Journal of Health Informatics in Africa (J Health Inform Afr) is an official journal of the Pan African Health Informatics Association (HELINA) published by Koegni-eHealth Innovation for Development
Improving health literacy in rural Africa through mobile phones: a systematic literature review
Background and Purpose: Mobile phones have been used to support healthcare systems through various mobile health (m-health) applications. In Africa, m-health initiatives have been used in many interventions, including education and awareness, clinical and non-clinical decision support systems, epidemic outbreak tracking, training of healthcare workers and remote monitoring, and many others. But despite the great enthusiasm around m-health, few studies have examined the use of mobile phones to improving health literacy in rural areas in Africa. Methods: We performed a literature review using SCOPUS and Google scholar, combined with manual searching methods to search for studies related to m-health initiatives in Africa. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol. Four steps were followed to identify relevant publications related to the contribution of mobile technologies in improving health literacy :(1) Database selection (2) Keyword search, (3) Study selection and (4) Data extraction. Results: In our study, we found 5 studies related to health literacy and mobile technologies in Africa. However, none of them were focused on health literacy and mobile technologies in rural areas of Africa. This result provides insights of future studies to conduct. Conclusions: We found that m-health initiatives were so far not inclusive. It appears that few m-health solutions integrate local languages in the development of m-health solution. The mhealth initiatives need to be implemented based on the local realities, so experimental studies are desired to test the adaptability of mhealth projects and to explore any adjustments required.
Copyright (c) 2022 Journal of Health Informatics in Africa
Use of a digital database of cardiac auscultations to search for associations between auscultatory and echocardiographic abnormalities in children with congenital heart disease
Introduction : L’auscultation cardiaque et l’échocardiographie sont essentielles pour l’évaluation des cardio- pathies congénitales. L’utilisation d’outils numériques (stéthoscopes électroniques, logiciels de traitement et d’annotation) permet l’enregistrement audio des auscultations cardiaques, améliore leur écoute et favorise leur description détaillée. L’objectif de cette étude était de rechercher les associations qui existeraient entre les anomalies retrouvées à l’auscultation cardiaque et les paramètres échocardiographiques chez les enfants por- teurs de cardiopathies congénitales, en s’appuyant sur une base de données d’auscultations annotées. Méthodologie : Une étude transversale descriptive a été réalisée au Centre Mère et Enfant de la Fondation Chantal Biya. Les enfants porteurs de cardiopathies congénitales non corrigées étaient inclus. Les sons issus de l’auscultation cardiaque de ces enfants ont été enregistrés et permis de constituer une base de données d’aus- cultations cardiaques. Les bruits d’intérêt issus de ces auscultations ont été décrits et annotés par un cardiopédi- atre à l’aide d’un logiciel de traitement et d’annotation d’enregistrements audios. Ces enfants ont ensuite bé- néficié chacun d’une échocardiographie. Les associations qui existaient entre les anomalies retrouvées à l’aus- cultation cardiaque et les paramètres échographiques ont été recherchées chez les enfants porteurs de commu- nication interventriculaire (CIV), de sténose valvulaire pulmonaire (SVP) ou de persistance du canal artériel (PCA) isolées. Résultats : 54 enfants ont été recrutés, soit 324 enregistrements audios pour une durée totale de 121 minutes. Les enfants de 29 jour à moins de 3 ans représentaient 51,9 % des participants. À l’auscultation, 51 patients (94,4 %) avaient un souffle cardiaque et 6 patients (11,1%) avaient un éclat du B2 pulmonaire. Les cas de CIV, PCA et SVP isolés représentaient respectivement 37%, 20,4% et 11,1% des participants. Il existait une diffé- rence statistiquement significative entre ces trois groupes de pathologies isolées par rapport au foyer où le souffle avait une intensité maximale à l’auscultation cardiaque (p=0,005). Par contre, il n’y avait pas d’associ- ation statistiquement significative entre l’intensité du souffle et les différents gradients de pression ainsi qu’avec la pression artérielle pulmonaire moyenne pour ces trois groupes de pathologies isolées. Enfin, l’éclat du B2 n’était pas associé de manière statistiquement significative à la pression artérielle pulmonaire moyenne chez les patients ayant une CIV isolée. Conclusion : L’utilisation d’outils numériques permet d’améliorer l’expérience et les performances en auscul- tation cardiaque. Il servent comme support pour la description d’anomalies de l’auscultation cardiaque et fa- cilitent ainsi la recherche d’associations entre les anomalies retrouvées à l’auscultation cardiaque et les paramètres échocardiographiques. Le foyer d’auscultation où le souffle est perçu avec une intensité maximale pourrait permettre de prédire la nature de la cardiopathie pour les trois groupes de pathologies isolées étudiées. Mots clés : Cardiopathie congénitale, auscultation cardiaque, échocardiographie, stéthoscope électronique.
