Health Affairs: Sustained partnerships needed for global e-health

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Partnerships between academic and government institutions in high- and low-income countries can help establish health informatics programs which can capture and manage data that are useful to all parties. However, establishing effective partnerships in e-health will take time and sustained effort, according to an article in the February edition of Health Affairs.

“Ultimately, we must improvethe availability of electronic health information broadly inthe developing world, not just in an increasing number of targeteddemonstrations,” wrote William M. Tierney, MD, chancellor’s professor at Indiana University and the Regenstrief Institute in Indianapolis, and colleagues.

Low-income countries often lack the IT that is taking root in developed countries to manage health data and work toward evidence-based practice and culture, the authors stated. “Interdisciplinary/academic” and “private/public” partnerships are already helping to overcome obstacles and lead to further expansion and adoption of e-health, the authors wrote.

For example, Informatics Training for Global Health, a program of the National Institutes of Health’s Fogarty International Center, led to the use of OpenMRS, a free open source EMR system jointly developed by investigators from the Regenstrief Institute, Partners in Health and the South African Medical Research Council. The program supports research in low-and middle-income countries through collaboration among academic institutions, care providers and governmental agencies, according to the article.

OpenMRS was spawned by the Academic Model Providing Access to Healthcare (AMPATH) partnership, which includes more than a dozen North American institutions that have established a long-term relationship with Moi University in western Kenya. OpenMRS is an EMR system used in developing countries such as Kenya, Rwanda, Uganda, Tanzania and Malawi, and well as several facilities in the U.S.

To continue the spread of global e-health partnerships, the authors wrote, these steps should be taken:
  • Dissemination of information about successful partnerships, through regular meetings or other exchanges in which e-health partners share their methods and provide mutual support;
  • Funding of new multidisciplinary relationships among academic, public and private partners;
  • Support for mentoring relationships between successful and new partnerships;
  • Development of training programs including on-site, off-site and Web-based learning initiatives to support the effective use of e-health tools in developing countries; and
  • Ensuring local commitment. Health informatics initiatives will become sustainable and serve local populations only if those implementing e-health tools have a sense of ownership of these systems and believe that they will ultimately pay for themselves through increased efficiency of health systems.

Tierney and colleagues noted the following challenges, however:
  • Cultural differences and geographic distances can become major impediments to transnational collaboration;
  • Miscommunication and misunderstanding can be common, especially among inexperienced partners. Mentoring by experienced global health partners can help prevent and minimize such problems;
  • Maintaining funding and momentum for initiatives. Consistent funding can be difficult in resource-constrained countries. To avoid dependence on outside funds, developing countries can recoup investments in health IT through increased clinician productivity that the systems help achieve; and
  • Lack of consistent, basic services such as electricity and Internet connectivity.

Quoting John F. Kennedy, the authors concluded that "We choose to do these things, not because they are easy, but because they are hard."