In this era of the digital revolution, innovative computer software programs and Information and communications technologies (ICTs) are disrupting different industries of most economies and the healthcare sector is one of the nascent and emerging opportunities for technology disruption and innovation. This is an “inevitable” welcome development as Global health innovation is at the forefront of embracing the use of technology solutions in various parts of the world to improve access to health services and medicines, and Nigeria is not to be an exception. This symposium is focused on asking the fundamental questions; how much impact are e-health applications making in the Nigerian health sector and how do we improve the level of impact and
effectiveness of these applications via a user-centric approach?
Taking these proactive steps serve to ensure that we focus on the real needs of the Nigerian people and put in place quality and safety measures that will give users the confidence needed to use e-health applications and solutions adequately and appropriately. This symposium invites key-stakeholders in the e-health
ecosystem to share their views on the pains and gains of e-health as of today and how to shape the future of e-health in Nigeria (and similar countries). Some of the presentations and panelist sessions will include real field experience and user-centered qualitative research that will elicit the current level of impact and the real needs of e-health users in the southwest region of Nigeria.
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E health in Nigeria Current Realities and Future Perspectives. A User Centric Assessment
1. eHealth in Nigeria
Current Realities & Future Perspectives
A User Centric Impact Assessment …
Ibukun Fowe, MBChB
MS Global Health Candidate
Northwestern University, USA
26/01/2017
2. Outline
● What is eHealth?
● eHealth in developing countries
● Global eHealth Trends
● The state of eHealth in Nigeria
● Impact assessment of eHealth on Women in South West Nigeria
● Inferences and perspectives
● Opportunities
3. What is eHealth?
According to the journal of medical internet research, e-health is an emerging
field in the intersection of medical informatics, public health and business,
and often refers to health services and information delivered or enhanced
through the Internet and related technologies.
eHealth can also be described as the use of ICT (information, computer
technology) for health.(WHO)
4. What is eHealth (contd)
The term eHealth serves as an umbrella for a wide range of systems,
services or platforms that are at the edge or intersection of
healthcare/medicine and information technology, and these may include:
Electronic health record, computerized physician order entry, ePrescribing,
clinical decision support system, telemedicine, consumer health informatics,
health knowledge management (Medscape), virtual healthcare teams,
mHealth/m-Health, health informatics / healthcare information systems
(appointment scheduling, data management for patients, work schedule
management)
5. The context of eHealth in developing countries
such as Nigeria
Lack of access to timely health information and timely treatment options
result in more morbidity and mortalities. Health systems in the developing
world are still faced with myriads of challenges as regards the provision of
health care services of equitable standard, at affordable costs and on a
locally universally accessible scale. In response to this challenge, health
policy makers, donor organizations and programme organizers/implementers
are actively searching for innovative approaches and alternatives to eliminate
the geographic and financial barriers to health in developing nations.
6. Historical contexts of eHealth in developing
countries such as Nigeria (contd)
This search for cheaper and more
optimal alternatives has resulted in a
growing interest in the potential of e-
health (the use of ICT for health) and m-
health (the use of mobile technology for
health, a subset of e-health) in low- and
middle-income countries for use in
addressing the challenges associated
with health care delivery in resource
constrained environments.(WHO)
7. Historical contexts of eHealth in developing
countries such as Nigeria (contd)
This venture has been further accelerated with
the decline in the prices of cell phones and
internet technology services, and an increase in
the number of overall users and the rate of use of
these devices and platforms. However, despite
this seemingly excessive surge in interest, in
some developing countries the ehealth field is still
relatively nascent with little or no coordination of
the few up to scale implemented programmes.
There have also been very few papers or studies
describing the impact, safety and effectiveness of
these emerging health related technologies.
8. Global eHealth
Trends ... The surge in the use and adoption of smartphones and
internet services is one of the factors that heralded this new
era of digital health across the globe.
9. eHealth
milestones
Medscape was launched in May 1995,
in New York.
This is the most authoritative e-
referencing platform for physicians and
health professionals today.
Healthscape founded in 1996, acquired
WebMd in 1999
The Web (www):
10. eHealth
milestones
1999:
The term e-health was
introduced at the seventh
International Congress on
Telemedicine and Telecare in
London as the death of
telemedicine.
