Advancing public health through information technology. A developing African country perspective

Transcription

1 Advancing public health through information technology A developing African country perspective Deshen Moodley UKZN/CSIR-Meraka Centre for Artificial Intelligence Research Health Enterprise Architecture Lab School of Computer Science, University of KwaZulu-Natal, Durban, South Africa EO2Heaven workshop 10 November 2011 Durban

2 ICT for HEALTH ICT can facilitate: capture & storage of health related data clinical decision making: patient level & public health level management, logistics & planning preventive health interventions Different types of health related data, different scales/ levels of granularity: cellular -> person -> population -> country

3 Country profile ehealth Maturity Level (ISO 14639) 3

4 The genome, the individual & the environment Genome analysing a patients genetic makeup (genotyping) can assist in determining predisposition to disease & treatment, e.g. HIV drug resistance Individual capturing observed and inferred data, by clinicians medical diagnostic & monitoring devices: in-situ, remote and portable presenting patient history and suggest options for treatment or further testing Living environment Identifying, monitoring and controlling adverse environmental factors is essential

5 Rwanda NHIS landscape in African countries progressive and expansive ehealth policy, driven by a ehealth coordination unit currently deploying patient and hospital information systems, community health information systems using mobile phones, and a health information exchange implementation project. Mozambique enterprise architecture project is underway other projects include a death registration system and national data warehouse South Africa advanced systems in larger cities, e.g. Nkosi Albert Luthuli Hospital in Durban, limited systems in deep rural areas currently developing a National Health Insurance system

6 Characteristics of African HIS Systems are typically adhoc, fragmented, application specific. Many pilot systems, not within the control of ministries of health Funded largely by international donors, often employing temporary, mostly foreign, software developers Interoperability, post project/funding sustainability, especially local skills development is often neglected

7 Disparate components of an MCH system in Rwanda 7

8 What is needed? Urgent deployment immediate & tangible impact to facilitate & optimize health interventions in critical disease areas Balance between innovation and pragmatism disrupting current systems -> disastrous consequences for an already overburdened health system opportunity to leverage latest advances in computer science & rapidly improving ICT landscape Evidence-based and effective lessons learnt from previous deployment should be incorporated

9 What is needed? Sustainable and affordable systems must be harmonized with the country's strategic plans, balance good design and rigor with rapid engineering buy-in from non technical stakeholders & development of specialized IT skills is important Support practical modes of operation systems must include both computerized and manual, paper-based solutions & both network-connected & network-disconnected scenarios

10 Challenges How to get agreement among stakeholders with different & even contradictory viewpoints How to apply the state of the art in Computer Science while utilising scarce resources in a responsible manner? What model of R&D operation is required that balances deep reflection & thinking with urgent ICT field requirements? How do we balance ICT and software implementation with Computer Science research?

11 What is being done? Research & implementing organisations include: Jembi Health Systems: NGO, designing & implementing systems in several African countries Meraka Institute: South African National Health Insurance initiative Medical Research Council: ehealth Unit, Medical Device Innovation Platform EO2Heaven: EU FP7 programme, research in architectures that support integration of environmental data with health d

12 Health Enterprise Architecture Lab/Centre for AI, School of Computer Science: Open architectures, technologies & frameworks for developing African countries Dept of Tele-Medicine & School of Information Systems & Technologies: Medical Informatics training & Telemedicine Mechanical Engineering: Medical devices

13 HEAL s: Research focus areas Next generation architectures: investigate architectures, such as service oriented & agent based architectures, for interoperability, distributed information processing, software adaptability & reusability Knowledge Representation and reasoning: data mining & clinical decision support in developing countries Remote and mobile device integration: interoperability, communication protocols required to deploy low cost portable medical devices in rural communities, e.g. foetal heart rate, lung function devices.

14 HEAL: Future activities Long term objective: mobilize CS researchers to provide ICT solutions to improve health care in developing countries: establish a global research network where nodes work together to solve challenges in health informatics develop a long term research agenda establish strategic partnerships to advance the research agenda: UNU-IIST Macau

15 Summary African (developing) countries provide unique environments for NHIS development potential for high impact, but also high risk Continuous innovation requires highly specialised computer scientists & the development of open technologies Must lower the cost and improve effectiveness of health services Improve health equity, i.e. better access to health care in rural & disadvantaged communities

16 References 1. Health Enterprise Architecture Lab (HEAL): 2. Moodley D, Pillay AW, and Seebregts CJ (2011), Position Paper: Researching and Developing Open Architectures for National Health Information Systems in Developing African Countries, Foundations of Health Information Engineering and Systems, FHIES 2011, First International Symposium, August 2011, Johannesburg, South Africa. 3. Seebregts CJ (2011), Health Enterprise Architecture for Integrating National Health Information Systems, presention at HISA, August 2011, Johannesburg

17 Acknowledgements We acknowledge our funders: Rockefeller Foundation Canadian International Development Research Centre (IDRC)