ICT for Health Paper

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ICT in Health care delivery system: A Framework for developing nations1Omotosho A , 2Emuoyibofarhe O.J ,3 Adegboola O1,3 College of Information and Communication Technology

Bells University of Technology, Ota, Ogun State2 Department of Computer Science and Engineering

Ladoke Akintola University of Technology , Ogbomoso1 [email protected]

[email protected]

mailto:[email protected]






AbstractThe aim of Information and Communication Technologies (ICT) for Health (also known

as eHealth) is to improve significantly the quality, access and efficacy of healthcare forall citizens. ICT for Health describes the application of information and communicationtechnologies across the whole range of functions that affect the health sector.Every nation is seeking to improve the quality of its health care and at the same time tocontrol escalating costs.In 2001, the size of IT-enabled healthcare services is estimated to be about $ 3.1 billion,

of which about 80 per cent are in developed countries (Poste, George 2000). On-lineconsultations by patients and doctors through websites and email, distance referrals,emergency evacuations, and advance transmission of images and data of patients fromambulances can reduce lead times of intervention in emergency wards of hospitalsA critical mass of professional and community users of ICTs in health has not yet been

reached in developing countries. Many of the approaches being used are still at arelatively new stage of implementation, with insufficient studies to establish theirrelevance, applicability or cost effectiveness (Martinez, et al, 2001). This makes itdifficult for governments of developing countries to determine their investment priorities(Chandrasekhar and Ghosh, 2001). However, there are a number of pilot projects thathave demonstrated improvements such as a 50% reduction in mortality or 25-50%increases in productivity within the healthcare system (Greenberg, 2005).This paper discuss how ICT has contributed of health in different part of the world, itscost effectiveness and provide a framework for implementation in developing countrieswith evidences to why developing nations must embrace the opportunity and benefits ofICT in their health sector reform .

Key-Words: Ehealth, ICT, developing nation, framework



1.0 IntroductionThe World Health Organization's definition of health is not merely the absence of disease

but the attainment of a state of physical, mental, emotional and social well being.(source:Wikipedia, the free encyclopedia).Information and communication technologies ,ICT is used to describe a range oftechnologies for gathering, storing, retrieving, processing, analyzing, and transmittinginformation (www.wcpt.org/node/29562). Information is seen as a key element toachieving these objectives, as is a workforce trained in the appropriate health informationskills (Berland G.K et al, 2001). It is an unfortunate reality that healthcare is not as safeas it should be. Adverse events and preventable errors that cause patient harm and deathare commonplace in healthcare. These errors are most often not the fault of individuals, but of a system that fails to provide safe and effective care. The cause of preventableerrors can be traced to gaps in the flow of information and communication failures both

within organizations and across different healthcare service providers. The personal costof these errors is immeasurable.ICT has helped in bridging distances and providing access to clinical knowledge,specialized expertise and health services thus saving lives and costs. ICT provides accessto clinical information, Telemedicine, Online Discussion groups and other tools.The need for reform of health sector and the need for investment in, and deployment of e-health has been part of the healthcare agenda for many years.These well documented challenges include rising demand for healthcare services due tothe ageing of the population, the rise in chronic disease and increased consumerexpectations; problems with health workforce supply and distribution; inequity of accessto services, particularly amongst Indigenous, rural and poor populations; quality andsafety concerns; and fragmented and limited ability to share information (Bruce KArmstrong et al, 2007). The extent of our challenges is great and they must be met withless resources (Coiera E, 2004).

2.0 Literature ReviewHealthcare is an information intensive industry and healthcare professionals rely onaccess to correct and comprehensive information, when and where they need it, to informthe daily decisions they make about a person‟s care. Information and communications

technology is largely absent from the way we generate, capture and share healthinformation as we continue our reliance on handwritten paper records. To say that thisreliance on paper is inefficient, wastes money and scarce resources and compromises patient safety and the quality of care is an understatement (Nichols, P et al, 2008).In order to meet these challenges and ensure the sustainability of healthcare, we need tochange the way healthcare is funded and delivered. Failure to do so means thesechallenges go unchecked, needs go unmet, and the health system continues its downwardspiral of unsustainability with resultant detrimental flow on effects for workforce participation, productivity and economic growth.

http://www.wcpt.org/node/29562






The challenges facing healthcare, if not addressed appropriately and soon, will becomeoverwhelming. They call into question nation‟s ability to deliver efficient, equitable,affordable, portable, universal, highly accessible and safe, high quality healthcare.