2006:
Germany launched the electronic health card which contained
patient’s biodata and health information and can be used by the
general practitioners to fill prescriptions electronically. This was
a major starting point for e-health in Europe.
11. eHealth
milestones
Chinese companies began
creating mobile phone
wristwatches in the late 2000s,
and Apple and Nike's
collaboration on the Nike+iPod
fitness tracking device gave
consumers a way to use their
existing technology to keep fit.
Fitbit, launched in 2009,
worked in a similar manner,
attaching to the user's belt and
measuring steps taken with an
accelerometer.
2016: Multi function
development platforms (for
medical devices/eHealth
apps) such as MySignals
got into the market.
Mysignals:
- It measures more
than 15
different biometric
parameters.
- Helps you develop
your own eHealth
applications on top.
- Adds your own
sensors to build new
medical devices
- You can view
recorded parameters
on your computerhttps://www.wareable.com/media/images/2014/11/nike-plus-touch-nano-print-1416577488-2nqy-
column-width-inline.jpg
http://www.my-signals.com/
https://www.wareable.com/wearable-tech/a-brief-history-of-
wearables
13. eHealth
milestones
mHealth:
A health professional using a
mobile phone as an indirect
ophthalmoscope
http://www.thejournalofmhealth.com/single-post/2016/07/25/Is-the-mHealth-Industry-Facing-a-Skills-Shortage
15. The state of eHealth
in Nigeria
This recent proliferation of health related technology
platforms is generally believed to have helped to
advance health care and services, improve patient
outcomes, and reduce morbidity and mortality.
Although this is a welcome development, not much
has been said about the level of health impact that
these technology enabled platforms have produced
in Nigeria.
http://cdn1.dailypost.ng/wp-content/uploads/2012/06/nigeria-map-
flag.jpg
16. The state of eHealth
in Nigeria
“The greatest barrier to e-Health is the difficulty for
consumers to find accurate and reliable information
(Maloney et al., 2005). According to Dutta-Bergman
(2004), the two critical indicators of e-Health
information quality are source credibility and
information completeness. Medical experts suggest
that health information provided by a source that is
not credible is detrimental to consumer outcomes.
Also, unless health information is complete, it is
likely to mislead the consumer into making
incorrect decisions. The completeness of health
information is considered the single most important
criterion in health care decision making (Dutta-
Bergman, 2004).”
http://www.medscape.com/viewarticle/551712_4
http://www.chcuk.co.uk/wp-
content/uploads/2016/04/E-Health.jpg
18. Impact Assessment
An on-going research on the assessment of the
quality and impact of ehealth in Nigeria. The cohort
for pregnant women, mothers and female
caregivers of children ages 0 to 12yrs in
southwest Nigeria ...
Awareness:
Out of 200 respondents so
far, 15% only are aware of
any pregnancy or child care
related health application,
and 83% of the respondents
are younger than age 40
19. Impact
Assessment
Usage & eHealth Platforms:
69.2% of those aware of pregnancy and child care related health applications
used at least one application in their last or current pregnancy.
Most use web & sms platforms ...
21. Impact
Assessment
Barrier to access:
Lack of information on
available health applications
was the most commonly
reported barrier by 84% of
respondents who were not
aware of any pregnancy or
child care related health
application.
22. Inferences and
Perspectives
Although the cross sectional survey shows high rates of safety and
satisfaction by the consumer with the use of majorly foreign apps,
this is still not representative of the true level of health impact.
This is because in the use of ehealth platforms by individuals to
optimize their health outcomes, in many cases, the consumer alone
cannot ascertain the user health experience (UHX) .i.e. The true
health impact.
I am highlighting this global health concern from West Africa by
asking: do we allow the proliferation of technology innovations in
healthcare without check? The development of health related
ehealth platforms cannot be left in the hands of software
developers (techies) only. This is because the usability being
highlighted here is beyond user experience (UX), as described in
the tech world. For eHealth, user experience has to involve safety,
quality of healthcare knowledge and service delivery.
http://b-i.forbesimg.com/danmunro/files/2013/05/CSDevicesFinal.png
23. Inferences and
Perspectives
What is User eXperience(UX)?