eHealth Architecture-based Health Data Exchange
Background and Purpose: A blueprint of the national-level arrangement of health system components in Ethiopia is depicted in the eHealth Architecture (eHA). At the time of the study, the lack of practical implementation experience limited Ethiopia’s ability to move toward maturing the architecture. In this study, the team set out to explore practical implementation and scaling solutions that leverage open standards and tools. Two major components of the eHA were used to demonstrate the health data exchange: the legacy Electronic Medical Record (EMR) system and the national electronic Health Management Information System (HMIS) instances. At the time of the research, the HMIS contained 53 data sets used by more than 35,000 health facilities serving at different layers of the health sector, including health posts, health centers, hospitals, and other facilities, to deliver reports of various types. It is the major source of information by the Federal Minister of Health. The main purpose of this study was to explore potential opportunities and overcome challenges related to health data exchange patterns of national eHA. Methods: A thorough assessment of related works were conducted to examine global, national, and local perspectives. An eHA-based health data exchange model was developed, which leveraged open tools and standards. HAPI FHIR, an open-source and Java-based HL7 FHIR solution was adopted to extract local relational EMR data to FHIR messaging formats. With the main focus on design scalability, the team developed a strategy for mapping local data elements to FHIR resources and created an OpenHIM mediator. To demonstrate the developed model, existing architecture components with high impact on national-level health data quality were selected. Finally, an evaluation method was conducted using the top ten diseases which compared the computer-based solution and manual tally sheet-based data entry. Results: The developed model was aligned with national eHA data exchange patterns and resulted in enhanced data quality. Data quality was examined using timelines, accuracy, completeness, and cost parameters over a 12-month period of production EMR data for the top ten disease classifications. Scalable local EMR data-to-FHIR resource data element mapping was developed using the HAPI FHIR library. Its effectiveness was proven as the model effectively mapped to the elements for the identified FHIR resources. Study results also showed the use of eHA interoperability patterns produced enhanced HMIS data quality and established reusable data exchange modules with national impact. Though Ethiopia has a standardized national classification of disease adopted from World Health Organization ICD-10, this extensive experiment revealed fragmented efforts toward health data reporting resulting in inconsistent data elements. To overcome the challenge, the study suggested using national terminology service instances with the capability to cascade concepts at a facility level. Conclusions: A scalable health data exchange model was developed and tested with the major data source components of eHA, EMR, and the national HMIS instances. Interoperability of those systems significantly fostered national eHA maturity. Therefore, this study asserts the use of open global standards and tools facilitates the maturity of the national eHA.
Leveraging technology to support HELINA Education Working Group activities
Background and Purpose: Working groups implementing activities for health informatics associations need the right technological infrastructure to support the range of activities they conduct. In this paper, we describe the approach taken and results achieved in developing the technology-based infrastructure to support HELINA Education Working Group activities. Methods: Technological infrastructure needs for the EWG were guided by work sets for the WG. In collaboration with the technical team, the technology tools were identified with a bias towards open-source tools. The waterfall model was used for the development of needed features. Results: Tools implemented to support the HELINA EWG included a website (HELINAnet), a discussion forum (HELINAtalk), an eLearning and content organization platform (HELINALearn), social media accounts (Twitter, LinkedIn, and Facebook), a video conferencing platform based on Zoom, an email-based google mailing list (helina-ewg@googlegroups.com), and an electronic newsletter. Metrics of use were maintained. Conclusions: The approach taken to implement the technological infrastructure to support EWG activities can serve as a demonstrative model that could be employed by other HELINA WG, as well as the larger organization. Keywords: Health Informatics, Education, Working Group, Technology
Assessing the Knowledge and Practice of E-Tracker Among Nurses in the Ho Municipality
Background and Purpose: Electronic health is an integration of technology in healthcare delivery to facilitate its service delivery. It ranges from the use of desktops to handheld devices to facilitate care, data capture, and data transmission. Due to the wide ranges of technology usage in varieties of services, the healthcare industry is not left behind. It improves upon quality of data generations to facilitate proper decision making. The current study aimed at evaluating the knowledge and practice of e-tracker among nurses in the Ho Municipality of the Volta region of Ghana. Methods: A descriptive cross-sectional approach was used. Simple Random Sampling technique was used to recruit the participants and a semi-structured questionnaire was used to capture the desired data. Data collected was entered using EpiData 3.0 and further exported into Stata 16 IC for analysis. Results were presented using tables and graphs. Results: 129 (69.3%) of the nurses had high knowledge of e-tracker while 42 (22.6%) had high e-tracker usability. 66 (35.5%) of nurses synchronized data immediately after entry while 114 (61.3%) do not ask clients whether if they had been enrolled onto the e-tracker for their first visit. Nurses who consulted District (HI) were 4.9 [COR=4.9; CI(95%)=2.45 – 9.63; p-value=0.000] and 6.8 [AOR=6.8; CI(95%)=2.78 – 16.53; p-value=0.000] times to have high knowledge than their counterparts that did consult their in-charges for assistance. Conclusions: Though there was a high knowledge level of e-tracker among nurses in the Ho municipality there was a very low usability of e-tracker among nurses.
The Journal of Health Informatics in Africa is the official journal of the Pan African Health Informatics Association (HELINA) and publishes the proceedings of the HELINA conferences, as well as open-call issues. This issue is the second open -call issue for 2020 comprising of five research papers submitted directly to the journal. These papers have been double blind peer-reviewed before being accepted for publication. Although papers written in French are also published by the journal, all five papers in this issue was written in English. In addition to the five research papers, this issue also includes a Letter to the Editor that the JHIA Editorial Board considered very relevant and important to publish. The open letter was submitted by Neumann, Dunbar, Espino, Mtonga, and Douglas and highlights six themes that the authors consider important when developing Electronic Medical Records (EMRs) in low- and middle-income countries (LMIC). The authors believe that the consideration of these themes may support more careful exploration of creative, innovative, and sustainable EMR solutions that could ultimately improve patient outcomes through a positive impact on care delivery processes. The paper by Doualla, Bediang, Nganou-Gnindjio, Boombhi, and Kingue presents the use of an electronic stethoscope coupled with tele-transmission and remote interpretation by a distant physician as a proof of concept of a tele-auscultation system in the assessment of cardiovascular diseases in remote areas of developing countries. Msendema investigates the question of how research, policy and practice in health information systems interface to guide design and implementation of health information systems. Authors Asah, Kanjo, Addo, Logo, Msendema explored the usability factors that influence the use of mobile technologies among healthcare staff at the point-of-care. Bbosa, Wesonga, Nabende, and Nabukenya reports on a hybrid data mining technique for predicting reliable malaria incidence rate thresholds that they developed. In their paper authors Olwendo, Otieno, and Rucha employed a retrospective cross-sectional study design in order to investigate the prevalence and complications associated with Diabetes Mellitus at the Nairobi Hospital in Kenya. As we continue to live through the COVID 19 pandemic and its impact on both our work- and private lives, I realise the tremendous effort that went into completing this issue. The admirable commitment shown by authors that still managed to carefully prepare and submit manuscripts to JHIA, as well as the dedication of reliable peer-reviewers that took time out of their already busy schedules to assist with the review process. The editorial team also persevered under very difficult circumstances to manage the review and publication process and showed commendable determination to get this issue published. I would thus like to take the time to thank the editorial team, authors and peer reviewers that made this issue of JHIA possible. Your dedication, commitment, and perseverance is very much noted and appreciated.
