1. eHealth a use of ICTs for effective healthcare service delivery
Vincent Sikakane
Deputy Director eHealth and Information Technology
KwaZulu Natal Department Of Health
November 2014

2. Content
1. Health systems strengthening 2. Challenges of health system 3. e-Health/telehealth/telemedicine/mHealth 4. Best practice in implementing e-Health innovation/initiatives 5. “Costly failures of e-Health” – guidelines not stop sign. 6. KZN Dept. of Health e-Health initiatives

3. 1. Six components of health system need to be strengthen to provide better health care:
Telemedicine

4. Setting the Stage for Healthcare Transformation: Key Drivers
2.Challenges of Health system
We are doing well despite…
Distance between health facilities
Paper
records
Medico legal issues
Bandwidth
South African government hospitals are poorly resourced, overcrowded, understaffed and underfunded, contributing to the pressure under which emergency departments operate.
Quadruple burden of disease
Communicable diseases,
Non-communicable chronic diseases,
Trauma (load is one of the highest in the world). 
HIV/AIDS
The result is prolonged waiting times.
Way forward: An effective system to ensure early recognition of sick patients and prioritisation for treatment is essential.
Triage
Telemedicine
HIV & AIDS and TB;
High Maternal and Child Mortality;
Non-Communicable Diseases; and
Violence and Injuries.
Setting the Stage for Healthcare Transformation: Key Drivers

5. Before
Paper Records

6. Patients seeking primary care To be treated by a doctor
Why do we have patients bypassing clinics and CHCs to attend outpatients at district and regional hospitals
Staff shortages
Patients seeking primary care
To be treated by a doctor
To collect medication
To get an X-Ray
To see a Specialist

7. At your facilities… Do you have an effective referral program?
Do you have an effective in reach program?
How often do you get specialists
Do you have an effective outreach program?
How often do you visit clinics
Do medical officers view Lab results in their consulting rooms?
Do medical officers view X-Rays in their consulting rooms?
Do you have a digital X-Ray?
Are your X-rays being reported by specialist radiologists?
Turn around time for a patient visiting your facility?

8. At your facilities… Do you have enough doctors, nurses, Pharmacists…
Do have specialists
Are your X-rays being reported by specialist radiologists?
Do you have an effective referral program?
Do you have an effective outreach program?
Do medical officers view X-Rays in their consulting rooms?
Do medical officers view Lab results in their consulting rooms?
Turn around time for a patient

9. Challenges faced on a daily basis…
Long waiting hours at our Health facilities-Patients get referred for minor ailments
Medical officers leave a busy consultation room - To view X-Rays/To check lab results
Most of the routine X-Rays are not being reported by specialist radiologists
Time lost looking for the right patient information at the wrong workstation
Duplicate tests and procedures when doctors share patients but not patient information
A Patient gets a new folder and new folder number
Open to litigation due to lack of complete information

10. Aim
Not to wait for patients to fall sick and come to health facilities
Early detection of Diabetes, Hypertension, TB, and Counseling at an early stage.
Reduce the number patients coming to Clinics
Patients seen closer to where they live.
Reduce number of referrals to the District hospitals
Especially the unnecessary & avoidable ones
Reduce number of referrals to the Regional hospitals.

11. 3. eHealth

12. eHealth begins with a vision of:
connecting people to people,
connecting resources to needs, and
connecting healthcare problems to health care solutions

13. 4. Best practice Strategic Plan
Constantly look at how healthcare services are rendered and identify those that can be delivered and or enhanced through telemedicine and ultimately achieve improvement in efficiency in service delivery

14. Capacity Building Information management Partnerships
HIS/HER Document Mx
Infrastructure
mHealth
Monitor Public health
Tele-health
Telemedicine
Capacity
Building

15. What is eHealth?
The World Health Organization defines eHealth as “the use of information and communication technologies (ICTs) for health to,
treats patients,
pursue research,
educate students,
track diseases and
monitor public health.”

16. What is mHealth? mHealth applications including:
education and awareness;
remote data collection;
remote monitoring;
communication and
training for healthcare workers;
disease and epidemic outbreak tracking; and
diagnostic and treatment support.

17. Putting eHealth into practice
Physician outreach to remote clinics and facilities, especially where clinics are located in rural areas. The technology is used here to prevent travel of patients, doctors and specialists, saving time and improving efficiency.
Remote patient assessment via video connectivity allows physicians to make remote initial assessments of patients, potentially preventing unnecessary transport of patients who do not require special care.
Access to specialty physicians – Since there is usually a dearth of specialists in remote areas, gaining access to such specialties as radiology, dermatology, cardiology and neurology can be a challenge.
Outreach to school districts – Placing video endpoints in schools allows physicians to consult with students without the students having to leave the school premises.
Distance Learning (Continuing Education) – Remote training via video connectivity provides increased learning capacity and saves significant time.