2.1 ICT in developing countriesIn Peru, Egypt and Uganda, effective use of ICTs has prevented avoidable maternaldeaths. In South Africa, the use of mobile phones has enabled tuberculosis patients toreceive timely reminders to take their medication. In Cambodia, Rwanda, South Africa,and Nicaragua, multimedia communication programs are increasing awareness of howcommunity responses to HIV and AIDS can be strengthened. In Bangladesh and India,global satellite technology is helping to track outbreaks of epidemics and ensure thateffective prevention and treatment methods can reach people in time (www.infodev.org.)

Investment in information and communication technology (ICT) in the health sector inUganda and sub-Saharan Africa is limited for a number of reasons. One of these is failure by planners to appreciate that ICTs – computers, telephones, the Internet, radio, etc can

improve healthcare delivery. Many policy makers will ask, “Why should we invest incomputers and Internet connection when people are dying of malaria, diarrhoea andAIDS?”( I-Network Uganda ,2003).Many of this type of related questions are asked by government and stakeholders inseveral developed countries.We believed that with the information, framework, contributions, evidences andrecommendations provided in this paper on the application of ICT in health will helpgovernments and stakeholders of developing countries to invest more in E-health

2.2 ICT Diffusion Index

The WHO Report for the World Summit on Information Society (WHO, 2005) indicatesinequity between burden of disease and spending in developed and developing countries.Health conditions and ICT diffusion in countries provide a basis for outliningopportunities for action in eHealth.Health conditions can be expressed by WHO‟s mortality strata.United Nations Conference on Trade and Development (UNCTAD) has established anICT diffusion index, ICD development which is based on connectivity, access and policy.These terms are defined as follows:Connectivity: Physical infrastructure available to a country: per capita internet hosts,PC‟s, telephone mainlines and mobile phones. Excludes electricity, broadband, andaffordability measures.Access: Number of internet users, adult literacy rate, cost of a local call, and GDP percapitaPolicy: Comprises presence of internet exchanges, competition in the local loop /domestic long distance and competition in the internet service provider market.ICT diffusion index can be calculated from the formula:ICT diffusion = (Connectivity + Access+ Policy) /3ICT diffusion takes on values from 0 to 1 range (e.g. Iceland has the highest ICT diff inEurope = 0.76);

http://www.infodev.org/






Table 1. ICT diffusion – summary.Region Max ICT diffusion

Region Max ICT diffusion

Africa 0.36 Mauritius

South East Asia 0.33 Maldives

Americas 0.80 USA

Europe 0.76 Iceland

Eastern Mediterranean 0.58 United Arab Emirates

Western Pacific 0.68 Singapore

Low ICT diffusion value for a given country indicates obstacles in eHealth development.Better telecommunications infrastructure, more reliable and user friendly access devicesare of a high priority in developing countries.(Robert Rudowski, Department of MedicalInformatics and Telemedicine, Medical University of Warsaw, Poland)

2.3 The need for a new landscape in healthcareHealthcare systems around the world are facing major challenges related to chronicdiseases, demographic changes, nursing shortages, medical accidents and rising costs. Forexample in Europe, the proportion of people over 65 is expected to almost double by2050 (Eurostat ,April 2005.). More elderly people will require prolonged medical careand assistance to ensure they live independently. Furthermore, chronic diseases are on theincrease, as are their management costs. All these factors are starting to place additional

strain on national healthcare systems.Traditional healthcare institutions offer treatment mainly on the basis of diseasesymptoms. This approach is associated with high costs and a reduced quality of life for patients. Even though the advantages and benefits of preventive healthcare are widelyrecognized, current health systems in developing countries invest only a fraction of theirexpenditure in prevention of diseases. Moreover, most healthcare services are deliveredinside medical premises. Despite being built for acute events, many hospitals allot asignificant number of their beds to chronically ill patients, with considerable costconsequences. Efficient remote monitoring and care are thus required.Evidence suggests that every year hundreds of thousands of deaths worldwide areattributed to medical accidents, adverse drug effects and preventable injuries. The

majority of these deaths are due to communication difficulties in the healthcare processand lack of information on patients‟ medical history. In the USA, it is claimed that moredeaths are attributed to inappropriate medical decisions than to motor vehicle accidents, breast cancer or AIDS (To Err is Human: Building a Safer Health System, WashingtonDC, Institute of Medicine, 2000. Experts consider that the figures are likely to be of asimilar magnitude throughout Europe.)

