Dr. RUDAKEMWA E
INTRODUCTION Digital healthcare often referred to as Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.
TELEMEDICINE CART/ROBOT PATIENT PORTAL & APP WEARABLE/ MONITORING DEVICE
CURRENT SITUATION-babyl in Rwanda Rwanda has been able to make significant improvements in the citizens of Rwanda s health in a very short period of time. The ability to eradicate disease, improve healthcare outcomes and increase the trajectory of a population is phenomenal.
CURRENT SITUATION-babyl in Rwanda There is an understanding that there is a need for innovation to advance healthcare through ICT. Babyl has been working collaboratively with the Minister of Youth and ICT. The IT sector in Rwanda is on the brink of transformative results. Mobile will be the channel by which transformative and progressive health care solution occurs
CURRENT SITUATION-babyl in Rwanda After signing Head of Terms with RSSB and agreement to move to a full contract, babyl has set-up a working center staffed with Rwandan nurses and doctors supported by an in-house call center launching what is Rwanda s first private digital healthcare service. After gaining a license from the Ministry of Health, babyl launched to the public with a free trial period in mid September 2016. Over 500,000 Rwandans have registered with babyl to date. Over 88,000 appointments have been booked. The number continues to rise everyday
HOW IT WORKS IN RWANDA babyl created a feature phone version to allow those without smartphones to access the full spectrum of our services. Working in conjunction with our UK software team, our Rwandan developers created a platform that allows all to register and book an appointment to talk to doctors and nurses with ease. The integration with National ID Agency (NIDA) helps to have reliable data of the patients.
CURRENT SITUATION-babyl in Rwanda Launched an AI clinical triage agent that can process hundreds of millions of symptom combinations. From December 2016, AI triage agent will serve over 1 million people in London on behalf of the UK s National Health Service (NHS).
The Medical AI Agent To make the service universally scalable and affordable, we are building a comprehensive medical AI agent that mimics a doctor s brain medical AI agent that mimics a doctor s brain. Learning Natural Language Processing Knowledge Base Millions of data points collected from hundreds of structured data sources into one cohesive whole.
WHAT IS THE ADMINISTRATIVE STRUCTURE
BENEFITS IN DIGITAL HEALTH CARE Improved continuity of care through a centralized electronic health record Improved reach of clinical services Improved data collection and condition specific monitoring Improved financial Reduced clinical complications with improved service access
BENEFITS IN DIGITAL HEALTH CARE Reduced cost of service provision due to less infrastructure investment Reduced administration Provide clinicians with a new skill set to keep them in line with technology advancements in healthcare Patient empowerment and adherence through access to a patient s own clinical records
OBLIGATIONS FROM THE SERVICE PROVIDER 1. Digital facilitates a more grown up conversation between clinician and patient. 2. Doctors feel threatened by digital data overload. They are scared they will miss key information and be sued for negligence. 3. Data are important but not a panacea: we shouldn't underestimate the importance of the physician / patient relationship 4. Digital healthcare should focus on healthcare and not on digital. Digital is just a tool 5. Healthcare should not just be a service to patients - it should be for patients
ROLE OF HEALTH REGULATORY BODIES It is the expectation of the health Regulatory Bodies, that Health care providers physicians who provide medical care, electronically or otherwise, maintain the highest degree of professionalism and should: 1. Place the welfare of patients first; 2. Maintain acceptable and appropriate standards of practice; 3. Adhere to recognized ethical codes governing the medical profession; 4. Properly supervise non-physician clinicians; and 5. Protect patient confidentiality.
PROFESSION REGULATIONS Digital health care company should be reauthorized by the Ministry of health Doctors and nurses will be registered with the Medical Council and the council of nurses and midwives respectively
MAIN FEATURES OF A DIGITAL MEDICINE On a smart phone, Digital Health care offers a fully integrated platform with a multitude of features: Ask: Provides a simple text solution, where general healthcare queries can be sent to an experienced doctor or nurse for a quick response. Consult: The ability to book an appointment quickly and painlessly at a time that suits the individual, from wherever they are and with a highly trained nurse or doctor. Prescriptions: Prescriptions can be arranged and collected from a local pharmacy. There is also the choice to have prescription delivered to a home address. Referral: The system can generate instant referrals to specialists or for diagnostics as and when needed, either through the system or to a consultant of choice if a physical consultation is required.
Cont d Record: Clinical records are securely stored and easily accessible. Notes, audio and videos of all previous consultations are stored, including GP details, previous tests, images, medicines, allergies, and more. Monitor: An in-built Monitor function allows individuals to keep track of their internal systems and enables close health monitoring throughout the body. Check: State of the art proprietary algorithms allow the self-check of symptoms that gives clear advice on the appropriate action to take. With Check, we went back to the drawing board to design a tool that is effective while simple and swift. Tests: Bringing individuals products that our doctors have tested and approved to make the remote management of healthcare simple. Our starter Kit will provide the basic diagnostic tools that provide the ability to check symptoms and can assist our doctors in delivering effective and informative consultations.
Examples
Example: Patient receiving service on a feature phone
Prescription Pathway
E-HEALTH ACCREDITATION STANDARDS STANDARD #1 - Leadership & accountability Have a governance and accountability model that will allow e-health to be managed in a way that delivers the government s goals of transforming the healthcare system in a coordinated and integrated way. Leadership responsibilities and accountabilities clearly identified in the organisational structure.
