Welcome to Room 2!

Policymakers, health service providers and community members face a myriad of challenges in rolling out or using telehealth services. These challenges relate to a broad range of issues, including policy and regulatory frameworks, governance structures, user adoption, digital literacy and capacity, infrastructure, as well as service quality, data safeguards, and institutional resistance to digital disruption.

This room aims to facilitate a discussion around the key policy and regulatory drivers, and other key building blocks, including those related to structural, capacity, technical and financial factors, for the effective introduction and scale-up of telehealth.

Please respond to one or more of the following questions, and indicate which question you are responding to in your post, don't forget to press "Comment":
  1. What are the technical, programmatic, policy or strategic factors that can drive or hinder the expansion of telehealth services in your country? These may include factors related (but not limited) to:
    1. governance and implementation of telehealth services;
    2. appropriate regulations and policies;
    3. integration of telehealth into the existing health system in your country;
    4. Interoperability;
    5. equitable access to telehealth services;
    6. sustainability and resource allocation;
    7. working with the private sector;
    8. mobile penetration and digital literacy of users and providers;
  2. What regulations are effective in ensuring data privacy and safeguarding against the misuse of data and technology?
  3. What are the key approaches in improving acceptance, broad uptake/usage and sustainability of telehealth services? How can service providers effectively build awareness and use of telehealth services among community members and health professionals, and promote their retention on these platforms?
  4. What approaches have been effective in promoting collaboration between key actors in the public and private sectors in the roll-out of telehealth services? Are there any examples of successful public-private partnerships?
  5. How can UNDP best support the introduction and scale up of telehealth? What should UNDP be focusing its efforts on?

 

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ūüí° Return to the¬†main group page for background information or go directly in Room 1: Country experience in implementing telehealth services.

Comments (95)

Calum Handforth Moderator

Week 4 Discussion Summary, 20 - 24 September 

Hi all,

I'm circling-back to wrap-up this final (extended!) week of what has been a very vibrant, and exciting, discussion.

Two particularly pertinent points that came up this week:

  • First, as with all things digital, we need to avoid being led by the solution. Any usage of tech must be founded on the context, needs, and realities of the user (including their aspirations). This point was highlighted by [~117328], [~117781], and [~117780]¬†who each reaffirmed the importance of telehealth solutions being integrated into clinical and broader healthcare workflows. If not, healthcare staff (and patients) won't use them.
  • Second, is the importance of standards. This is a topic that we come back to a lot in the case of digital health (and digital development more broadly). Standards are crucial for quality assurance, safety and security, but also in avoiding duplication as we develop solutions. [~94889]¬†shared her experience of ISO certification (fun-fact: there's an ISO for telehealth - ISO 13131:2021), and [~117780]¬†shared a number of broader guidelines and normative standards.

Thanks to all of you for sharing these details - and a sincere thank you to everyone who has participated, shared, liked, read, or browsed this discussion this month.

So, what's next?

We're now going to spend some more time digging into the fantastic insights, perspectives, lessons, and case studies that have been shared over the past few weeks. We'll then resurface with a more detailed summary of this consultation.

But, more importantly, we're going to be using what we've learned here to shape a UNDP value proposition and strategic approach to supporting countries who are exploring, implementing, or scaling telehealth services. Stay tuned!¬†ūüďĪūüíĽūüŹ•

Very best,

Calum (and the team!)

Kenechukwu Esom Moderator

Hello everyone and welcome! I am Kenechukwu Esom and I will be the moderator of the discussion for this week. I am a lawyer by training and policy specialist with UNDP working on human rights, law and gender, including the ethical and rights-based use of digital technologies in health.

The discussion that we are starting today is very important because in order to maximise the immense benefits of telehealth, key policy, regulatory and other critical building blocks are required. The COVID-19 pandemic catalysed the use of digital solutions to enable and enhance self-management of healthcare, facilitate remote access and support to healthcare providers and other components of the health systems. However, the pandemic also highlighted the complexity of delivering successful telehealth solutions in the absence of strong regulatory framework and infrastructure.

In this Room, drawing from your respective country experience, we will discuss the actors that can drive or hinder that adoption and expansion of telehealth; regulations necessary for guarding against the misuse of data; approaches for building acceptance and sustainability; what effective collaboration - especially between the public and private sectors - should look like; and how UNDP can support the expansion of telehealth services globally and in your specific context.

Please be open, and also respectful to each other. We really want to learn from what has worked very well and not so well in your country. Please feel free to write in the language you prefer, the message will be automatically translated. Welcome once again - we look forward to a productive discussion!

Leslie Ong

Hi all! I would like to start off by emphasising the importance of a national digital health strategy as a critical tool in enhancing the effective adoption and scale up of telehealth. The development and implementation of a national digital health strategy (or its equivalent) goes a long way in providing the blueprint for an enabling digital ecosystem and in guiding the digital transformation of the health system. It sets out a clear governance framework and defines the policies, regulations and laws that are needed to ensure effective and sustainable adoption of telehealth. The strategy should also identify workforce and institutional capacity gaps, and define key strategic priorities for digitising the health system, which in turn influences planning for resource allocation.

What else should a digital health strategy aim to achieve? What important factors must be considered when developing an effective digital health strategy? (Eg. Conducting a comprehensive digital maturity assessment? ensuring coherence with broader national digital transformation strategies? Etc.). What are some of the barriers to effective implementation of the strategy?

Kate Sutton Moderator

I dont want to disrupt your flow Leslie but we know that most technology and innovation leads strategy and regulation rather than the other way around. Governments are usually playing catch up to tech rather than strategy leading it. I think the UNDP could play a role in helping governments be anticipatory and create a space for enterprise and innovation to flourish in this space as I doubt any government strategy would be able to develop a strategy for what might come (strategy obviously needs to be done but Im arguing this happens in parallel) Whats more important in my mind is principals ie - are we ensuring people are safe and protected , do we have legislation that accounts for this across any telehealth/digital health product that might be developed. 

Leslie Ong

Hi [~111516] I don't think we're saying different things here (if I'm reading your comment correctly). The national strategy is not there to define "what might come", but to ensure, as you rightly say, the 'right' principles and legislation are in place, so that innovative technologies are introduced in an environment that is conducive to their effective implementation.

As you also rightly point out, UNDP has an important role in helping governments in creating a space for enterprise and innovation - exactly the type of action a national digital strategy would call for! 

You hit the nail on the head by saying that governments often play catch up to tech. Even though this is obviously the reality, it is something that really needs to change. For example, look at the never-ending battle between the US congress and big tech, particularly around issues of data use and data privacy. I'm afraid we can't just sit and wait for disruptive tech to come along before we decide to take policy and regulatory action against such infractions. The question is - how do we do this right / well? I'd imagine a (good) national digital health strategy goes a long way in providing countries with a blueprint for that.

Looking at it from the standpoint of 'innovation', do you know of any good examples of national strategies / policies that drive innovation (whether they relate to programme, policy or practice)?

Kate Sutton Moderator

SCALING: Im mostly interested in the scaling side of what the UNDP could do here. I think there are some really practical challenges for an organisation like the UNDP to take something to scale. There are a lot of great examples internationally of telehealth products and services but there are many challenges around data rights/privacy and security of data which we cannot guarentee in many places, the buying and selling of data etc. There are also challenges around quality and cost as well as the ethics of this.

So what CAN we do - should we be agnostic about the above and invest in a variety of start ups in this space who are already working in certain countries and trust the market or do we try and develop some public good products from scratch (we are not tech entrepreneurs or product specialists so this might fail! 

It feels a bit passive to just "promote telehealth" people need access, they need assurance etc. Interested in what others think!

Calum Handforth Moderator

Thanks for your input, Kate Sutton! 

Back to your earlier point about regulation and policy and best practice, is this perhaps an area that UNDP could play a role?

We see, for example in this (Asia-Pacific region), many governments haven't drafted or implemented digital or data privacy policies. Similarly, the telehealth private sector is very fragmented - with innovators duplicating work, and no established standards or frameworks.

Is there therefore value for UNDP in being a platform or steward of key aspects of telehealth - but not building solutions directly?

For example, we could draft and host 'model policies' for governments to accelerate their discussions and protections around privacy.

We could also look at identifying the 'non-negotiables' for those building solutions and start developing a common standards-base (e.g. hosting open-source code that others can build-into solutions to ensure privacy safeguards - like Flowminder has done to allow mobile operators to analyse data without revealing individual data)?

This also has broader links into other areas of digital health (like vaccine-credentialling) - but will keep this on topic!

I think this 'steward' or 'shepherd' role is particularly important for all aspects of digital in development, and is something that we've seen with open-source over the past few decades. But, there hasn't been a central advocate with the scale and reach (and credibility) of an organisation like UNDP. It also aligns well with UNDP's mandate as steward of the 2030 Agenda.

Leslie Ong

Great question [~111516] about defining how UNDP can best offer value (and I agree, it is probably not in developing innovative technologies - although others may disagree!). Part of the answer lies with understanding what our core competencies are, what country needs are and where we can make the biggest impact - all of which [~91917] touched on quite eloquently. Even if UNDP isn't the one driving the development of innovative solutions, I think the "multisectoriality" of UNDP's approach (as well as its scale, reach and credibility as Calum mentioned) offers significant value when it comes to promoting cross-disciplinary collaborations (and stakeholder coordination) and prioritizing resource allocation for digital health. I'd also add that UNDP has played important roles in the non-technology aspects of promoting the use of digital technologies, including the strengthening of digital infrastructure (see Philippines free wi-fi project) and building of the health workforce capacity (see eVIN project in India), which are critical 'building blocks' of an enabling digital ecosystem. [~106427] and [~93911] may wish to comment further

Mr Kevin From Aria Universal Inc

Hello everyone & the UNDP. Thanks a lot for setting up this fantastic platform to point out,learn , highlight several factors in health, ehealth  and i hope i ain't too late for this.

PS i'm following through the points  and Kate , great discussion again; just to emphasize while  I answer your question, In my opinion , the UNDP should adopt the role of an intermediary  an intermediary who can assist in forging partnerships between these private ehealth, telehealth players (start ups ) and  the Governments. I ain't sure if such is already in practice ,  but i believe an approach similar to this will be key; to serve as the first step  to assist create a sense of first hand approval for most of these startups' products, efforts , ideas & "new "technology solutions thus increasing the chances of Governments embracing/ considering  adopting those new solutions/ products since of course they have a UNDP approval or work history with other relevant health organizations etc.. . This will enable open minded /inclusive approaches when Governments are formulating policies i.e and even foster partnerships with the private players ,thus empowering lives across various nations.. As of now there's some sense of "mistrust" between technology players & governments. And the people who end up "suffering "  if i'm to use the word) . Are the Citizens, the people who really need instant access to highest quality healthcare affordable heath care solutions. 

