The Impact of Information and Communication Technology on Future Health Systems

Transcription

1 The Impact of Information and Communication Technology on Future Health Systems Alain B. Labrique, PhD, MHS, MS Director JHU Global mhealth Initiative Associate Professor Dept. of International Health, Bloomberg School of Public Health Dept. of Health Informatics, School of Medicine Dept. of Community Medicine School of Nursing Center for Bioengineering, Innovation and Design, Whiting School of Engineering Chair WHO mhealth Technical Evidence Review Group

2 Lookup Information Video recording Long Distance Communication Vital signs sensors (heart rate, etc)

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4 Why are we talking about Phones in Public Health or Medicine?

5 The Mobile Phone Revolution

6 Under 5 Mortality ~2000 / Worldmapper.org Of the 6 3 million children who died before age 5 years in 2013, 51 8% (3 257 million) died of infectious causes and 44% (2 761 million) died in the neonatal period. Liu et al, Lancet 2015

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8 The Mobile Revolution is Democratic Household Mobile Phone Ownership over time in rural Bangladesh, by Wealth Index (n=44,469) Proportion of Probability HH reporting of Mobile Phone Ownership Year Lowest Quartile WI (n=17,176) High Quartile WI (n=6,472) Low Quartile WI (n=19,789) Highest Quartile WI (n=1,032) Tran MC, Labrique AB et al, 2015 JMIR

9 Ownership Access Illiteracy Phone Competence Center for Public Health and Human Rights

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11 What is the problem? What do users want? Appropriate Innovation What is viable? What is sustainable?

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13 Reflections on Quality of Care Clinical care: Correct Time Correct Diagnosis Appropriate for Patient Health system goal: That all patients who need healthcare receive timely, affordable and appropriate services and goods, from skilled providers in a respectful manner to maximize quality of life.

14 Reflections on Quality of Care Population health / Preventive care: Correct Time Correct Services Complete Denominator Health system goal: That all persons due for preventive services receive timely, affordable and appropriate goods and services, from skilled providers in a respectful manner to minimize risk of ill-health.

15 October 2016: WHO Launches Evidence-based Guidelines for Digital Health Strategies Process.

16 EFFECTIVE COVERAGE INTERVENTION OF KNOWN EFFICACY Jo Y, Labrique AB et al. PLOS One 2013

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18 Digital Health is not about shiny technology. Its a Health Systems Catalyst EFFECTIVE COVERAGE Shift focus from Does Digital Health work? to Does Digital Health optimize what we already know works? INTERVENTION OF KNOWN EFFICACY Jo Y, Labrique AB et al. PLOS One 2013

19 DEFINITIONS

20 mhealth Projects across JHU, 40+ external assistance

21 What have we learned?

22 Digital Health is more than digital data collection.

23 12 Common Applications of mhealth Labrique et al. GHSP, 2013

24 Digital Health is not a single THING. ICT tools can be used to improve quality and strengthen different parts of Health Systems.

25 6 STEEEP AHRQ Domains of Health Care Quality Safe: Avoiding harm to patients from the care that is intended to help them. Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care. Effective: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively). Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and energy. Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. The Six Domains of Health Care Quality. Content last reviewed March Agency for Healthcare Research and Quality, Rockville, MD.

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27 Digital Health doesn t work in a vacuum Systems thinking is needed

28 Making the Case for Investment in Digital Health Reductions in stock-outs and supply losses Increased adherence to treatment guidelines Greater demand for services Timely provision of preventive / curative care Fewer losses to follow-up Real-time data-driven program operations Improved health outcomes Greater patient satisfaction?

29 System Efficiency & The Burden of Data

30 Tremendous time and effort is invested in manual data summarization and reporting. 19 registers contain 473 separate data fields! Only 60 fields would be required for a digital system to process the same information. Masters J. et al., WHO THRIVE Report 2014

31 Multiple DAYS spent EACH WEEK aggregating data. FIVE layers of aggregation occur before data is digitized.

32 Engage government. Align to national priorities.

33 Dissatisfaction with Digital Solutions globally (~ ): - developed in isolation - without appreciation of health system pain points - contextually inappropriate - lacking sustainability plans - not integrated across systems - not adherent to guidelines and priorities set by Ministries of Health Map of mhealth pilots in Uganda by Sean Blaschke (Unicef Uganda)

34 Investment in the Enabling Ecosystem is Necessary

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39 An important step toward addressing the fragmentation is a national digital health strategy. These strategies are essential to facilitate standards for interoperability, regulations and policies to support digital health solutions Clear governance mechanisms are needed to support this crosssectoral work within a government. Ann Aerts Chair, Broadband Commission Working Group on Digital Health Head, Novartis Foundation

40 The Global Digital Health Index

41 Quality of Care Innovations Using ICT -Examples-

42 Targeting the CLIENT

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44 GOOD MORNING! THIS WEEK YOU SHOULD BE PLANNING A HEALTHY PREGNANCY CHECKUP AT YOUR LOCAL CLINIC. BUZZ OR PCM FOR MORE INFO - MAMA

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46 SMS REMINDERS IMPACT ADHERENCE AND VIRAL LOAD Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, et al. Lancet Nov 27; 376(9755): Epub 2010 Nov 9.

47 Targeting the WORKFORCE

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51 Mobile Academy for Frontline Health Workers

52 Targeting the SYSTEM

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55 Program Mwana: SMS to reduce Infant HIV PCR Turnaround Time (Median 46% Reduction in DAYS)

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58 Building for SCALE is not easy or cheap. Many pilots were not built to scale.

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60 Planning for scale is a continuous process

61 A host of tools have emerged to help implementation and guide scale-up

62 The M.A.P.S. Tool mhealth Assessment and Planning for Scale To assess scalability by reviewing key considerations and activities To plan for future activities after identifying areas of weakness To improve on progress through scale

63 Summary Scorecard Allow users to identify areas requiring attention Can be used to assess progress over time

64 User-centered design is critical to effective digital health innovation.

65 Human-Centered Design Human-centered design is about listening. When we better understand the realities of people s lives, we are able to design and deliver solutions that are useful to them. Melinda Gates, May 20, 2015

66 Learn from each other s successes and failures. Build on other s work, not recreating the wheel.

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69 Communities of Practice

70 Important questions remain unanswered

71 A research agenda for Digital Health in Health Systems Implementation science around sustaining ICT innovations through effective Change Management Robust costing and cost-effectiveness assessments Budget impact analyses under various scale-up scenarios Equity and last-mile access innovations Ethical, legal and social challenges

72 Draw inspiration from Botswana and Bangladesh to Baltimore to understand what is m POSSIBLE Thank you.