The exact definition, as outlined by the International Organization
for Standardization, is a “person’s perceptions and responses
resulting from the use and or anticipated use of a product, system
or service.” Or, more simply, user experience is how you feel about
every interaction you have with what’s in front of you in the moment
you’re using it.
Therefore, a consumer usually is able to rate user experience
solely on his own.
This is not so in ehealth as a consumer is usually unable to rate
user health experience on his own, simply because he may not
fully understand the overall health and safety implications of the
platform in question without the help of a health professional.
User Health eXperience(UHX):
UHX = UX + Health (Impact and safety)
https://s-media-cache-
ak0.pinimg.com/originals/ee/e3/44/eee344eee4ec75382e59d05
24. Inferences and
Perspectives
The Health impact of eHealth can be categorized in
two non mutually exclusive dimensions:
The User’s
assessment of the
health benefits
The health
professional’s (known)
approval or validation of
it’s health benefits
https://encrypted-
tbn0.gstatic.com/images?q=tbn:ANd9GcT2Vl89Drb8KXMiIq5hm4C
Cj1HIMDusqUcMdJNMKUrqgiwuuv1H
Until these two assessments are captured, we are not sure
of the health impact of an ehealth application or solution.
→ See a real user corroborating this in a video in appendix
25. Inferences and
Perspectives
True Health Impact of ehealth cannot be fully ascertained only
by software developers (techies) or even by the users.
The input of the health professionals is paramount.
Hence it is the responsibility of we health care professionals
to rise up to the opportunity of ehealth in Nigeria and
proactively guide the technology solutions and content of the
software applications or platforms to ensure that it is:
- Correct
- Safe
- Local and culturally adept .i.e. addresses the
appropriate local issues that may not be addressed in
foreign applications or platforms
- Has the right health impact
http://www.nggovernorsforum.org/index.php/73-featured-news/732-borno-employs-60-
doctors-750-midwifeshttp://www.nggovernorsforum.org/index.php/73-featured-news/732-
borno-employs-60-doctors-750-midwifes
26. Opportunities
...
With an appropriate focus on ensuring the true impact of ehealth
platforms in Nigeria:
● We can win the war against preventable conditions and
diseases through health education
● Have a rapid alert and response system for epidemics and
highly contagious diseases such as Ebola and Lassa fever
● Win the war against preventable maternal and child deaths
● Combat chronic conditions, such as hypertension and diabetes
mellitus through health education and lifestyle changes
● Attain Nigeria’s goal 2020 for health ICT by achieving universal
health coverage with the provision of health care and services
of equitable standard across board
● Get Nigerians better informed about their health and overcome
people's belief in myths related to local/quack health practises
● Leapfrog by using locally relevant softwares to improve health
service delivery and processes in hospitals
● Attain SDG 3: Ensure healthy lives and promote well being for
all people at all ages
http://www.e57partners.com/im
ages/career-opportunities-
open-doors.png
In today's digital world, the term ehealth has become a buzz word and means different things to various categories of people and can be described in various ways depending on the use case.
http://www.jmir.org/2001/2/e20/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761894/
in a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve healthcare locally, regionally, and worldwide by using information and communication technology. http://www.who.int/topics/ehealth/en/
Image ref: http://www.itu.int/en/ITU-D/ICT-Applications/PublishingImages/ehealth_main.jpg
A list from wikipedia includes the following: https://en.wikipedia.org/wiki/EHealth
E-health in low- and middle-income countries: findings from the Center for Health Market Innovations.
November 2011. http://www.who.int/bulletin/volumes/90/5/11-099820/en/
E-health in low- and middle-income countries: findings from the Center for Health Market Innovations.
November 2011. http://www.who.int/bulletin/volumes/90/5/11-099820/en/
E-health in low- and middle-income countries: findings from the Center for Health Market Innovations.