STANDARD #2 - Strategic and operational planning Engaging with stakeholders across the county to gain their participation in building awareness of the e health initiative. A detailed strategic & implementation plan should be available. All operations involving patients ensures patient safety and privacy The staff should be well qualified to support patient care
STANDARD # 3 - Health information management Information Technology support personnel should have a basic understanding of the technical requirements for the required workflows and are familiar with aspects of networking, interfaces, and the operating systems involved A technical support plan should match the urgency and critical nature of the use case implemented for telemedicine applications. Patient information is reliable to support processes associated with patient referral, on-call and emergency intervention. There should be immediate physician access to laboratory results, enabling more timely and effective clinical decision making. Patient confidentiality should be ensured. All patient data should be protected by secure passwords and accessible only to authorized personnel All patient data should be stored securely on servers and need to meet standard regulations in the country
STANDARD # 4 - Mentorship and oversight All health care providers using e health methods should be properly trained and mentored on the use of e health technologies. Regular refresher trainings should be offered to keep staff up to date with newer technology. There should be a designated e health officer at each health care level
STANDARD # 5 - Financial management: There should be sufficient financial resources needed to provide the e health service. Hospital leaders and managers should use accurate and complete financial data to effectively manage hospital resources to achieve the strategic objectives and deliver a sustainable service
STANDARD # 6 - Efficient use of resources: The designated personnel at each health care level ensure proper e health resource management Where equipment or medicines should be supplied by the healthcare provider, ensuring that there are sufficient quantities of these to ensure the safety of patients and to meet their needs
STANDARD #7 - Leadership for quality and patient safety: There should be systems and processes in place to assess, monitor and improve quality of the e health service. The leaders accountable for quality and patient safety should be clearly identified, trained and set the priorities for quality improvement.
STANDARD # 8 - Safety and risk management Assess, monitor and mitigate the risks relating to the health, safety and welfare of patients and others who may be at risk which arise from delivery of the service. There should be systems and process in place to enable healthcare professionals to identify and assess risks to health, safety and/or welfare of people who use the service. Where risks are identified, professionals must introduce measures to reduce or remove the risks within a timescale that reflects the level of risk and impact on people using the service. Identified risks to people who use services and others must be continually monitored and appropriate action taken where a risk has increased There is a transparent and open process for reporting risks which are logged in a risk register
STANDARD # 9 - Integration of quality, safety and risk management There should be integration of all quality, safety and riskmanagement activities to increase the efficiency and effectiveness of measurement and improvement activities. There should be an open and learning culture in which safety and risk is reviewed. Systems and process are adapted accordingly.
STANDARD # 10 - Alignment with SMART strategic objective #1(Expand medical and health services to enhance citizen squality of life) The e health service ensures access to affordable, preventive, curative, and rehabilitative health services of the highest attainable quality The service empowers and transforms communities through improved access to health information and services Have an effective infrastructure, applications and information systems
STANDARD # 11 - Protecting patient and family rights: The organization s leaders and managers identify patients and family rights and staff respect and protect the rights of patients and their families in the health care process. Service users and their care takers must be treated with dignity and respect The e health service complies with relevant international standards with regards to safe guarding of patients.
STANDARD # 12 - Patient access to services: There should be efficient and effective processes in place to facilitate patient access to health care services regardless of age, gender and mobility.
STANDARD # 13 - Effective inventory management: There should be an efficient and effective supply inventory management system is in place. Where equipment or medicines should be supplied by the healthcare provider, ensuring that there are sufficient quantities of these to ensure the safety of patients and to meet their needs.
STANDARD # 14 - E-health medical records management: Maintain securely accurate, complete and contemporaneous records for each patient, including a record of the care and treatment provided to the patient and of decisions taken in relation to the care and treatment provided on the digital platform. Maintain securely other records as are necessary to be kept in relation to persons employed in delivering the service. Ensure security and good quality when transferring data
STANDARD # 16 - Oversight for human subject research: Oversight is provided of any human subject research conducted in the organization, which includes a clear mechanism to protect patient rights and safety.
CHALLENGES IN DIGITAL HEALTH CARE 1. Digital health is a new way of providing health access and services. It requires changing behaviors and perceptions to health across all stakeholders involved in the healthcare system (ie. clinicians, patients, pharmacies, governing bodies etc.) 2. Healthcare is a heavily regulated and complex industry which requires engagement and buy in from multiple stakeholders to implement and execute innovative solutions.
CHALLENGES IN DIGITAL HEALTH CARE 1. Huge variation in technology adoption could lead to two tier 2. health system. 3. Data privacy is paramount. Anonymizing data creates win-win for users and providers. 4. The changes digital will bring to healthcare will be explosive, but will take a long time 5. Challenges for digital health: consent, data security, privacy, capability
KEY RECOMMENDATIONS For an effective legal and regulatory framework of digital heath care there is a need of: 1. Integrate telemedicine into care delivery structures. 2. Enable citizens' access to their data. 3. Develop appropriate reimbursement strategies. 4. Establish a harmonized data protection regime that 5. allows innovation. 6. Provide clear regulatory guidance 7. Foster use of widely recognized standards and 8. Support mobile broadband policies
THANK YOU ASANTE SANA Murakoze!