2.4 E-Health



EHealth is a relatively new term in health care practice and one of the most rapidlygrowing areas in health and ICT today. The World Health Organization defines eHealthas „the cost-effective and secure use of information and communications technologies(ICT) in support of health and health- related fields, including health-care services, healthsurveillance, health literature , and health education, knowledge and research‟.(WHO

2005). ”Ehealth is the use of information and communication technologies (ICT) forhealth” (WHO, 2008). Ehealth then encompasses services such as health- related internetinformation sites, automated online therapy, email consultations, online pharmacies,telehealth, home monitoring systems and virtual clinics. It also includes informationtechnology – based health system developments. It comprises health promotion, disease prevention and care to improve health conditions and equity. Involving differentstakeholders with different interests and needs, this requires a plurality of solutions inmeaningful contexts.E-health technologies and processes such as individual electronic health records, clinicaldecision support systems and intelligent, responsive buildings and equipment haveenabled the delivery of safe, high quality healthcare. The culture of healthcare has

evolved substantially from the days where mistakes, errors, omissions and duplicationwere common in healthcare delivery.This restructuring entails a two-fold paradigm shift :a) from symptom-based to preventive healthcare and b) from hospital-centred to person-centred health systems.

Traditional model of

healthcare

New model of health

services delivery

Model/Philosophy Disease centred cure Citizen centred andwellness focused

Interactions Episodic , on demand Continuously , autonomous

Data Characteristics Fragmented, proprietary Integrated , distributed,Shared , continuous update

Care giver Healthcare professional Citizen ,informal carers,community , healthcare professional

Care receiver Patient All citizen (independent ofsocial , mental , physicalcapacities)

Entry into healthcare

system

Disease triggered Choice

Consultation delivery

process

Linear (cottage industrytype)

Ubiquitous , seamless ,collaborative

Consultation receiver

location

Hospital , GP Office Home , community-based

2.4.1 Cost benefit of E-health



Price-performanceIn 1997, the Information Industries Taskforce noted that: "A 1975 mainframe computercould carry out 10 million instructions per second and cost about $10 million. By 1995the ordinary desktop computer could compute nearly 70 million instructions per secondand cost only $3,000. In cost/performance terms, the capital cost of performing one

million instructions had dropped from $1 million in 1975 to $45 in 1995, a decline ofmore than 99.99 per cent in 20 years. ( Hudson Institute , 1997). If this level of success ifapplied to healthcare delivery then the impact would be immeasurable.

Bandwidth and mobilityBandwidth capacity and communications traffic also growing rapidly. Broadband andnetworking technologies have received a large share of development interest and fundingin recent years. Gilder's 'Twenty Laws of the Telecosm' include one that states that bandwidth grows at least three times faster than computer power. Manyworlds noted thatthe doubling time for computer capacity (i.e. machine instructions per second per dollar)has fallen from two years to one year, but bandwidth capacity is doubling every nine

months ( Manyworlds , 2001)

Internet

The number of internet users is difficult to gauge, but the number of hosts (i.e. uniqueaddresses advertised to internet) has increased rapidly in recent years. From a little over200 in 1981, the number of hosts increased to more than 300 000 by 1990 and reached147 million in January 2002 – growing at a compound annual rate of 90 per cent over 21years. (Network Wizards (www.mw.com), and Netsizer (www.netsizer.com).)

Miniaturizations

Miniaturization continues, with the development and proliferation of microelectricalmechanical systems (MEMS) - including sensors, actuators, and monitors. The potentialhealthcare applications of these developments, and of more readily availableminiaturizations of existing medical equipment and tools are likely to see improvedhealth outcomes, greater mobility and a consequent growth in community and home- based care possibilities. (Manyworlds, 2001)

Imaging technologiesThe process of scanning and storing images that are pictures of a paper form is calleddocument imaging. The electronic image has the ability to be shared and accessed morereadily by clinicians and administrators in various geographic locations.Materials science is feeding a number of emerging trends with potential application inICTs, medical instruments and healthcare. Clearly, these kinds of developments couldimprove and make more affordable a wide range of medical imaging, remote diagnosticand even treatment technologies. ( Manyworlds , 2001)

Data handling

Rapidly advancing data storage capacity is far from a new trend, but within this long-term growth are some newly emerging technologies that promise to keep alive theexplosive growth in storage capacity.



By some accounts, the density of disk drives is now doubling each year. The totaldeployed storage capacity has increased even faster, as the number of disks shipped hasgrown. It is estimated that installed magnetic disk drive capacity alone reached over 3million terabytes in 2000, and is likely to be in excess of 30 million terabytes by the endof 2003 (Coffman, K.G. et al , 2001 ) The boom in optical storage is at least as

impressive.

