- 1. Capacity-building for eHealth and Telemedicine: Strategies
for Developing Countries Alvin B. Marcelo, MD University of the
Philippines Manila National Telehealth Center
2. Outline
3. Definitions
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- is not a developed country nor a failed state
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- in the process of being a developed country
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- underdeveloped industrial base
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- moderate to low Human Development Index (HDI) score
4. Our topic does not cover these scenarios. 5. We cover these.
6. Current health situation
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- chronic, lifestyle diseases
- Inadequate compensation for health human resource pool
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- to other developed countries [external]
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- from rural to urban [internal]
7. Current health situation + = 8. Demands of the health
system
- Growing population requires more health professionals
- Devolution of health care makes allocation of scarce resources
more challenging
- Lack of doctors makes staff training a hit-or-miss
phenomenon
- Documentation of services for reimbursement and compensation
--> automation --> eHealth
9. Inventory of Existing Resources
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- residency training program
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- continuing medical education
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- professional board certification
10. Inventory of Existing Resources
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- masters of arts in nursing
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- continuing nursing education
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- professional board certification
11. Inventory of Existing Resources
- Allied Health Professionals/Midwifery
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- professional board certification
12. Gaps
- Not embedding in any curriculum the new knowledge and skills
needed to maximize the benefits of IT for the profession
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- Result: reluctant (recalcitrant) attitude towards IT-oriented
enhancements to the workflow
13. Gaps
- Teaching concepts that are not natural to the workflow of the
health worker
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- Example: teaching health workers word processing, spreadsheets,
and presentation software
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- Result: empowered trainee, but still unable to contribute to a
better workflow environment
14. Gaps
- Technology-centric training programs
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- Example: mouse and keyboard, workstations
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- Result: encumbered and harassed staff, bottlenecks in the
workflow
15. Challenges
- Teaching IT to staff who have not used computers all their
lives
- IT in areas with electricity only between 6pm and 12
midnight
- Two hours by bus, then four hours by motorcycle, then one hour
by foot
- Islands in the middle of the typhoon belt
16. Strategies 17. Strategies 18. Strategy #1: Consolidate on
EHR EMR 19. Strategy #2: Use Open Source
- free or low-cost (license-free)
20. Strategy #3: Adopt Modular Framework
- separation of logic and presentation
- coding standards and convention
21. Strategy #4: Build Concept Dictionary
- Attempt to standardize the language and vocabulary (local)
22. Strategy #5: Get Data Out Fast
- Embedding reports in the data entry application may not be the
shortest route
- Be open to third-party report generation systems
- Geographic information systems allow for more participation of
community members (closes the loop)
23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38.
39. 40. 41. 42. 43. 44. Training Tip#1
- Never let the participants use the computer on the first day of
training
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- they are nervous and apprehensive
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- they will project their fear onto your application
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- they will have misconceptions that prevent thorough
understanding of why they need to develop these new skills
45. Training Tip#2
- Introduce the concepts of information systems using structured
learning exercises/games
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- allow them to verbalize the difficulties (in the SLEs)
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- let them to identify their coping mechanisms
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- map the SLE concepts to information systems
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- this prepares the participant for the actual hands-on
training
46. Training Tip#3
- Eliminate the interface problem through the use of computer
games
47. Training Tip#4
- Make sure the application is useful to their work
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- documentation is part of their daily routine
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- do not ask them to do word processing, build spreadsheets, make
presentation slides if they won't be doing that when they return to
work
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- always revert back to the SLEs if you sense them having
difficulties
48. Implementation Tip #5
- Keep the design realistic and the budget small
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- involve staff in design [open source makes that possible in an
affordable way]
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- let staff grow with the system [makes them think the system is
their baby]
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- prevents formation of prima donna attitudes such as expecting
vendors to solve their problems [well you're paying them good money
aren't you? why should we suffer?]
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- close the loop by letting them act on their data (GIS)
49. CHITS is a Finalist in the 2006Stockholm Challenge
www.stockholmchallenge.se 50.