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
 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
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?
 UK: Transformation NOT automation!
E-governance and ICT is central to the UK Governments
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
 The traditional approach to service provision

Central Government
Policy, co-ordination and funding Silo service
support
environments
each
Social Care organisation
Laboratory
Primary Care has its own
Voluntary Org information
STD Clinic
Acute Hospital Private Sector service

Information outside of a single

organisation is hard to get.
Integration rarely happens
Patient and practitioner
Source: Booth 2002 How can e-governance
and ICTs help?
 e-governance transformation:
Electronic Health Record (EHR)

Central Government
Policy, co-ordination and funding

Social Care
Accident &
Primary Care Emergency
Voluntary Org
Radiology Integrate legacy
Acute Hospital Private Sector systems using
brokerage
technologies

BROKERAGE TECHNOLOGY
EHR is the consequence of joining together
organisational systems
9Process
Patient and practitioner
9People
9Technology
Source: Booth 2002
 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

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: http://www.nhsia.nhs.uk/erdip/pages/picker/lessons/

..the successful implementation of telemedicine depends

on the process being treated as major clinical process
change and an organisational developmenta 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

 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)
Value of ICT in health services
strategic resource E-governance value-chain

data information knowledge action

Accurate & relevant 9 Better decision making

Storage 9 Efficient allocation of resources
Durable 9 Targeted healthcare interventions
Retrieval 9 Identification of patient and community
Distributed needs
Analytics 9 Preventive health education and changes
How do you join up in health-oriented behaviour
this value-chain? 9 Effective disease management
What technologies?
What approaches and 9 Better quality care
processes?
 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
(email, 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
 AfriAfya: Results
Community health benefits
9 Broke the silence on HIV/AIDS
9 Started discussion on high-risk cultural practices
9 Increased condom uptake
9 Increased demand for voluntary counselling and testing services
9 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
 Joining-up ICT: virtuous circle
The links in the e-governance
value chain can be mutually
reinforcing and create
information flows

data information
This model also works well
with the paradigm of patient &
preventive health care community
Information
action knowledge
Attitude
Behaviour
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,
HUB patients and practitioners into
networks of care
Over time implement shared e-
governance services of common
administrative activities to
avoid duplication and wastage
e.g. purchasing, payroll
National interoperability
policy; infrastructure
development; shared
services; other sectors
 Patient-centred healthcare
Prioritise and sequence
9 Africa - HIV/AIDS UK heart disease/cancer
9 Low cost preventive health care
9 Front-line service delivery

Contextualise
Political, cultural, economic, technical environment?
Root and focus e-governance project in specific Getting the
health care programme e.g. disease management
right balance
Localise to e-
9 Patient/community health needs governance
9 Training and education
9 Monitor benefits and adapt if necessary investments
Innovate
9 Join-up services
9 New kinds of professional health carers
9 Technology mix radio, TV, CDROM, Kiosks, internet
 Conclusion
Could your organisation benefit from quicker
access and receipt of relevant, better quality health
information?

How could it be used to really improve peoples health?

Where are the information resources, and can ICTs help to

exploit those resources for health provision?

What are the health care priorities in your region and

communities?
 Thank you!

Ben Crowe
Demos
url: http//:www.demos.co.uk
Email: bencrowe@breathe.com
Telephone: +44 (0)20 7401 5330
Fax: +44 (0)20 7401 5331

The Mezzanine, Elizabeth House 39 York Road, London SE1 7NQ, UK

Appendices
 Reform of health services
Across the world, public health services are being reformed to
respond to various challenges:
Aim of reform
Efficiency
rising demand and costs
Equity (access)
aging population Effectiveness
population growth Sustainability
decline in economic growth
serious disease Tangible benefits
public expectations 9 Better quality care
private sector competition 9 Reduced costs
9 Sustainable improvements in
health status

ICT is a key tool to support these efforts

 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 ICTs help?
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?

 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
 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

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

People are at the heart of successful e-

governance
 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 http://www.idrc.ca/

Forrest, Andrew October 2000, Electronic Record Development and Implementation Programme
Cornwall and Isles of Scilly Health Community Demonstrator Project, Implementing Telemedicine
http://www.nhsia.nhs.uk/erdip/archive/documents/corn/deliverables/corn1-5a.doc

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, FinallyGetting 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 http://www.longwoods.com/eh/

Richardson, W.C. 1999, Putting Patient Safety First Press Release http://www4.nationalcademies.org

NHS Information Authority, March 2002, Electronic Record Development and Implementation Project
http://www.nhsia.nhs.uk/erdip/pages/news_items/march_2002.pdf