e Health Trends and the Use of Standards and Guidelines Mr Mark Landry

1. eHealth Trends and the Use of Standards and Guidelines Mr Mark Landry Health Information Technical Officer World Health Organization, Regional Office of the Western Pacific

2. Outline • Introduction • Trends in eHealth • Next steps: identifying and implementing standards • Future possibilities and potential impacts eHealth: Using Information Communication Technology (ICT) such as computers, mobile devices, and satellite communications – for health services and information

3. Health and eHealth • Health and eHealth are inseparable due to the fact that health is an information intensive sector. • Health is a global concern that is trans-border by definition and affects the world population. • Information technology and telecommunications (ICT) is a global issue especially with the emergence of the knowledge economy and the information society. • This has required WHO to adopt global approaches to eHealth.

4. Why eHealth? • Health systems unable to deliver high-quality, affordable services with universal access • Increasing time and effort needed for acquiring information and data as well as for administration and documentation • Critical health information buried in thick medical files and unsystematic data storage and retrieval system • Specialisation & Sub-specialisation • New Diseases • Increasing support to eHealth…the next breakthrough in health systems improvement

5. Global Cellular Subscriptions

6. 2010 Key Global Statistics Source: mHealth Alliance

7. Scope of eHealth Services and Applications Disasters HIS e-Surveillance Emergencies IHR Society Research Obstetrics/ Gynaecology Journals Patients Dermatology eHealth Governance e-Learning e-Care Websites Pathology Radiology Nurses Training Course Health Professionals e-Management Electronic Health Records Referral Systems

8. WHO's Response • Adoption of the World Health Assembly Resolution on eHealth (WHA58.21) in 2005 by WHO Member States • The eHealth resolutiongave legitimacy to the concept itself but also defined: • the scope of eHealth • the potential stakeholders • the role of governments and the private sector • the need for legal, ethical and regulatory frameworks for its implementation • Catalyzed recognition of the role of eHealth in: • strengthening health systems • improving health services • reaching out to remote communities • enhancing the capacity of health workforce • health promotion

9. eHealth Global Uptake • WHO Global Observatory of eHealth and the eHealth Intelligence Report: http://www.who.int/goe/ehir/en/ • First Global eHealth survey, 2005: • Benchmarking • Comparison between countries • Hard data and evidence on progress made. • Second Global eHealth survey, 2009: • More in-depth analysis • Included eight thematic areas: mHealth, Telemedicine, Management of patient information, Legal and ethical frameworks for eHealth, eHealth policies, eHealth foundation actions, eLearning and country profiles.

10. Most Commonly Reported mHealth Initiatives in GOe • 50% in emergency/disaster situations • 50% in health call centre or healthcare telephone helpline • 45% for surveillance programs • 40% for voice/text messages to achieve treatment compliance • A number of countries highlighted using mHealth for HIV/AIDS and maternal health services

11. eHealth Value Stack Transformation Expert Systems Intelligent cross-platform solutions Benefits to Participants/providers Integration Decision Support Systems Enhanced health, clinical and administrative decision-making Transaction Management Systems Identity, security, audit; payments; health systems management Interaction Information Systems Bi-directional communication Information Communication Systems Health and wellness content; messaging Time/Maturity of Services Source: mHealth Alliance

12. The Grand Challenges to eHealth • Organizational and governance challenges • Technical challenges • Financial challenges • Legal and ethical challenges • Local challenges based on differences in healthcare systems, culture, economy, regulations, policies, ICT infrastructure, and human resources

13. Global and National Governance of eHealth • Code of ethics • Multi-sectoral coordination • Human resources development • Standardization • Interoperability • Charters and frameworks • Collaboration and partnerships

14. Awareness and Accessamong eHealth End Users • Value of ICT in health not fully recognized • eHealth typically not high on national health priorities • Evaluation of eHealth has concentrated mainly on pilot projects • There is often a communications gap between health and ICT professionals • China is a uniqueexception—with strong political will and excellent leadership to continue maximizing health outcomes with increasing use of eHealth solutions • China’s world-class eHealth solutions and outstanding experience should be shared with the rest of the world