Copyright (c) 2021 Journal of Health Informatics in Africa
A LMIC-First Manifesto to Developing Electronic Medical Record Systems
The inability to quickly design, develop electronic medical record (EMR) systems and deploy new clinical guidelines remain bottlenecks to successful scale up and continued use in low- and middle-income countries (LMIC). Significant gaps persist in EMR designs for LMIC settings. These gaps result from failure to understand how the environments, models and processes of delivering healthcare in LMICs are fundamentally different from high income countries. Additionally, EMRs are often planned in top-down fashion, driven by an implementers or external funder’s vision. EMR systems for LMICs model those used in the global north, requiring heavy text data entry, complex data models, and heavyweight hardware to support. We outline a “LMIC-First” approach to designing EMR systems intended for LMICs. This approach considers the EMR system, its environment and how these interact when the system is implemented by following six themes to EMR design.
Reliability of Predictions Using Hybrid Models: The Case of Malaria Incidence Rates in Uganda
Background and purpose: Reliability of estimates emanating from predictive independent data mining techniques is a complex problem. This could be attributed to cross-cutting weaknesses of individual techniques such as collinearity due to high dimensionality of attributes in a dataset, biasedness due to under fitting and over fitting of data as well as noise accumulation due to outliers and thus affecting the reliability of predictions emanating from these models. This study thus aimed at developing a hybrid data mining technique for predicting reliable malaria incidence rate thresholds. Methods: The decision tree and naïve Bayes classifiers were used to build a hybrid prediction model. Results of the developed hybrid model were compared with independent data mining models using 10-fold cross-validation on a previously unlearned data set. Accuracy, F-measure and the area under the receiver operating characteristics curve (AUC) were the key performance metrics used to evaluate the generalizability of the hybrid model in comparison to the independent models. Results: Findings revealed that the hybrid classifier attained an accuracy of 79.3% and an F-measure score of 84.2%, the naïve Bayes classifier achieved accuracy and F-measure value of 69% while the decision tree classifier registered an accuracy of 72.4% and an F-measure score of 80%. Conclusions: The developed hybrid model outperformed both independent decision tree and naïve Bayes models. Notably, the hybrid model outperformed the independent decision tree and naïve Bayes classifiers in terms of accuracy by 6.9% and 10.3% respectively.
The Digitalization of Routine Data Management at the Point-Of-Care: The case of Ghana
Background and Purpose: Mobile technologies in the healthcare sector has the potential to address some data collection challenges in resource constraint settings. However, one main issue faced by mHealth users is the lack of users' acceptance since these technologies are designed to enable users to use them while mobile, thus the mobility impact of users is critical to measuring their success or failure. The purpose of this study is to explore the social environment that influences the usability of e-Tracker, among community health nurses at the point-of-care. Methods: This was an exploratory and cross-sectional study design, using a combination of qualitative and quantitative approaches to data collection, applying both inductive and deductive analyses. A usability questionnaire was adapted, data was collected from 52 health facilities, and 5 interviews conducted between April – June 2018 from two health districts in Ghana. Results: The study found that two of Norman’s concepts of usability were evident. The nurses found the technology easy to use, access, manipulate, and quickly to capture and generate reports. The nurses were satisfied using the device as it made them more efficient and productive in performing their tasks, and more importantly, the offline feature enabled them to capture data even when they are in areas with no internet coverage. Of interest, were the challenges encountered by nurses due to the implementation and use of the device. Nurses were not confident using the tablet in front of clients. Data processing became time-consuming because they have to do twice as much work coupled with poor internet access and connectivity issues. These challenges, though inevitable, but need to be attended to because they influence the usability and continuity of nurses using the technology. If they persist, nurses might end-up abandoning the technology. Conclusions: Though the device has the potentials of improving routine data collection, some social-environmental challenges hinder its usability. Keywords: Usability, e-Tracker, mHealth Technology, Ghana Health System, Routine data management
Prevalence and Complications Associated with Diabetes Mellitus at the Nairobi Hospital, Nairobi City County, Kenya
Background and Purpose: Diabetes mellitus is a lifestyle disease and there is an increase in mortality and morbidity related to diabetes in Kenya. This study purposed to identify sub-types of diabetes in the EHR dataset through clustering. Methods: A retrospective study design was employed in the analysis of 652 records of cases of diabetes mellitus collected and stored in the EHR during routine care between January 2012 and December 2016 at the Nairobi Hospital located in Nairobi City. The dataset was subjected to pre-processing; cleaning; handling cases of missing values, identification and handling of outliers, and resolving cases of inconsistencies. Thereafter, data were subjected to the analysis of measures of central tendencies and measure of dispersion. Data were then normalized using the z-score standardization method before being subjected to a density-based clustering algorithm; DBSCAN for cluster analysis. Results: The prevalence of T2DM is at 92% and there is an increasing trend of the presence of T1DM and hypertension among cases of T2DM. On the other hand, the most common complications of diabetes include; retinopathy (12%), neuropathy (11%), and cardiovascular (11%). As a result, there is need for public awareness of the dangers of diabetes mellitus. Conclusions: There is need for sensitization for the members of the public on the usefulness of physical exercise and dietary requirements for healthy living to slow the development and progression of diabetes mellitus.
