Improving access to healthcare Improving access to healthcare services by using information and services by using information and telecommunication technologies.telecommunication technologies.

Information Session on « Digital Health for Rural Communities: Potential, Trends and Challenges »ITU, Geneva, 17 September 2010

Prof. Leonid AndrouchkoITU-D Study Group 2, Q14-3/2:

Telecommunications for e-HealthInternational University in Geneva

Health and ITU

What are the relations between Health and ITU?

What is the role of ITU?

What is eHealth? (1)

The advances in medical science, biomedical engineering on one side and information and telecommunication technology on the other side are offering today wide opportunities for improving access to and quality of health care.

What is eHealth? (2)

eHealth is an umbrella term for health-related activities, services and systems, carried out over a distance by

means of information and telecommunication technologies.

International Telecommunication Union(1) The introduction of eHealth

services in developing countries requires multidisciplinary collaboration, with active participation of both sectors:telecommunications and health care.

International Telecommunication Union (2)

ITU is active in the field of Telemedicine/eHealth from 1994, when developing countries during the time of the First World Telecommunication Development Conference in Argentina asked ITU to study this question from the angle of interest of developing countries.

From 1994 there are two streams of ITU complimenting activities:

ITU/BDT Development Programs,ITU-Development Sector Study Group

International Telecommunication Union (3)

From 1994 till 2010, ITU implemented a lot of pilot projects, missions, conferences and seminars in developing countries in order to demonstrate potential benefit of eHealth/telemedicine services and disseminate information on how to improve access to medical services for people living in rural areas.

Resolution 41 of ITU World Telecommunication Development Conference, which took place in 2002 in Istanbul, Turkey, recommended to all countries to create national eHealth Committees or Task Forces for such cooperation and coordination.

WHO

The World Health Assembly in May 2005 officially recognized eHealth and adopted Resolution WHA 58.28 establishing eHealth Strategy for the World Health Organization.

ITU, WTDC 2010 Hyderabad,India

Resolution (COM3/5) was approved on « Improving access to healthcare services by using information and communication technologies ».

ITU-D Study Group 2, Q-14

The main goal of the study is how to assist developing countries in the introduction of eHealth services and solutions, covering the technical part.

This is the unique international study group in the ITU-D SG2, Q14 dealing with needs of developing countries.

How healthcare service in rural areas could be improved?

eHealth or Telemedicine is the one practical solution which exists today.

Access to healthcare services could be provided via telecommunication networks: fixed terrestrial network, mobile network, satellite network.

International Telecommunication Union

Experience demonstrates that there is no single solution that will work in all settings. The complexity of technologies and the complexity of needs and demands of healthcare suggests the gradual introduction, testing and refining of new technologies.

Mobile telecommunication in developing countries

The number of mobile phones in many developing countries is drastically increased during the last five years offering technical platform for many mobile eHealth services to be organized.

Mobile network coverage in selected countries

(ITU, 2007)

Combodia 87%, Gambia 85%, Guinea 80%, Kenya 77%, Pakistan 90%, Rwanda 90%, Senegal 85%, Togo 85%, Uganda 80%, Zimbabwe 75%.

Comparison of mobile and fixed phones (Source – ITU)

Mobile and fixed telephone line per 100 inhabitants

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Mobile networks in selected developing countries

(Source – ITU )

Mobile Network Coverage and Telephone Penetration

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Penetration

Mobile eHealth in rural areas

There are two solutions:Mobile phone can be used for

management and consultations related to medical services.

Mobile eHealth care clinics/units traveling in rural areas from one village to another and connected to nearby hospital by wireless communication for consultations.

ITU-D Study Group 2, Q-14

It was decided to prepare the questionnaire and ask the opinion of medical staff in developing countries about Telemedicine and eHealth.

It was also a question asking participants about their view with regard to the implementation of eHealth services.

ITU-D Study Group 2, Q-14

The study was done in the following countries: Pakistan, Uganda, Bhutan, Sri Lanka, Saudi Arabia and recently in Mongolia.