While most start ups hold the key to these solutions , ideas,plus they've got the speed & energy to solve most of the challenges facing humanity today, governments are really slow and reluctant to adopt but if there's that partner that's  always ready to adopt/ accept most of these solutions and willing to put them to work.Then Governments will have no option but come, observe, learn,  to play along and even assist in faster adoption of these solutions.

Quick fact;  at my start up we developed a several ehealth based & this smart covid self diagnostic solution in first 3 months of  global widespread of covid cases and to date we never deployed it in our country since our government was never open to such ideas meanwhile  and surprisingly later when we outsourced the ideas to other tech players across the globe,  their  governments fully accepted the solutions /products and one product was used to save their lives.While my own country was reluctant to adopt the ideas to date.

So  i think its a matter of  convincing the other person across the table that such a solution is worth it . AND my best suggestion would be a good partner that readily accepts to test /work with it.

 

Thanks again

Calum Handforth Moderator

[~117835] Hi Kevin, thanks for the great input - and sharing your very important and particularly salient expertise. What should UNDP (or government) be looking to identify when confirming whether a solution is relevant? Is there a 'checklist' or similar that you had in mind - or key concepts or components?

We do a lot of work on digital readiness assessments, so there's also scope to make any checklist quite technical (e.g. alignment with data privacy requirements, ensuring interoperability with existing systems and standards, etc.). 

I'm also interested in your perspective as a startup working with governments. What do you think drives the 'mistrust' that you mention? 

cecilia oh

[~85614] [~111516] - On the question of national strategies for digital health, it is true that governments often play catch up to technology rather than lead it. But perhaps we need to think differently about strategies; that they are not about the technologies per se, but rather what governments (and their people) would like to see as outcomes of technology adoption. For example, how avoid unequal access to technologies, or how can/should technologies be evaluated before and after adoption to ensure they are still meeting the objectives for which they were adopted.

Also, as already noted, there are concerns about data rights and privacy. This is where national digital strategies can explicitly signal the importance of addressing these concerns. In this context, UNDP¬†¬†launched the ‚ÄúGuidance on the rights-based and ethical use of digital technologies in HIV and health programmes‚ÄĚ which sets out a framework for standards and good practices for digital health, regulations for ethical and lawful use of data.¬†The guide provides guidance on the need for data management policies and processes that not only ensures accurate analytics and efficient data flows, but also stringent data security safeguards that protect privacy and confidentiality of personal health data.¬†

Calum Handforth Moderator

Thanks for this point, Cecilia - just replying to give it a bit more prominence as I think this is a very important topic. I've spent quite a bit of time exploring outcome-focused regulation, and I think it has some real merit in the context of not trying to 'keep up' with technology. Instead, focusing on what equalities of access, opportunity, or other outcomes 'should' look like - and avoiding being prescriptive (as this can never be comprehensive). 

Manish Pant

Hi everyone...this is a very interesting topic to be discussing on and also very relevant currently. I will add my perspectives on this in multiple posts.

In recent times the COVID crises has  been a driver for an increased uptake of Telehealth (including its major subset - Telemedicine). This increase is mainly due to a rising demand from consumers, who are now more willing to utilize it and at the same time there's been an increased willingness amongst clinicians in providing tele-consultations. This has been useful for both parties as it reduces the risk unnecessary exposure to the virus.

With government's across the world committed on improving access to affordable healthcare to its citizens there is a felt need for legislative measures to govern telehealth. In most countries the legislative Acts are specific for health care - e.g. drugs & equipment, registration of clinical establishments, medical practice & ethics (these are examples from India)...or we have Acts on IT technology including data privacy and security which broadly govern the use of technology in healthcare. In India, we do not have a specific Act or Rule on TeleMedicine.

In the absence of legislative measures the next best option is for developing normative guidelines on Telehealth (specifically on TeleMedicine). These guidelines can provide a framework of incorporating digital technology into healthcare service delivery models. These guidelines should ideally provide norms for doctor-patient relationship, informed consent, continuity of care, referrals, emergency services etc. In addition, these guidelines can also expand on linking existing clinical protocols with the use of technology - e.g. medical data transmission through video, voice or text. The governments can mandate the development of these guidelines by the national registered medical body that provides the license to practice medicine (e.g. we have the Medical Council of India).

Having said this, I  believe that TeleHealth a great enabler in improving access to healthcare, but it cant replace the direct clinician-patient interaction especially for those requiring surgical or emergency care interventions. However Telehealth has an immense potential to bridge the service delivery gap for primary healthcare and referrals in rural, peri-urban, tribal and other hard to reach areas. A well managed tele-health program will strengthen the public health system for responding better to outpatient cases (which form the largest group of people who seek health care) and reduce the burden on secondary and tertiary care facilities that provide in-patient and critical care services.

I would love to hear from everyone on how the telemedicine is regulated in their countries (In India we dont have a law, but we have telemedicne guidelines).

Also in my next post, I will share my thoughts on the scale up of telehealth in the context of existing national digital eco-systems.

Nithima Ducrocq

To answer question 3, What are the key approaches in improving acceptance, broad uptake/usage and sustainability of telehealth services? I think we also need to look at telehealth from a tech product perspective. Telehealth company that prove successful look at both users:  the patient and the provider. Online consultation services is usually not enough to ensure usage and retention from both side. Whoever is designing the service (and I agree with  Kate Sutton, UNDP might not be the best tech-provider and/or product owner of such service) needs to understand their incentives to use those services.

When you look at telehealth services in the industry, they also provide the user content, instant chats and/or target specific users to give personalized content on specific topics (fertility, diabetes, etc.).

On the supply side of the telehealth service, it is important to understand (and test) what incentives the health worker will have using the digital service (even if it is a top-down decision, the product is more likely to work if their is a personal interest from the user). And if not, how can the service provider involve them in the project? 

To give an example, I was the co-founder of a mobile-health company focusing on sexual and reproductive health for Thai women. We designed some prototype of a extra-feature that would allow the user to connect with their OBGYN. We received a lot of positive feedback from the patients but all interviews with the doctors showed us that they wouldn't use yet another tool. They were very positive on the content we provided and we partner with the Royal college of OBGYN in Thailand to back up our medical content and disseminate it.

Calum Handforth Moderator

Thanks for this, Nithima! What was stopping the doctors from using the tool?

I think you've also highlighted a great point that sometimes is forgotten about. Often, the tech is the comparatively 'easy' bit. The hard bit is behaviour change, and organisational change management - i.e. getting people to use technology. There's a lot we can do better here, I think. Has anyone found methods that work well in driving behaviour change?

Nithima Ducrocq

Hi Calum Handforth, 

I think it was moslty lack of time and lack of integration of this tool with their current patient management system. I think what was interesting is that dotors likes some of the features - for instance, they really like the ability for patient to find more (reliable and medically backed-up) information because they usually don't have a lot of time to give them during consultation.

They also said that it was good for to have all the patient information at the same place.

However, when we show them the prototype they all said that it was still unlikely that they would use the tool. Most of them said they were too busy already.

Ana Guadalupe Argueta

Un saludo a todos, soy Guadalupe Argueta, m√©dica de El Salvador, labora en el Instituto Salvadore√Īo del Seguro Social en el √°rea de Pol√≠ticas y Estrategias de Salud, y les cuento que a partir de mi experiencia en la Telemedicina, proyecto desarrollado durante la cuarentena para paliar las necesidades de la poblaci√≥n y evitar riesgos los riesgos ante el Covid, estoy de acuerdo con Manish Pant, sobre que es crucial incorporar la telesalud y la Telemedicina en los modelos de prestaci√≥n y modelos de atenci√≥n de los servicios de salud a nivel nacional, en todas las instituciones prestadoras de servicios.

Al hacerlo, las instituciones deber√°n crear sus planes para la implementaci√≥n y el desarrollo de manera permanente, a√ļn despu√©s de haber superado la pandemia de Covid (y que se vuelva end√©mico). Esto parte por establecer hacia donde van encaminadas las pol√≠ticas de salud, y cuales son las necesidades de nuestros pacientes.

Al ser parte de las estrategias para brindar atenciones m√©dicas, podremos establecer el momento oportuno de brindarlas, ¬Ņser√° como puerta de entrada a los sistemas? ¬ŅEn la selecci√≥n de los pacientes para establecer su nivel de riesgo y asignar los mejores servicios seg√ļn sus necesidades? Se requieren para brindar interconsultas entre niveles de complejidad?

A mi juicio, es importante que la Telemedicina forme parte de las atenciones de primer nivel o establecerlas a√ļn antes del primer nivel, en un nivel anterior que ayude a los pacientes para ser m√°s eficientes y efectivos en su trato.

Es crucial que antes de establecer normativas, se elaboren las políticas de país con las líneas de conducción y el rumbo de la telemedicina, y a partir de estas de las necesidades de cada país, se establezcan las regulaciones necesarias para desarrollarlas.

 

 

 

Clara Aranda

Hola Ana Guadalupe,

Muchas gracias por compartir esta experiencia. Quer√≠a preguntarte si el ISSS tiene planes y pol√≠ticas para la adopci√≥n y gesti√≥n a largo plazo de telemedicina. Tal vez estas existen desde antes de la pandemia de COVID, ¬Ņpodr√≠as compartir un poco m√°s sobre la experiencia en el Salvador? Saludos, Clara

Kenechukwu Esom Moderator

Hello everyone and thanks for a really stimulating discussion.

[~111516] you raise a very crucial point on how effective government regulation of such a rapidly-evolving spaces as digital health and telehealth would be. In addition to government's important role of providing an enabling environment for innovation and technology to flourish, is there also a concurrent responsibility to establish and enforce standards [non-negotiables] that ensure that these technologies do not cause harm or result in violations of human rights? Is there an opportunity for UNDP to support governments in this respect?

[~91917] I love the idea of model policies and legislation to help governments accelerate their discussions, and ultimately establish effective regulation of telehealth. [~93911] on the governance of telehealth, and the question of legislative measures v. normative guidelines, do you see any advantages of one over the other? Some argue that tech companies can self-regulate and therefore the normative guidelines that they develop will be more effective than legislative measures which, as Kate highlighted, are not always as agile or up-to-date.

Thanks [~117328] for responding to the question on approaches to improving acceptance and importance of consultation with end users from the conceptualisation and design stage. As your example illustrates, the needs of end users will always be different and even within a particular group e.g. women of reproductive age, the experiences of sub-categories of the group will also be different [urban/rural, literate/illiterate, refugee/nationals, married/unmarried]. Is it possible therefore to develop a tool or service that has [near] universal end user acceptance? And are there acceptable trade-offs?