15. Technical Competenciesof Health Professionals • Healthcare professionals usually do not receive ICT training. Their understanding of it comes late in their career. • ICT professionals are mainly hardware and software engineers with little orientation on biomedical applications. • There is a need for in-service training and continuous education are missing in the area of health informatics. • This is challenged by having very few specialized health informatics programmes. • Promote peer-to-peer learning and sharing within and between countries: • China Health Informatics Society (CHIS) • International Medical Informatics Association (IMIA): http://www.imia-medinfo.org

16. Standardization and Systems Interoperability Challenges • Fragmented efforts to develop eHealth applications in the absence of adequate governance, standards and national plans resulted in development of eHealth systems that cannot exchange data. • These systems are mainly standalone and disintegrated, lacking unified coding schemes, following different or no standards which resulted in total lack of interoperability between them.

17. WHO eHealth Standardization Coordination Group (eHSCG) • Platform to promote stronger coordination amongst the key players in all technical areas of eHealth standardization. • Place for exchange of information on standards: • Identify areas where further standardization is required • Provide guidance for implementations and case studies • Consider the requirements for appropriate development paths for health profiles of existing standards • Support activities to increase user awareness of the existing standards, and case studies • eHealth Standards List: http://www.who.int/ehscg/resources/en/ehscg_standards_list.pdf

18. Two Examples:HL7 and SDMX-HD • Health Level 7 (HL7) • Data exchange/messaging standard primarily for patient-based transactional systems within a health system • EMR, Laboratory, Rx, Billing, Immunization, maternal health, others • Statistical Data and Metadata Exchange— Health Domain (SDMX-HD) • Intended to be part of national HIS and M&E infrastructure strengthening strategy, facilitating seamless flow of information from facility to district, national, and international levels • Contains a data structure definition (DSD), which defines concepts, dimensions, attributes, code-lists and other artefacts necessary to describe the structure of data • Defines attributes of a data items, which reduces the negotiation required to exchange data between information systems

20. Public Health Informatics Innovations • Communication among geographically dispersed health workers and consumers • Strengthening and streamlining data collection • Implementing standards and promoting interoperability • Disease prevention via electronic health records and improved lab systems • Data collection for research and evaluation

21. WHO Collaborating Centre for Health Informatics • Work planning and application submission/review process underway now to establish the Chinese Centre for Health Statistics and Information (CHSI) as a new WHO Collaborating Centre • Areas of focus may include: • Improving vital statistics and monitoring & evaluation systems • Building capacity in health informatics • Developing and implementing standards • Evaluating eHealth solutions and demonstrating success • Sharing and learning from experience in China • The rest of the world is eager to learn more from China

22. Can eHealth Save Livesand Improve Health? Yes • Could be directly, could be indirectly, to the individual and to the society. • Citizens, patients • Healthcare professionals • Healthcare providers • Governments • Benefits are clear: • To improve the quality and efficiency of healthcare; • To expand access and contribute to equity/universal access; and • To contribute to reduction of cost of health services.

23. Future Possibilities in eHealth • Innovative tools – remote diagnosis, medical consultation, just-in-time training • Hand-held ultrasound connected to phone • Holograms of blood cells using phone camera for malaria, HIV-AIDS, anaemia, clean water • Phones that listen to heart and lung sounds, cough • Transfer of images: cervical cancer diagnosis • “Serious games” via handsets for training CHW • Disaster relief communications • Connect families • Assist emergency relief workers

24. Future Possibilities (continued) • Internet trends - peer to peer network, which allows individual computers to function as both server and client without central administrator • Clinical eHealth services - real-time medical consultations • Biotechnology and Nanotechnology - decoding of human genome, storing and interpreting genetic testing and evaluating treatment options

25. Thank You Mark Landry World Health Organization, Regional Office of the Western Pacific