A Proof of Concept of the Contribution of Tele-auscultation in the Screening of Heart Disease: A Cross Sectional Study
Background and purpose: Cardiovascular diseases are the leading cause of death worldwide, accounting for 31% of all deaths in 2016. Echocardiography is the reference screening tool, but its widespread use in developing countries is limited by its high cost. The objective of this study was to evaluate auscultation of heart sounds using an electronic stethoscope coupled with tele-transmission and remote interpretation by a distant physician as a less expensive alternative. Methods: This was a descriptive cross-sectional study. Participants meeting inclusion criteria were examined face-to-face by a cardiologist (A) using a traditional stethoscope and following a well-defined protocol. Heart sounds were then recorded by a health professional using an electronic stethoscope. A part of these digital auscultation records were randomly selected and evaluated by cardiologist (A) and remotely (via a telemedicine platform) by cardiologist (B), then rated as normal or abnormal. Diagnostic findings of cardiologists A (digital-based) and cardiologist B (remote) were compared to those found by the cardiologist (A) during face-to-face consultation by using the Cohen?s Kappa coefficient. Results: We enrolled 22 patients in the study and ten (n=10) were randomly selected for analysis. The level of agreement between face-to-face and digital-based auscultatory findings by cardiologist A was moderate (K = 0.583). It was satisfactory (K= 0.615) between face-to-face auscultatory findings by cardiologist A and tele-auscultation findings by cardiologist B. Conclusions: This study highlights the potential of using a tele-auscultation system in the assessment of cardiovascular diseases in remote areas (developing countries) where there is a shortage of qualified personnel. Keywords: Telemedicine, Tele-auscultation, Screening, Heart disease, Electronic stethoscope
Interfacing Research and Policy in Informing Data Management for Quality Data in Health Information Systems: Case of DHIS2in Malawi.
Abstract Like in many other fields, there is an ever growing need for new knowledge in health services delivery on how we should better our decisions in delivering our services. In response to that desire of knowledge Universities and other institutions have been funding and motivating students and academicians into research. The expectation is that knowledge acquired from research will inform us how to improve our practices. Method This qualitative desk research attempted to answer the question how research, policy and practice in health information system interface each other to inform design and implementation of health information systems. It used DHIS2 in Malawi as a case, PhD and masters students’ theses, Health Information System Policy and Strategy to explore how these resources inform each other. Data analysis was done through thematic tabular analysis, and themes were derived from predefined set of criteria. Results The findings showed that there is considerable effort by researchers to publish and share their findings to practitioners through conference, journals and working together in workshops. It also shows that participation in policy formulation workshop has been a key means by which researchers directly contribute to practitioners works. Conclusion There is considerable effort by stakeholders to create and make use of platforms that should enable the link between researchers and practitioners. The paper has to a considerable extent, managed to answer how research, policy and practice in health information system interface each other to inform design and implementation of health information systems. Apart from that it has most importantly, stimulated a need to conduct a detailed field study to ascertain how actually the researchers work inform practitioners on the ground.
Copyright (c) 2020 Journal of Health Informatics in Africa
Towards a Digital Health Curriculum for Health Workforce for the African Region: A Scoping Review
Background: Digital technologies are fast gaining space in health. A skilled workforce is required to use existing and emerging technologies that support healthcare. However, existing medical informatics curriculum from the USA, UK, and African regions reveal gaps in the required competencies for a digital health worker, especially for the African region. Therefore, this study aimed to identify the need for and suggest a structure of the digital health curriculum for the African region. Methods: The study retrieved articles published in English between 2000 and 2019 from PubMed Central, Google Scholar, and Biomedical Central. Only 39 that addressed any form of pre-service and or in-service training of the digital health workers were included in the review. Also, eight national eHealth strategies and 13 medical informatics curricula from the USA, UK, and African regions were reviewed to determine the gaps and suggest a structure of the Digital Health curriculum suitable for the African region. Results: Many countries in the African region have developed eHealth strategies that highlight the need to train the DH workforce. Results showed the knowledge gaps of a communicator, a collaborator, a professional technologist, an advocate, and a manager required of digital health workers in the African region. However, the existing digital/health informatics programmes in the region lack balanced course programmes to develop these core competencies. Besides, the corresponding online training is modeled after the traditional face-to-face training, thus limiting the opportunity for in-service health workers. Validation of the Lesotho curriculum confirmed only 10 modules are suitable to develop a rounded digital health worker (particularly health leaders) for the African region. Conclusions: Since it is important to develop the competencies consistent with the local health systems to realize the full benefits of eHealth technologies, the African region needs to bridge their human resource gaps. Thus, African countries need to first develop or adopt a digital health worker competency framework and then re-organize their national health training curriculum to ensure a standardized/universal eHealth curriculum for training the digital health workforce. Future works will assess the DH worker competencies and expected outcomes for the African region.
Assessing Evaluation of eHealth Interventions in Uganda: Practices, Challenges and Insights
Background and Purpose: Electronic health (eHealth) is the use of information and communication technology (ICT) to support healthcare. It is becoming more popular in healthcare management with expectations of improved effectiveness, access, quality, and efficiency of the healthcare systems. The increased investment and implementation of eHealth across the world calls for its evaluation to evidence its value. This study thus aimed at investigating the practices, challenges, and suggestions for optimising the evaluation of eHealth interventions in Uganda. Methods: A cross-sectional survey was used to conduct the investigation among key eHealth implementing institutions in Uganda. Primary data provided by 22 participants from 18 institutions were used to establish an understanding of the institutions’ perspectives with respect to eHealth evaluation practices and challenges faced, as well as to derive insights from these perspectives in relation to the World Health Organization (WHO) understanding of digital health evaluation. Results: The study revealed that various eHealth interventions are implemented in Uganda; however, very little of their evaluation is undertaken, as it is not a key activity with most of the eHealth implementers. Focus is put on monitoring the eHealth initiatives’ functionality and adoption rather than their outcome and impact. Limited skills/capacity and unavailability of national guidelines on eHealth evaluation were reported as key limitations. Conclusions: Accordingly, the study recommends the need for an evaluation framework to elucidate and guide on the notion of evaluation, its characteristics, and measurement indicators regards the outcome and impact of eHealth interventions in healthcare and service delivery for Uganda’s health system.