@Ana Guadalupe Argueta's point about the importance of re-evaluating and fine-tuning policies and programmes on an on-going basis based on patient experience is an important one.

I would also love to hear people's thoughts on approaches for promoting collaboration between key actors in the public and private sectors in the roll-out of telehealth services. Examples of successful public-private partnerships?

Manish Pant

Thanks Kene...in my opinion (and I also agree with Kate on this), legislative measures specifically on Telehealth might not be required in every country (perhaps larger ones like India or Indonesia may find it optimal for their context in the future). But its necessary to have proper guidelines on Telehealth (Telemedicine) prepared by an expert group - ideally a gazetted body of medical professionals under the mandate of the government. Essentially, the ethics and clinical protocols underpinning a telemedicne consultation are no different from a direct clinician-patient interaction (both in public and private sector) and should therefore be similar to guidelines that govern in-person clinical practice. Private sector may self-regulate themselves for sure, but that should be within the ambit of nationally approved guidelines - particularly for patient identification, case management, appropriateness of the technology, patient consent, data privacy, data transmission, documentation etc. 

Osama Mansour

I want to share some insights and experience about scaling up the telemedicine initiative in Libya for the first time.

As you may know, Libya is a conflict country, and institutions remain fragile. A significant proportion of Libya’s population does not have guaranteed access to good quality healthcare, most notably those who live in rural areas. Urban areas have many clinics, hospitals and pharmacies, while rural areas often lack or have fewer facilities available. As a result, many patients in rural areas travel long distances to access modern healthcare facilities in Tripoli and other major cities. Moreover, many specialist physicians are based in urban areas.

The Accelerator UNDP Libya mapped the telemedicine initiative to support the government in defeating the first wave of COVID-19. 

The main objectives of the telemedicine services are to strengthen the MoH capacity by introducing the telemedicine services in Libya that can serve and feed to two compounds:

  1. To provide safe consultation online through the utilization of telemedicine technology to enable a centralized and fully integrated network of Doctors, testing centres and medical care facilities to triage high-risk corona patients, provide them remote care, monitor patient recovery and coordinate patient hospitalizations for extreme cases.
  2. To reduce the load on the healthcare system by introducing telemedicine and enable patients to book appointments, remote treatments and provide e-prescriptions.
  3. Develop a Telemedince Strategy for the government.

The telemedicine project required tremendous coordination between the UNDP and MoH to agree on the proposal/plan. We had faced a considerable challenge in contracting with a Start-up that proved excellent capacity in implementing the project.
The UNDP allocated 150k to contract with a vendor who should work very close with MoH and UNDP/AccLab.

We contracted with a vendor through REQUEST FOR PROPOSAL.
It was the first partnership between the public and private sectors.

 

Currently, we are designing with the national partners the implementation of the second phase of telemedicine.

Reflections and Insights:

  • Before implementing an e-health/telemedicine project, ¬†the telemedicine strategy should be considered to develop with the national partners. This strategy outline essential elements such as data privacy, regulation/law, policies etc. and Law experts need to be involved.
  • Sustainability of the project‚Äď particularly the financial side, maintaining the platform, training etc.
  • Comprehensive data to be collected before the project‚Äôs design and mapping the health facilities across the country.
  • Implement the telemedicine initiative on a low scale, then scale up with some adjustments to improve.
  • Involve all stakeholders in the telemedicine project to ensure the success of the initiative.
  • Consider the best contract modality to engage with the private sector in rolling out the telemedicine project.

Materials: 

https://www.undp.org/speeches/first-regular-session-undp-executive-boar…

https://www.ly.undp.org/content/libya/en/home/presscenter/pressreleases…

I hope that helps. Please feel free to contact me for any further details. And look forward to going through the other insights and inputs. 

Many thanks,
Osama


 

Manish Pant

Congratulations Osama! You provide a very good example of how and why telehealth can be used to plug in gaps in service delivery in rural areas during covid times. I would be interested in knowing more about your experiences in setting up this platform in low resource settings -   the internet connectivity and digital literacy. Whats the initial feedback from the consumers?

Calum Handforth Moderator

Hi Osama, thanks so much for sharing! I'd be very interested in hearing more about what you learned from working with the private sector - and if there is anything you would do differently if doing this again. Did startups and other service providers inform the development of the telemedicine strategy?

Osama Mansour

[~93911]¬†Manish Pant¬†‚ÄstThe platform is designed to match the local internet speed and the communications infrastructure, where the user can use the application even at a low internet speed. ¬†Also, modern solutions and technology have been used so that the user can book an appointment and communicate with the doctor by calling over IP, which allows contacting the doctor in the absence of the Internet. The patient can obtain a medical consultation by direct calling from the platform. ¬†Also, patients can pay directly through the phone credit for the services, and this technology and solution is considered one of the most prevalent among all users.

Osama Mansour

[~91917] - thanks for your questions!

Next time I would consider using the responsible party agreement modality to engage with the private sector (startup or well-established company). 
Notably, a national telemedicine strategy should be developed far before the project is rolled out.
Next time, I would be more precise about property rights, who can run the platform within the MoH, the potential future development, scaling up plans,
Next time, I would go quite small but strategic (later, scaling up to create impact).
 

Leslie Ong

Hi [~40058] thanks for your insights and congratulations on your successes so far! I'm interested to know about the financial sustainability model, particularly around revenue generation and incentivizing health providers. We've are having a similar discussion in Room 1, where [~93308] has shared with us their approach in promoting sustainability of their Tele-ICU system (subscription-based, revenue-sharing model).

Kate Sutton Moderator

Hi all 

We havent quite managed to get a summary of last weeks chat up but thats okay. Im going to moderate the chat this week.  So far we have had a really interesting intervention from [~40058] which with some great videos I really enjoyed.  We are going to try and loop some new people into the chat too! Looking forward to hearing more... Kate

 

Kenechukwu Esom Moderator

Week 1 Discussion Summary, 23 - 27 August

Hi all, 

Looking forward to continuing our conversation this week.

Last week, we began our discussions of the framework that is required to guarantee effective delivery of telehealth, promote acceptance and guarantee the protection of rights. I had three key take aways from the conversation -

a. Telehealth, and indeed digital health requires strong governance and regulatory framework to be effective. This would include legislative measures and other normative guidelines; some contexts may be more conducive to one or the other.

b. Many countries lack comprehensive and coherent policies on telehealth, and given the fast evolving nature of this field, there was some discussion about the value that UNDP can bring to countries in this respect. One concrete suggestion made was the development of 'model policies and laws' which government can use to accelerate discussion and ultimately adapt to their contexts.

c. Consultation of stakeholders is critical to successful development and deployment of telehealth. On-going review and evaluation of telehealth including through user feedback is important for improving the telehealth service.

We had a couple mentions of private-public partnerships on telehealth but did not get into a discussion on what made them so successful so I am looking forward to more discussion on this. Thanks to all the contributors of week 1 and looking forward to the discussions in week 2.

Kebebe Bekele Gonfa

We need very urgent  telemedicine in ethiopia

Kate Sutton Moderator

Righto! thanks so much to [~92184] for his fab write up of week one - we are well into week two and keen to get some contributions from people. I am really interested in public private partnerships to make this stuff happen but worry about the ethical "stuff" with the private sector with regards to health. What do others think? where are there good examples of public/private partnerships in digital heath?

Laura Sheridan

Hi, very interesting points above. Just to add a bit more detail on our experience in Pakistan below. Given that we didn't have health specialists are part of the CO team at that time, we were really happy to receive the support of BRH and Singapore teams to help us focus on a strategic document which looks at the bigger picture of digital health and feeds into the wider Digital Pakistan Agenda being led by the Ministry of IT. Our AccLab has also been a great support to help link this work with our wider Digital Transformation Strategy which we felt was very timely. 

The draft strategy developed by the government with technical assistance from UNDP and others seeks to encourage national collaboration and to support provinces/areas in the achievement of improved healthcare service delivery, implementation of health strategies, and the achievement of universal health coverage and the health-related Sustainable Development Goals.

The strategy identifies the priority areas in digital health in the areas of communicable and non-communicable diseases, maternal and child health, emergencies and healthcare delivery, taking stock of the various existing digital initiatives in the health sector of Pakistan, identifying the gaps and opportunities and presenting the way forward in strengthening synergies between initiatives and stakeholders.

UNDP also placed 2 consultants (Senior Software Engineer & Junior Software Engineer) who designed and developed the Pakistan Health Information System (PHIS) dashboard whilst also assisting in upgrading the existing Pakistan Health Knowledge Hub.

Since the initial draft was completed by the consulting team, our major challenge has been ensuring sustained engagement of UNDP following the end of our 2020 COVID funding boom, while UNDP technical assistance was extremely timely and instrumental to draft the initial Digital Health Strategy document (currently under subsequent review) we were unable to sustain substantive funding for the consultancy team beyond 2020 and fund country wide consultations, as such other partners are now taking the lead on the strategy finalization, which is positive, but a lost opportunity for UNDP in my opinion. As UNDP is now taking on the role of Global Fund recipient in Pakistan, and thus hiring a new team of health experts we are hopeful that our engagement with the Ministry of Health can also ensure more sustained engagement in the TeleHealth Space. 

Kate Sutton Moderator

[~104518] thanks so much for sharing!! Great to hear your experience and I do understand how this stuff can happen re not being able to keep going at such a crucial time. What partners/NGOs others could continue this work for/with us do you think as well as our Global Fund work = this sort of work probably requires a movement rather than just one org? What do you think?

Which of the priorities areas do you think the govt are most likely to move on?

Laura Sheridan

On Kate's point on public/private partnerships, our partner Sehat Kahani is now trying to establish this kind of sustainable partnership where they charge private hospitals for the Tele-ICU service so they can subsidize public hospitals and are in discussions with various provincial health departments who really like the idea to see if there can be some public funding for this service. We are continuing to follow these discussions and hope to have some good news soon on how they were able to formalize this arrangement beyond our funding.  

Kate Sutton Moderator

Cool! I did a google search but do you have a link? I am really interested in which "bits" the public sector do and which "bits" private sector does. 

Jai Ganesh Udayasankaran

Last year during the first wave of Covid in India when the demand for ICU beds were high a critical care friend of mine and myself wrote an article "Tele-intensive care unit networks: A viable means for augmenting critical care capacity in India for the COVID pandemic and beyond" on the utility of tele-ICUs and how they can augment the critical care capacity in the country during the pandemic and beyond. While this is not about funding our work might provide insights for those who have plans to setup tele-ICUs. 

