Advancing Health Information Systems in Developing Regions
Dr. Peter Drury discusses how ICT brings connectivity and collaboration to healthcare in emerging regions
Connected Health White Paper (PDF 2.3 MB)
February 22, 2010
Information and communications technology (ICT) holds enormous promise for tackling some of the challenges facing healthcare professionals in developing regions.
Many medical facilities in the world's most rural areas still do not have computers; even fewer enjoy Internet connectivity. But as ICT spreads across remote communities, its potential benefits are dramatic.
Imagine clinicians in remote towns gaining access to e-learning opportunities and the chance to confer on diagnoses or specialists from a particular region being able to discuss and collaborate on treatment for an outbreak of cholera or tuberculosis (TB). Picture patients in rural areas learning more about and being more proactive in their own healthcare.
Dr. Peter Drury, healthcare lead in emerging markets for Cisco's Cisco Internet Business Solutions Group (IBSG), has spent more than 25 years working in information management in the United Kingdom's National Health Service as well as addressing healthcare challenges in developing countries in particular Ghana and Kenya. He also advises organizations such as the World Health Organization, the American Medical Informatics Association and the Commonwealth Secretariat on ways that ICT can support the delivery of capacity-building and knowledge for the health and development agenda.
News@Cisco asked Dr. Drury to share his thoughts on the state of health information systems in developing regions, current challenges, opportunities and more.
Where does the health information system stand in emerging nations, generally speaking?
Peter Drury: There really isn't one health information system. Information tends to be dispersed in disease- and hospital-specific silos, for example both among countries and within the same country.
Health information systems, as they exist today, are not designed to link together and share data; there is very little overall integration and collaboration and very little integration with a knowledge support system that can be shared with all stakeholders from health workers at all levels to community members.
Can you expand on the idea of knowledge support?
Peter Drury: Health information systems are primarily geared to report on what has already happened. We need to provide health workers, whether in a hospital or out in local communities, with relevant, up-to-date knowledge to support their decision making.
The Map of Medicine is one example of how ICT can help. Developed in the United Kingdom, it is an online medical reference tool that provides health professionals with the information they need to diagnose and treat patients.
For each step along the pathway of a patient's health journey, the Map of Medicine delivers current clinical knowledge. A critical feature is its flexibility to adapt pathways to local health issues such as malaria and TB in Africa, for example and individual communities' needs.
"The solutions must become locally owned. We can help provide ICT and healthcare tools and show people how to start using them, but we must step back and encourage regional and local leaders to determine how to use them successfully in their own individual situations."
The Map of Medicine also supports collaboration. Not only will clinicians in rural and developing areas find the information provided by others helpful, they can also add to the knowledge base with their own region- and disease-specific expertise.
What are some of the other challenges facing developing nations when it comes to implementing ICT and health information systems?
Peter Drury: A major challenge in establishing these systems is articulating the range of healthcare issues people are facing and the solutions that are applicable and affordable. It is difficult to provide healthcare systems to middle- and low-income communities, whether urban or rural, at a reasonable cost, but this is what we're working on now.
Cisco is collaborating with others, including the U.K.'s National Health Service and the World Health Organization, to develop a spectrum of ICT tools and specific guidance on when it is most appropriate to use them. The good news is by using technology-based knowledge support systems we can begin to disseminate knowledge to support public health, even in less-developed regions.
What role does poverty play in relation to the challenges these regions face?
Peter Drury: The majority of the developing world's health issues relate to poverty. That, in turn, is tied to a lack of opportunity for economic development, which results from a dearth of information and education.
For example, in countries where risk factors (poor hygiene, smoking, unsafe sex, alcohol or drug abuse) are high, the level of understanding around these behaviors is low.
The burden of poor health a combination of mortality and disability is heavy. To show the impact, the World Health Organization uses the "disability-adjusted life year" metric, which quantifies the impact of premature death and disability in a population by combining them into a single, comparable measure. Chronic health conditions such as depression that can have a major impact on the burden of ill health are often overlooked.
