contextualizing digital health · who europe symposium on the future of digital health in the...

WHO Europe Symposium on the future of digital health in the European Region UN City, Copenhagen, Denmark | 6 February 2019 |

Contextualizing Digital Health Developing an Interoperable

Digital Health Ecosystem for the Future

Ramesh S. Krishnamurthy, PhD, MPH, PHIF Senior Adviser, Health Systems and Innovation Cluster

World Health Organization - Geneva, Switzerland


Key Messages

• Effective digital health system is needed for better healthcare delivery and better health outcome

• Functional digital health system depends on the use of appropriate standards for interoperability between and within information systems

• Establishing national digital health system requires ownership, legal mandate and effective governance, multi-sectoral engagement, appropriate use of ICT, and adequate human capacity


One Health

the interconnectedness of human health, animal health and the

ecosystem


Source: OIE, 2016; http://www.oie.int/for-the-media/onehealth/

One Health


Data Flo

w A

nalysis

Logical D

ata Mo

de

l

Re

po

rting P

latform

Data A

ccess

Data an

alytics

Ge

osp

atial refere

nce

Ne

ar real-tim

e fe

ed

back

Dash

bo

ard


Milestones of WHO’s work in

2000……………………………………………………………………………………..….2019


2000


eHealth - WHA Resolution

Source: http://www.who.int/healthacademy/media/WHA58-28-en.pdf

WHA58.28

Recognized the value that

ICT bring to health

2005


eHealth Global Forum

2012


eHealth Standardization and Interoperability WHA Resolution

Source: http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R24-en.pdf

WHA66.24

2013: Adoption of resolution on eHealth Standardization and Interoperability by 66th World Health Assembly

Recognized the value of adoption of standards for

interoperability and Health on the Internet

2013



2014



2015


Digital Health - WHA Resolution

Source: http://www.who.int/healthacademy/media/WHA58-28-en.pdf WHA71.7

Recognized the importance of digital health interventions and the need for

governance

2018

Space Science, Technology and Data for Public Health

2012-2018


2018

Digital Health is promptly represented


Digital Health Ecosystem

Source: OMSignal, 2016.Biometric smart wear equipped with accelerometer, a gyroscope, and a heart rate monitor

Source: Nike, 2016. Nike SS Smart Shoe

Source: Admares, 2018. Smart Hospital Source:JIRAROJ PRADITCHAROENKUL, 2017, Robotic advisory services


AMAZON Project (TEMPUS) Developed through ESA’s

Integrated Applications Programme

Field diagnostic device, enhanced with telemedicine and GNSS locatisation.

Commercially available as Tempus device End-to-End interoperability

Source: ESA 2018

Tele-health applications, connecting patients and caregivers

Source: Ivar Mendez, June 2015

examiner on-site: space station off shore rigs

hospitals doctors offices

ships aircrafts

patient‘s home research station

ASYSTED joystick or smartphone-app

presentation of control commands

ASYSTed examiner‘s system

expert in ultrasound scanning

change of probe position

ASYSTED expert‘s system

remote expert located at: control center

hospital doctors office

telemedical expert center

SATcom

terrestrial cellular

[email protected] www.asyst.care

Source: Dr Gerzer, German Aerospace Center, June 2015

Advanced System for Tele-guided Ultrasound Diagnosis

http://www.google.de/url?source=imgres&ct=tbn&q=http://www.conrad.de/medias/global/ce/9000_9999/9200/9240/9240/924011_BB_00_FB.EPS_1000.jpg&sa=X&ei=Hd9dVeO4K8OSU5OegdAP&ved=0CAUQ8wc&usg=AFQjCNGSHxDTc5LrUBvtA4Adtn0h6X3GXQ

http://www.google.de/url?source=imgres&ct=tbn&q=http://www.godandscience.org/images/ultrasound.jpg&sa=X&ei=9tpdVZKZJ4vcUfm_gYgP&ved=0CAUQ8wc&usg=AFQjCNGsdXKCfu4-cpleKJIFETEdQ1Oxhw