Jai Ganesh Udayasankaran

While the "Telemedicine Practice Guidelines" from Government of India had been intended for practitioners of modern system of medicine (allopathy), its release on 25th March 2020 was quickly followed by practice guidelines by the councils of traditional/alternate systems of medicine within a fortnight as well as the¬†Indian Speech ‚Äď Language and Hearing Association (ISHA) who brought out Telepractice Guidelines who brought out theirs few months later. Those interested in these practice guidelines may access them via the following weblinks. I am attaching their copies as well.

Telemedicine Practice Guidelines for Ayurveda, Siddha and Unani Practitioners by Central Council of Indian Medicine - https://www.ayush.gov.in/docs/CCIM_Telemedicine_Guidelines.pdf

Telemedicine Practice Guidelines by Central Council of Homeopathy, Ministry of Ayush, Gov of India - https://www.ayush.gov.in/docs/126.pdf

Telepractice Guidelines for Audiology and Speech, Language Pathology Services in India by¬†¬†Indian Speech ‚Äď Language and Hearing Association (ISHA) - https://www.ishaindia.org.in/downloads/TELEPRACTICE-GUIDELINES.pdf

These practice guidelines are meant to be living documents that will guide and promote the practice of virtual care especially in the current context of pandemic wherein patients find it difficult to access health facilities during lock down for in-person consultations and get periodically updated in terms of scope with time, developments in enabling technology environment as well as legislation like "The Personal Data Protection Bill, 2019" that are awaiting to be enacted by the parliament. 

Kate Sutton Moderator

Thanks so much for sharing [~117780] - who is responsible for keeping them "living" and how hard is it to do?

Jai Ganesh Udayasankaran

Hi Kate Sutton in the practice guidelines documents I had shared you may find a section on "special responsibilities" wherein the respective Ministry/the Central Council governing the system of medicine have mentioned the following:

  • Any of the drug-lists contained in Telemedicine Practice Guidelines can be modified by the Council / Ministry of...¬†Govt. of India from time to time, as required.
  • The ..... may issue necessary directions or advisories or clarifications in regard to these Guidelines, as required.
  • The Telemedicine Practice Guidelines can be amended from time to time in larger public interest with the prior approval of Ministry of ....., Government of India.

Also the Indian Speech ‚Äď Language and Hearing Association (ISHA) in their ‚ÄėTelepractice guidelines for audiology and speech, language pathology services in India‚Äô have mentioned that the document will be reviewed as warranted or in October 2023, whichever is earlier.¬†

From what I am aware the list of medicines permitted to be prescribed over tele-consultation had been updated at least once. 

 

Sean Blaschke

Very happy to be joining this discussion! I wanted to see if there were any ongoing efforts to document key functional and non-functional requirements for generic Telemedicine Services, and map these against existing Digital Public Goods. One of the biggest challenges we are facing is that many of our Government Partners know they want a "Telemedicine Solution", but 1) haven't identified the specific requirements needed, and 2) once these requirements are known, there are no resources (that I know of at least) to objectively assess options at this level of granularity. Is this something that others are working on, or would be covered under this group?  

Jai Ganesh Udayasankaran

Being an implementer to facilitate clinical consultations as well as continuing education/professional development of health and allied health professionals I would say the requirements will depend on the scope of services envisaged, type (store-and- forward/asynchronous, real-time/synchronous, remote monitoring) as well as the mode of delivery preferred. Assuming we are looking at an app or a portal, the wishlist of requirements/expectations will vary depending upon whether the user is a patient or a practitioner providing the service. In my opinion the most common or baseline requirement will be a audio-video interface, connectivity and means of clinical documentation (that can qualify as electronic health record). A vast majority of telemedicine in LMICs are either an audio or video call combined with or without text messages that might become prescription!

Gertjan van Stam

The actual feasibility and sustainability of telehealth depend much on soft/social factors. These can be, for instance, ‚Äėwho introduced who‚Äô, ‚Äėhow/who is talking‚Äô, and ‚Äėwho is involved‚Äô. The wholesome import of ‚Äėsystems from abroad‚Äô is more and more being frowned upon. Following ‚Äėin country‚Äô developments is regarded more and more important: a manner of ‚Äėdoing it right‚Äô. Thus, telehealth necessitates the drive of governments, involvement of local industries, but also national/regional knowledge centres as universities, hubs, and other expertise embedded in (and accountable to) the context. Possibly, the ineffectiveness of some of the existing policies might lie in the fact that they are often subsidized (including the provisioning of texts) from ‚Äėthe outside‚Äô, not congruent to the complexity of the context, and not being ‚Äėowned‚Äô.¬†
 
The participants contributing and shaping the "transnational framework digital health in international cooperation" ‚Äď developed during 2020 - were geographically balanced, taking into account the cultures and values base of the contexts involved (e.g., synchronising with ubuntu and Bien Vivir). The framework was approved for use by NGOs assembling in Medicus Mundi in Switzerland. The framework paints a picture of a decentering through community engagement, workforce enhancement, thought leadership, and system conciliation. Thus, it provides input for the processes needed of respectfully ‚Äėworking together‚Äô and provides suggestions on filling the voids between honourable intentions and daily practice.

Amitrajit Saha Moderator

Thanks [~99893] for sharing your insight re context; in-country developed vs. 'imported from outside' and the issues of national/local contexts, respect and the role of 'soft-skills'... thanks also for sharing the Medicus Mundi document from 2020... very, very relevant for us working in Africa...

Amitrajit Saha Moderator

Excellent interventions re telehealth in this room from a number of colleagues: [~93911] from India and [~40058] from Libya adds a lot to the discussion from real-life experiences as does [~117780] who shares his hands-on experience as well as a paper he wrote with a collaborator in the context of telehealth in India and from the Apollo Hospitals experience.

There's also been some excellent earlier interventions too--in what would be UNDP's 'niche' in providing government support for telehealth, digital health, etc. focusing on the fact that we mostly work in the policy space with governments; convene multiple interested stakeholders into dialogue spaces and support governments to transform their ideas and visions into reality. The other area of our intervention is also raising flags related to human rights (and risks of violations of those rights in pursuit of data/surveillance), client privacy, and confidentiality of data and to ensure that no 'harm' visits citizens as a consequence of using tele- or digital platforms for health care and other public goods.

As always, I am drawn to more fundamental issues whenever we discuss innovations and I would therefore like to seek some answers from colleagues in the 'know' related to:

  1. How do we support government departments in strengthening and increasing digital and telephony / mobile telephony penetration in many African jurisdictions? For example, a colleague from Ethiopia has entered a plea that Ethiopia needs telehealth as soon as. I completely agree since Ethiopia is a big country with varied geography and a large and dispersed population that often live in rural, arid/semi-arid conditions. Quite a few Ethiopian citizens live not only in remote locations, but have pastoralist livelihoods--that by nature of the way of life--precludes fixed point healthcare centres. Nevertheless, the country depends on a single telecom and internet service provider--which limits a lot of fundamental options of initiating and running telehealth systems. In such situations, how do we, as UN/UNDP support governments to reflect on the need for widening competition, increasing service providers, AND maintaining regulatory authority? This means working with not only ministries/departments of health, but also with departments of trade and commerce, ministry/dept. of telecommunications, security and policing, ministry of home, ministry of justice, etc. Unless such fundamental gaps are addressed--in Ethiopia as well as in many other African countries--the rolling out of necessary telehealth programmes will continue to remain beset with limitations and challenges.
  2. Ensuring participation of citizens and clients of healthcare services in planning of digital or telehealth--it would be interesting to know if there are guides or national experiences on how multiple stakeholders: citizens, government departments, private sector, human rights and civil society organisations, can be engaged when discussing the role of telehealth/digital health to address needs of communities and to ensure that safeguards regarding citizens' private information, confidentiality of data, etc. are protected.
  3. Capacity-strengthening of healthcare workers to transition from a face-to-face service delivery to a remote-based service delivery system. Would be grateful if colleagues could point out to tools/guidance/material available for training healthcare workers on digital/tele-health triage and online service delivery for mild-to-moderately illnesses. Focusing not only on Internet-based services but also on GSM/SMS/basic-mobile telephony based services. (As we know, smart phones and mobile and fixed line/Wi-Fi Internet are costlier to set up, procure and maintain than GSM-based phone systems, and a lot of preventative healthcare, including reminders for antenatal visits, vaccination days, alerts to pick up either DOTS for TB or MMD for Anti-retrovirals can be done via GSM / SMS-based technology).
  4. Use of remote controlled devices--robots and drones--to assist in facility-based or home-based care giving, in addition to tele-health consultations and triage functions--without diminishing the critical importance of the latter. Are there any experiences? For example, in Africa Rwanda began using robots in its fight against COVID-19. Also, Rwanda used drone technology during the pandemic. It would also be good to know from other countries where this is being tried.
  5. Financing telehealth services and systems is a final question/concern. How has successful telehealth/ digi-health interventions been financed? Particularly if the services are run by private players rather than the public health systems? During the pandemic, a number of such interventions were funded through government's domestic resources and through emergency funding from bilateral/multilateral institutions and through IFIs. However, once we move to telehealth as a norm, financing it will become a concern. Do we think we, as UNDP have a role to play in supporting governments to conduct national investment cases to understand how moving to telehealth platforms enables wider reach of public services while at the same time managing scarce resources to deliver better healthcare.
  6. Monitoring and evaluating the success (and/or failure, and/or challenges) in delivering telehealth and how they have fulfilled their objectives and whether they are cost-efficient to run and cost-beneficial for their clients--as well as fulfilling the task of providing necessary healthcare for all.
  7. Maintaining data privacy, national data ownership, client confidentiality and secure data storage are critical elements of any information system--particulalry that which depends of networked solutions to maintain and use. It would be beneficial for us to know how countries with big telehealth programmes are addressing these questions. We have learned a little of what India is doing; but would welcome some other examples.

Thank you, Amitrajit/Piklu (amitrajit.saha@undp.org) 

Jai Ganesh Udayasankaran

"Telehealth around the world: A global guide" from the global law firm DLA Piper is very helpful quick reference that sums-up the status of telehealth from about 45 countries. The guide documents responses to the following common yet important questions:

1. Is the use of telehealth permitted?

2. How is telehealth regulated?

3. Are there specific fields of healthcare in relation to which telehealth services are currently available, and do they involve the use of proprietary technology or platforms?

4. Does the public health system include telehealth services, and if so, are such services free of charge, subsidised or reimbursed? Where the public health system does not include telehealth services, are such services covered by private health insurance?

5. Do specific privacy and/or data protection laws apply to the provision of telehealth services?

6. How should the cross-border transfer of personal information collected and processed in the course of telehealth services be carried out to ensure compliance with applicable privacy laws?

7. Are there any currently applicable codes of conduct on the use of telehealth systems and/or security of telehealth data in your jurisdiction?

