Telemedicine was fundamentally born during the ‘space race’ between the USA and the former USSR. The National Aeronautics and Space Administration (NASA), the USA military and USA government funded many telemedicine projects. NASA was keen to build up a distant monitoring system to manage the health of American astronauts in space (Sullivan, 2001). Generally “Telemedicine involves the use of modern information technology, especially two-way interactive audio/video communications, computers, and telemetry, to deliver health services to remote patients and to facilitate information exchange between primary care physicians and specialists at some distances from each other” (Bashshur, 1997).
In this Information Age, telemedicine and computer driven treatment methods are being used in the field of treatment of disease including cancer in different ways. eHealth created a new medium that changed the environment of the entire health sector and its relationship with its constituencies. It has had a profound impact on various socioeconomic and political aspects of society. The information system brings delivery of health services in a much more convenient and cost-effective way, offering great opportunities to develop the efficiency of the health sector. However, the route of change also gives rise to new challenges and difficulties, especially in developing countries, where were not many successful initiatives. This is the result of the massive deficiencies in basic infrastructure, human capacity and financial resources, along with the attendant political and cultural constraints. These factors are crucial and impede the adoption of eHealth, many models and frameworks that were built to assist in the process of adoption in developing countries have been adapted from the experiences in the implementation of e-Western developed countries health. While there are important lessons to be learnt, these frameworks have limited application in Africa and developing countries in other regions.
2 – Thesis Outline
The study presents examination of the subject background, data collection, analysis, findings and discussion for the issues and concerns of eHealth in Sudan. The findings of the study will contribute to the identification of the critical factors in eHealth in Sudan, and to the development of adoption of a system of user-friendly approach to eHealth
Chapter One: Introduction
Presents the background of the subject of this study and explains the research problem; the purpose; the objectives and the main research questions to be answered, and what this research will contribute in the field of health informatics
Chapter Two: The literature review
Reviews the literature in order to provide a clear vision of the concept of eHealth and the main characteristics, including: definitions, benefits, challenges and stages of eHealth in Sudan
Chapter Three: Methodology
Addresses important choices, resources and information on the principles of design research. This information is to help to make the right decision on the nature of the research problem and how it should be investigated. There are different options in terms of research approaches and techniques that can be used in the research design
Chapter Four: Data analysis and findings
Presents the findings of the data analysis techniques used. Figures and tables are effectively used to present the research findings
Chapter Five: Conclusions and discussions
Gives a brief summary of the main research findings, followed by a discussion of their theoretical and practical implications.
3, Concepts of eHealth
The use of emerging information and communication technology, especially the Internet, for improving or enabling health and health care can be defined as eHealth and this ‘eHealth’ term bridges both the clinical and nonclinical sectors and includes both individual and population health-oriented tools (Eng, 2001). The nature and functions of eHealth services are expanding rapidly, so it is difficult to define eHealth accurately. For the hospital care setting, eHealth refers to electronic patient administration systems; laboratory and radiology information systems, electronic messaging systems; and, telemedicine, teleconsultations, telepathology, teledermatology etc. In case of the home care setting, examples include teleconsultations and remote vital signs monitoring systems used for diabetes medicine, asthma monitoring and home dialysis systems. For the primary care setting, eHealth can refer to the use of computer systems by general practitioners and pharmacists for patient management, medical records and electronic prescribing. Electronic Health Record can act as a fundamental building block of all these applications. It allows the sharing of necessary information between care providers across medical institutions (Ali E, 2008)
eHealth in Developing Countries
Health systems in low- and middle-income countries continue to face considerable challenges in providing high-quality, affordable and universally accessible care. In response, policy-makers, donors and programme implementers are searching for innovative approaches to eliminate the geographic and financial barriers to health. This has resulted in mounting interest in the potential of eHealth (the use of ICT for health) and m-health (the use of mobile technology for health, a subset of eHealth) in low- and middle-income countries, (Bulletin of the World Health Organization 2012)
Developing countries are experiencing an unprecedented increase in the number of users of cell phone and internet technologies, as well as a decline in the price of devices and services. As a result, many health programme implementers and policy-makers are exploring the extent to which e- and m-health (henceforth referred to simply as eHealth) can help address the challenges faced by resource-constrained health markets in terms of the availability, quality and financing of health care. This increasing interest is evidenced by the growing number of events, web sites and literature focused on eHealth, including the Saving Lives at Birth Grand Challenge, the recent Health Affairs thematic issue on eHealth in the developing world, the m-health summits that took place in Washington, DC, United States of America, and Cape Town, South Africa, and the survey recently conducted by the World Health Organization on the use of m-health by its Member States (Trevor, L, Christina, S, Gina, L & Julian, S 2011).
