Fighting Diseases with eHealth: A WHO Perspective

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Dr. Najeeb Al-Shorbaji, director of knowledge management and sharing at the WHO's headquarters in Geneva, Switzerland.

Image courtesy of the World Health Organization (WHO)

Image courtesy of the World Health Organization (WHO)

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World Health Organization (WHO)

This story is one of an occasional series on Connected Healthcare.

November 16, 2009

The World Health Organization (WHO) has a simple but sweeping mandate. According to its constitution, the UN agency's objective is "the attainment by all peoples of the highest possible level of health." That means not only coordinating international efforts to monitor outbreaks of infectious diseases such as SARS, malaria, pandemic influenza H1N1 and AIDS, but also sponsoring programs to prevent and treat them. No small order.

Over the past decade, information and communications technology (ICT) has emerged as a powerful tool in developing and organizing new ways of providing efficient healthcare services. In an increasingly digital world, the potential benefits of using ICT applications in healthcare, collectively known as eHealth, have not been lost on WHO, particularly in relation to developing countries. eHealth can be defined as the use of digital data – transmitted, stored and retrieved electronically – in support of healthcare, both locally and remotely.

For more insight into how WHO is using eHealth to help promote the general health of people in developing countries around the world, and what the organization looks for in the private technology companies it partners with, News@Cisco spoke with Dr. Najeeb Al-Shorbaji, director of knowledge management and sharing at the WHO's headquarters in Geneva, Switzerland.

What is the value of ICT in healthcare settings, especially in developing countries? What benefits can it bring and in what ways?

Dr. Al-Shorbaji: The health sector is tremendously knowledge-intensive—everything we do involves collecting, disseminating and sharing information. We use that information for decision-making, be it a diagnosis, a treatment or development of a facility. ICT can make information available, accessible and more usable for people working in healthcare, which can help in the building and functioning of health systems and services.

In addition, ICT can help bridge the digital divide by helping developing countries "leapfrog" unnecessary steps and mistakes that developed countries made in developing health information systems. At the same time, ICT is a cost-effective way to reduce the burden on health systems in terms of data collection, analysis, reporting and sharing at the national and global level.

Can you give an example of the leapfrogging effect made possible by ICT?

Dr. Al-Shorbaji: One example is the telephone landline. In Africa, mobile phone use is booming, with many countries now having more mobile phones than landlines. According to a recent study by the International Telecommunication Union, there will be 4.6 billion mobile phone subscriptions globally by the end of 2009. Rather than go through the whole landline development cycle, these African countries can go straight to technologies that take advantage of cellular and other wireless networks. They don't have to convert legacy systems or develop systems based on them.

It's often much easier to develop new health information systems in countries that have no such systems in place to begin with. Starting from scratch, we can build systems with the new requirements, specifications and interoperability standards, using current technology that's robust, user-friendly, graphic-based and appealing to programmers and policy-makers alike. It shortens the time for developing countries to adopt and deploy systems.

With so many developing countries lacking basic medical needs, what is the justification for implementing costly technologies?

Dr. Al-Shorbaji: The technology we use isn't costly; it is cost-effective and efficient.

In developing countries, we are trying to promote technologies that are appropriate, affordable and sustainable. Personal computers, for example, offer many advantages over paper-based records for such tasks as recording the number of deaths in a given area, maintaining a small registry of diseases, or enabling people to make appointments or to register to see a specialist in a hospital.

A simple application running on a personal computer or a small network can reduce the amount of time patients have to wait for appointments. It also gives healthcare providers the ability to process and aggregate data as well as promote efficiency, which opens up the opportunity to introduce new services—all of which reduces costs.

In the health sector, we look to technology to increase efficiency, reduce costs, boost utilization of resources, provide more accessibility, and more importantly provide safety for people using medicines.

For example, you can reduce costs by using computer systems to monitor and create an inventory of drugs, check expiry dates and the adverse reactions of certain drugs. Patient safety is a major issue which eHealth can address. Short messages sent via a mobile phone can remind patients to take their medications or follow health advice. You can imagine how effective this can be and how little it costs. In the sphere of eLearning, you can deliver health information and the medical education curriculum to people in their own workspaces, so they don't have to spend money on travel.

There are many examples—in telemedicine, in teleradiology, in databases and electronic health records—in which having the data helps reduce the cost and provides more efficient and cost-effective products and services. Using teleradiology has allowed one radiologist in a health facility to serve multiple sites simply by sending images by email or accessing them through the Internet.

So "costly" is not the word I would use. It is costly if you don't use it properly, if it's not for the right purpose, if it's not made in a way that meets people's needs.

What types of WHO programs are underway or in development?

Dr. Al-Shorbaji: We have been active in the area of eHealth for many years. Probably the most important development was the adoption of a resolution on eHealth by the World Health Assembly in 2005. In that resolution, WHO's Member States agreed on actions and strategies regarding standardization, policy development and specific types of applications in support of strengthening health systems and health services. WHO has been providing leadership in guiding eHealth at a global level since then.

In addition, we work with other United Nations agencies on our Millennium Development Goals (MDGs), which are eight goals we want to achieve by 2015, including reducing extreme poverty, reducing child mortality rates and fighting epidemics such as AIDS, malaria and tuberculosis. One of the more important sub-categories of this has to do with providing affordable, essential technologies in developing countries through partnerships with the private sector.