8. Are any specific laws, regulations, or self-regulatory instruments expected to be adopted in the near future?

Assuming there are colleagues from countries that are not covered in this guide and telehealth is being practiced widely it might be helpful if they can respond to these eight above-mentioned questions in their country context. 

Gertjan van Stam

Telehealth zero-measurements in 'the South' are often just benchmarks against what happens in 'the North'. Therefore, engagement means, first of all, carefully listening. Work registering 'the local voice' appears scarce. A recent example of recording and assessment of these voices in the area of telehealth is in press in the¬†African Health Sciences journal under the title:¬†‚ÄúConceptualisation and Practices in Digital Health: Voices from Africa‚ÄĚ (pre-print attached).

An example of how to engage communities in defining their own telehealth services is the hackathon in Masvingo, Zimbabwe, described in ‚ÄúEHealth: Connecting Communities for Health, Selected Cases in Zimbabwe‚ÄĚ

Amitrajit Saha Moderator

[~117780] Thank you---unfortunately, a quick glance through the contents tells me that no country in the African continent makes it to this guide. Although Ghana, Rwanda and a number of other African countries have been part of telehealth interventions... Nevertheless, an excellent handbook for a review of national situations. Regards, Amitrajit

Amitrajit Saha Moderator

I would also like to add a couple of more things:

  1. Reaching women and girls and vulnerable and marginalised populations through Telehealth and digital health interventions--is there any experiences that are out there where there was review of the telehealth program in the light of it's 'gendered penetration'? As we know, in many societies across the world, access of technology, including digital tech for women and girls are often limited and/or restricted by patriarchal norms and/or by adherence to 'traditional' cultures. Any experience of addressing the gender barrier through telehealth/digital health models would be critical for us to know if we are to 'leave no one behind'.
  2. I'd like to share this paper that I came across titled: "Intricacies of medical drones in healthcare delivery: Implications for Africa" (available here or https://edepot.wur.nl/548416).
  3. I would also urge colleagues to read the document shared by [~99893] "Transnational Framework Digital Health_extended.docx" to understand the criticality of ethics and local knowledge and context and ownership, as also the importance and centrality of environmental concerns when planning digital/e-health systems. Digital and electronic systems and hardware/software require energy, generate waste including toxic waste (batteries, etc.) and often lead to sourcing of minerals and metals for such equipment through exploitative practices including use of forced and child labour. So, we need to be cognizant and aware of these issues as well when supporting countries in rolling out 'e-health' or digital health.

Thanks you, Amitrajit/Piklu (amitrajit.saha@undp.org)

Kenechukwu Esom Moderator

[~88695] You raise a very crucial issue about the engagement and experience of women and girls, and other gender minorities in telehealth.

We know that globally, women and girls use the Internet 12.5 per cent less than men and boys. According to the International Telecommunication Union [ITU], only 5 per cent of women in the least developed countries [LDC] used the Internet in 2019, compared to 86 per cent in developed world. This 'gender digital divide' has serious implication for the design and uptake in telehealth in low - and middle-income countries where UNDP works.

The ITU identifies four main areas where this gender digital divide exists globally:

a. gap in access and use of the internet; b. gap in digital skills and the use of digital tools; c. gap in participation in science, technology, engineering and mathematics [STEM] fields; and d. gap in tech sector leadership and entrepreneurship.

Being aware of and addressing these gaps are key to improving acceptance, broad uptake/usage and sustainability of telehealth in any given context.

Mindful of this gender digital divide, I will love to hear how countries are promoting the acceptance and uptake of telehealth among women and girls.

Kate Sutton Moderator

 

Week 2 -  Discussion Summary, 30th August - 3rd September

Hi all

Following on from the great summary of week one here is the discussion summary for week two. Week three we will be joined by moderator [~91917] 

Here are my key takeaways from the conversation this week

  1. There was quite a lot of chat about how to successfully embed telehealth and digital health into country strategies.  Either supporting a Ministry of ICT/IT or a Ministry of Health to carry the torch for this work
  2. Identifying priority areas for strategies is very important - leading with the ‚Äúwhy‚ÄĚ ie stopping communicable diseases rather than the how being digital health and getting this balance right
  3. Ideally creating ‚Äúliving‚ÄĚ frameworks that can grow and adapt as time goes on and technology changes
  4. There was chat about how to actually get this work going after a framework has been created - this can be  hard to find suitable experts and ensure they can keep embedding this work 
  5. We got into how to implement a bit more - if ‚Äúdigital public goods‚ÄĚ are developed - how can we help governments to identify what they really need/want and then find the right people to help execute, they often struggle to define the needs and then products that are not needed are developed
  6. There is a growing interest in public private partnerships and how effective they are, understanding the ‚Äúpieces‚ÄĚ that each sector can put together is very important in rolling these services out
  7. There was a call for localisation of services or at least designing for communities rather than importing models from overseas. Some of this comes from the health part being so personal and trust based
  8. In terms of UNDPs role there was discussion about how we can convene and bring people together and how we have an ethical role to ensure no one is left behind in the development and delivery of digital health services
  9. We chatted about the digital divide and shared ideas about how new technologies could help develop the digital health sector further particularly in a development context.
  10. Some GREAT links and resources were shared this week  - thanks to everyone. If you scroll you can see them and click quickly through.

Thanks to everyone for the discussion - a few threads left hanging wanting some experts to jump in and share so id encourage you to do so in week three!

 

 

Mr Kevin From Aria Universal Inc

This is so great !

Stan Mierzwa

The increasing incidents surrounding cybersecurity breaches and cybercrime have come further to light during the recent global pandemic. More and more countries have turned to telehealth to provide supplementary and augmented access to health services. A growing and constant concern revolve around ensuring the telehealth products created, used, and maintained are protected from cyber threats to protect both the management stakeholders but equally, and even more importantly, those in need of health services.

An approach to help shed greater awareness of cybersecurity threats is to ensure global public health experts and technology engineers are familiar with the best practices. As such, a team I led developed an approachable framework that global public health researchers, practitioners, and implementers could introduce into their projects to help stymie the growing cybersecurity incidents - https://vc.bridgew.edu/ijcic/vol3/iss2/4/

In reviewing the threat of comments in this formidable forum, I see a few mentions of security. However, I would like to further raise awareness into the cybersecurity and cybercrime challenges integrated with telehealth that should be addressed.

 

Calum Handforth Moderator

Hi Stan, 


Thanks for sharing this. Very agreed on the importance of this topic - and would very much appreciate any thoughts you have on how governments and other regulators can work with the private sector here. I posted a question a little further down on this!

Best,

Calum

Calum Handforth Moderator

Hello, all!

I'll be your moderator for this week. It's been very exciting to follow the discussion in both rooms, and to hear more about your experiences and engagement with such an important topic. As a quick intro: I'm an advisor at the UNDP Global Centre for Technology, Innovation, and Sustainable Development - in Singapore. Prior to joining UNDP, I worked on digital and digital health interventions (from connectivity, to chatbots - and digital ID) in international development. I've also worked in consulting, and in government (on policy, legislation, and behaviour change). 

As Kene mentioned, below, telehealth is a very important topic. COVID-19 has reaffirmed the need for accessible and inclusive healthcare, and digital technologies have a key role to play here. But, these successes won't happen in isolation. 

We need to understand more about the barriers to implementing and scaling telehealh solutions, but also to identify potential opportunities and catalysts in this space. I'm particularly interested in what role regulation can play in protecting fundamental patient and citizen rights, but also how regulation can drive the roll-out of telehealth. Similarly, what technical factors are most important (interoperability and connectivity are big interests of mine) - and how can UNDP best add value across all of these areas, including in collaboration with the private sector?

I'm very much looking forward to hearing (and learning!) from you all! Feel free to message me on here (or via email: calum.handforth@undp.org) if you have any questions about the consultation.

Calum

Mark Wien

Hi,

I posted this in other room but relevant here as well.

We are a digital health and electronic medical platform that is currently most active across Africa and Asia. We have had quite a few experiences trying to integrate and work with telehealth. One of the big problems we have encountered is lack of interoperability, and lack of secure patient management systems that can be accessible for more stakeholders. Most of the work is on paper, patients don't have their medical history or doctors aren't able to pass on pertinent information to other health practitioners as patients move through the health systems. The lack of information and follow-up leads to significant waste, increased cost and decreased quality of care, and often worse compliance. Being able to ensure that patients records and telemedical visits transfer over to in-person points of care is extremely important and also improves resiliency of health systems.

This is a problem we are actively overcoming with our platform.

 

Best,

Mark

Clara Aranda

Hi Mark,

Thanks for sharing this. You mentioned that through your platform you are trying to help overcome the digitisation of patient records and medical appointments. Would you be able to share more about this? I was wondering if you could share some details about how you work with the implementation and management of change of practice. Thanks, Clara

Mark Wien

[~117791] I'd be happy to share more. In terms of implementation and management, we provide all training and support at no cost, and offer a free platform. We have other features such as multiple languages and customizability and are built and designed for a clinical setting taking doctors into account first. Most solutions are designed by people without a medical background and without taking the providers needs into account. Everything is about statistics and billing. We take a different approach. I am happy to share more, I contacted you on linked in.

Leslie Ong

Hi [~117843] thanks for sharing your experience and the solution that your platform brings! I'd like to know the challenges you face in navigating the fragmented telehealth landscape in the countries you're active in - what are barriers to introducing your technology in a new setting? what is needed to promote a more nurturing environment, from an innovator's perspective, for quicker adoption of telehealth solutions? [~117835] [~117820]  your perspectives on this question also welcomed.

Mark Wien

[~85614] happy to answer this. One note- we are not a telehealth platform, but rather an electronic medical record platform, so telehealth doctors use our platform for recording their visits and consultations and we can link to telemedicine platforms.

The three main barriers we have seen have been the same everywhere: connectivity, equipment, and on the public side you need Ministry of Health approval (sometimes ICT as well). With telehealth, you need connectivity so even having offline versions does not help. When there is connectivity it can still be expensive (cost of data, wifi). A doctor or facility also needs a smartphone, tablet, or computer.  We have found many facilities and doctors want to use new technology but the cost of connectivity or lack of access to equipment slows that down. We even have Ministry of Health approval in countries, and have seen pilots slower to begin as we will likely need to find partners to subsidize data costs or provide computers for those facilities and doctors.

 

Calum Handforth Moderator

Hi all,

Thank you for such great insights and discussion - and providing very varied and exciting perspectives!

A few of the points raised by [~111516] , [~117835] , and [~117834] made me think more about the regulatory environment for telehealth. There are very real and valid concerns about the safety and security of patient data. Similarly, working in (justifiably) highly-regulated sectors presents a very real challenge to startups and innovators. 

