Transcript Slide 1

eHealth a use of ICTs for effective healthcare service
delivery
Vincent Sikakane
Deputy Director eHealth and Information Technology
KwaZulu Natal Department Of Health
eMail: [email protected]
November 2014
Content
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Health systems strengthening
Challenges of health system
e-Health/telehealth/telemedicine/mHealth
Best practice in implementing e-Health
innovation/initiatives
“Costly failures of e-Health” – guidelines
not stop sign.
KZN Dept. of Health e-Health initiatives
1. Six components of health system need to be
strengthen to provide better health care:
Telemedicine
2.Challenges of Health system
We are doing well despite…
Distance
between
health
facilities
Medico legal
issues
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Paper
records
Bandwidth
HIV & AIDS and TB;
High Maternal and Child Mortality;
Non-Communicable Diseases; and
Violence and Injuries.
Setting the Stage for Healthcare Transformation: Key Drivers
Before
Paper
Records
Why do we have patients bypassing clinics and CHCs to
attend outpatients at district and regional hospitals
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Staff shortages
Patients seeking primary care
To be treated by a doctor
To collect medication
To get an X-Ray
To see a Specialist
At your facilities…
• Do you have an effective referral program?
• Do you have an effective in reach program?
– How often do you get specialists
• Do you have an effective outreach program?
– How often do you visit clinics
• Do medical officers view Lab results in their consulting rooms?
• Do medical officers view X-Rays in their consulting rooms?
– Do you have a digital X-Ray?
• Are your X-rays being reported by specialist radiologists?
• Turn around time for a patient visiting your facility?
At your facilities…
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Do you have enough doctors, nurses, Pharmacists…
Do have specialists
Are your X-rays being reported by specialist radiologists?
Do you have an effective referral program?
Do you have an effective outreach program?
Do medical officers view X-Rays in their consulting rooms?
Do medical officers view Lab results in their consulting rooms?
Turn around time for a patient
Challenges faced on a daily basis…
• Long waiting hours at our Health facilities-Patients get
referred for minor ailments
• Medical officers leave a busy consultation room - To view XRays/To check lab results
• Most of the routine X-Rays are not being reported by
specialist radiologists
• Time lost looking for the right patient information at the
wrong workstation
• Duplicate tests and procedures when doctors share patients
but not patient information
• A Patient gets a new folder and new folder number
• Open to litigation due to lack of complete information
Aim
– Not to wait for patients to fall sick and come to
health facilities
oEarly detection of Diabetes, Hypertension, TB,
and Counseling at an early stage.
• Reduce the number patients coming to Clinics
oPatients seen closer to where they live.
• Reduce number of referrals to the District
hospitals
oEspecially the unnecessary & avoidable ones
• Reduce number of referrals to the Regional
hospitals.
oEspecially the unnecessary & avoidable ones
3. eHealth
eHealth begins with a vision of:
• connecting people to people,
• connecting resources to needs, and
• connecting healthcare problems to
health care solutions
4. Best practice
• Strategic Plan
• Constantly look at how healthcare services are
rendered and identify those that can be
delivered and or enhanced through
telemedicine and ultimately achieve
improvement in efficiency in service delivery
Building
Monitor
Public health
HIS/HER
Document Mx
Telemedicine
Information
management
mHealth
Partnerships
Tele-health
Infrastructure
Capacity
What is eHealth?
The World Health Organization defines eHealth as “the
use of information and communication technologies
(ICTs) for health to,
• treats patients,
• pursue research,
• educate students,
• track diseases and
• monitor public health.”
What is mHealth?
mHealth applications including:
• education and awareness;
• remote data collection;
• remote monitoring;
• communication and
• training for healthcare workers;
• disease and epidemic outbreak tracking; and
• diagnostic and treatment support.
Putting eHealth into practice
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Physician outreach to remote clinics and facilities, especially where clinics
are located in rural areas. The technology is used here to prevent travel of
patients, doctors and specialists, saving time and improving efficiency.
Remote patient assessment via video connectivity allows physicians to
make remote initial assessments of patients, potentially preventing
unnecessary transport of patients who do not require special care.
Access to specialty physicians – Since there is usually a dearth of
specialists in remote areas, gaining access to such specialties as radiology,
dermatology, cardiology and neurology can be a challenge.
Outreach to school districts – Placing video endpoints in schools allows
physicians to consult with students without the students having to leave the
school premises.
Distance Learning (Continuing Education) – Remote training via video
connectivity provides increased learning capacity and saves significant time.
eHealth Strategy South Africa
• The principles are:
• Get the basics right – infrastructure, connectivity, basic ICT literacy, human
resources and affordability planning.
• Take an incremental approach – build on what exists already in both the
public and private sectors and fill the gaps where necessary.
• Look for early wins in implementations and benefits to build the confidence
of health professionals, patients and the public in eHealth.
• Advocate the benefits of care enabled by eHealth and ensure that these
benefits are realized.
• Constantly evaluate eHealth initiatives and measure improvements in health
outcomes in order to build an evidence base that demonstrates the net
benefits over time of eHealth and guides planning and decision-making.