http://www.google.de/url?source=imgres&ct=tbn&q=http://us.cdn1.123rf.com/168nwm/ginasanders/ginasanders1307/ginasanders130700270/20785823-junge-frau-mit-telefon-headset-im-b-ro-in-der-auftragsannahme-vertrieb-und-kundenservice.jpg&sa=X&ei=4NtdVYnKNoayUe6jgcgB&ved=0CAUQ8wc4Xw&usg=AFQjCNEWjSvWFIBGYY1VWHMpZ7qe1Cb4lA

http://www.google.de/url?source=imgres&ct=tbn&q=http://www.godandscience.org/images/ultrasound.jpg&sa=X&ei=9tpdVZKZJ4vcUfm_gYgP&ved=0CAUQ8wc&usg=AFQjCNGsdXKCfu4-cpleKJIFETEdQ1Oxhw

Source: Ivar Mendez, June 2015

Robotics and health care delivery

Data from Diagnostic/Laboratory Instrumentation

ALOS and Topographic Maps

Bosnia (1/25,000)

Source: JAXA 2013

Topographic map from ALOS is useful in developing countries. Road network is essential to deliver vaccines and to visit medical facilities.

Surface Temperature by GCOM-C (Launch will be in 2016)

Example of MODIS Satellite

JAXA’s GCOM-C observes surface temperature,

which can be used for countermeasures of heat stroke.

Source: JAXA, 2014

Source: Dr Hatton, ESA 2015

•Spread of animal borne diseases

Tracking of spread of animal born diseases: Small Animal Tracking from ISS: DLR ICARUS Project

Polio eradication project: Locating sample sites on the satellite images and tracking over time

using JAXA’s 5-m resolution DEM data


What problem are we trying to address?


Problem we are attempting to solve Establishing standards-based interoperable systems

Indicator-based Records

Individual/Patient Records

Registries Diagnostics/Images Records

Seamless data

Exchange


Digital Health and Information System Complex


Common health-relevant data sources Information Needs and Tools at Different Levels of Data Collection

Source: HMN, WHO 2008


An Example of Health Information System A Set of Complex Sub Systems

Modified after Health Metrics Network, 2007.

HIS Sub Systems

Data

Warehouse

Monitoring

Evaluation

Research

Extract, transform and load data into warehouse

Census Vital Event Registry

Surveys Health Events & Risks

Health Service Records

Resource Tracking

Policy

Resources

Processes

Information

Services

Allocated Length-Of-Stay Utilization

0

100

200

300

400

500

600

700

Pa

tie

nts

Status 143 221 412 574 325 172 68 145

25% 50% 75% 100% 125% 150% 175% 200%

Allocated Length-Of-Stay Utilization

0

100

200

300

400

500

600

700

Pa

tie

nts

Status 143 221 412 574 325 172 68 145

25% 50% 75% 100% 125% 150% 175% 200%

DRG Cost Variance

-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

Variance 10% 4% -20% -21% 30% 8% 10% -17% -28% -13%

B02 E02 E04 E15 H01 H02 H03 H04 H10 J03

DRG Cost Variance

-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

Variance 10% 4% -20% -21% 30% 8% 10% -17% -28% -13%

B02 E02 E04 E15 H01 H02 H03 H04 H10 J03

Data Collection Forms & Methods

Statistical

Systems

Financial

Systems


Courtesy: HMN, 2007

Example of HIS Data Sources

Many Producers and Consumers of HIS Data

Ministries of Health, Finance, Education, Labour, Local Health Governments, Private Health Sector, Insurance Providers, Development Partners, etc…


Examples of earth observation data Near-real-time health-relevant earth observation data obtained from satellites

375 m Active Fire Aerosols Brightness Temperature Carbon Monoxide Cloud motion vectors (Winds) Cloud Top Pressure Clouds and Trace Gases Clouds/Aerosols Columnar Cloud Liquid Water over ocean Columnar Water Vapor over ocean Corrected Reflectance Imagery Dust Fire Global Rainfall Global Total Precipitation Land Surface Reflectance Land Surface Temperature Moisture Profiles Nitric Acid

Nitrous Oxide Ocean Wind Speed Ozone Profile Ozone Precipitation Radiances Retrieved Carbon Monoxide (Thermal Infrared Radiances)