In this context, are there other models of regulation that we can be thinking about? [~82470] mentioned outcome-focused regulation earlier, which I think is a very important initiative. But, what about other approaches like regulatory sandboxes?

Keen to hear your thoughts!

Calum

Amitrajit Saha Moderator

Dear [~91917] -- I was struck by the example of regulatory sandboxing in Singapore that you shared. There's an interesting paper arguing in favour of regulatory sandboxing focusing particularly on the feedback of end-users' in the context of scaling up e-health/digital health. The authors argue, using the Indian example, of the need for such regulatory sandboxing to address/counter what they call e-health 'pilotitis'. The paper is titled "Regulatory Sandboxes: A Cure for mHealth Pilotitis?"

Calum Handforth Moderator

Hi Amitrajit Saha, thanks for sharing this! A very interesting read, and some very exciting potential too.

Stan Mierzwa

Greetings everyone!

There do exist other more formal certifications that can be approached or followed with regard to information security.  Some to consider are the HIPAA regulations in the United States, or the International Organization for Standardization (ISO) and the International Electrotechnical Commission (IEC), via the ISO/IEC 27001 information security management framework. These guidelines and regulations help to ensure that organizations, involved in privacy and health related information is put front and center with security. 

For those organizations developing telehealth solutions, in the world of global public health, having the ISO/IEC 27001 accreditation can be bring confidence to the market for the consumers. 

Best wishes,

Stan

 

 

Calum Handforth Moderator

Week 3: Discussion Summary (6th - 10th September)

Hi all,

Thank you for another great week of very interesting - and important - discussion! I've definitely learned a lot! And it's been very helpful to have a real variety of perspectives, including from our friends in the private sector. 

A few points that I think it's important to mention:

  • Cybersecurity and data security are not just the responsibility of government or regulators, they should be priorities for all of us. Stan shared a very useful proposal (below) on integrating cybersecurity awareness into public health training - and also some international certifications that could be a guide (HIPAA in the US, and ISO/IEC 27001). I think this is a very important consideration.
  • There are still some very real challenges around digitalisation. Interoperability (I'd like to share this great video from PATH on this topic) is still a big issue, and can constrain the usefulness and impact of telehealth - and other digital health - solutions. Similarly, affordable and high-quality connectivity is a challenge in many settings. And lack of (or lack of access to) hardware and other equipment.¬†
  • There was also a broader mention of regulation, building on some topics raised last week. There are very valid concerns about the safety and security of patient data. Similarly, working in (justifiably) highly-regulated sectors can be a challenge to startups and innovators. We heard a bit about outcome-focused regulation last week (to avoid having to play 'catch-up' with the tech sector), and I'd be very keen to hear perspectives on other approaches next week. For example, regulatory sandboxes.
  • We need to found everything on the needs and realities of patients, and the local context. This includes working closely with patients in co-designing solutions - but also understanding the perspectives and priorities of healthcare providers. It's more than just 'statistics and billing'. Another opportunity for me to also highlight the Principles for Digital Development, which UNDP supports.

There have also been some great resources shared over the past few weeks. I'm enclosing a few here for reference (I've missed many others, but just wanted to mention a few that came up in discussions this week):

  • eHealth for service delivery in conflict: a narrative review of the application of eHealth technologies in contemporary conflict settings - a useful overview of how telehealth is improving health outcomes in conflict-affected settings. Link.
  • Telehealth around the world: A global guide - from the legal firm DLA Piper. This looks at the regulatory environment in a number of countries (although many important regions, particularly Africa, are not represented). Link.
  • Digital Health in International Cooperation: A Transnational Framework - a very thoughtful and important read from Medicus Mundi, which reaffirms that telehealth must be led by patients and not by technological solutions. Link.
  • Proposal for the Development and Addition of a Cybersecurity Assessment Section into Technology Involving Global Public Health - as mentioned above, a useful consideration as to how we can integrate cybersecurity in public health training. Link.

We also have UNDP's Guidance on the rights-based and ethical use of digital technologies in HIV and health programmes.

Looking forward to the discussion next week!

Best,

Calum

Amitrajit Saha Moderator

Hi everyone, I am very excited to be your moderator for this 3rd and final week of this e-consultation. I am [~88695], Team Leader for HIV, Health and Dev Projects in Africa for UNDP. I have been with the UNDP Africa team for the last 10 years, and have supported countries in Africa and regional entities of Africa in assessing problematic and punitive laws pertaining to health, HIV, SRHR, that adversely target (and often harm) the lives of ‚Äėkey populations‚Äô (i.e. sex workers and their clients, gay men and other men who have sex with men, transgender people, people who inject/use drugs, and persons in incarcerated settings‚ÄĒincluding prisoners) in the context of HIV and AIDS, LGBTI communities, and young women and adolescent people (including young ‚Äėkey populations‚Äô). We have supported the regional formation of an African Judges‚Äô Forum (which is an active forum of senior judges from across Africa, who have also deliberated on the impact of the COVID-19 pandemic in Africa), support parliamentarians and other stakeholders in addressing punitive laws that disproportionately criminalise/impede access to much needed health and other services.

I think this background and context is important‚ÄĒas we work in a continent that has some of the fastest growing economies on the one hand, but has some of the poorest and badly-served countries, post-conflict, in-conflict countries on the other‚ÄĒin addition to having remote and daunting terrain, poor transportation and connectivity, and high burdens of hunger, deprivation as well as communicable disease burdens of HIV, TB, malaria, and local epidemics of Ebola Virus Disease, etc. It is was in this context that Africa was ‚Äėstruck‚Äô by the COVID-19 pandemic‚ÄĒthat you know, may have ‚Äėhit‚Äô African countries a little later than in other parts of the world, but nevertheless has had more devastating impact on lives, livelihoods and economies of many African nations‚ÄĒwhich were well on way to addressing some of the critical issues facing them through economic growth, reduction in poverty, increase of innovations and technology, etc. Unfortunately, COVID-19 pandemic seems to have hit some of these countries hardest, wiping away hard-earned development gains, and may even plunge many economies further into indebtedness. Particularly, 10 African countries are responsible for 80% of the COVID-19 cases in sub-Saharan Africa and some of the effects of the COVID-19 pandemic in the continent can be found here.

As you will appreciate therefore, this conversation around e-health and telehealth become quite critical for African countries. We must remember that in addition to the COVID-19 pandemic, sub-Saharan Africa also has, by far the largest number of people living with HIV and AIDS. As WHO pointed out in a news release on May 2020, COVID-19 related service disruptions could ‚Äúcause hundreds of thousands of extra deaths from HIV.‚ÄĚ

In addition, we need to remain cautious about the ‚Äėpossibilities‚Äô of surveillance and other harm that may face citizens with widespread use of telehealth: as a number of articles have pointed out, there has been evidence of widespread discrimination against citizens during lockdowns in many African countries. Further, LGBTIQ and transgender people were adversely affected by state players in addition to being deprived of access to care and community comradeship. Finally, domestic- and gender-based violence during the pandemic disproportionately affected women and adolescent girls.

I appreciate that lots of great knowledge and experience has been shared by colleagues‚ÄĒboth within and outside the UNDP on how to strengthen national and local capacities for the delivery of e-health/telehealth services‚ÄĒhowever, I‚Äôd like to see, if possible, inputs from colleagues that focus on some of the challenges: of human rights, cyber-crime, acceptance by community, risk of state-led surveillance; inclusiveness in rolling out of e-health/telehealth services, etc. also during this week‚Äôs deliberations. (For example, during earlier part of the Pandemic response, quite a few countries in Africa requested UN agencies to support procurement of electronic 'tags'‚ÄĒwhich are used to 'tag' criminals‚ÄĒas a method of tracking COVID-19 patients‚ÄĒthese are tendencies about which we must, as UN, remain vigilant). If I may also challenge you to think infrastructurally as well: the issues related to distant locations in harsh geographies; communities living in remote location that are off-grid for electricity; use of alternative energy sources to power telehealth/e-health, etc. We also need to keep in mind the nearer urgent reality of supporting COVID-19 vaccine equity in African countries through use of e-health/telehealth/digital health interventions‚ÄĒa region that has suffered most from inequity and lack of reach of vaccines. In comparison to other parts of the world, as BBC reported on 11 September, only 3% of population in Africa have been fully vaccinated in comparison to 65% in the UK.

I look forward to reading your inputs. As you know, your inputs can be in English but the platform can also translate the text of pages into over 100 languages (use the ‚ÄúSelect your Language‚ÄĚ option at the top right of SparkBlue). So use this function to translate comments in other languages, and feel free to post in the language you feel most comfortable with. At the end of this week, I will pin a summary to the top of the page; and we shall also do a summary of the deliberations and rich discussions that has happened on Room 2 during the entire 3 week. Thank you all for your kindness and for your willingness to share experiences, knowledge and insights.

Amitrajit (amitrajit.saha@undp.org)

Kaloyan Kamenov

Hi everyone,

My name is Kaloyan Kamenov and I am a technical officer in the disability programme of WHO. I recently got to see the background paper you have been working on as well as this great initiative.

While going through the document, I noticed that the topic of equal access to telehealth services for certain populations such as persons with disabilities is not covered. We know that during the current Covid-19 pandemic, the use of telehealth services has increased substantially in many countries and telehealth has become a basic need for the general population. However, we also have a lot of evidence that due to the lack of global comprehensive standards and guidelines for accessibility of telehealth services, many persons with disabilities experience difficulties accessing and using such services and are often forgotten.

For example, we know that most telehealth platforms are not compatible with screen readers or assistive devices (e.g. Braille keyboards), which impedes persons with vision impairment to get the services needed. Or captioning is not available which is a difficulty for deaf or hard of hearing persons.

Therefore, WHO and ITU initiated the work on a global standard for accessibility of telehealth services, which aims to summarize and define those technical requirements and features that the industry and healthcare providers can implement to ensure accessible provision of telehealth services.

For the development of the document, we did series of literature reviews adopted and consulted closely with civil society including persons with disabilities and their representative organizations, as well as the industry. The starting point in the development of the document was the identification of challenges and barriers that persons with disabilities experience when accessing telehealth services. After a complete set of challenges was defined, the corresponding requirements to address these barriers were determined. A workshop organized by ITU with the participation of representatives from the industry was held in June 2021 to obtain their perspective and input on the document. 

The recommendations included in this standard are built around groups of persons with disabilities with different impairments. For example, we have recommendations for persons who are deaf or hard of hearing, for those who are blind or with vision impairment, for persons with psychosocial disabilities, etc.

The document is in draft form right now and contributions are still welcome, but we hope to have it published early next year.