Despite the increased interest – perhaps bordering on excess – in some individual programmes, in low- and middle-income countries the eHealth field is still relatively nascent. Few programmes have gone to scale and implementation has typically been fragmented and uncoordinated. To date, the literature on eHealth in low- and middle-income countries has largely consisted of articles describing single uses of technology in health care delivery, as well as theoretical discussions and recommendations surrounding the implementation of eHealth-based programmes and policies, with few examinations of the actual global landscape of these programmes. One exception is a white paper commissioned by Advanced Development for Africa that lays out a series of case studies and provides best-practice recommendations from eHealth experts. Another paper reviews the evidence on the impact of eHealth in low- and middle-income countries. The aforementioned WHO survey of Member States’ utilization of m-health presents a systematic landscaping of health programmes; nevertheless, the survey relied on local government knowledge, which is often limited when it comes to the private sector, where much of the eHealth activity is taking place.
By analyzing health programmes in low- and middle-income countries that engage the private sector, our paper fills gaps in the eHealth literature and provides new insight into several central questions. It examines specifically the geographic distribution of technology-enabled programmes, the key issues technology can address in the health sector, and the key challenges posed by the adoption and implementation of technology for health-related purposes (Trevor, L, Christina, S, Gina, L & Julian, S 2011).
4- 2.11.1 Executive Summary
The eHealth Strategy study was assisted by, indeed in great part based on, design and implementation of eHealth solutions in several countries. This eHealth Strategy study also builds on the study of the Sudan requirements for TeleMedicine links, which was requested through and funded by the ITU, and which led to the actual operational start in April 2005 of a Sudan National TeleMedicine Network with pilot links between four remote general hospitals and Khartoum University Teaching Hospital.
At present, the Sudan health sector, led by the Federal Ministry of Health and the State Ministries of Health, is in the middle of a major, ongoing reform of the managerial technical and clinical aspects of the health sector, including the delivery of the medical care services. The underlying theme of such reform is to increase the capacity of the health care institutions (hospitals, health centres, laboratories, etc…) to deliver more and better quality medical care and to gradually strengthen these institutions to independently manage their own human, financial and other resources. These responsibilities were until hitherto the FMOH’s responsibility; but the FMOH is gradually limiting its role to setting national health policy and strategy, monitoring their implementation and progress thereon, and conducting evaluation and audit
One of the key features of the “ongoing reform”, referred to above, is the concerted effort to explore more, and increase the current, uses of “Information and Communication Technologies (ICT)” support to the National Health Care Services, including its clinical, public health and managerial aspects – referred to briefly as “eHealth support”. Cost-effective eHealth support is indeed the most worthwhile avenue for the Sudan.
This eHealth Strategy study started with a rigorous analysis of the requirements of a wide range of users in hospitals, health centres and their various technical and administrative support services, both in Khartoum and several other States. It also included an analysis of the capacities and potential for running and managing eHealth technological support
The study established, and recommended, the following Users Requirements to be adopted as the priorities for eHealth Support:
The following priorities are specified by, (Mandil, 2005):
1) The development of a National Health Information Platform that networks all the Sudan health sector institutions and supports all forms of communications between them this could be referred to as “Aafya-Net” or “Shabakat Al-Aafya”
2) The development of a National Health Care Management Information System, comprising mainly of MISs for hospitals and health centres, and aimed at the direct support of the day-to-day health care services. This NHC/MIS also sets the core for key services such as Electronic Medical Records
3) The extension of the current National TeleMedicine Network to ensure at least one site in each of the remaining 22 states, and to launch the TeleEducation services
4) The development of a National Health Data Dictionary to hold, and make publicly available, all the standards of data items and related procedures
5) The enforcement of a strict Digital Security on all eHealth support
It is recommended to start the implementation of the above five priorities. Nation-wide implementation could take 5-15 years. It is recommended to start with the implementation of a core of the proposed NHC/MIS in as many health care institutions as possible, initially a pilot of 12 hospitals and 12 related health centres. An approximate budget of US$ 5.3 million is proposed.