Other activities include the Global Observatory for eHealth that aims to collect data on the global uptake of eHealth, eHealth standards, institutional building and policy. Over 100 countries have so far completed the second survey. Our Health Academy eLearning courses promote health and education, and are coupled with another eLearning initiative that's focused on improving the quality of the health workforce and providing training for nurses, health workers and physicians.

Other initiatives include our ePortuguese network, which aims to improve access to health-related information for Portuguese-speaking countries in a collaborative way; the Africa Health Infoway initiative, an ICT-based network of eHealth tools to support health in many African countries; and Sharing eHealth Intellectual Property for Development (SHIPD), which aims to provide eHealth systems and tools to developing countries free of charge.

What about mobile health?

Dr. Al-Shorbaji: That's another initiative we are supporting by working with our regional offices. Mobile health, or mHealth, is the use of mobile telecommunication technologies such as mobile phones, the popular GSM mobile phone standard, personal digital assistants (PDAs) and intelligent systems to collect health information data and disseminate health messages.

A typical scenario would be using text messages on a mobile phone to arrange for such health services as making an appointment or reminding patients about drugs they need to take. This can be especially useful for diseases like HIV/AIDS or tuberculosis, where medication has to be taken on a regular basis for there to be any sustained benefit.

The mobile phone can be used in conjunction with GPS technology to help you identify, locate and get to a hospital or primary health care center in the vicinity, deal with your own electronic health records (EHRs), receive health education material and so on. WHO is very much engaged with other partners to develop legal, ethical and sustainability frameworks for mHealth.

What problems are you looking to address, and what results have you seen?

Dr. Al-Shorbaji: There are many problems in the eHealth area, but from a governance, standardization and policy point of view, we are trying to help countries that do not have national policies.

When a partner such as a technology company goes to a country without a national plan, they start carrying out pilots, but in a fragmented way. Many of these pilots are never set up at a national level or scaled up, so there is a lack of standardization and interoperability between eHealth systems. One system developed in one country or in one hospital does not communicate with other software packages or other systems, and so there is a lack of sustainability.

Another issue is the very acute shortage of people who are trained in health informatics, medical informatics or different aspects of eHealth. We are trying to promote the concept of eHealth at a global level, and one thing we'd like to do is to have a global eHealth forum that would bring together the different partners and players at the global level to develop the vision, standards, strategies, governance and structures, working with countries towards the concept of eHealth, funding it and making it more sustainable.

What are WHO's the main challenges in achieving greater adoption of eHealth technologies?

Dr. Al-Shorbaji: We face a lack of understanding among many of the stakeholders of what ICT can do in the health arena. People who do not know the value of ICT in health automatically equate it with something costly. They ask: Which is most important—to buy medicine or to buy computers? But we never put it in that way. We need to buy both medicine and computers.

Another issue is the abundance of so-called vertical programs related to health. That is, you might have a malaria program, an AIDS program, a tuberculosis program, or programs for non-communicable diseases such as diabetes or cancer, each with its own eHealth application, but in many cases these systems do not work together. There is no infrastructure at a horizontal level to support all these programs in a standards-based way.

Another challenge is that many countries do not have a legal framework to support eHealth, so they never get beyond the pilot program stage. They can't scale up to a national level. In addition, if you want to use services from another country, such as a teleconsultation or getting a second opinion about a diagnosis from a specialized physician, who bears the responsibility if something goes wrong? If a medical record exists, who owns the data? How can you achieve the maximum level of security and ethical considerations in relation to that? These are some of the issues that arise in the absence of a legal framework.

There are also challenges relating to funding. A number of donors and private-sector partners are interested in providing support, but often their efforts are fragmented or constrained to a one-to-one basis because of the lack of a national framework.

Despite these hurdles, I can assure you the picture is changing by the day. More countries are trying to work on their governance, on their legal frameworks and their funding mechanism for eHealth.

What does WHO look for in technology providers to work with it in these areas?

Dr. Al-Shorbaji: UN agencies and governments need to work with the private sector to go forward. In partnering with the private sector (and technology providers in particular), we want partners that take this engagement seriously. It's a shared responsibility.

One problem we run into is technology partners in some countries who don't like working in remote areas. They prefer to concentrate in urban areas and leave remote areas without much infrastructure, because their business model brings greater financial benefits when their user base is more focused in a city. What we try to do in the interests of equity is to ensure that the infrastructure is available everywhere, so that eHealth services can reach rural areas, islands and remote communities wherever.

In a similar vein, we prefer our governments and Member States to work with technology partners whose primary incentive is not solely generating revenue. We prefer they view this as a developmental activity to help the UN, the government and the other sectors in promotion of health and development. This is not to say that companies should subsidize operations unless they have a business model that supports that.

Ideally, we'd like technology providers to look at the human side of an operation, to be interested in development as a health issue, not just as a means of selling technology. We'd also like them to ensure that their products meet the highest criteria for technical, linguistic and cultural standards. It is very difficult for organizations like WHO to work with providers that offer proprietary technologies that are not interoperable, not interchangeable, not transferable, not replaceable.

Finally, we look for partners with the willingness to make a long-term commitment so that these technology projects can be sustainable. When a technology partner comes along, we don't want them to offer a one-year pilot and then adopt a "we'll see what happens" approach. We want a higher level of engagement. These are the kinds of things we dream of.