I am writing all this for two reasons. Firstly, it would be great to open a discussion here on this important topic and hear what others think. Secondly, our team will be happy to provide input to your document with some concrete suggestions if there is still time for this. I am not sure when you plan to publish it, but if it is more or less at the same time as the WHO-ITU standard, a reference to the standard could be made.

Many thanks,

Kaloyan

Amitrajit Saha Moderator

Dear Kaloyan:

Thank you for your contribution related access to telehealth for people with disabilities--particulalry visual, auditory and for those with mental health issues. It is heartening to learn that the WHO and ITU are convening to develop guidance on telehealth standards for improving access for persons with disabilities--and are working with both communities and supply side (industry). I was wondering if convenings have included people with disabilities from across the world, or has such consultations been restricted only with people with a common language and/or geography? Be that as it may, we'd be eager to learn more, and also find out how our deliberations could contribute to the guidance in development.

Looking forward to learning more,

Amitrajit (amitrajit.saha@undp.org)

Jai Ganesh Udayasankaran

This is a very relevant topic. More information about the workshop conducted by ITU/WHO on "The role of industry in making telehealth accessible for persons with disabilities" mentioned by Kaloyan Kamenov can be found @ https://www.itu.int/en/ITU-T/Workshops-and-Seminars/dh/202106/Pages/def…

and the draft recommendation F.ACC-TH "Accessibility of telehealth services" is available @ https://www.itu.int/en/ITU-T/Workshops-and-Seminars/dh/202106/Documents…

Amitrajit Saha Moderator

@Jai Ganesh Udayasankaran thank you. The ITU/WHO draft recommendations seem very comprehensive. These would be useful going ahead when designing e-health/digital-health platforms to ensure no one is 'left-behind'. Already within 24 hours we have had a new access issue raised and shared material to support how to address that access gap for people with (different kinds and levels of) disability. The Draft Recommendations are quite comprehensive focusing on vision, hearing, mobility and mental health impairments/challenges as well as psychosocial disabilities. 

 

Leslie Ong

Hi [~117905] ! Thanks for highlighting the importance of promoting equitable access to telehealth services for marginalized communities. It is interesting to learn about your work on developing global standards and guidelines for accessibility of telehealth services. I’m wondering if your recommendations would include guidance for countries on how they would monitor/enforce the implementation of these standards and guidelines? perhaps through a monitoring or assessment framework and the introduction of appropriate policies/regulations?

We would certainly welcome your inputs for the draft background paper, particularly where they related to key policy, regulatory and programmatic approaches, as well as good practice examples, on promoting access to telehealth solutions for people with disability. So please do provide your comments on this thread (this e-discussion has been extended to 24 September!). The content of the e-discussion and the background paper will be synthesized into a policy brief later this year.

Pedro Cortez

Hello everyone,

It has been great to read through so many insights within the telehealth space. My name is Pedro Cortez, I work as an Impact Specialist at UNDP's Business Call to Action.

We have recently published a report called "Two hands to heal: How health inclusive businesses collaborate with governments during the COVID-19 pandemic", which highlights lessons learned from telehealth businesses collaborating with the government during the pandemic and suggests recommendations for governments on how to integrate inclusive businesses in their efforts to reach low-income communities.

I invite you to join me at the launching of the report which will happen at BCtA's Annual Forum, in the sidelines of UNGA, in a session called " A Win-Win for Business & Government: The case of telehealth inclusive business models amid a pandemic" More information here 

I look forward to seeing all of you at the event and to keep exchanging ideas on how to scale telehealth services!

Pedro

Amitrajit Saha Moderator

Dear [~83507] thank you for sharing the coordinates for the Forum--I just registered and I hope colleagues in this discussion group might have time to do so as well. I understand that the Report will be launched at the Forum--but was wondering whether there are background papers, research publications/briefs on the matter that you are able to share now? 

As we all know, we will not be able to achieve digital health/telehealth to the levels we need without inclusion and engagement and active innovations and participation from business and private sectors. 

Looking forward to hearing more from you.

Best, Amitrajit (amitrajit.saha@undp.org)

Stan Mierzwa

Dear All!

Greetings!  The topic of making technology, either via telehealth or otherwise, available in a usable and effective format for those with disabilities has peaked my interest.  In a previous role I was tasked with creating technology to be used in clinical trials in the Global South and in other developing parts of the globe, for those individuals that may be semi-literate.  In these situations, it would be important to ensure that the technology solution created was aimed at delivering a very useful to those stakeholders.  My team built technology self-assessment survey solutions, via Audio Computer-Assisted Self Interviewing (ACASI).  In the product, both translated locally audio files would be used to query participants, as well as appropriate videos and graphics that are relatable to those individuals with disabilities.  I wonder if using ACASI may have a role in the development or augmentation of future developed telehealth solutions.  Here's a few references on the topic if useful to the community:

"Approaches that will yield greater success when implementing self-admi" by Stanley J. Mierzwa, Samir Souidi et al. (popcouncil.org)

and

Effective approaches to user-interface design with ACASI in the developing world | Interactions (acm.org)

Very best regards,

Stan Mierzwa

Amitrajit Saha Moderator

Thanks Stan Mierzwa for sharing the Effective Approaches document on use of ACASI--there seems to be possibilities in using similar methods to enable differently-abled persons access telehealth. However definite adaptations need to be made for visually- and hearing-challenged as well as for people with limb-loss (for example) disabilities that prevent them from using styli, visual and audio devices. I also found the process related to using different languages very informative. My question, following up on [~92184] is on collaborations with the 'target' communities--not just NGOs/local staff for the Pop Council surveys you refer to. Were there any done? And if so, how did that help?

Thanks, Amitrajit (amitrajit.saha@undp.org)

 

Stan Mierzwa

[~88695] - Greetings!  Thank you for the feedback and comments, this is a genuinely excellent forum.  Regarding interfacing with actual end-users for feedback, the answer is yes, we would include this as a task.  The way we approached end-user input was to pre-test the solution with actual end-users, and then de-brief with them afterwards for practical and useful feedback.  This proved valuable and we would often retrofit the solution based on this suggestions - that is if they were technically feasible.  Often times, the changes were reflected in the audio recording text, or graphics utilized. 

Very best regards, Stan 

Kenechukwu Esom Moderator

Hello colleagues,

Thanks for all the very informative contributions. I am really delighted to see this conversation on making telehealth accessible for people with disabilities. [~117905] [~117780] thanks for sharing about the ITU meeting.

Like [~88695] I am interested in learning how people with disability have been involved in these convening and particularly how to make consultations and global discussions such as this one on telehealth more inclusive of people with disability.

Are there features on the existing platforms - Zoom, Teams, Sparkblue, etc that improve accessib for people with disability? Are there alternative disability-friendly platforms that are being used?

As we discuss, better inclusion and accessibility for people with disability in telehealth, we should also be mindful of the socio-cultural contexts where people with disability live, and how these contributes to further marginalisation beyond the disabilities. Myths and stigma around disability in many context often mean that people with disability may not complete their education or be literate, may not receive adequate attention to other health conditions or reside in context that prioritise health access for people with disability. it is imperative therefore that people with disability are meaningful engaged and participate in dialogue about the utility of telehealth service to ensure that digital health generally and telehealth in particular meet their needs. This is critical to improving acceptance, broad uptake/usage and sustainability of telehealth services.

Amitrajit Saha Moderator

Hello colleagues: thanks once for a range of very thoughtful interactions/interventions and sharing of exciting material today. In particular, the exciting new thread discussing telehealth for people with disabilities is highly welcome, for which I thank Kaloyan Kamenov, Jai Ganesh Udayasankaran and @Stan Mierzwa. 

I would, however, request colleagues to circle back to the key questions posted on this Room, read with the issues I'd raised yesterday re accessibility of telehealth in harsh terrain, and in places off-grid for stable electricity--and help us drill down solutions that would be rights-based, robust, stable and sustainable as well as assist countries in acute need of supporting COVID-19 vaccine equity using digital/telehealth platforms--to track and trace vaccination events, adverse events following immunization (AEFI) events, awareness-building to address vaccine hesitancy and providing vaccine certification. 

I look forward to your open and kind inputs on these issues over the next few days.

Thanks, Amitrajit (amitrajit.saha@undp.org)

Eva Lacinova

Hello,

Many thanks for your interesting insights, I am thrilled to read them and to be a part of the discussion. Many important issues have already been covered, but I see that the question regarding procurement standards and processes has not been touched into the detail yet.

The full effectiveness of strategies and new approaches in the telehealth and related topics cannot be done without adequate procurement, which has to be fair, open and detailed ‚Äď and at the same time it should be flexible enough to attract innovations (in telehealth).

Here, I would like to highlight the benefits of the innovation challenge (also called challenge fund) as an unique procurement tool ‚Äď and our experience from the portfolios supported by the Polish and Slovak MFAs (as Donors).

Innovation challenges are defined by the UNDP as prized challenges that country offices organize to solicit innovative ideas and solutions to address development challenges which cannot be achieved through traditional solicitation processes. So, innovation challenges are a great method for support of the introduction and scale-up of the forward-thinking solutions and long-term partnerships.

With innovation challenge, you can open the competition for the selection of the suitable telehealth solution for the harsh terrain with low accessibility, and for places off-grid for stable electricity ‚Äď and look into possibilities that the local, regional, or global market offer to you. Under the innovation challenge, you evaluate the merits of the idea ‚Äď under the same rules and metrics established for the sustainability of the solution, maximum award/prize, or experience of the team. ¬†

At the UNDP Istanbul Regional Hub, we have used the tool several times ‚Äď and the results are amazing. We were able to get offers from many telehealth solutions.

  • With the support from the Slovak MFA, we have got the interest from the S-Case ‚Äď a top-notch innovator, who is developing a small, portable point-of-care medical device combining smart sensors with predictive analytics and a patient database for healthcare professionals and physicians working in remote areas of low-income countries. With the funds from the challenge fund, S-case was tested in the North Macedonia ‚Äď and now it scales up to other countries in the region (Albania, Georgia, Serbia). (You can read more details in this blog about an innovator‚Äôs journey to bring a medical device to those who need it.)
  • Another example is the support from the Polish MFA, which enabled us to get in the portfolio interesting innovations. Most of them were focused on sustainable use of natural resources, green technologies, etc. However, some of them have the overlap into the health sector ‚Äď and here, I can name Airly¬īs solution for a real time monitoring of the air quality. (More information could be found in this blog.)

Many interesting solutions in the telehealth were identified under the UNDP BOOST Solutions for COVID-19, an acceleration program with a mission to boost and scale-up solutions to COVID-19 challenges (supported by the Polish MFA, Slovak Ministry of Finance, Koç Holding, among others).