Sea Ice Concentration Sea Ice Snow Cover Snow Water Equivalent Soil Moisture Sulfur Dioxide Temperature Total Column Ozone and Aerosol Index Total Precipitable Water Water Vapor

Source: NASA, 2017. https://earthdata.nasa.gov/earth-observation-data/near-real-time/download-nrt-data


An Example of Health Information System Conceptual Functional Categories of Country HIS

Health

Facility-

Based

Services

Diagnostic

Services

Community-

based

Services

Environmental (Monitoring)

Services

Health

Commodities

Infrastructure

Human

Resources

Financial

Resources

Information

and

Knowledge

Resources

Stewardship

Functions


An Example of Health Information System Primary HIS Sub Systems

Supply Chain Management System

Environmental Monitoring System

Patient Management System

Alert and Response System

Asset Management System

Knowledge Management System

Diagnostics Management System

Vital Statistics

System

Financial Management System

Disease Surveillance System

Human Resources Management System

Highlighted systems are often prioritized for standardization


Supply Chain Management System


Supply Chain Information System


Examples of complexity of data flow

within disease-specific Health Information Systems


Active Pneumonia Surveillance


National Public Health Data Flow


Framework, Architecture and Standards for Interoperability of Data Systems


Example eHealth Architecture: ISO TR 14639

Framework, Architecture, and Standards

A need for systematic approach to health information design, implementation and management


Architecture and Standards


Measuring Digital Health Systems Progress Over Time Figure depicting Countries at Various Levels of HIS Maturity

0

1

2

3


Digital Health Ecosystem and the importance of data standards


International Standards Road Traffic Lights Joint ISO/CIE Standard

ISO 6508:1999

CIE S006.1/F-1998

CIE S006/G-1998

Example of a Widely Accepted Standard


Standards Development Process


Simplified Standardization Process

Standards Development

Standards Maintenance

Standards Adoption

Standards Development

Organizations (SDOs)

Standards Setting Organizations (SMOs)

Designated Standards Maintenance Organizations

(DSMOs)

National Authorities (Implementation,

Policy, Governance)

Identify Need and Develop

Standards

Review and Update

Standards

Implementation of Standards


Standards Relevant to Health Data

• Data Standards

• Information Content Standards

• Information Exchange Standards

• Entity/Person Identifiers Standards

• Privacy and Security Standards

• (Functional Standards; Business Requirements)


Data Standards • Disease Classification

• Drugs Classification

• Laboratory Data Standards

• Digital Images

• Medicinal Products, Pharmaceutical Doses, Units, Common Terminology Services

• Clinical Procedure Terminology

• Pharmacy Terminology

• Nursing/HRH Terminology

• Payer Terminology

• Financial/Business Transactions Terminology

• Units of Measurements

Examples only (non exhaustive list)


Entity/Person Identifier Standards

• Patient Identifier • Provider Identifier • Employer Identification

Number • Country Identifier • Health (Insurance) Card

Issuer Identifier

Examples only (non exhaustive list)


Privacy and Security Standards

• Anonymization and Pseudonymization Standards

• Security Standards • Confidentiality Standards • Patient Consent Standards • Data Audit Trails

Examples only (non exhaustive list) B10


Digital Health in a Country Context


An information system to respond to functions of MOH

National Health Agenda

Function 1 Function 2 Function 3 Function n

Health Division/Unit


Representation of HRH Functions within MOH in a One Health Context

Essential Health Workforce Functional Domains

Essential Activity 1 Essential Activity 2 Essential Activity 3 Essential Activity n

National Ministry of Health Sub-National

Ministry of Health

Function 1 Function 2 Function 3 Function 4 Function n

Information Need 1 Information Need 2 Information Need n

Data 1 Data 2 Data n

Function-Specific Data Set

Information Need Data Need


Minimum Data Set Data Elements

Identification Number Unique Identification Number, Date of Issue, Date of Expiration,

Place of Issue

Full Name First name, last name, middle name, maiden name, other names

Birth History Date of Birth, Sex, Place of Birth, Etc.

