The African Health Information Exchange Network: transforming chronic disease care

非洲健康信息交换网络：改变慢性病护理

• 批准号: EP/T029323/1
• 负责人: Andrew Boulle
• 金额: $ 17.93万
• 依托单位: University of Cape Town
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=EP%2FT029323%2F1
• 关键词: African; Health; Information; Exchange; Network

In most African settings, there is huge enthusiasm for the transformative potential of digital health solutions, especially given the availability of mobile technology. New digital health initiatives are frequently piecemeal, single-issue-focused, are responsive to select vertical reporting needs of donors, and do not interoperate or integrate well with routine health care information systems. Patients in long-term chronic care continue to be asked to visit over-burdened health facilities frequently, where they often experience long waiting times and receive very limited services. This frequent visit schedule occurs as this is often the only mechanism health services have of verifying that patients are in care, and of providing medicines and laboratory or clinical (e.g. blood pressure) monitoring. Clinicians are faced with incomplete information about their patients as details of care provided elsewhere are not readily available, and paper-based records sometimes spanning decades are poorly maintained and difficult to assimilate in short consultations. Health systems are poorly equipped to respond to patients who fall out of care, are being sub-optimally managed, or have multiple morbidities with poorly co-ordinated care, and as a result often fail patients.Pragmatically applying the principles of inter-operability where all solutions share a common unique client identifier, and interact with a health information exchange, requires long term investments and systems maturation. This approach however has immense transformative potential, especially if coupled with empowering patients through access to their own health data, and direct enrolment in digitally-supported programs which link to their government health profiles and services. Achieving this requires partnerships with local long-term stakeholders who are in the business of supporting public sector health care and digital health solutions, and who have the institutional memory to transcend changes in health service management and donor funding cycles. Sustained investments over time and long-term partnerships between civil society and government have helped to achieve some measure of digitization and interoperability for HIV and tuberculosis services, including in the proposed implementation sites for the currently proposal, initially in South Africa. The proposed network of academic, technical and industry partners who work directly with health service providers, seeks to extend and generalize these approaches to all chronic conditions, and to harness the potential of direct-to-patient communication opportunities which arise from patient-facing digital solutions. This potential is maximized when these patient-facing solutions integrate with a functional health information exchange. There are limited African jurisdictions where this is currently possible, but many more will come on-line soon as unique health identifiers and health exchanges become more widely adopted. The required technologies are well-understood - the challenge is pragmatically optimizing them in support of specific health objectives in unique health and technology contexts. Working with and adapting existing scaled technology platforms in the selected implementation contexts, the network and collaboration will: focus on developing these new patient-facing interfaces to directly support self-management and interaction with the health services; utilise direct-to-patient digital interfaces and the inter-operability and connectedness of all health service delivery components to assist government to provide patients with out-of-facility service options such as for medicine collection; ensure the ability to intervene efficiently when patients fall out of care, based on system-wide data availability; and, utilize system-wide data intelligently to enhance care at all levels based on cutting edge data-science techniques and associated data competence in government health services.

在大多数非洲环境中，人们对数字健康解决方案的变革潜力怀有巨大的热情，特别是考虑到移动技术的可用性。新的数字保健举措往往是零碎的、以单一问题为重点的，对捐助者选定的垂直报告需求作出反应，与常规保健信息系统不能很好地互操作或整合。长期接受长期护理的患者继续被要求经常访问不堪重负的卫生设施，在那里他们经常经历漫长的等待时间，得到的服务非常有限。之所以会出现这种频繁的就诊计划，是因为这往往是卫生服务机构在核实病人是否在接受治疗以及提供药物和实验室或临床(例如血压)监测方面的唯一机制。临床医生面临着关于他们患者的不完整信息，因为在其他地方提供的护理细节并不容易获得，有时长达数十年的纸质记录维护不善，难以在短期会诊中被吸收。卫生系统装备不足，无法应对失去护理、管理不佳或患有多种疾病且护理协调不力的患者，因此常常导致患者失败。务实地应用互操作性原则，即所有解决方案共享一个共同的唯一客户标识符，并与健康信息交换进行交互，需要长期投资和系统成熟。然而，这种方法具有巨大的变革潜力，特别是如果再加上通过获取患者自己的健康数据以及直接参加链接到他们的政府健康档案和服务的数字支持的计划来增强患者的能力。实现这一目标需要与当地长期利益攸关方建立伙伴关系，这些利益攸关方从事支持公共部门卫生保健和数字卫生解决方案的业务，并拥有超越卫生服务管理和捐助者资金周期变化的机构记忆。长期的持续投资和民间社会与政府之间的长期伙伴关系帮助实现了艾滋病毒和结核病服务的某种程度的数字化和互操作性，包括目前提议的拟议实施地点，最初是在南非。拟议的学术、技术和行业伙伴网络直接与卫生服务提供者合作，旨在将这些方法推广和推广到所有慢性病，并利用直接与患者沟通的机会的潜力，这些机会来自面向患者的数字解决方案。当这些面向患者的解决方案与功能健康信息交换相结合时，这种潜力得到最大限度的发挥。目前可以做到这一点的非洲司法管辖区有限，但随着独特的健康识别码和健康交换得到更广泛的采用，更多的司法管辖区将很快上线。所需的技术是众所周知的--挑战是务实地优化这些技术，以支持在独特的卫生和技术背景下实现具体的卫生目标。在选定的实施背景下，网络和协作将与现有的规模化技术平台合作并使之适应，将重点放在开发这些新的面向病人的界面，以直接支持自我管理和与保健服务的互动；利用直接面向病人的数字界面以及所有保健服务提供部分的互操作性和连通性，协助政府向病人提供设施外的服务选择，例如收集药品；确保能够根据全系统数据的可用性，在病人失去护理时进行有效干预；而且，根据尖端数据科学技术和政府卫生服务中相关的数据能力，智能地利用系统范围的数据来加强各级的护理。