I would be happy to get in touch and discuss the details and our experience: eva.lacinova@undp.org

Amitrajit Saha Moderator

Dear [~94889] thanks so much for sharing the examples of S-Case and Airly... both are great innovations and are easily transportable as technology to even remote locations. The S-Case example is particulalry important as a point of care device with multiple sensors and its battery-based power solution. I have one question: how did the S-case device address regulatory and QA concerns?

Thanks, Amitrajit

Amitrajit Saha Moderator

Week 4 Discussion Summary, 13 - 17 September 

 

Dear colleagues,

Thank you for another exciting week of discussions and deliberations and sharing of resources and documents during this week (13-17 September). As I come to the end of my moderator duties--which I've immensely enjoyed--let me try and highlight some of the issues that we touched on and discussed during this week.

Overall, it was another week of very rich discussion and active participation by colleagues from within and outside UNDP. 

I began the week highlighting some of the challenges that I envisage in Africa: the region where my energies are focused--and requesting colleagues to reflect on those.

Some of that was effectively touched upon, by [~94889] through her sharing of the S-CASE and Airly stories and her comments about using solar for health in remote locations. We also look forward to engaging with Eva and her team re the innovative solutions shared under UNDP BOOST. Thank you Eva.

This week also saw some great and exciting interventions specifically the new thread discussing telehealth for people with disabilities begun by [~117905] and then followed up by [~117780] who shared the ITU resources and of course Stan Mierzwa. Stan's sharing of his experiences with I.O. processes not using English for e.g., which can be modified to ensure engagement of people with disabilities was particulalry exciting. As was some of the guidance documents he shared. We shall need to focus on the question of addressing e-health of people with disabilities including thinking through on how best to adapt/adopt technologies and interfaces for such persons who may not be able to use one or more of the senses/functions that others use normally--e.g. speech, hearing, vision, touch, finger/hand movements, etc. so it is not merely a hardware/software issue, but also an issue of rights, access and leaving no one behind. Thank you to all for flagging/raising these issues.

Also this week we had an exciting exchange on how to 'run' new processes quicker by using 'regulatory sandboxing' as pointed out by [~91917] with his Singapore's MOH Regulatory Sandbox LEAP example. This opens up newer horizons and adaptation of newer (and perhaps quicker--although the jury is out on that, as a World Bank blog and a global report on regulatory sandboxing in fintech says), regulatory frames to run with innovations. There's some exciting literature on using regulatory sandbox in the context of digital/e-health, coming out of India which makes it something for us to chew on going forward.

Lastly, during the week [~83507] reminded us of the launch of a report at BCtA's Annual Forum, in the sidelines of UNGA, in a session called " A Win-Win for Business & Government: The case of telehealth inclusive business models amid a pandemic" and invited us to join in that session. I hope some of us will be able to join that session--which I am sure will highlight the critical element of linking up with the private sector to make Telehealth more widespread and acceptable. Information for the BCtA Annual Forum is found here.

Thank you all for your active engagement and participation and we hope you are enjoying the deliberations and processes as much as we are doing as moderators.

Onwards then to the final week!

Warm wishes, Amitrajit/Piklu (amitrajit.saha@undp.org) 

Eva Lacinova

Dear Amitrajit, 
Many thanks for the reply. From July 2021, S-Case is certified for ISO 13485. However, there is still a long journey in front of us to ensure the deployment on market. We would be happy to share the experience and learn more from others, e.g. during a common workshop or similar event. (You can check the details about the certification here: https://www.linkedin.com/posts/scaseslovakia_medicaldevice-certificatio…)

Jai Ganesh Udayasankaran

Dear All,

International Standards Organization (ISO) has a dedicated standard focusing on telehealth services known as ISO 13131:2021 Health informatics - Telehealth services - Quality planning guidelines. Have a look @ https://www.iso.org/standard/75962.html

This standard provides processes that can be used to analyze the risks to the quality and safety of healthcare and continuity of care when telehealth services are used to support healthcare activities. ISO 13131:2021 provides guidelines for the operations of telehealth services in several domains like:

  • management of telehealth quality processes by the healthcare organization;
  • strategic and operational process management relating to regulations, knowledge management (best practice) and guidelines;
  • healthcare processes relating to people such as healthcare activities, planning, and responsibilities;
  • management of financial resources to support telehealth services;
  • management of information management and security used in telehealth services;
  • processes related to the planning and provision of human resources, infrastructure, facilities and technology resources for use by telehealth services.

The standard provides a set of example guidelines containing quality objectives and procedures for each domain. From India we were involved involved in contributing five of the use cases on teleICU, telepathology, teleradiology, and telepractice (both audiology and speech). These use cases covering application of quality planning guidelines in different types of real-world telehealth services went into Annex B of the standard. This standard was fast-tracked and published in May 2021 given the increased uptake of telehealth services as well as the potential for use of quality planning during the pandemic.

Amitrajit Saha Moderator

Thanks so much [~117780] for sharing the access link for the ISO standards.

There may be a strong case for countries seeking to initiate telehealth programmes to purchase the Standard set from ISO (it is not 'cheap', priced as it is at CHF 158 for EPUB and PDF copies)--it may also make sense for institutions supporting such efforts to purchase access as well... Kenechukwu Esom, [~91917] what do you think? The documents may be accessed, at https://www.iso.org/standard/75962.html 

Cheers, Amitrajit (amitrajit.saha@undp.org)

Jai Ganesh Udayasankaran

[~88695] following resources from WHO Americas as well as WHO Western Pacific Regional Office might be of interest to colleagues in this forum.

COVID-19 AND TELEMEDICINE ‚Äí Tool for assessing the maturity level of health institutions to implement telemedicine services (July 2020) from WHO Americas/ PAN American Health Organization (PAHO)

Available @ https://www3.paho.org/ish/images/toolkit/COVID-19-Telemedicine_RATool-e…

Apart from English the above tool is also available in French, Portuguese and Spanish 

For more information please look-up https://www3.paho.org/ish/index.php/en/telemedicine

 

Implementing telemedicine services during COVID-19: guiding principles and considerations for a stepwise approach (May 2021) from WHO Western Pacific Regional Office (WPRO) which is meant to be an interim guidance first published in November 2020 and republished again in May 2021.

Available @ https://iris.wpro.who.int/handle/10665.1/14651

https://iris.wpro.who.int/bitstream/handle/10665.1/14651/WPR-DSE-2020-0… (Direct URL to download the guidance in pdf)

WHO WPRO has also commissioned a report focused on implementing telehealth in Pacific Island Countries (PIC) but it is not yet published. 

Simpa Dania

Dear All, 

Thanks for the very enriching discourse thus far. I would like to add a few notes especially considering the African healthcare ecosystem. While national central telehealth systems seem good on paper, there however be issues with implementation and adoption.  I would advocate for facility-led telehealth programs where the facilities are enabled to offer telemedicine services to their clients and can be part of a network.  I believe this concept would help drive adoption in terms of utilization, not just in terms of deployment of systems. 
Telehealth systems should be integrated into the care workflow of clinicians. It looks counterproductive for clinicians who are already stretched to try to use or different care tools or workflow just for telehealth clients. The referral network between telehealth services and physical care locations is also critical for adoption. 
Thank you.

Calum Handforth Moderator

Hi Simpa,

Thanks for sharing this! Do you have any examples of facility-led telehealth programmes? I'm very intrigued by your distinction between national-level and facility-led. What are your thoughts on how other stakeholders - particularly government - can make this happen? Providing connectivity and foundational data infrastructure?

Great point on the workflow, too. [~117328] also discussed this above, from the perspective of a startup trying to integrate into these workflows!

Calum

Jai Ganesh Udayasankaran

Agree with what Simpa has said. For wider acceptance by the physician community, telehealth services should be well integrated as part of their routine clinical workflow as well as referral networks for wider adoption and utilization. After all telehealth is merely a "virtual extension" of their routine existing out patient services that otherwise happens "in-person" with their patients. If designed to be standalone, complex systems that will take longer learning curve there is bound to be reluctance to adoption and the facility will not be utilized adequately. 

Simpa Dania

[~91917] Thanks for your comments. National government can help in many ways. They can make the calls reimbursable through insurance, they can also help with the cost of connectivity and provision of technology stack, The service rendering and utilization is left in the hands of the facility care providers.
One of the big paradigm shift is to consider telemedicine as a "channel" of care provision and not a "form" of care provision or a care service in itself. 
So care provision happens in three channels: in-facility, teleconsult, out-of-facility and most care services can be administered through this channel. 
Technology thus helps the care provider to change "Channels" at will or as demanded by the client.
This concept belies the work we are currently doing at HealthStack.africa

Calum Handforth Moderator

[~117781] Thanks, Simpa! The 'channel' distinction is an important one, echoing some earlier points that we need to make this integrated and not a siloed solution. Thanks for sharing! 

Stan Mierzwa

Dear All,

Thank you for sharing the information on the ISO 13131:2021, this is information I was not aware of and this can certainly be a helpful contribution and addition to ensuring proper developing of telehealth tools.  One constraint with ISO I have found is that it is not available without paying for the product guidelines.  I tried to download it, but ISO wishes payment.  If we are going to make guidelines available for those creating solutions, it would be great if they were available to the sector without cost challenges.  Does anyone have access to these resources without payment through the UN?

Best wishes and this is a really great forum and venue for sharing knowledge.

Stan Mierzwa

Ian Mungall

Hi folks, I wanted to take this opportunity to share an upcoming webinar on 30 September (13:30-16:00 CAT) that you may be interested in joining, titled "A Dialogue: Trends and Strategies in the Use of Competition Law to Promote Innovation of and Affordable Access to Health Technologies". The event will feature sharing of national experiences and insights from competition authorities and experts from around the world, and seeks to contribute to better understanding of the role competition law and policy can play in increasing access to health technologies. Telehealth is a very fragmented private sector, and competition legislation has the potential to add value. 

The webinar is being organized by the Government of Namibia, the Namibian Competition Commission and UNDP. 

You can register here: https://bit.ly/CompLawWebinar

Competition law webinar flyer

Amitrajit Saha Moderator

Thanks [~59885] for sharing the details of the important webinar on competition law and its uses in access to technologies, particularly health technologies. In the context of the pandemic and the need for all of us--- governments, international and regional bodies on health, trade, tech, etc., and communities and people---to quickly, urgently and equitably adapt/adopt newer digital tools and tech to improve access to health, using/utilizing existing laws and policies also plan an important part. 

I would urge colleagues interested in the regulatory/legal aspects of healthcare product access (including for access and utilisation of digital platforms/tools), to join and enrich this webinar.

Thank you, Amitrajit (amitrajit.saha@undp.org)