digital african health library by bruce dahlman, infamed
TRANSCRIPT
The Digital African Health Library:
Relevant Resources for Decision
Support at Point of Care
Bruce Dahlman MD MSHPE
Institute of Family Medicine, Nairobi
Africa Church Health Association Platform
Safari Park, Nairobi, Kenya
25 February 2015
Reflective Question
What medical information resource(s) do
the nurses, clinical officers or doctors
working in your health institutions use to
provide the best care possible for their
patients?
What are the challenges and barriers to
access current medical information
in your country?
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Motivation for Development of the
Digital African Health Library - I
Health workers in Africa shoulder:
• 25% of the global disease burden
• in 11% of the world’s population
• with only 3% of the global health workforce
• and just 1% of the health care resources
Can health information decision support
resources be of at least some potential
assistance to them? WHO (2006) The global shortage of health workers and its impact. Retrieved from
http://www.who.int/mediacentre/factsheets/fs302/en/ index.html
Motivation for Development of the
Digital African Health Library - II
• Family medicine post-graduate training in a rural setting in Kenya
• “Learner-centred” approach of bedside response to patient –prompted questions
• “Information divide” - locally relevant availability *
• “Internal digital divide” - internet access rurally *
* Rhine, L. (2006). The impact of information technology on health
information access in sub-Saharan Africa: The divide within the divide. Information Development, 22: 242.
Motivation for Development of the
Digital African Health Library - III
Kenyan nurse South Sudanese doctors
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Overview of Research on Doctors Info Needs
Kenya Point of Care Health Information Study
2008-9 with 8 Kenya Family Medicine Registrars
Rwanda Point of Care Study
2009 with 64 Rwandan Residents and Faculty
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Study Conclusions
• Post-graduates and faculty in two East Africa
training programs embraced the use of
smartphones as a tool to assist clinical
decision making to provide best care
• Patients significantly benefited because the
smartphone brought answers to clinicians’
questions to the point of care
• Smartphone format can be used to widely
distribute large amounts of evidence-based
information
Goals for Digital Africa Health Library
The Format and Platform:
• Portable – available where you see patients
– Smartphone is the emerging technology
• Single search engine for all resources
– Enter the search term(s) once
• Easy to set up and use
– No lengthy downloads or complicated sync
• Local resources
Digital African Health Library
Video demonstration
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Resources
• Oxford manual- each usually $35-50
– Anaesthesia
– Clinical Medicine
– Clinical Specialities
– Surgery
– Tropical Medicine
• Future
– Family Medicine – South Africa
– AfricaFEM Emergency Medicine 10
Resources - II
• British National Formulary
• Dynamed integrated resource
• CALS Emergency management
• Africa Health continuing education journal
• WHO Handbooks
– Pocketbook of Care of Hospitalized Children
– Pregnancy, Childbirth, Postpartum &
Newborn Care
• Kenya MoH Clinical Guidelines
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Resources - III
• RHealth Advisor – Robertson
• Helps nurses and clinical officers make
better diagnoses
• India – Accuracy increased from
52% to 85%.
• This requires internet access – otherwise,
all other resources can be used offline.
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Features
• Smartphone or tablet
• iPhone or Android
• Single search of all texts
• Relevant resources for Africa
• No internet connection needed after startup
• Resources updateable
• Option to include your Ministry of Health
Guidelines
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Digital African Health Library:
Country Roll-out
• 2015
Kenya, Uganda, Rwanda, Botswana
Ethiopia, South Sudan and Somaliland
• 2016
Other Anglophone countries – Ghana,
Malawi, Nigeria
How can your hospitals help?
• Our goal is to provide it to rural clinicians
• Needs a data transfer where there is no 3G
network
• IT departments can do the transfer to help
the clients get access
• Please speak to us afterwards
• Fill the response form if you are interested
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Why the Digital Library
• To Support primary care nurses, COs and
doctors in their clinical setting, but also
• Supporting COs and doctors in their training.
• Family Medicine is a primary care specialty
that is becoming understood and promoted
by Ministries of Health as the “missing link” in
especially the rural health delivery scheme
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Family Medicine:
Who is a Family Physician? Kenya Ministry of Health Family Medicine Policy (2007):
“A family physician is a medical doctor
– providing competent and comprehensive clinical care
– over a wide range of patient conditions
– considering the person’s physiologic, psychological, socio-economic, cultural and spiritual dimensions
– within the context of their family and community and
– not limited by the person’s age, gender, organ system or disease entity.”
African Family Doctor
Distinctives
• Is in a consultant role to other primary
care providers: medical officers, nurses,
clinical officers;
• Coordinates to community and Level 2
and Level 3 facilities
• Significant surgical capabilities where
there is no general surgeon available
• M.Med. trained – has speciality degree
The African Family Doctor: A summary
• 4 year M. Medicine speciality training
• Clinical specialist as “consultant to the
primary care team”
• Competent emergency surgeon
• “Bridge” to the community providers
• Equipped to stay & “build” the hospital; not
wanting to become another specialist that
takes them away from the rural facility
Why Family Medicine?:
World Health Organisation “Given the need to provide primary care services to
the entire population, as well as the family doctor’s ability to manage most medical problems,
it makes sense that a majority of physicians should be trained to practice as family doctors. This may be even more important in developing countries, where it may be prudent to limit the utilization of costly hospital-based technology” (WHO, 1994).
Acknowledgements
• Our faithful supporters through AIM Int’l
• Generous resource partners: DynaMed,
Oxford U Publishers, CALS, WHO
• Technical partner – Medhand Int’l
• Research subjects from Moi U., Rwanda
National University, South Sudan doctors
• INFA-MED development team:
Lead Consultant - COO, IT programmer,
Partner Service Officer
Comments and questions?
Correspondence to:
Dr. Bruce Dahlman, Director
Mr. Musya Mutua, Lead Consultant
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