Regional workshop on building e-governance capacity in Africa

Transcription

1 Regional workshop on building e-governance capacity in Africa E-governance and Efficiency in Health Services: Putting People at the Heart of ICT and Health

2 Information Communication Technologies (ICTs) Collapse of time and distance Breakdown barriers to communication and information exchange Ability to transport masses of data and information to anywhere in the world Ability to access huge amounts of diverse types of information from anywhere in the world

3 Where is the value in e-governance? strategic resource E-governance value-chain data information knowledge action Quality? Integrated? Communicated? Would your organisation benefit from having better information, more of it and quicker?

4 UK: Transformation NOT automation! E-governance and ICT is central to the UK Government s modernisation of public services and health care The context is a much wider process of radical organisational reform and professional change in health services Breaking down silo structures and cultures patient-centred health services patient needs - not administrative structures providing a continuum of care specialised, timely and targeted health care interventions

5 The traditional approach to service provision Policy, co-ordination and funding Social Care Central Government Primary Care Laboratory STD Clinic Acute Hospital Voluntary Org Private Sector Silo service support environments each organisation has its own information service Information outside of a single organisation is hard to get. Patient and practitioner Source: Booth 2002 Integration rarely happens How can e-governance and ICT s help?

6 e-governance transformation: Electronic Health Record (EHR) Central Government Policy, co-ordination and funding Social Care Primary Care Accident & Emergency Radiology Acute Hospital Voluntary Org Private Sector Integrate legacy systems using brokerage technologies BROKERAGE TECHNOLOGY Patient and practitioner EHR is the consequence of joining together organisational systems Process People Technology Source: Booth 2002

7 Cornwall Electronic Health Record Pilot CASE STUDY, UK Aim: Join up patient information and allow remote access 24/7 across range of health service providers to clinical care system Topic: Clinical care system Established: April 2000 Project Budget: Structure of project Pan-community EHR demonstrator Connect all General Practitioners to NHSnet (national-level NHS Virtual Private Network or intranet) 24 hour emergency care record Common information architecture Condition-specific care modules mental health, coronary heart disease, diabetic care Telemedicine in minor injuries units facilitates nurse-led service and links to remote Accident & Emergency consultant including tele-radiology Source: Forrest 2000

8 Cornwall Electronic Health Record Pilot: Results Initial Benefits Massive cut in time taken for X-ray process & diagnosis from 2 days to one hour Evaluation ongoing see: successful implementation of telemedicine depends on the process being treated as major clinical process change and an organisational development a properly integrated telemedicine project can produce cost reductions, increases in staff training and ability and improvements to patients quality of care. Andrew Forrester, Head of EGR Programme, Cornwall NHS IT Services

9 Clinical Decision Support System, USA CASE STUDY, USA Aim: reduce clinical errors esp. adverse drug events via evidence-based decisions and transparency of route to decision Project: A 450 bed tertiary care organisation in USA automated clinical functions including laboratory, radiology, pharmacy and clinical decision support system. Deployed 37 medication rules in the system (out of 1,000s) Project Budget: Not known Results of alerting system: 36 deaths avoided over 12 months Savings - $US 3million (Newman & Walters 2000) Background Source: Protti & Catz 2002 To Err is Human: Building a Safer Health System, USA Institute of Medicine (IOM), 2000 IOM research finds there are 44,000 98,000 unnecessary deaths per annum in USA due to medical error. This results in a large financial burden to healthcare system. The IOM report estimates that medical errors cost the US approximately $US 38 billion per year with $US 17 billion of those costs associated with preventable errors. This means there are more people dying from medical error than traffic accidents, breast cancer or AIDS (Richardson 1999)

10 Value of ICT in health services strategic resource E-governance value-chain data information knowledge action Accurate & relevant Storage Durable Retrieval Distributed Analytics How do you join up this value-chain? What technologies? What approaches and processes? Better decision making Efficient allocation of resources Targeted healthcare interventions Identification of patient and community needs Preventive health education and changes in health-oriented behaviour Effective disease management Better quality care

11 Harnessing ICTs for Community Health: AfriAfya Initiative CASE STUDY, Kenya AfriAfya: African Network for Health Knowledge Management and Communication Aim: communicate relevant information to local change agents in rural, marginalised areas with limited resources and to enable feedback of community information and care needs Topic: HIV/AIDS Established: April 2000, multi-ngo/kenya MoH Project Budget: $US 198, 538 Pathfinder Topic: HIV/AIDS Structure of project Coordinating hub: collates data and information, translates, repackages and redistributes ( , internet, print, disks, CDROM, fax, telephone, radio?). Currently developing Knowledge Management Unit. Seven field centres (urban/rural; public/ngo; health/education) supplied with computer, Operating System software, printer, data modem, WorldSpace wireless satellite, PC adapter card where no telephone connectivity Three to four trained staff Solar panels used where no electricity Source: Driscoll 2001

12 AfriAfya: Results Community health benefits Broke the silence on HIV/AIDS Started discussion on high-risk cultural practices Increased condom uptake Increased demand for voluntary counselling and testing services Bigger turnouts at health meetings and action days Lessons Partnerships enable synergy and resource sharing HIV/AIDS focus provided clear framework Two-way communication essential Continuous training and support is needed Community participation leads to greater self-care and self management Too early to demonstrate health improvements, but if it continues there will be a definite improvement on health

