cyb/app/e-health.html

eHealth componentseHealth components

Health Information System ExampleHealth Information System ExampleA Set of Complex Sub Systems of

Medical Record Systems and Aggregate/Indicator-based Systems Systems

Modified after Health Metrics Network, 2007.

HIS Sub Systems

Data Warehouse

Monitoring Evaluation Research

Extract, transform and load data into central location

Census Vital EventRegistry Surveys

Health Events & Risks

HealthServiceRecords

ResourceTracking

Policies

Resources

Processes

Information Services

Allocated Length-Of-Stay Utilization

0

100

200

300

400

500

600

700

Pa

tie

nts

Status 143 221 412 574 325 172 68 145

25% 50% 75% 100% 125% 150% 175% 200%

Allocated Length-Of-Stay Utilization

0

100

200

300

400

500

600

700

Pa

tie

nts

Status 143 221 412 574 325 172 68 145

25% 50% 75% 100% 125% 150% 175% 200%

-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

Variance 10% 4% -20% -21% 30% 8% 10% -17% -28% -13%

B02 E02 E04 E15 H01 H02 H03 H04 H10 J03-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

Variance 10% 4% -20% -21% 30% 8% 10% -17% -28% -13%

B02 E02 E04 E15 H01 H02 H03 H04 H10 J03

Data Collection Forms & Methods

Statistical Systems

FinancialSystems

Need for Data ConsistencyNeed for Data Consistency

Paper-based System

Electronic System

Need for Standards

Need for InteroperabilityNeed for Interoperability

Indicator-based Records

Individual/Patient Records

RegistriesDiagnostics/Images

Records

Strategy and Plan of Action on eHealthStrategy and Plan of Action on eHealth((PAHO/WHO Document; PAHO/WHO Document; CD51/13 Eng. 1 August 2011)CD51/13 Eng. 1 August 2011)

2011 - 20172011 - 2017• Electronic medical records • TeleHealth• mHealth• eLearning• Continuing education • Interoperability and

standardization

National eHealth strategiesNational eHealth strategies

Innovation through IT for MNCHInnovation through IT for MNCHSelection of illustrative MNCH eHealth projects

Guatemala: TulaSaludhttp://www.tulasalud.org

Peru: WAWAREDhttp://www.wawared.andeanquipu.org/

Mexico: AMENECE http://www.salud.carlosslim.org

TulaSalud – CobanTulaSalud – Coban

Alta VerapazAlta Verapaz

n

Recommendation 3

“By 2015, all countries in the Global Strategy for Women's and Children's Health have

integrated the use of Information and Communication Technologies in their national health

information systems and health infrastructure.”

Progress towards the Commission’s RecommendationsProgress towards the Commission’s Recommendations

Telecom 2011

http://www.itu.int/ITU-D/cyb/events/2011/Telecom11/e-health/index.phtml

http://www.itu.int/ITU-D/cyb/events/2011/Telecom11/e-health/index.phtml

Commission on Information and Accountability for Women’s and Children’s Health

Innovation through IT for AccountabilityInnovation through IT for Accountability

www.who.int/topics/millennium_development_goals/www.who.int/topics/millennium_development_goals/accountability_commission/en/ accountability_commission/en/

THANK YOU

Dr Véronique Thouvenotveronique.thouvenot@itu.int