• Establish national co-ordination on all initiatives in order to improve the
effectiveness of eHealth at all levels.
5. Costly failures…
Why is eHealth so Important in Our Healthcare System?
eHealth is emerging as a critical component of
the healthcare crisis solution.
eHealth holds the promise to significantly
impact some of the most challenging problems
of our current healthcare system:
• access to care,
• cost effective delivery, and
• distribution of limited providers.
eHealth increases access to healthcare:
• Remote patients can more easily obtain
clinical services.
• Remote hospitals can provide emergency and
intensive care services.
eHealth improves health outcomes:
• Patients diagnosed and treated earlier often
have improved outcomes and less costly
treatments.
• Patients with eHealth supported ICU’s have
substantially reduced mortality rates, reduced
complications, and reduced hospital stays.
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eHealth reduces healthcare costs
• Home monitoring programs can reduce high
cost hospital visits.
• High cost patient transfers for stroke and
other emergencies are reduced.
eHealth assists in addressing shortages and
misdistribution of healthcare providers:
• Specialists can serve more patients using
eHealth technologies.
• Nursing shortages can be addressed using
eHealth technologies.
eHealth supports clinical education
programs:
• Rural clinicians can more easily obtain
continuing education.
• Rural clinicians can more easily consult with
specialists.
eHealth improves support for patients and
families:
• Patients can stay in their local communities
and, when hospitalized away from home, can
keep in contact with family and friends.
• Many eHealth applications empower patients
to play an active role in their healthcare.
eHealth encompasses four distinct domains of applications.
These are commonly known as:
• Live Videoconferencing (Synchronous): Live, two-way interaction between a
person and a provider using audiovisual telecommunications technology.
• Store-and-Forward (Asynchronous): Transmission of recorded health history
through an
electronic communications system to a practitioner, usually a specialist, who
uses the information to evaluate the case or render a service outside of a realtime or live interaction.
• Remote Patient Monitoring (RPM): Personal health and medical data
collection from an individual in one location via electronic communication
technologies, which is transmitted to a provider in a dierent location for use in
care and related support.
• Mobile Health (mHealth): Health care and public health practice and education
supported by mobile communication devices such as cell phones, tablet
computers, and PDAs. Applications can range from targeted text messages that
promote healthy behavior to wide-scale alerts about disease outbreaks, to name
a few examples.
KZN Department of Health Case
studies
Telemedicine initiative: TeleRadiology
Remote Site
Radiology
Reporting
Station
Send Station
ADSL/
ISDN
Router
ADSL/
ISDN
Router
TeleRadiology Network
Greys Tertiary Hospital
IALCH Centre of Competence (CoC)
Report/Send Station
Reporting Station
ISDN
Madadeni
Ngwelezana
Router
Router
CT Scan
Send Station
Send Station
Stanger
Router
Send Station
ISDN
Prince Mshiyeni
Edendale
...
Router
Router
Send Station
Send Station
Router
Send Station
CPSI
PUBLIC SECTOR
INNOVATION AWARDS
22 November 2013
WINNER:
Kwa Zulu Natal
Department of Health
Cash Award: R10,000
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Problem statement:
information collected by CCG as part of OSS – there is a backlog of 6-8
months
ICT Solution Data collection
Pilot at Gcumisa clinic using mHealth
technology
– Using digital pen + Cellular phone
+ Web based software to collect
information from households by
community care givers based at
Gcumisa clinic.
– 17 CCGs have been trained to
uses the Digital pen
– 400 households information has
been captured
Benefits
It takes about 10 seconds after
completion of the form for
information to go into a web
based solution.
Reports can be generated for
statistics screening and
management purposes
CPSI Awards 2014
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Problem statement:
Patients referred to a psychiatric hospital before proper assessment
Quality of service is being compromised in facilities that do not have a
Psychiatrists
ICT Solution for telePsychiatry Benefits
• Medical officers can discuss with
The use of videoconferencing
Psychiatrists in real time.
technology to facilitate the
• Counselling sessions using Video
confernecing
provision of health care for
• Access to specialised care by
persons with mental health
disadvantaged communities
issues
• Quality of care and outcomes are
improved
VC equipment
• Cuts down travel time and costs
Board room setting
Consulting room
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Opportunity for training and education for
health care workers
Reduces professional isolation
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Problem statement:
Pharmacy stock-out can have severe negative effects on patient care,
especially in the case of complex, chronic diseases like HIV and TB when
poor outcomes, such as drug resistance and death, can often result.
ICT Solution for stock management in PHC
mHealth as a tool to combat
pharmacy stock-out in Primary
Health Care facilities in
KwaZulu Natal
Tele-education initiatives
Conclusion
It is important to emphasize that
eHealth is not substitute for face-toface medical practice, but rather it is a
tool to compliment the current health
care delivery in South Africa
From the Initial Telemedicine Evaluation Report for the year 2000
Thank You!
Vincent Sikakane
Deputy Director eHealth & Information Technology:
KwaZulu Natal Department Of Health
Contact Us
eMail: [email protected]
Cell: 072 371 7081
Telephone: 033 8467116