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e-Health in the J'can public health system: Where are we?

Adella Campbell

Sunday, February 04, 2018

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In a recent visit to Estonia I had the opportunity to interface with aspects of their information and communication technologies (ICT) in health and was very impressed with their e-Health initiatives. I was compelled to contemplate Jamaica's progress in this area. Not only did I envision similar initiatives in our health system, but a system which could potentially improve patient care and the overall customer experience in the health system generally.

I am concerned that, as a country our e-Health agenda is lagging behind.

In brief, e-Health is the use of ICT for health (World Health Organization, 2005). e-Health integrates health care personnel. Most countries boast a national health information system which covers all residents from birth to death — a system similar to the proposed national identification system (NIDS), except there are no intrusive procedures such as an iris scan.

Generally, e-Health enables transfer of patient data between several health care professionals by way of health records. Requests for diagnostic tests and treatments are electronically done and results are obtained by similar route. It is not surprising that most health institutions and more than one million people in Estonia possessed and utilised e-documents. Medical data are online and include services such as e-laboratory, e-consultation, e-prescriptions, digital images, drug-drug interaction services, e-referral, and e-ambulance. Noteworthy, is that over 70 per cent of prescriptions in Estonia are sold by e-Health.

While these options are available to users, opportunities exist to network, create virtual health care teams, and collaborate with other team members. Users may also access support systems and standards which ensure delivery of quality health care services.

WHO e-Health agenda

e-Health is a gateway through which the sustainable development goals (SDGs) may be achieved. It is citizen-driven and may result in more sustainable health and social services and ultimately a catalyst for economic development. It is no doubt that at the 58th World Health Assembly, in 2005, the potential of e-Health to strengthen health systems and improve quality, safety and access to care was highlighted. For this purpose member countries were encouraged to establish mechanisms to incorporate e-Health into health systems and services. (World Health Assembly, 2005)

The WHO is confident that e-Health has an important role to play in achieving universal health coverage. This may be accomplished by adopting tele-health or mHealth (mobile health) to reach remote and underserved populations. Similarly, health practitioners may be trained through e-learning initiatives.

The Jamaican experience?

Jamaica is listed among 125 countries in the WHO Atlas of e-Health states suggesting that e-Health strategies, such as policies, funding, capacity-building, and necessary legislative framework to protect patients' data, inter alia, are in place. In addition, mention is made of the existence of telemedicine, mHealth, engagement of the population with social media, use of electronic records, use of e-learning in health sciences, and having a system in place to manage large amount of data (Big Data). Despite being very impressive on paper, the realities in the public health system cannot be ignored and, as such, this question: Are we serious about the e-Health agenda?

A recent item of news in Jamaica suggests that patient records will go electronic in 2018. I am ecstatic about this new development and trust that all stakeholders will embrace this move. I believe it is time we embrace this kind of technology as we seek to improve efficiency in the health system, improve quality health services, and ameliorate patients' and health practitioners' experience as they interface with the health system.

Benefits of e-Health

Benefits associated with e-Health are non-exhaustive. I will, however, highlight a few. e-Health impacts positively on the health care system by increasing efficiency. It fosters effective communication between health care providers and encourages active engagement of patients in the processes regarding services they receive. Correspondingly, it averts duplication of effort and procedures ensuring financial efficiency.

With patient involvement, e-Health provides a platform for quality care delivery. It is a system in which patients value not only drive the processes, but feedback on services is valued and concerns are addressed in a timely manner. Under this system, patients have the option of utilising services provided by revered health care facilities and practitioners. Further, e-Health empowers communities, families and consumers of health services thereby creating a patient-centric health system.

Additionally, barriers to accessing needed health services, such as long waiting time and geographic location of the health facilities may be addressed by e-Health, thereby improving patients' and health practitioners' satisfaction.

Drawbacks

How patients and their data will be protected under e-Health arrangements is a question that must be tackled in today's world. Privacy concerns have been found to be one factor negatively affecting acceptance and use of e-Health. During the exchange with my Estonian colleagues I questioned the ethical issues surrounding managing patients' data when utilising this platform. Responses suggested that the system while not 100 per cent secure (in my opinion) is meticulously designed with a built-in apparatus to minimise and avert any form of unscrupulous interference. A platform known as X-Road is used to secure and standardised the data exchange environment among users. In addition, some jurisdictions utilise a coding system among users to ensure privacy during the transfer of patient data.

Is there equal access and equity in an e-Health environment? Some segments of society could be disadvantaged under this system. Being mindful of our local situation, I foresee a potential widening of the gap between the rich and the poor, and rural and urban communities. Unlike in some countries, not all Jamaicans have access to information and communication technologies despite a large number of Jamaicans possessing at least two cellular phones. There is the perennial problem with accessing the Internet and having reliable connectivity. This situation could worsen during periods of natural disaster, for example in a hurricane or during period of heavy rain. For e-Health is to be a reality, it is prudent that sufficient resources be mobilised to support and sustain an efficient ICT network across the country.

All things considered, e-Health is not just a buzzword but a necessary initiative in the development of health care systems. The technocrats at the national policy-making level in both central government and at the Ministry of Health should move to adapt and implement the processes involved in making e-Health a reality across the entire Jamaican public health system. This will include seeing to the establishment of efficient and effective ICT arrangements as well as capacity-building in which the relevant personnel are trained to ensure sustainability.

Adella Campbell, PhD, JP, is an associate professor and head of the Caribbean School of Nursing at the University of Technology, Jamaica. Send comments to the Observer or adcampbell@utech.edu.jm.

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