18. eHealth Strategy South Africa
The principles are:
Get the basics right – infrastructure, connectivity, basic ICT literacy, human resources and affordability planning.
Take an incremental approach – build on what exists already in both the public and private sectors and fill the gaps where necessary.
Look for early wins in implementations and benefits to build the confidence of health professionals, patients and the public in eHealth.
Advocate the benefits of care enabled by eHealth and ensure that these benefits are realized.
Constantly evaluate eHealth initiatives and measure improvements in health outcomes in order to build an evidence base that demonstrates the net benefits over time of eHealth and guides planning and decision-making.
Establish national co-ordination on all initiatives in order to improve the effectiveness of eHealth at all levels.

19. 5. Costly failures…

20. Why is eHealth so Important in Our Healthcare System?
eHealth is emerging as a critical component of the healthcare crisis solution.
eHealth holds the promise to significantly impact some of the most challenging problems of our current healthcare system:
access to care,
cost effective delivery, and
distribution of limited providers.

21. eHealth increases access to healthcare:
Remote patients can more easily obtain clinical services.
Remote hospitals can provide emergency and intensive care services. 

22. eHealth improves health outcomes:
Patients diagnosed and treated earlier often have improved outcomes and less costly treatments.
Patients with eHealth supported ICU’s have substantially reduced mortality rates, reduced complications, and reduced hospital stays.

23. eHealth reduces healthcare costs
Home monitoring programs can reduce high cost hospital visits.
High cost patient transfers for stroke and other emergencies are reduced.

24. eHealth assists in addressing shortages and misdistribution of healthcare providers:
Specialists can serve more patients using eHealth technologies.
Nursing shortages can be addressed using eHealth technologies. 

25. eHealth supports clinical education programs:
Rural clinicians can more easily obtain continuing education.
Rural clinicians can more easily consult with specialists.

26. eHealth improves support for patients and families:
Patients can stay in their local communities and, when hospitalized away from home, can keep in contact with family and friends.
Many eHealth applications empower patients to play an active role in their healthcare. 

27. eHealth encompasses four distinct domains of applications.
These are commonly known as:
• Live Videoconferencing (Synchronous): Live, two-way interaction between a person and a provider using audiovisual telecommunications technology.
• Store-and-Forward (Asynchronous): Transmission of recorded health history through an electronic communications system to a practitioner, usually a specialist, who uses the information to evaluate the case or render a service outside of a real-time or live interaction.
• Remote Patient Monitoring (RPM): Personal health and medical data collection from an individual in one location via electronic communication technologies, which is transmitted to a provider in a dierent location for use in care and related support.
• Mobile Health (mHealth): Health care and public health practice and education supported by mobile communication devices such as cell phones, tablet computers, and PDAs. Applications can range from targeted text messages that promote healthy behavior to wide-scale alerts about disease outbreaks, to name a few examples.

28. KZN Department of Health Case studies

29. Telemedicine initiative: TeleRadiology

30. TeleRadiology Network

31. PUBLIC SECTOR INNOVATION AWARDS
WINNER:
Kwa Zulu Natal
Department of Health
Cash Award: R10,000
CPSI
PUBLIC SECTOR INNOVATION AWARDS
22 November 2013

32. 1
Problem statement: information collected by CCG as part of OSS – there is a backlog of 6-8 months
ICT Solution Data collection
Benefits
Pilot at Gcumisa clinic using mHealth technology
Using digital pen + Cellular phone + Web based software to collect information from households by community care givers based at Gcumisa clinic.
17 CCGs have been trained to uses the Digital pen
400 households information has been captured
It takes about 10 seconds after completion of the form for information to go into a web based solution. Reports can be generated for statistics screening and management purposes

33. CPSI Awards 2014

34. 2
Problem statement: Patients referred to a psychiatric hospital before proper assessment Quality of service is being compromised in facilities that do not have a Psychiatrists
ICT Solution for telePsychiatry
Benefits
The use of videoconferencing technology to facilitate the provision of health care for persons with mental health issues
VC equipment
Board room setting
Consulting room
Medical officers can discuss with Psychiatrists in real time.
Counselling sessions using Video confernecing
Access to specialised care by disadvantaged communities
Quality of care and outcomes are improved
Cuts down travel time and costs
Opportunity for training and education for health care workers
Reduces professional isolation

35. 3
Problem statement: Pharmacy stock-out can have severe negative effects on patient care, especially in the case of complex, chronic diseases like HIV and TB when poor outcomes, such as drug resistance and death, can often result.
ICT Solution for stock management in PHC
mHealth as a tool to combat pharmacy stock-out in Primary Health Care facilities in KwaZulu Natal

36. Tele-education initiatives

37. Conclusion
It is important to emphasize that eHealth is not substitute for face-to-face medical practice, but rather it is a tool to compliment the current health care delivery in South Africa
From the Initial Telemedicine Evaluation Report for the year 2000

38. eMail: vincent.sikakane@kznhealth.gov.za
Thank You!
Vincent Sikakane
Deputy Director eHealth & Information Technology: KwaZulu Natal Department Of Health
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