Factors that Influence Potential Success of eHealth Standards Adoption in a Low- and Middle-Income Country: a review
Background: Assessing the potential success of adopted technology, innovation, or standard in a Low and Middle-Income Country like Uganda continues to focus on outcomes of adoption. This study aimed to investigate the potential success of eHealth standards adoption that may arise from the adoption process as well as outcomes of such adoption. Methods: PubMed and Google Scholar were searched using alternate terms for “eHealth”, “standards”, “adoption” “success” and “theory”. On screening and assessing the quality of publications, only nineteen peer-reviewed publications were included in the review. Both quantitative and qualitative analysis was used to synthesize evidence from the included literature. Thematic analysis was used to develop themes regarding the success of standards/technology adoption. Results: Constructs from the theories of Diffusion of Innovation Theory (DOI), Unified Theory of Acceptance and Use of Technology (UTAUT), and Internet Standards Adoption (ISA) were used to extend the Success Model of Innovation Adoption. The Success Model for Innovation contributed to the foundational concepts aligned to categorical factors of the adoption process, organizational, environment, and user context that influence the potential success of eHealth standards adoption in healthcare systems. The study identified 13 factors that contribute to the successful adoption of standards for eHealth. Conclusion: Since the review showed that the success of standards adoption starts with assessing readiness to adopt the standards, followed by the standards adoption process and assessment of the lasting outcomes, the study proposes a model for assessing the potential success of eHealth standards adoption. The model has pre-adoption, actual adoption, and post-adoption phases. The proposed model and identified factors have not been evaluated and therefore may not in the current form support eHealth standards adoption processes. Future work is needed to evaluate/validate the model and factors of eHealth standards adoption success. Notwithstanding, the study believes any assessment of the success of standards adoption that uses the identified factors over all three phases of the model is comprehensive to present a true picture of any potential success of standards adoption.
Not Missing a Step: South Africans Taking Control of their Personal Wellbeing using Wearable Health Devices
Globally, the number of people living with chronic diseases is increasing, with unhealthy lifestyles as major contributing factor. Although the benefits of preventive healthcare is documented, majority of policy makers spend only a fraction of their health budgets on preventive healthcare. There is growing evidence that increasing physical activity contributes to improved personal wellbeing and reduce chances of developing chronic diseases. Consequently, awareness of the importance of good personal wellbeing is increasing. Heightened health-consciousness has also brought along growth in wearable health device market. This study investigated the role of wearable health devices in preventive healthcare and promotion of personal wellbeing. We employed the interpretive research paradigm to understand the role of wearable health devices in preventive healthcare and the promotion of personal wellbeing, from users’ perspectives. Data was collected through a one-on-one, semi-structured interviews with 30 participants who currently own and use a wearable health device and/or a mobile fitness-tracking application. Study results showed that the use of wearable health devices can motivate users to increase their physical activity and maintain healthy lifestyle, thus promoting personal wellbeing. The use of wearable health devices/mobile fitness-tracking applications play significant role in promoting personal wellbeing. Different kinds of rewards by health insurers also provide additional incentives for users to reach their monthly fitness goals. A shift towards primary preventive healthcare, where citizens are encouraged to increase their physical activity, can go a long way in reducing the high rate of chronic diseases.
Copyright (c) 2019 Journal of Health Informatics in Africa
Digital Empowerment for Health Workers and Implications on EMRs Utilisation
Background and Purpose: Utilization of Electronic Medical Records (EMRs) bring many benefits to patient record handling. Previous research has shown that medical doctors in hospitals in Africa had poor IT skills, partly disabling their use of EMRs. Working in health centres, we wanted to know how to improve the digital skills of their personnel. Methods: Qualitative methods including interviews, informal discussions and observation were used for data collection. The study was conducted in three health facilities in Malawi, selected purposively as these were the ones implementing the EMR under study. The study targeted all staff that were capturing data at point of care using the app between January and June 2019. Results: Personnel in the health centres were computer illiterate, even if they used phones, and some smart phones. After computer training, they were still not comfortable using EMRs because their typing speed was delaying the process. Improving the typing speed allowed the users to comfortably use the EMRs. Three levels of EMR empowerment were identified; being able to 1) use EMR where typing speed is less relevant, 2) use EMR at point of care, 3) guide colleagues on their EMR use and find new ways of exploiting the technology. For reaching level 2, 50-100 hours of typing practice would be necessary. Conclusions: Health workers who lack computer skills tend to shy aware from using EMRs. Even if falling prices of equipment will enable more EMRs in rural areas, the digital empowerment process will still require significant resources.