How developing countries are informed about eHealth?

(1)

The health care administrations in developing counreies are not well informed about potential benefit of eHealth services.

How developing countries are informed about eHealth?

(2) The Telemedicine Group of ITU-D SG 2 made a study among medical staff in five countries and found the following level of information: Pakistan-61%, Mexico-18%, Uganda-73%, Bhutan-31% and Malaysia-66%.

This average level is still low.

ITU-D Study Group 2, Q-14

In favor of eHealth services Uganda – 96.6% Pakistan – 86.5% Bhutan – 87.5% Sri Lanka – 81% Saudi Arabia – 90.7% Mongolia – 77%

What is it nesessary to speed up the

implementation?

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What is it nesessary to speed up the

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Why eHealth services are not implemented?

Main obstacles: Lack of Government policy Lack of the knowledge about

eHealth successful projects Lack of training at all levels

ITU Strategies for e-HealthITU Strategies for e-Health

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2. Provide tools for the development of national e-health strategies

1. Advance the establishment of ICT infrastructure

3. Promote cooperation among relevant stakeholders

4. Facilitate information exchange

1.1. Advancing ICT InfrastructureAdvancing ICT Infrastructure

Connecting the unconnected remains a challenge:

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High speed broadband connectivity, needed for key e-health applications, is expensive or unavailable

High speed broadband connectivity, needed for key e-health applications, is expensive or unavailable

Insufficient local content Insufficient local content

Traditional business models often do not support the needed investment

Traditional business models often do not support the needed investment

Few trained people in the required technologies Few trained people in the required technologies

Wireless Broadband InitiativeWireless Broadband Initiative

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Objective :Objective :

Ambitious ITU initiative to expand broadband access in underserved areas of Africa

ITU’s initiative: ITU is working with governments and other partners

Expected outcomes :Expected outcomes :

Develop and deploy wireless networks

Guarantee capacity for schools and hospitals

Train local experts and build human capacity

Develop ICT Applications: e-health, e-education, e-government

2. Providing Tools 2. Providing Tools

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Methodology to assess actual Health System Status, Needs and Action Priorities

An integrated Action Framework covering: Infrastructure, Applications, Financing, Governance, Legal and policy, Human Capacity, Information quality

Guidance on how to set eHealth targets, benefits and Key Performance Indicators

Practical guidelines for the development of national e-Health strategies will developed in collaboration with WHO and the World Bank in 2010

The Guidelines for National e-Health Strategies :

Providing Tools Providing Tools (cont.)(cont.)

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Survey some of the major Tele-health initiatives in India comprising basic information about activities and infrastructure

Practical guidelines to map e-Health infrastructure to desired outcomes

Grouping of activities across care cycle within various services Map of Activities and diseases being addressed by those activities, correlated to corresponding infrastructure being utilized

Map the gaps between the desired and existing facilities as evidenced by some of the efforts

Provide insights in terms of infrastructure planning for eHealth.

3. Promoting Cooperation3. Promoting Cooperation

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The introduction of e-Health applications requires multidisciplinary collaboration

The introduction of e-Health applications requires multidisciplinary collaboration

All countries to create national e-Health committees

or Task Forces for cooperation and coordination

All countries to create national e-Health committees

or Task Forces for cooperation and coordination

ITU facilitates the establishment of public-private partnerships

ITU facilitates the establishment of public-private partnerships

Based on Resolution 41 World Telecommunication Development Conference (Istanbul, 2002)

Based on Resolution 41 World Telecommunication Development Conference (Istanbul, 2002)

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Harness digital health care solutions for scaling up Interventions in even the most resource poor settings.

