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What is your digital health wallet?

Monday September 30 2019

By BITANGE NDEMO
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In the not-too-distant future, the first question a doctor will ask you is: What is in your digital health wallet? Here is why.

Charles Bengo (not his real name), a 65-year-old farmer experienced some back pain and went to see a doctor at his nearby rural health clinic. The doctor gave him some paracetamol to treat his pain.

After a few weeks, he was back at the clinic, since the pain had not gone away. The doctor gave him a prescription to get a stronger painkiller containing codeine.

This too did not help much. He decided to go to a Level Five hospital where all manner of tests were done. Doctors here recommended that he exercise his spinal column while taking the painkillers he had been given earlier.

Four years since the pain started, he still was not doing well. His children brought him to the National Referral Hospital where it was established that he had renal cell carcinoma.

The doctors recommended surgery to remove what they called a small tumour. Surgery gave him a temporary reprieve before the pain came again. This time the family decided to transfer their father to India.

In India, several tests were done including some that were done at their Level Five hospital and at their National Referral Hospital. It was established that cancer had spread to other parts of the body.

The doctors recommended chemotherapy and several other medications. These interventions had other complications.

AVOID DUPLICATION

Mr Bengo lost his six-year battle early this year, leaving his family next to destitute after his ailments depleted their resources. There are many lessons to learn from his experience.

The first is the fact that the family could have managed his health record better to avoid duplications of tests at every level of treatment and to provide a consistent view of his medical history.

Like Bengo’s family, many families do not have the capacity to manage all their health records and as a result escalating the cost of healthcare.

In some cases, it is even worse when doctors have no visibility of the patient history to know what to avoid or recommend for the patient. This could change.

In their paper, Enabling Care Continuity using a Digital Health Wallet, Samuel Osebe, Charles Wachira, Fiona Matu, Nelson Bore, David Kaguma, Juliet Mutahi, William Ogallo, Celia Cintas, Sekou Remy, Aisha Walcott, and Komminist Weldemariam, all from IBM Research Africa, report their preliminary findings on how to best manage patient health records to improve health outcomes in a digital economy.

The team developed and tested the Digital Health Wallet (DHW) using blockchain (a distributed ledger system) that allows the patients to manage their data across separate health facilities and systems, and enables care providers to have a holistic view of the patient at all time.

Also, the DHW uses blockchain technology to preserve patient privacy. The patient can choose to share their data with other caregivers through consent for the purpose of understanding the history of their treatment.

The paper presented experimental results of the performance of the DHW in a resource-constrained healthcare facility in Western Kenya.

Preliminary findings show that “the DHW can be used to improve the efficiency of care coordination and patient referrals by supporting communication between care providers, eliminating unnecessary paperwork and reducing duplicate services. Such patient-centric systems could be useful in promoting patient engagement, enhancing medication adherence, safety, and effectiveness, and in providing patients with the opportunity to monetise their health data.”

Similar solutions are increasingly being adopted in much of the European Union countries, India and Australia. They leverage technology known as Electronic Health Records (EHR).

An EHR stores patient information electronically in a digital format. The aim of the DHW is to connect separate, disconnected EHRs across any number of health facilities where the patient may go for care, along with any other of their personal health data (for example, home blood-pressure readings, home glucose readings, and food journals).

SHARE DATA

The patient can have the data on their mobile and can share the data across different health care systems. The data can include radiological X-rays and scanned images, immunisation, medication, allergies, medical history, lab tests, vital signs, personal statistics like age and weight over time, and even physicians a patient has dealt with.

EHRs were initially used for administrative purposes and billing, and now have become integral for improving quality of care and medical research. Today, patient data is part of big data initiatives that have led to greater understanding of disease burdens for better health outcomes.

In some cases, EHRs leverages on data to prevent hospitalisation among the high-risk patients, thus improving quality of care.

India has been preparing the groundwork by developing their national EHR program and have progressed in four areas, that is, policy & regulations, standards & interoperability, ICT infrastructure, and research, development & education.

They are in the process of creating a secure health network, a health information exchange, privacy laws, an agency for health IT standards, research and development, and plan for human resource development among other activities they want before the systems are adopted.

The use of EHR will bring many other benefits such as management of pharmaceutical drugs that will improve the overall effectiveness and efficiency in healthcare that.

IBM Research Africa’s DHW innovation sets the country in motion to demonstrate global leadership in the adoption of novel healthcare technologies to consent and share health data across distributed and fragmented systems.

Such technologies are an important part of President Uhuru Kenyatta’s agenda for affordable healthcare in the country.

The writer is a professor of entrepreneurship at University of Nairobi’s School of Business. @bantigito