Cost Analysis of an Electronic Medical Record System at an Urban Clinic in Kampala, Uganda
Background and Purpose: While the benefits of electronic medical record systems (EMRS) are well known, the costs associated with their implementation in resource-constrained settings are not well documented. Establishing such costs is crucial for sound decision-making regarding allocation of scarce resources. This study aimed at conducting a comprehensive cost analysis for developing, implementing and maintaining an EMRS in a resource-constrained setting. Methods: The study was conducted at an urban HIV/AIDS clinic in Kampala, Uganda using an organizational perspective. A cost inventory was used to collect costs from original receipts and invoices, and vendor market prices used where receipts could not be accessed for the 8 years under study. All costs were converted to the equivalent US dollar value and those with a lifetime more than one year annuitized. A paper-based and an open-source record system were the comparators. Results: The total direct cost of the system was USD 1,066,965 while an open-source instance would cost just over USD 800,000. The paper-based system cost was half the cost of the EMRS (USD 544,159). Salaries and wages contributed 70% (USD 757,332) and 81% (USD 438,842) of costs in the EMRS and paper-based system, respectively. The other major cost driver was software and licensing (20%, USD 258,341). Conclusions: EMRS have higher costs as compared to paper-based medical record systems. However, expenditure on the system reduces with time. Salaries and wages are the largest contributors to the cost burden. Open-source systems have a potential to lower costs.
A Fraud Detection System for Health Insurance in Nigeria
Background and Purpose: This research developed a Fraud Detection System for National Health Insurance Scheme (NHIS) in Nigeria. This was with a view to addressing the fraudulent activities of some stakeholders in NHIS; as many researches have proven that the lack of appropriate tools to do this has negatively affected service providers as well as the beneficiaries of this Scheme. Methods: In order to achieve the aim of this research, an inspection of organizational documents, direct observation and collection of existing data from NHIS accredited health facilities and Health Maintenance Organizations in Nigeria were carried out. The system was designed using Unified Modelling Language (UML) tools. The implementation of the system was done using MongoDB as the big data storage mechanism for the input, Comma Separated Values (CSV) files as a storage facility for the intermediate results generated during processing and MySQL as the storage mechanism for the final output, Apache MapReduce as the big data processing platform, Association Rule Mining as the data analytics algorithm, and Java programming language as the implementation technology. Results: The system modules of comprised of four modules: user management, enrollment processing, referral processing and claims processing. With this, it identified different types of frauds in NHIS such as double billing, billing for services not provided, ghost patients, identity theft, self-referral, collusion with providers and kickback schemes. Conclusions: This paper developed a system for the detection of the fraudulent activities of the actors of NHIS. This system employed data from the Nigerian NHIS which was categorised into: enrollment, referral and claim data with different file formats: pdf, jpg, png, csv and excel. Keywords: Fraud, Detection, Health, Insurance, Prevention, NHIS.
Examining Challenges Affecting Management of Health Workers’ Information in Uganda
Background To effectively plan for human resources for health, health managers need to keep track of the size and composition of their human resources and to anticipate their future needs. Effective strategic planning is however informed by quality and reliable workforce information. However, in Uganda, existence and access to adequate information on human resources for health still remains a challenge. This limits the capacity of health managers to effectively monitor and make policies. To this end, this study set out to examine the challenges that affect the management of health human resources information in Uganda; with an aim to recommend a single authoritative source of health workforce information that can provide an accurate count of all health work-force in Uganda’s health system. Methods We used qualitative methods to examine the challenges that are affecting the management of health workers information in Uganda. Key informant interviews were conducted with purposively selected health-related organizations with a stake in human resources for health information management. Results The study reports various systems used for health workforce information management, the common one being the integrated Human Resources Information System (iHRIS). The study also provides various challenges affecting these systems including fragmentation and uncoordinated human-resource systems, which results to duplication of health workers records, incomplete or missing data elements, and inaccurate health workforce accountability. Conclusion Given the nature of the challenges, the study denotes the need for a single authoritative source of health workforce information that can provide an accurate count of all health workforces in Uganda’s health system commonly known as a National Health Worker Registry. The registry can be used to aggregate the key attributes for all health workers in the country. Thus our future study will focus on defining country-specific features and requirements that NHWR should poses.
Information needs, access and coping strategies for cervical cancer clients at Mulago Uganda Cancer Institute.
Background The advent of effective infection control and treatment measures has shifted the burden of disease from infectious causes to chronic; non-communicable diseases (NCDs). Diseases such as cardiovascular and cancer are on the rise globally with a rapidly growing crisis in low-income and middle-income countries (LMICs). In 2015 for example, cancer was responsible for 8.8 million deaths globally and approximately 70% of these deaths occurred in LMICs. With lung, female breast, stomach and colorectal cancers combined with liver and cervical cancer (CaCx) explaining over half the incidence burden (54%) in LMICs. For CaCx, the pattern is striking since around 85% of women diagnosed and 87% of those who die from the disease live in LMICs. In Africa, CaCx is high in the sub-Saharan region with Uganda being ranked 10th with 44.4|100,000 women; Age-standardized incidence rate of CaCx cases. Among the contributing factors for the high incidence of the disease in the country include; lack of screening tests and vaccines to prevent HPV limited access to cervical screening programs as well as lack of information among others. This study investigated the information needs priorities about CaCx and coping information access strategies for CaCx clients and the general public. Material The study was conducted at Uganda Cancer Institute (UCI) gynae-clinic and participants were women with CaCx (CaCx clients), women without CaCx (general public) and healthcare professionals in active care for CaCx (gynae oncologists, nurses, & clinical officers). All participants were first informed of the study and those willing to take part, were recruited between April and May, 2018. For eligibility, participants had to be adults of above 18 years, able to speak the local language (Luganda) or English or both, confirmed evidence of CaCx or CaCx negative. Clients who were attending the clinic for the first time, and unaware of their diagnoses were excluded. While recruiting CaCx clients, a list was generated and participants