Sunday, February 21, 2010

Plans for Global E-Health

E-Health presents tremendous opportunities and promises to transform health and healthcare in remote areas in many developing countries according to Susan Dentzer, Editor- in-Chief, “Health Affairs” and on-air analyst with “The NewsHour with Jim Lehrer”. The February 2010 Health Affairs thematic issue is devoted primarily to finding workable solutions to make it possible for e-Health to reach its full potential in developing countries.

Dentzer moderated the Health Affairs briefing supported by the Rockefeller Foundation at the National Press Club in Washington D.C. on February 16th. Key leaders in the field presented their ideas on the future for e-Health, methods to implement new technologies, the need to collaborate on mHealth, achieving interoperability, and ways to increase the health informatics workforce worldwide.

The current Health Affairs issues includes a paper in the current issue written by Ariel Pablos-Mandez, Managing Director for the Rockefeller Foundation, Tica Gerber MHS/HP, Senior Program Officer, Health Metrics Network at the World Health Organization, and other colleagues.

The paper summarizes the results and thoughts on the Rockefeller Foundation’s 2008 Conference “Making the eHealth Connection: Global Partners, Local Solutions”. The paper discusses the conference recommendations that stress the need to develop global partnerships, find health technology solutions based on local needs, provide for cross-border interoperability, and find ways to leverage current open source networks and shared informatics systems.

Hamish Fraser, PhD, Assistant Professor of Medicine at Brigham and Women’s Hospital, and as Director of Informatics and Telemedicine at Partners in Health (PIH) for ten years has played an important role. He led the development of web-based medical record systems, data analysis tools, and pharmacy systems to treat drug resistant tuberculosis and HIV in Peru, Haiti, Rwanda, Lesotho, Malawi, and the Philippines.

At the briefing, Dr. Fraser stressed that since high quality clinical data requires a large investment in IT systems and training this means that data management has to be an ongoing process. However, he reports that there are insufficient studies to show whether information technology systems are making a positive clinical impact question. The question is whether all systems are delivering high quality timely data for clinical care and reporting, and at the same time, able to provide up-to-date research information?

Dr. Fraser mentioned PIH has been very responsive to the Haiti earthquake and that PIH sites are equipped with satellite internet along with backup generators and/or solar power. PIH sent over 90 flights, hundreds of staff, and over 100 tons of critical supplies in the first 3 weeks. Tracking was accomplished by using a web-based medical information system to track supplies, track surgical cases, monitor the caseload, and resolve infrastructure issues.

Today, partnerships among healthcare and information technology researchers and designers worldwide are creating mobile health tools tailored to local community needs and resources. Walter H. Curioso, M.D., Research Professor at the Universidad Peruana Cayetano Heredia in Lima, Peru, and an Affiliate Assistant Professor, at the University of Washington, reports that much of the hardware and infrastructure is coming from the developed countries of the global north. However many mHealth innovations are also coming from Asia, sub Saharan Africa, and Latin America known collectively as the global south.

He wants to enhance mobile health with south- to-south collaborations but today, most of the mobile health collaborative efforts are still in pilots or demonstration phases. These projects include activities in education and awareness, remote data collection, remote monitoring, communication and training for healthcare workers, disease and epidemic outbreak tracking, and diagnostic and treatment support. Dr. Curioso emphasized that groups must now pull together, and set up more collaborative efforts and develop curriculum to move mobile health forward.

Why is it so hard to achieve interoperability worldwide? Charles Jaffe M.D, PhD, CEO of Health Level 7, the global authority on HIT standards for interoperability, focused on some of the reasons. Major problems can result since many languages are very complex, using medical language can be complex, policies written in different languages can be difficult to understand, and systems can differ and as a result make data hard to transfer.

Dr. Jaffe stressed that HL7 is successfully providing for e-learning related to standards and were the first to develop an educational program in Argentina translated into Spanish. Today teachers teach in real-time in three languages in every time zone. This educational experience provides third world countries with essential information free of charge.

According to Dr. Jaffe, there are several lessons that the developing world has taught the international health technology community. The fact is that it is easier to do it right the first time, the most expensive solution many not be the best solution, stand-alone solutions almost always stand alone, and education trumps almost everything else.

One of the greatest needs to increase the use of health technology is to build up the global health informatics workforce in developing countries. William Hersh, MD, Professor and Chair, Biomedical Informatics, Oregon Health & Science University in Portland, knows that the problem while not limited to developing countries is a serious issue.

To build health informatics capacity in developing countries, it is important to be cognizant of workflow, organizational and cultural factors, local needs and capabilities, and be open to partnering with existing programs and institutions.

Dr. Hersh described a few of the projects that are helping to build capacity in health informatics. For example, the American Medical Informatics Association (AMIA) with others developed the “10x10” program to train healthcare professionals in applied health and medical informatics. The Rockefeller Foundation just awarded a $630,100 project grant to help AMIA implement a global e-Health training program in sub-Saharan Africa, and the Foundation actively supports the “Health Informatics Building Blocks” program developed by AMIA.

In the public sector, NIH’s Fogarty Center is heavily involved in a global e-health. Their grant program “Informatics Training for Global Health” supports informatics research and training in low and middle income country institutions.

For more information on Health Affairs and the current publication, go to The contact at Health Affairs is Sue Ducat at or call (301) 841-9962. Email Caroline Broder at for more information on the briefing or call (301) 652-1558.