Converging technologiesIn a recent summary of emerging technologies, Manyworlds (2001) suggested thatconvergence is the 'mega-trend'. The biotech revolution has highlighted the deepinterrelationships between the biological sciences and information technology. As mattergrows in intelligence with the spread of embedded processors, wireless tracking, andubiquitous computing, it becomes responsive to human desires and commands. Matter isincreasingly becoming programmable like software. Medicine and biotechnology are being transformed by numerous simultaneous revolutions. Bioinformatics usesmathematical techniques to uncover information in several areas including the gene

sequences studied in genomics and the newer field of proteomics which reveals thestructure and function of proteins. Many of these new biotechnologies are drawing uscloser to an era of truly personalized medicine, where patients will take only drugsknown to be safe and effective for them as individuals. ( Manyworlds , 2001)

3.0 Framework for implementation

3.1 Steps in eHealth services deployment:

Fig 3.1 Connectivity – linking all the points of care

(http://www.gvg-koeln.de)



Fig 3.2 Connecting individuals with Health Information Networks

(http://www.gvg-koeln.de)

3.1.1 Recommendations for this implementation

The World Information Technology and Services Alliance (WITSA, 2006) suggest thatthe health care community, information technology providers, and governmentinstitutions consider ways to make better use of information technology resources. In particular:

Build on and complement information and communication technologies already being used as no single technology will be suitable for all situations. That is,innovative combinations of old and new ICTs will provide added value and new possibilities.

Ensure a legal and regulatory environment that allows information andcommunication services, innovation and entrepreneurship and free flow ofinformation. To be effective and efficient, the health care industry must operate ina digital environment that includes connectivity, commerce, community/contentand information sites.



Work with interested stakeholders to identify and address laws that forestall theimplementation and utilization of health care related information technologiessuch as telemedicine.

Establish private and public sector partnerships to ensure patient privacy, security,

and confidentiality concerns are addressed. Encourage the development of user-friendly computer-related technologies and

couple these developments with training and physician support services that helpfacilitate the transition from paper to computer based systems.

Strive to involve physicians and other health care practitioners in the developmentof information technologies by including them at the inception of projects and byconsistently requesting physician feedback and advice.

3.2 Some Benefits of ICT in healthcare delivery (Ajeet Mathur,2003) 1. In addition to containing costs, advanced information technologies furnish health care

providers with the opportunity to improve patient care by streamlining clinical processesand creating a seamless flow of information.

2. Currently, healthcare providers use paper- based records to record a patient‟s receipt ofhealth care services. Unfortunately, the use of such records leads to the inadequatedocumentation of the care-giving process, a severe disruption in the flow of patientrelated information, and a substantial delay in the delivery of health care services.Advanced information technologies - such as computer-based patient records, portablecomputers, and expert information systems - alter this situation by providing clinicianswith real-time access to patient information at the point of care.

3. Within domestic economies of U.S.A., Canada and Japan, Telemedicine serviceshalved traditional costs and increased the productivity of medical professionals.TeleExpertise has evolved as the basis for branded healthcare chains with an internationalscope

4. IT enables inexpensive arrangements directly and indirectly through partnerships, branches, representation offices, subsidiaries, affiliates, franchises, licences and alliancesthrough on-line tele-services and data transfers and there are numerous ventures in India,Pakistan, Srilanka, Kenya, and Mexico where transfers of know-how have been soarranged.

5. Within domestic economies of U.S.A., Canada and Japan, Telemedicine serviceshalved traditional costs and increased the productivity of medical professionals.

4.0 Conclusion and RecommendationThere are three main areas in which ICT can help to make healthcare more effective andefficient beyond solutions which are already available (http://www.eurescom.de):1. Management of healthcare2. Medical treatment



3. PreventionInnovative ICT solutions in theses areas may be based on advancements towardsubiquitous and personalized network access and the miniaturization and connectivity ofdevices. New or improved equipment might be used for enhancing healthcare, such asminiaturized and cheaper electronics and sensors, high-density memory, micro-

electromechanical systems, and novel combinations of existing devices.The decreasing cost and size of sensors, monitors and other equipment enables both noveluses for existing technologies and applications of completely new technologies. Theincreasing bandwidth and pervasiveness of communication networks, including ad-hocand sensor networks, opens up new opportunities for transferring medical informationfaster through both wired and wireless systems. (http://www.eurescom.de)Information and communication technologies (ICT) combined with wireless and mobiledevices, are strengthening the production, dissemination and global use of healthinformation. The increasing capacity of information producers, intermediaries and usersis triggering the explosive growth of easily accessible information. This paper has provide solution to the major challenge for wider deployment of eHealth in developing

countries which is „Lack of hard evidence of benefits „ and also provide a model forimplementation.



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