randomly selected. For healthcare professionals and women without CaCx, convenient sampling and simple random sampling were used. Interviews were audio recorded and hand written notes were done throughout the interview session. Focus Group Discussions (FGDs) comprised of participants with and without CaCx. Key informant interviews (KIIs); nurses (n=2) clinical officers (n=2) and gynae-oncologists (n=2), and In-depth individual interviews (IDIs) comprised of women without CaCx (n=4). Data collected was transferred from the recorders onto a secured password protected computer. Notes taken during interviews together with consent documents were securely kept under lock and key for further reference. Interviews were transcribed then verbatim transcriptions were generated. Analysis of data was done using Atlas.ti version7 taking an exploratory approach (inductive content analysis), and findings presented as themes. Research and Ethics Committees of Makerere University, and Uganda Cancer Institute (UCI-REC) approved this study, and participants consented to take part. Each participant consented before taking part in the study. Results It was evident that clients desire more extensive information concerning the disease, treatment, and prognosis. Important information themes are highlighted in bold italics. CaCx Symptoms CaCx noted that if information on symptoms was known to them and to the general public, there is/was a high likelihood to seek medical attention when the disease has not reached advanced stages. Screening Participants needed screening information on where to find this service, how it is done and who to seek for it and when. Such information will help in early diagnosis; a point when medical intervention can still make a long-term difference. Dos and Don’ts Information concerning health-lifestyle which contributes to improved health was among what needed to be shared to CaCx clients as supported hereunder. Treatment Side Effects CaCx clients want to know information concerning the side effects of the different kinds of treatment lines they receive along their care journey. They noted that along treatment, both short and long-term side effects occur; something they need to be cognizant of since some effects turn out to lead to a deteriorating health. CaCx and its Causes. Many people seem not aware of this silent killer as it emerged that basic information relating to CaCx such as what it is, where it affects, who is at risk and the risk factors among others were not obviously known to them and needed to be shared to the public. The commonest mode of information sharing is by the word of mouth (face-face) and this does not facilitate adequate information sharing since it is affected by language barrier besides the clinic being a high-volume facility with small numbers of care providers. Conclusion Information needs slightly differed between CaCx clients and those of the general public yet between CaCx clients and healthcare professionals, they were comparable. Majority CaCx clients prefer to receive extensive information at their first diagnosis. Information about treatment, procedures as well as side effects, and prognosis are of particular relevance. Findings demonstrated that information seeking continues from diagnosis to follow-up. Therefore, healthcare providers listening to the clients might be more effective way to prevent and fight CaCx. It is also imperative to make use of the increasing adoption of ICTs to develop a centralized information portal on CaCx where all awareness information can easily be accessed by whoever might need it. Then efforts be made by referring and encouraging clients to use this portal as an effective way to further increase CaCx awareness. Keywords; Cervical cancer, information access, information needs.
Networking and Securing Botswana’s Public Health Care System (BPHS) to enable a secure digitalized patient-centered environment.
Background and Purpose: The aim of the research was to investigate and develop an e-health mobile application with associated algorithms for use in managing patient information collection. The research explored the current role of Information Technologies (ICTs) in the Botswana Public Healthcare System (BPHS). Specifically, it dealt with elucidating, discussing and understanding the current status of BPHS and ICTs role in BPHS in relation to the utilisation of Electronic Health Records (EHRs). The author explored the current BPHS ways of gathering and processing patient information, categorization of the current BPHS and users’ satisfaction levels with it and ascertained people’s behaviours towards employment and utilisation of ICTs in health. Methods: Triangulation of quantitative and qualitative methods was followed, with questionnaires, interviews and observation techniques employed to draw conclusions. Results: There was strong evidence that many users showed dissatisfaction with BPHS, which is mostly paper oriented and manual, and indicated an embracement of mobile applications in health. Conclusions: The study concluded that the current BPHS is mostly paper based and the satisfaction levels of users negate such systems in this modern era of utilisation of ICTs. In conclusion, the author designed and developed a working prototype for BPHS.
Managing Patient Identification in Uganda's Health Facilities
Background and Purpose: Managing accuracy to identify any patient is very crucial in ensuring continuity, quality and coordination of their healthcare over time. Patient identification management (PIM) in healthcare is still a challenge in Uganda for both public and private healthcare institutions including insurance companies using different mechanisms to uniquely identify clients. This deters PIM and individual health data linkage across healthcare organizations. An integral part of individual health data linkage and health information exchange (HIE) process across healthcare organizations is verification and/or validation of a client’s identity. This vital service can be provided by an administrative electronic health information system known as a client registry (CR). A CR is a central electronic database that holds patient identifying information and demographics with a mechanism to uniquely identify each of them using select identifying information such as unique identifiers within a given territory. Consequently, in preparation for the establishment of a National CR (NCR), we needed to first examine the current mechanisms used and the challenges faced in PIM in Uganda’s health facilities. The NCR is envisaged to facilitate and harmonize PIM and HIE in Uganda's healthcare system. Methods: A cross-sectional study was conducted to document the mechanisms used for and challenges facing PIM in Uganda and define NCR requirements. The Design Science Research (DSR) approach was employed to achieve the overall study aim with a much broader goal beyond this paper. Specific to this paper, the research question for which the methods and results presented was formulated under stage two of the DSR six-step process model. 35 key informant interviews with purposively selected representatives from select organizations and health facilities were conducted. Results: Majority of health facilities use either paper-based or a combination of both paper-based and electronic tools to register clients, manage their identities and data. Key challenges reported facing PIM relate to data storage, retrieval, client identity verification, and tracking. These translated into four key NCR requirements that can facilitate PIM and HIE in Uganda’s healthcare system. Conclusions: The study proves that there is need to address the various PIM challenges; as such our next steps are to establish actual NCR requirements/services in order to harmonize PIM across Uganda’s health facilities.