Map the current state of play in this field

ITU is co-chairing the DHI, a unique, multi-stakeholder collaboration between the ICT and healthcare sectors :

Develop an economic model for policy-makers and practitioners

Cooperation: Cooperation: Digital He@lth Initiative (DHI)Digital He@lth Initiative (DHI)

Put in place a partnership platform for fast and high impact country-specific projects of regional importance

Put in place a partnership platform for fast and high impact country-specific projects of regional importance

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ITU-D SG 2 Question 14-2/2: Telecommunications for e-Health

ITU-T SG 16 Question 28/16: Multimedia Framework for e-Health Applications

Study Groups (SG) dedicated to e-Health related issues :

ITU-T SG 17 Question 9/17: Telebiometrics

These Study Group Questions bring together ITU diverse members (government, industry, academics, other stakeholders) to lead the work (studies, recommendations, best practices) on diverse aspects of e-Health

These Study Group Questions bring together ITU diverse members (government, industry, academics, other stakeholders) to lead the work (studies, recommendations, best practices) on diverse aspects of e-Health

Cooperation: Cooperation: ITU Study Groups on e-HealthITU Study Groups on e-Health

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Mobile phones can be integrated into a computer system to create an integrated health care information system

mHealth technology for rural areas can also include mobile healthcare units

Goal: Promote the coordinated introduction of cost-effective mHealth applications in developing countries

ITU Study Group 2, Q14 is discussing withmembers of industry and Research organizations to assit developing countries introducing mHealth solutions:

Cooperation : SG2/Q14-2/2 m-Health supportCooperation : SG2/Q14-2/2 m-Health support

Provide tailored support to developing countries to transfer knowledge, build local capacities, implement feasibility studies and support elaboration of project proposals to deploy large-scale, simple and cost-effective mobile solutions for Health

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Mobile clinics &

Portable eHealth terminals

Mobile Health Information Services

Telemedicine services in remote areas

(Telediagnostics, Teleconsultations, Telecare, etc.)

Health Education (Health awareness campaigns, tips, quizzes, games, etc.)

Health Data gathering (surveys, disease surveillance, research trials, etc.)

Training for Health Workers

Remote Patient Management & Monitoring (helpline, alerts, reminders, access to patient record, history, medication plan, tracking, Remote sensors, etc.)

Dignostics and Treatment Decision Support Systems

(2 ways SMS, , DSS software)

Emergency Telemedicine services

Cooperation :SG2/Q14-2/2 m-Health supportCooperation :SG2/Q14-2/2 m-Health support

Remaining ChallengesRemaining Challenges

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Problems achieving interoperable e-Health applications and standardization

Need for improved evidence of the economic and social benefits of e-Health

Many pilots for e-Health projects exist, but scalability is an issue

Improved communication between telecom and health sectors

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Conclusions (1)Conclusions (1)

The telecommunication and health care sectors have to work together in developing national e-Health strategies

The telecommunication and health care sectors have to work together in developing national e-Health strategies

Developing countries urgently need a strategic document – eHealth Master Plan and a Roadmap

Developing countries urgently need a strategic document – eHealth Master Plan and a Roadmap

Successful e-Health services require commitment to promote national strategies and facilitate capacity building

Successful e-Health services require commitment to promote national strategies and facilitate capacity building

Conclusion 2

Effective governance of eHealth requires codes, regulations, and standards to ensure satisfactions of the consumers.

Issues include legal liability, ethical standards, privacy protection, and cultural and social standards.

Additional ResourcesAdditional Resources

ITU statistical database of ICT indicators per country and region(www.itu.int/ITU-D/ict/index.html)

Expert aid in drafting and implementing national e-Health projects (www.itu.int/ITU-D/projects/index.html)

Training opportunities (www.itu.int/ITU-D/hrd/tc/index.asp)

Policy and regulatory reports and symposia(www.itu.int/ITU-D/treg/index.html)

Regional office in Addis Ababa to support Member States in Africa (www.itu.int/ITU-D/afr/CMS/index.asp)

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Thank YouThank You!!

For more information on ITU’s e-Health Activities

visit the website at:

www.itu.int/ITU-D/cyb/app/e-health.html