0Bangladesh is a densely populated country of around 150 million within an area of 150,000 sq. Kilometres with a per capita income of <1000 USD (700750). The medical professionals including specialist doctors are mainly concentrated in capital city Dhaka and other large cities along with the concentrated tertiary care hospitals. While most people are still living in rural areas, the disparity in health care delivery is easily apprehended by the distribution pattern of the medical expertise and healthcare facilities. The discrepancy opens the options of either establishing equipped health facilities in rural areas or improving the infrastructure so that the service providers feel motivated to stay in village and impart in health service, or to initiate an alternative to provide quality health care to rural areas. In this very aspect Telemedicine can play a vital in a developing country like Bangladesh. There have been small initiatives from some private organizations like BIRDEM, Medinova Telemedicine, Grameen Telecommunication Network, Bangladesh Telemedicine Services, DNS Telemedicine etc. along with personal correspondence like Canadian expatriate initiative with some professors through Grameen Telecommunication Network. But these are very much sporadic and the results of these initiatives are yet to be tested.
Computer literacy and skill is an integral part of activities in Telemedicine. However, medical professionals are not sufficiently skilled in computer literacy. Training of the medical professional, establishing infrastructure, initiating basic information system, protracted service system and sustainable feedback of the initiative would enable the vast majority of the medical professionals to get on board.
Cost effective service by staying away from travel and accommodation for investigation and consultancy would have been achieved. The family care environment would also be retained for the patient. The emergency services would have been prompt with specialized consultancy served from central to remote and isolated areas. The physicians working in rural areas get the mental strength of handling the patients in their vicinity and thereby the intellectual faculty development becomes a sustainable process.
The telemedicine service can be incorporated in health service networking system connecting the divisional districts with a central server based network. Through collaboration with developed countries telemedicine service could be widened to monitoring of cardiac, respiratory, diabetic, renal and other patients to combat emergency situation. Interactive Continuing Medical Education (CME) and training programs can be initiated to keep track of the latest advances and applications in medical technology and telemedicine. ITU can play a pivotal role to establish tele-consultation network. Robotic tele-pathology network is a dream with pathologists in Dhaka.
The main obstacles that are currently hindering the effort are security and confidentiality of data management, record keeping skill of the facilities, computer literacy, motivation and attitude of the service providers, scarcity of telemedicine supported equipment, patient awareness of the services, network connectivity and speed, cost of band width, and finally, government initiative, policy and support towards this growing demand of service provision.
Health service in Bangladesh is creeping and crawling with the developing economy albeit geographic barrier has become a live history. Medical knowledge should not be constrained by geographical borders. We want to think globally but act locally to bridge the digital divide.
0The Government of Ghana through the Ministry of Communications commissioned the development of the national Enterprise Architecture (EA) to serve as the technology blueprint for all Ministries Departments and Agencies (MDAs). It is believed that an EA can deliver that improved focus by enabling more informed decision-making and enhanced collaboration between agencies by highlighting opportunities for common solutions, information sharing and concurrent cost reduction. As part of the process, the GHS EA was also developed to enable the Service implement the appropriate e-Health solutions to improve the delivery of services to citizens.
The GHS is a Public service agency established under Act 525 of 1996 as an autonomous agency responsible for the implementation of national policies under the control of the Minister for Health through its governing Council the Ghana Health Service Council.
The GHS is an independent body with the freedom and flexibility to carry out is functions defined by the Act. The Service therefore needs to develop the appropriate strategies to support its mandate and the EA provides the perfect platform for the GHS to meet its responsibilities by defining the framework for technology selection and implementation strategy to improve health service delivery in the country.
The GHS EA is more than just technology architecture. It involves different architecture perspectives (Business Architecture, Applications Architecture, Data Architecture and Technical Architecture and security architecture), which are key to the implementation of an e-Health Programme.
The GHS EA describes the underlying infrastructure and provides the framework for aligning business and IT strategies of the GHS, enabling the integration of the GHS with organisations such as the National Health Insurance Authority (NHIA) and other international bodies.
The GHS has since adopted the EA reviewed and modified by GHS-EA review committee and has expressed its desire to start the implementation of the EA. It is generally accepted that EA implementation would enable the GHS meet some of its organisational challenges such as improving the delivery of service across the country and improving the efficiency of the Service.
The document serves as a comprehensive introductory paper covering the key aspects for a national rollout of the e-Health technologies. It also acts as a guide on how the different roles of national and local bodies as well as external consultants and Suppliers in the Programme will be achieved.
The Implementation Programme Strategy defines the necessary structures to minimise the risks of failures associated with technology projects in Ghana. It has been designed to avoid some of the mistakes made by other projects in the health sector, which have cost the government a considerable amount of money without delivering real value.
1.3.2 Programme Scope
The key aim of the e-Health Programme is to give healthcare professionals access to patient information safely, securely and easily, whenever and wherever it is needed. It is an essential part of the drive to improve patient care by enabling clinicians and other GHS staff to increase their efficiency and effectiveness.
The Programme is expected to cover all aspects of patient care, the management of facilities, assets and employees as well as the improvement of business processes under the control of the GHS. The scope of the Implementation Programme will be determined by a number of factors or constraints such as availability of funds. The Programme must also ensure the interfaces with other stakeholders such as the NHIA are effectively maintained by developing the appropriate solutions.
1.3.3 Key Areas to be Considered
The key areas to be considered include:
Electronic Health Records (EHR) an important element of EA is the widespread adoption of interoperable EHR. Effective use of EHR has the potential to positively influence both the quality and cost of health care for the nation. The EHR can improve quality by presenting clinical information and comprehensive patient data to the clinician at the point of care. This allows more informed decisions in a shorter time frame. Additionally, the cost of care can be decreased by streamlining data collection, decreasing the likelihood and associated cost of medical errors and by reducing resources used for duplicative or unnecessary information capture and testing.
Improving data sharing between the GHS and other national and international agencies. One of the key priorities of the Programme is the implementation of the appropriate data exchange mechanism in SDMX standards that will ensure timely and secure transfer of data between the GHS and the agencies, particularly the NHIA.
A medical billing system that will enable the health facilities to produce medical bills for the payer organisations such as NHIA. The prompt payment of bills is of immense priority to the GHS.
The need for the introduction of best in class applications to automate business processes such as Clinical Services, Public Health services, Scheduling and Capacity Management, Operational Research, Performance Management, Monitoring and Evaluation, etc.
A robust network infrastructure that will enable the GHS to connect the health and administrative facilities across the country.
The overall aim of the GHS EA is to move Healthcare towards a series of easily available, interconnected, reliable and efficient services. The EA is a model on which such solutions can be built.
The GHS EA presents a detailed analysis of the current state of the GHS’ business and ICT environments with the aim to improve services provided by the Service. It also provides a roadmap to move away from current applications and supporting technologies to an environment that better meets the current and future needs of the Service.