Standardizing Representation of Medication in LMICs: Case of Malawi and RxNORM
Background: Sharing medication data between different health systems is essential for continuity of care. To provide common and consistent representation of medication data across disparate health systems, the National Library of Medicine (NLM) developed RxNORM; a normalized naming system for generic and branded drugs that facilitates semantic interoperation between different drug terminologies. RxNORM has become the standard vocabulary for representing medicines in the United States. Objective: To assess the extent to which RxNORM concepts can be used to accurately represent essential medicine from a setting outside the United States. Methods: To assess the coverage of RxNORM for medicine outside the United States, we used the 2015 Malawi Essential Medicines (MEML-2015) list as a test case. Terms from the list were transcribed electronically for easy processing and matched to RxNORM concepts using exact and partial matching algorithms. Results from the electronic matching were manually verified for correctness. All terms that could not be matched using the algorithms were manually searched for in RxNORM to ensure accurate classification as a term without a corresponding RxNORM concept. Results: Of the 603 unique MEML-2015 medicines, 63% could be accurately represented by active RxNORM concepts. Anti-infectives were the class of medicines with the most unmatched medicines. Four other classes of medicine had complete coverage by RxNORM concepts. Conclusion: A significant number of essential medicines could not be accurately represented using RxNORM concepts. A framework for adding such medicine as RxNORM concepts while maintaining continuous integration with periodical RxNORM updates is needed.
The Development and Implementation of an mHealth-based Mentoring Application for Use in Resource-Constrained Settings
Abstract Background and Purpose: Clinical mentoring remains important in improving the quantity and quality of human resources for health (HRH) within low- and middle-income countries (LMIC). Few digital health solutions exist to support in-field mentoring. We herein describe the development and implementation of a robust HRH mentoring application for use within LMIC care settings. Our objective was to improve the quality of health care services through the collection of high-quality mentoring information that could be utilized expeditiously to improve programming. Methods: We adopted a user-centered approach to gather key features needed for the mHealth mentoring application, and internally developed the system leveraging agile approaches. Usability testing was conducted, and system improvements were made prior to wider-scale implementation of the mentoring application. Results: The developed mentoring application had three key components: (1) an android-based mHealth application for mentors, (2) a server-side application, and (3) a web-based front-end for platform administration. The mHealth application was used during routine mentoring sessions through smartphone devices capacitating users to collect mentoring session data, synchronize collected data to a secure server, and view individualized summary mentoring reports. The application was successfully implemented at health facilities supported by Friends in Global Health in Zambézia Province, Mozambique. By June 2019, 172 mentors were using the application and over 5,500 mentoring sessions were recorded into the system. Conclusions: An HRH mentoring mHealth application extends the reach of conventional solutions to support the provision of continuous provider education by placing digital technology in the hands of mentors performing on-site mentoring activities. Keywords: Mentoring, mHealth, Capacity building, Point-of-care, Mozambique
Assessing Users Involvement in Analysis and Design Tasks of Electronic Health Information Systems: Experiences, Challenges, and Suggestions to Optimise Involvement
Background: User requirements play a vital role in the development of usable EHIS. For developers to design better quality, relevant and safer EHIS that meet user needs, they are required to actively engage stakeholders especially in the analysis and design tasks of its development life cycle. This is because they provide context appropriate solutions based on their needs. However, in most cases developers ignore health stakeholders’ input especially during these tasks due to varying perspectives and expectations, complexity, high cost, and variability in time to complete the tasks. This has resulted into various challenges including difficulty in capturing and interpreting user requirements in an effective and efficient manner, poorly designed and unusable systems, unsatisfied user needs, and high maintenance costs. This study thus aimed at assessing users’ involvement in the analysis and design tasks when developing EHIS with a view to understand their experiences, challenges, and suggestions to optimise their involvement. Methods: We employed a cross-sectional survey to investigate and describe the level of user involvement and challenges faced in the analysis and design tasks of the EHIS development process. A total of 36 health practitioners from 13 Key health institutions located in Uganda were selected as respondents. Results: The study revealed that majority of the respondents was involved in EHIS development, with a few involved at analysis and design tasks. Increased costs associated with data collection, followed by lack of consensus in clarifying, articulating and defining user requirements were recorded as the biggest challenges faced by users at requirements gathering, analysis and system design tasks. Regards suggestions to optimising users’ involvement in EHIS development tasks, the study reported that users were very much interested in being involved at all tasks of EHIS development, and consultation of users was paramount in order to incorporate all their needs in EHIS. Conclusions: The results from the study demonstrate the value of user involvement at the analysis and design tasks of EHIS development cycle. User involvement offers benefits in form of reduction in costs, improved productivity due to users easily arriving at a common consensus and positive growth in user attitudes. The researchers intend to incorporate suggestions that emerged from this study to conduct long-term evaluations of existing EHIS and investigate how users’ involvement changes over time. Keywords: Keyword: Human Centred Design/User Centred Design, User involvement, User stories Analysis and Design
Introducing a Mobile Drug Formulary for Healthcare Professionals in Mauritius
Background and Purpose: Prescribing errors and faults are common in medical practice and are more prevalent among young doctors. These are mainly due to erroneous medical decisions that can unfortunately cause much harm to the patients. This study aimed at developing a mobile Drug Formulary application for Mauritius with the view to promote e-health and medication safety in Mauritius. Methods: Drug information were sought from pharmacies and wholesalers. The medications were categorized anatomically and relevant information about each medication was retrieved from established databases such as the British National Formulary and Vidal. A mobile framework was designed which allowed an administrator to upload a list of drugs on a cloud environment and the mobile devices to connect to this environment on startup to download the updates, if any, to the local device. Results: A database has been created with the existing medications provided by participating wholesalers in Mauritius. An Android and iOS compatible mobile application was developed that linked to the database on the cloud and enabled loading of all information on demand. A user-friendly prototype with access to comprehensive information about drugs currently available on the Mauritian market was implemented. Conclusions: This is the first initiative to develop an e-tool to facilitate the prescribing of medications in Mauritius. Further work is underway to improve the database as well as setting up of a reliable strategy for updating of the database.