WELCOME Remember The Locals
Philipp Grätzel von Grätz, Editorial Director, HIMSS Insights
This issue of HIMSS Insights features, among many other interesting articles,
a debate on whether healthcare IT projects should insist on using international
standards at all costs, a brief exploratory article on the potential of big data
analytics in infectious disease surveillance, and a feature on mHealth projects
in sub-Saharan Africa. No doubt that these topics are not directly related to each
other. But related they are.
In many debates about foreign aid for improving healthcare in Africa,
mHealth has been hailed as the ideal tool to address the shortcomings of
specifically Southern African and Western African healthcare systems. As a
consequence, literally hundreds of mHealth projects have been popping up during
the last few years, some of them extraordinarily exciting. Many of these projects
receive sufficient media coverage early on. But in fact, it is the late stages of
such projects that should interest the public - sustainability of African mHealth
projects, or the lack of it, is a massive issue (p. 40-3).
The majority of African mHealth projects run dry sooner or later. And despite
the claims of all these sleek project managers who are pointing to the allegedly
low costs of mHealth, it is a lack of money that lets most projects fade away or, to
be more precise, a lack of integration into the local healthcare systems. If an extra
nurse or a co-ordinating office is needed for an mHealth project to survive, it is
naïve to believe that the local Ministry of Health will somehow arrange this. They
would rather pay for another surgeon.
Local structures matter. This is also true in the case of haemorrhagic fever.
Ebola is a disease that does not have to become epidemic. It doesn’t spread easily
like chickenpox does. Ebola can be contained, or could have been. This was
one reason why claims from the health 2.0-field received some attention - big
data tools for social media-based disease surveillance had identified the Ebola
outbreak nine days earlier than the official WHO announcement.
But as interesting as this might be, a delay in outbreak detection was
certainly not the crux of the problem. The Ebola outbreak got out of control not
because it was detected too late, but because some of the countries affected didn’t
have the capacities to deal with it. It will certainly be worthwhile to think about
improving infectious disease surveillance by incorporating web-based big data
analytics. In fact, this is being tried already (p. 36-8). But ultimately, what decides
the fate of an outbreak is the quality of the local healthcare system and/or the
speed with which international aid teams take over.
Local structures matter in Europe, too. The European Commission has itself
had to learn the lesson that extensively funded eHealth projects are at risk of
running dry when local peculiarities aren’t taken into account. The point is that
‘taking into account’ means more than just talking to local people. It can also
involve making concessions in the field of healthcare IT standards, should this
help to increase acceptance. In ‘The Debate’, we discuss whether ‘home-grown’
standards can progress eHealth or whether international standards only will pave
the way towards interoperability (p. 29-34). There are valid arguments from both
perspectives, but we are very keen to listen to your views on this, and the rest of
the topics, as always. n