So the challenge is: How do we deliver the requisite information to people who have very little money and no wherewithal to obtain it themselves?
One project that addresses this challenge involves "Pasha Centers" in Kenya. ("Pasha" in Swahili means "to inform.") These centers focus on the local communities' needs, which reach beyond health and also include education, finance and government services everything one needs to make better decisions.
Tell us more about the Pasha Centers.
Peter Drury: The first, in Kangundo, opened in August 2009. Five more, in different communities around Kenya, have since opened to form a "connected laboratory test bed" that will run for four months as part of a baseline study to monitor community usage and the demand for different types of service. (See related blog on Pasha Centers.)
We are testing the proposition that if an ICT platform is provided to deliver content, services and training and this is done within a village or community context, it becomes possible to find ways that resource-poor communities can get affordable access to a very wide range of healthcare and other information. This becomes feasible because of economies of scale and the aggregation of demand reducing the unit price.
What are some other examples of how Cisco is working with others to address healthcare challenges in emerging nations?
Peter Drury: Cisco IBSG, the company's global strategic consulting arm, collaborates on many interesting health information system projects around the world. In emerging nations, we focus on healthcare as an important catalyst for the development agenda.
We work with governments and the private sector to look at ways of transforming and reshaping industry best practices. We apply advanced technologies in the design and delivery of healthcare to improve connectivity and health information outreach, doctor-patient experience, and collaboration among communities, educators and healthcare providers.
At Garrahán Pediatric Hospital in Argentina, we are implementing a telemedicine pilot project that is designed to offer remote pediatric consultation and services in different provinces. The pilot takes advantage of collaborative technologies such as Cisco TelePresence and Cisco Unified Communications.
In Turkey, the Kayseri Research and Training Hospital piloted a digital and mobile application that takes advantage of connected devices to provide caregivers with instant, secure access to information, medical records, hospital assets and people.
At Johannesburg General Hospital in South Africa, we've been involved in a managed-preventative-care study that looks at using different technologies to engage with diabetes patients. For example, patients receive SMS (text message) reminders to take their medications. Healthcare professionals there are also using social networking tools.
At Kijabe Hospital in Kenya, we installed a wireless network and introduced the Map of Medicine on a PDA.
Can you describe the links between ICT and education, when looking at improving healthcare in emerging nations?
Peter Drury: The big issue for developing nations is a lack of health workers, whether community-based workers, clinicians or nurses. The situation is dire.
The ICT challenge is to respond by making available to people in more remote locations the many training courses that exist online. In this way, people can receive health training but stay local while they learn, rather than travel to a city far away or live abroad.
If ICT can deliver online health knowledge and training to the local community, it will help redress the "brain drain" and, I hope, provide the opportunity to make quality global courses available. But these courses must be localized by the content developers.
The bottom line is that we want to get knowledge as close to the home as we can wherever that home is.
What are some of the next steps hospitals in developing nations can take to bring ICT into their healthcare systems?
Peter Drury: Traditionally, we have begun by introducing basic patient administration systems, focusing on point-of-care technology, bar codes, radio frequency identification (RFID) tags, sort of thing, similar to what we've done at the Kayseri Hospital in Turkey. These systems help make the hospital more digitally connected and interoperable, internally.
The next step is connecting the hospital with the wider community. This involves getting the right portals set up to enable people working in the communities and health centers to communicate with experts in their district as well as those in national and international hospitals.
These facilities need a combination of digital readiness and connectivity. Their healthcare information systems must be developed in a way that empowers collaboration and that empowers the local communities.
This is not something outside organizations or people do to developing regions; the solutions must become locally "owned." We are very cognizant that we can help provide ICT and healthcare tools and show people how to start using them, but we must step back and encourage regional and local leaders to determine how to use them successfully in their own individual situations.