Much of the actual development work should be outsourced to contractors and local service enterprises. But, it is necessary and recommended that the MOH IT Team be strengthened in calibre and in number of professionals, to be the necessary professional counterparts to such services providers.
5- 3.8 Data Analysis Procedures
Data analysis is an ongoing activity, which not only answers your question but also gives you the directions for future data collection. Data Analysis Procedures (DAP) help you to arrive at the data analysis (Bala, 2005). The uses of such procedures put your research project in perspective and assist you in testing the hypotheses with which you have started your research. Hence with the use of DAP, you can
Understanding of the data analysis procedures will help you to
The literature survey which you carried out guides you through the various data analysis methods that have been used in similar studies. Depending upon your research paradigm and methodology and the type of data collection, this also assists you in data analysis. Hence once you are aware of the fact that which particular procedure is relevant to your research project (Bala, 2005), you get the answers to:
There are numerous ways under which data analysis procedures are broadly defined. Fig. 3.1 diagram makes it evident.
There are, in fact, a number of software packages available that facilitate data analysis. These include statistical packages like SPSS, SAS, and Microsoft Excel etc. Similarly tools like spreadsheets and word processing software are multipurpose and very useful for data analysis (Bala, 2005).
6 – 3.10 The Health Metrics Network (HMN)
The Health Metrics Network (HMN) was launched by World Health Organization (first edition 2005, second edition 2008) to help countries and other partners improve global health by strengthening the systems that generate health-related information for evidence-based decision-making. HMN is the first global health partnership that focuses on two core requirements of health system strengthening in low and low-middle income countries. First, the need to enhance entire health information and statistical systems, rather than focus only upon specific diseases. Second, to concentrate efforts on strengthening country leadership for health information production and use.
In order to help meet these requirements and advance global health, it has become clear that there is an urgent need to coordinate and align partners around an agreed-upon “framework” for the development and strengthening of health information systems. It is intended that the HMN Framework1 shown in Fig. 3.2 will become the universally accepted standard for guiding the collection, reporting and use of health information by countries and global agencies. Through its use, it is envisaged that all the different partners working within a country will be better able to harmonize and align their efforts around a shared vision of a sound and effective national health information system (“national HIS”). As shown in Fig. 3.2, the HMN Framework consists of two major parts:
Components and Standards of a Health Information System (left-hand column of Fig. 3.2) which describes the six components of health information systems and provides normative standards for each.
Strengthening Health Information Systems (right-hand column of Fig. 3.2) which describes the guiding principles, processes and tools that taken together outline a roadmap for strengthening health information systems.
A crucial early step in this roadmap is the need for an effective assessment of the existing national HIS – both to establish a baseline and to monitor progress. In order to assist countries in this key activity HMN has developed this assessment tool which describes in detail how to undertake a first baseline assessment.
Such an assessment is complex, as overall system performance depends upon multiple determinants – technical, social, organizational and cultural. Assessment therefore needs to be comprehensive in nature and cover the many subsystems of a national HIS, including public and private sources of health-related data. It should also address the resources available to the system (inputs), its methods of work and products (processes and outputs) and results in terms of data availability, quality and use (outcomes). Important “inputs” to assess include the institutional and policy environment, and the volume and quality of financial, physical and human resources, as well as the available levels of information and communications technology (ICT). In terms of “outputs” the integrity of data is also determined by the degree of transparency of procedures, and the existence of well-defined rules, terms and conditions for collection, processing and dissemination. Assessing “outcomes” should include quantitative and qualitative approaches, such as document reviews and interviews with in-country stakeholders at central and peripheral levels, and with external actors. Here are the defined six components of HMN framework (WHO, Framework and Standards, HMN, second edition 2008):
A number of other data-collection approaches and sources do not fit neatly into either of the above main categories but can provide important information that may not be available elsewhere. These include occasional health surveys, research, and information produced by Community Based Organizations (CBOs)