Healthcare is largely data-intensive and collaborative in nature, with considerable amounts of data processing and storage needs. Cloud-based solutions are readily available to users through the internet, lowering operating and storage costs, streamlining services, offering offsite capabilities, and updating easily. Cloud-based solutions are common and expanding in many sectors globally but what does it mean for healthcare in East Africa?

Timothy Otieno, Head of Information Services at Gertrude's Children’s Hospital in Nairobi, the largest pediatric hospital in East and Central Africa in service since 1947, weighs in on the subject.

1. How can cloud-based technologies impact healthcare in Africa?

Otieno: To begin with, cloud technologies greatly reduce the cost of setting up and operating healthcare infrastructures. Installation time with older infrastructure often take anywhere from a week to a month. Installation on the cloud takes an hour at most and then it is ready to use. Second, you save greatly in terms of space. Previously, technology required a large server room and cooling equipment in the facility. With cloud technology all you need is a modem for hard to reach areas. Third, cloud increases reach. For many health facilities, whether in the urban or rural areas, it was impossible to connect using the old native servers, but with cloud that is not an issue. Internet access and use of mobile internet continues to grow in Africa, increasing accessibility what feels like tenfold or even more.

Low cost of infrastructure, minimal space needs, reachability and access to information are key ways that cloud technologies will revolutionize the African healthcare context.

Lastly, cloud technologies improve access to information including data. For a facility, a practitioner can get the patient information they need more quickly and with the correct coding standards that information can be easily analysed. As more facilities leverage cloud-based technologies and go digital, the quality and standard of care will improve.

2. How is it best to transition to digital health solutions? When is a health facility ready?

Otieno: Great digital health solutions are available now; amHealth and others are so easy to learn that the transition is rather straightforward. Tech solutions can do exactly the same tasks that were done on paper, but in an easier, faster and more manageable way.

In my opinion, each and every clinic is already ready for a cloud-based health technology. It takes a bold step and confidence in the benefits.

I am proud to work at Gertrude’s Children’s Hospital which is now about 97% paperless, the only exceptions being our theatre and surgical rooms. We use one central system that can be accessed by all our 13 clinics, so regardless of which initial clinic you visit, any doctor from any of our clinics can still view your history which is quite useful as a patient may use different clinics. While we are still striving to be 100% on cloud computing, I believe Gertrude’s is a true leader of health technology use and implementation and quite advanced for health information system management in our market. One reason I appreciate Gertrude’s is that we are always ready to advance.

3. How should providers assess health technologies?

Otieno: A technology must address all the facilities issues and meet requirements such as security, confidentiality and coding in accordance to the rules and regulations of the country’s governing body. Secondly, providers should consider the ease of use, availability, and again the cost of set up. Finally, consider the potential impact of the technology. For example, amHealth has been phenomenal in East Africa; in my view, it can really simplify and organise the provider and administrative work by streamlining filing systems, appointment scheduling, and patient information and providing access to information from anywhere or anytime, even at home from a mobile device.

4. What are the main challenges for the uptake and use of digital health solutions in East Africa?

Otieno: The largest challenge for a user in East Africa is probably reliable connectivity and proper training. While many of the new health technologies are relatively simple, training is essential when introducing a new technology and making sure that users can get up the learning curve.

In terms of uptake, awareness about new technologies is too often lacking. Many large health facilities that are not new to technology still rely on big server rooms and like that you can see and touch the technology; many health facilities that do not yet use technology are not aware of the options or how to start. Again, training is beneficial to build awareness and show the ease of use and advantages to making the digital transition.

5. Are there additional challenges for the uptake of cloud technologies?

Otieno: I would have to say trust. We don’t trust that the data or information sitting out there is safe. We don’t know where it is or who is seeing it. Raising awareness alleviates this issue.

Trust for cloud technology will grow with continued use and from seeing reputable facilities comfortably using and endorsing new technology. -Timothy Otieno

Timothy Otieno

6. What are the main concerns for health facilities going digital?

Otieno: One real and justified concern here is “what happens in case I don’t have connectivity? Does everything come to a stop?” At Gertrude’s, we are almost entirely digital, so during internet downtimes we experience this challenge - the doctor cannot access patient history, the pharmacy cannot access the doctor’s prescription, and the lab cannot process reports. Another challenge is the transition and continuity of care from the old manual records. Facilities may be on the fence as to when to use the manual systems and when to leave them. The third concern is security. A facility can become vulnerable to hacking, security breaches, and data leakage, which can lead to other issues including legal issues.

7. How do you recommend health facilities face the challenges of electricity outages, uptake, and security?

Otieno: Challenges don’t stop us from progressing. During down times, a facility can access manual records in the interim. Records can be scanned and uploaded into a digital system while manual records can be used simply for referencing. My recommendations to facing down times differ a little based on location. For urban settings, which typically have access to more reliable power, I recommend having two data (internet) links so if an outage occurs and one link fails, they are still operational. Clinics in remote areas simply need to be innovative in how they power up, whether solar power or generators, and for connectivity, they can use mobile connections like modems as a backup.

Challenges in uptake and adoption are best addressed and managed with continuous training and increased awareness from seminars, educational drives and the like. Security issues largely have to be handled by the solution provider and there is little a client can do aside from ensuring that users within the facility are using it properly and not vulnerable to social engineering hacks such as disclosing passwords which can be curtailed in the training stage.

8. What advice do you have for clinics worried about security of cloud-based solutions?

Otieno: I have found that information in the cloud is actually safer than when it is within your physical premise. Most reputable cloud solution providers heavily invest in security. Conversely with server rooms, the security is only as good as the person who is setting it up in the beginning. In most cases they are not as well trained nor well experienced in security matters compared to a company like Microsoft who has the established cloud infrastructure Azure. The latter is far more advanced in security in my view than a server room set up.

9. How will digital health in East Africa change in the future?

Otieno: I mainly see opportunities. For instance, I envision Kenya having a central data resource; a patient, with only identification details, could walk into any hospital, even if they have never been there, and all their medical information could be accessed by the facility. Someone’s known allergies, medications and treatments would be retrievable and that would greatly improve the quality and efficiency of care.

Technology also creates great opportunities for collaboration among hospitals and practitioners. For example, one patient’s case can be reviewed by different doctors in various locations for the best care or medical schools can access information for training and studies at the touch of a button. Lastly, with increased access to internet, I believe more clinics can be set up in remote locations

In the East African market, we need solution providers to shout a little more about the healthcare innovations, we are still lagging behind in terms of uptake and the solutions are out there and ready for use.

10. What excites you about health technology in 2017?

Otieno: The prospect of integration of systems and getting to a point known as the “internet of things.” With everything connected to everything and to the cloud, we are talking about reduced interpretation errors during patient care. That’s quite exciting and revolutionary.

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