13 Joining-up ICT: virtuous circle The links in the e-governance value chain can be mutually reinforcing and create information flows This model also works well with the paradigm of preventive health care Information Attitude Behaviour data action patient & community information knowledge

14 Joining-up ICT: the health network and hub Integrating organisations, functions and projects around the patient, to create a network with a supporting Hub Patient -community level treatment research & analysis (e.g. epidemiology disease patterns) - national policy making Over time integrate projects, patients and practitioners into networks of care HUB National interoperability policy; infrastructure development; shared services; other sectors Over time implement shared egovernance services of common administrative activities to avoid duplication and wastage e.g. purchasing, payroll

15 Prioritise and sequence Patient-centred healthcare Africa - HIV/AIDS UK heart disease/cancer Low cost preventive health care Front-line service delivery Contextualise Political, cultural, economic, technical environment? Root and focus e-governance project in specific health care programme e.g. disease management Localise Patient/community health needs Training and education Monitor benefits and adapt if necessary Getting the right balance to e- governance investments Innovate Join-up services New kinds of professional health carers Technology mix radio, TV, CDROM, Kiosks, internet

16 Conclusion Could your organisation benefit from quicker access and receipt of relevant, better quality health information? How could it be used to really improve people s health? Where are the information resources, and can ICT s help to exploit those resources for health provision? What are the health care priorities in your region and communities?

17 Thank you! Ben Crowe Demos url: http//: Telephone: +44 (0) Fax: +44 (0) The Mezzanine, Elizabeth House 39 York Road, London SE1 7NQ, UK

18 Appendices

19 Reform of health services Across the world, public health services are being reformed to respond to various challenges: rising demand and costs aging population population growth decline in economic growth serious disease public expectations private sector competition Aim of reform Efficiency Equity (access) Effectiveness Sustainability ICT is a key tool to support these efforts Tangible benefits Better quality care Reduced costs Sustainable improvements in health status

20 Reform of health services Two frameworks for reform: 1. Linkages between different institutional actors e.g.primary care, hospital facilities, community dispensaries, public/private/voluntary health providers 2. Linkages across different functional areas of reform e.g. packages of care UK National Health Service joining up institutions and integrating services provided by various groups within the NHS, Local Government social care, education and training organisations How can e-governance and ICT s help?

21 Databases, websites and networks There are hundreds of health-based websites, databases, health libraries and networks for sharing information, ideas and experience (OneWorldNet, GlobalHealthNet, ACTnet, AF-AIDS, NGO Networks for Health) Many are joining forces and partnering. But is the data, information and knowledge useful? Is it being transformed into health-improving ACTION? Can people in rural communities and target groups e.g. women and children access this information? Do they need education, training and support? Is it the right kind of information? Is it changing attitudes and behaviour? Is there a flow of relevant and clinically useful information going upwards - from patients and communities - to policy makers and practitioners? Is the e-governance value-chain being joined-up?

22 The next steps? clinical care systems and telemedicine Support practitioners/patients with communication and exchange of clinical information during and outside consultation Common Components: Self-managament & monitoring: patient questionnaires and alerts New problem solving; medication; treatment decision support via health databases Remote consultation Transfer of medical records Escalation of cases to experts Potential Benefits: Effective care increased contact with patient, better information flows: preventive care impact Timely care opportunity for earlier intervention and better monitoring: reduces acute care burden Quality care reduction of medical errors and lost records Efficient care reduction of travel costs for both patient and health practitioner; better use of medical time

23 Challenges to e-governance in healthcare Often difficult to argue the e-governance business case against competing priorities Cost savings if at all are long-term benefits often based on organisational transition and cultural change research into Electronic Health Records (EHR) suggests a minimum of 5 years after initial investment (Protti & Catz, 2002) Significant up-front investment cost Health status improvements may be over years Public sector ICT projects are high risk

24 International e-governance lessons 1. There is no model 2. Transform ways of doing things don t automate inefficient processes 3. National strategy and policy framework to set standards 4. Pilot and phased approach 5. Share ideas synergise don t need to re-invent the wheel 6. If it is not used it s of no value training and education is always essential People are at the heart of successful e- governance

25 Sources Booth, Dr Nick, April 2002, Sowerby Centre for Health Informatics, University of Newcastle Making the right choices using the computer in the Consultation Driscoll, Libbie, November 2001, International Development Research Centre, HIV/AIDS and Information and Communication Technologies, Final Draft Report Forrest, Andrew October 2000, Electronic Record Development and Implementation Programme Cornwall and Isles of Scilly Health Community Demonstrator Project, Implementing Telemedicine Institute of Medicine (IOM) Committee on Quality of Health Care in America, 2000, To Err is Human: Building a Safer Health System, Washington DC, National Academy Press Johnson, Karen & Bond, Laura, March 2001 NHS Executive/Newcastle University, Making Medical Information Work Newman, J.A. & Walters, R.M., 2000, Finally Getting Value from IT Investments and Going Paperless, HIMSS Proceedings Protti, Denis & Catz, Mariana, 2002, The EHR and Patient Safety: A Paradigm Shift for Healthcare Decision-Makers, ElectronicHealthcare Vol.1 No.3 page 35 Richardson, W.C. 1999, Putting Patient Safety First Press Release NHS Information Authority, March 2002, Electronic Record Development and Implementation Project