Address Physical address

Contact Information Telephone number, email address, emergency contact name

Employment Status Employment status, employment title and occupational category

Data Submission Institution Name of the institution submitting data; date and time of

submission EOC Function-Specific Data Set

Data Elements that correspond to Data Set

Representation of Functions and Data Needs for Emergency Operations Centers


Representation of Functions and Data Needs for Emergency Operations Centers


Representation of Data Elements within

Health Workforce Registry Example: Birth History

Date of xxx


Example of dataset required for national unified health information system

Prevention Preparedness Response Recovery

Essential medicines list Essential medical devices list

GIS with shape files, base maps and commonly used layers

National pubic assets data (Airport locations, transportation hubs, Road network maps)

Health workforce data (all cadre)

Health facilities list (all types and levels)

Country-specific population data (national/sub-national level; projections, census, actual)

Satellite Imagery (various types and resolutions)

Other remotely sensed data (temperature, precipitation, terrain and topology)

Data set

required for

Complete list of diseases, health conditions

Supply-chain information

Data from Routine Health Information Systems (Health Management Information Systems, Routine disease-specific information systems;

other health information sub-systems; national emergency operations systems situation reports; NCD and environmental health data)

List of donor and partner agencies

Other

context-specific data

Subject-specific

financial Data

Outbreak-related

health data


Integrated Health Data Dashboard Strategic Health Operations Center


Prioritizing standards for implementation


Unified information systems for health

• Prioritizing areas for standardization – Facility registries

– Provider registries

– Health workforce registries

– National insurance schemes registries

– National Citizen UIDs (patient/person UIDs)

– Essential drugs and commodities registries

– Coding of high-priority diseases, laboratory values, terminologies

– Device-to-device interoperability standards


Data Standardization in Digital Health Ecosystems

Conceptual Framework for Country Capacity Development For utilizing Digital Health in advancing

health-related SDG targets


1. National readiness for using digital health in conjunction with routine health systems data

2. Multi-sectoral engagement for establishing digital health utilization environment in the national context

3. Alignment of stakeholders, strategies, and efforts

Components of the Framework


Conceptual Framework for Country Capacity Development For utilizing Digital Health in advancing health-related SDG targets

Established DH utilization environment

Emerging DH utilization environment

Established enabling environment for bigdata analytics

Emerging enabling environment for big data analytics

Experimentation

Strengthening digital health enabled environment for big data analytics

Strengthening infrastructure, make the case for digital health environment

Scaling-up and integration, cost-effectiveness, policies for privacy, security and innovation

Beginning of penetration of digital health infrastructure and computing environment

Established digital health infrastructure, governance, policy, standards, resources

Early adoption

Developing and building up

capacity

Scaling up routine use

Mainstreaming

Level 1

Level 4

Level 2

Level 3

Level = National Readiness for utilizing Earth Observation Data in combination with routine health systems data

National readiness


Multi-sectoral engagement

• Ministry of Health

• Ministry of Finance

• Ministry of Education

• Ministry of Labour

• Ministry of Telecommunications

• Ministry of Infrastructure

• Ministry of Science and Technology

• Academia and Private Health Sector

• Donors and Implementing Partners

Coordination is essential

to owning and sustaining

data analytics capacities

at National and Sub-national Levels

Examples of Partners within Health Information Landscape



Align Stakeholders

Value Chain of Solutions driven by Public Private Partnerships

Activities related to SDG 3 targets

Better

Health

Outcomes

(stakeholder’s positions vary depending on the model)



Value Chain of Solutions driven by Public Private Partnerships

Health Information Activities

Better

Health

Outcomes

(stakeholder’s positions vary depending on the model)

Align Strategies



Health Data Science

Human Capacity

Appropriate Informatics Approach

Desired Impact

Sustainable Approach

Reliable Data to Results

Align efforts to reduce gaps



Key Messages

• Effective digital health system is needed for better healthcare delivery and better health outcome

• Functional digital health system depends on the use of appropriate standards for interoperability between and within information systems

• Establishing national digital health system requires ownership, legal mandate and effective governance, multi-sectoral engagement, appropriate use of ICT, and adequate human capacity

contextualizing digital health · who europe symposium on the future of digital health in the...

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