November 2011. http://www.who.int/bulletin/volumes/90/5/11-099820/en/
Image from: http://www.akita.co.uk/movement-of-data/img/globe-red.png
The surge in the use and adoption of smartphones and internet is one of the factors that heralded this new era of digital health across the globe. http://www.prnewswire.com/news-releases/global-digital-healthcare-market-trends-opportunities-and-forecasts-300336940.html
https://www.reportbuyer.com/product/4140278/global-digital-healthcare-market-trends-opportunities-and-forecasts.html
Image ref: https://ethicstechnologyandsociety.files.wordpress.com/2012/03/ehealth_wordle.jpg
More examples of wearable devices include: fitness trackers, fitness bands, smart glasses, smart watches, smart clothing. Popular wearables include: Fitbit, Apple Watch, and Google Glass Here is a good 2014 ehealth study on the use of wearable devices in the US (reported by technology advice). This just like many studies out there, basically shows us the volume of the use of wearable devices, and nothing much is said about the health impact
of this device on the consumers.
http://hitconsultant.net/2014/10/08/are-health-wearables-evangelists-fools/
Personalized healthcare; Now I can decide my health goals, how I want to achieve them and on which platforms.
Nigeria does not seem to be alone as regards the non availability of health impact assessments, according to the third annual report of the WHO Global Health Observatory in the European region, it was reported that 73% (33 Member States out of the 47 respondent member states) reported not having an entity largely responsible for the regulatory oversight of the quality, safety and reliability of mHealth applications.
Another challenge is that of the credibility of the information on these platforms. This challenge also exists currently in our great country Nigeria. With so many nice ehealth platforms and applications out there, we need to begin to ask ourselves : What is the quality of health information being disseminated? How credible are they? Who validates these pieces of health information?
Here are some ehealth platforms in Nigeria:
Omomi - helps mothers keep their children healthy by supplying them health tips/information
Safer mom - helps mums through pregnancy and Baby’s early years
RedBank - helps patient and hospitals find safe blood in emergencies
Kangpe - Ask real doctors your questions and get answers in minutes
Healthfacts - Disseminates health information and educates the public
SMS - Health focused SMS services have the largest coverage and reach in Nigeria
Doklink -
In the ongoing assessment of pregnant women and mothers/female caregivers of children zero to 12 years, the following findings have been observed so far amongst 200 respondents in the Lagos mainland area:
Most of the respondents reported the use of foreign apps in their pregnancy and in the care of their children. When asked for the reason behind this, some said it is because they do not trust the Nigerian local apps to carry out the necessary research needed to validate the information provided on their platform. However, most of the women reported that they would like to have access to quality assured local Nigerian applications for their pregnancy and child care needs as these local apps would be more culturally adept and accommodating.
This can be likened to people saying that they are ok with agbo jedi, that it is in fact very safe and effective for their needs, although we as health professionals know that there are many issues with this herbal remedy: such as what exactly does it contain, dose issues, mode of preparation and hygiene issues and so on and so forth. Imagine someone who uses a fitness tracker, he may not be able to ascertain the health impact of the exercises and activities of the device all alone, because he may not have a full understanding of how the suggested exercise regimen would affect his/her body system.
Software developers/techies are usually more concerned with user experience, how does it look? How easy is it to use? Hope the app does not crash when you are using it .e.t.c. They usually are not able to understand the full health impact of the applications they produce for obvious reasons. This brings us to the concept of User health experience (UHX), which is a new term that describes the user experience and true health impact, as well as addresses the safety concerns of consumers of ehealth platforms. As we all know, We can't stop at how fancy looking an application is, or how easy it is to use it; we have not started fully evaluating the effectiveness of the app, if we do not focus on the health impact and safety concerns for every unique individual user of the application or platform.
Currently in ehealth, there are two types of approval or validation: Known and unknown approval.
Unknown approval: the approval is known only to the developers of the ehealth platform, that a health professional validated the ehealth application. This is usually unknown to the consumer.
Known approval - For an approval to be known, it has to be known by the user as well as by the government through the ministry of health.
Nigerians have a huge respect for local health professionals (Doctors, dentists, pharmacists, nurses, physiotherapists .etc.), even though the infrastructure may not be perfect :) They know that we have top health professionals. So if we health professionals embrace ehealth Nigerians will start listening to us, instead of running to other applications from different demographies and cultures to solve their health problem.
Image ref: http://3.bp.blogspot.com/-IsavGlyOnGg/VOTJ0yaN45I/AAAAAAAABMc/45ExCoSaM9A/s1600/group-of-doctors.jpg
