Biovision's eyes

Impact of Digital Health on Global Medical Education & Training — March 31st 2017

Health professionals are the cornerstone of any health system. Yet the world is facing a global shortage of health workers. A scarcity which - along with the global epidemic of non-communicable diseases - is one of the most critical obstacles to the achievement of development goals. Shared solutions are needed, that involve massive changes in global health education and training of health practitioners.
In developing countries, this health workforce crisis is even more concerning with only 0.2 doctor and 1.2 nurse or midwife per 1000 people in Sub-Saharan Africa 1. In 2013, the WHO estimated a global shortage of over 17 million healthcare workers, mostly in Africa and Southeast Asia.2
The underlying problem is the lack of resources and a huge shortfall in educating health workers. In 2014, fifty percent of all medical schools in the world were located in ten countries. In America, there is one medical school per 1.2 million people; whereas Africa has only one per 5.0 million. 3
One of the key recommendations of  « Health professionals for a new century: transforming education to strengthen health systems in an interdependent world »  report by the Lancet Commission is “exploiting the power of Information Technology (IT) for learning.”
With Africa, for example, reaching 80% of mobile penetration in 2016 4 , ICTs undeniably represent powerful tools in facilitating access to health workers’ education.
One of the main benefits of digital training is that boundaries do not limit access or participation. A teacher in Kenya can teach the same material in any English-language school. This is why institutions can increase the number of course offerings and the number of students or teachers reached thanks to video and audio streaming of lectures, mobile-based multiple-choice questionnaires, or Q&A for distance training. Open-source learning materials and social networking learning approaches are thus becoming the basis of mobile education.
These mobile tools can be used also for short-term training such as when facing an emergency. To face an epidemic, health professionals must know how to behave appropriately. During Ebola, Liberia’s Ministry of Health and Social Welfare partnered with UNICEF and Intrahealth International to provide health workers with online materials that demonstrated the correct practices to avoid infection. 5
But implementing long-term training programs that provide health practitioners with consistent and replicable education is the most important. The Indian government has recently launched a nationwide mHealth program that aims to train one million community health professionals to reach 10 million pregnant women. As of 2016; 150,000 of these community health workers have already received this training. 6
AMREF in Africa is another organization well versed in using ICTs for medical training as they have trained to date 20, 000 nurses in Africa using eLearning. Over the last four years, Amref Health Africa has developed a mobile learning solution in partnership with the Ministry of Health, M-Pesa Foundation, Accenture, and Safaricom and used mLearning to educate over 3,000 community health volunteers, thus impacting over 300,000 community members with much needed health education and basic health services. 7
Training and educational digital health approaches have the potential to empower health workers in remote areas, improve quality of care at the frontline and reinforce health systems, as well as alleviate the workload at overburdened health facilities.

1- « World Development Indicators: Health systems », World Bank, 2017. 

3- Duvivier RJ, Boulet JR, Opalek A, Van Zanten M, Norcini J, 2014, « Overview of the world's medical schools: an update»

4- GSMA Intelligence, 2016.

5- O’Donovan James, Bersin Amalia, « Controlling Ebola through mHealth strategies », The Lancet, January 2015, Volume 3, No.1, e22.

6- « Digital Health: A call for Government Leadership and Cooperation between ICT and Health" p. 29, Broadband Commission Working Group on Digital Health, February 2017.


Florence Gaudry-Perkins

Digital health is a game changer but data interoperability has to be solved — March 29th 2017

So, we have established already that digital health is a game changer for healthcare. Just to keep emphasizing that point, a recent report from GeSI, the Global e-Sustainability Initiative, and Accenture estimates that 1.6 billion people could benefit from quality medical services through digital health solutions, which could generate over US$200 billion in additional annual revenue for the health sector by 2030. 1

”The use of eHealth to improve the delivery of health care continues to increase
around the world. In line with the principles of universal health coverage, eHealth
can potentially make health systems more efficient and more responsive to the needs
and expectations of the people they serve.”
Dr. Margaret Chan, Director General, World Health Organization (WHO) 2

To reach the benefits of digital health, there are still key barriers to overcome. One of them is the one I mentioned briefly in my last blog, i.e. lack of interoperability, critical to achieving an efficient national digital system.

Interoperability can be defined as “the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.”3  This means enabling data sharing between patients, hospitals, pharmacies, health workers, laboratories, health insurance etc., regardless of the device, application or platform used.  Interoperability is based on common standards and allows a secure and reliable exchange of data.  GSMA, which is the global association of mobile operators has recently released a very good report on this subject: Digital Healthcare Interoperability. Jeanine Vos, who is the Director of Connected Living and a great expert on digital health will by the way be speaking at Biovision this year.

The report explains that in a digital health environment, semantic interoperability in particular is crucial so data exchange is understood and acted upon in the appropriate way. Semantic interoperability can enable easier access to information for patients and healthcare professionals, along with opportunities for better diagnosis and quality of treatment. It also enhances cost effectiveness and increases the user’s choice.

Common global standards on interoperability already exist and are sufficient to reach this interoperability. But the main challenge relies in the consistent use of these standards. As digital health is a new area for many governments and organizations, awareness of standards and their applicability remain low.  However, open standards-based interoperable approaches represent a huge opportunity for systems to be able to exchange information and upgrade their solutions.

But it is only through action from all parts of the digital health ecosystem (healthcare providers, the health industry, governments and the mobile industry) that standards on semantic interoperability can be adopted.  Healthcare providers and professionals can educate people on the use of data, pharmaceutical companies can include open standards and interoperability in their final products, governments can drive adoption of those standards, and the mobile industry can advise on their application and deliver services based on semantic interoperability.

It is when the whole digital health eco-system joins forces to fully solve this interoperability equation, that digital health will be realized at scale and improve the life of many people.  There is also no question that governments have an important role in setting data standards for their nations as that will undoubtedly help the harmonization process.

1- Global e-Sustainability Initiative and Accenture Strategy, #SystemTransformation: How Digital
Solutions Will Drive Progress Towards the Sustainable Development Goals (Summary Report), 2016


3- « Digital Health: A call for Government Leadership and Cooperation between ICT and Health" p. xiii, Broadband Commission Working Group on Digital Health, February 2017.

Florence Gaudry-Perkins

Digital Health and Emerging Viral Diseases — March 27th 2017

The world was caught unprepared when Ebola struck West Africa in late 2013. The aftermath: over 30,000 Ebola cases, including more than 11,000 dead, and billions of dollars lost. Conversations at Biovision this year will include tackling the threat posed by emerging viral diseases like Ebola. The Ebola crisis showed us the critical importance of strong health information systems, including the use of digital information and communication technologies (ICTs), to enable resilience to disease outbreaks.

USAID has recently published a remarkable report that demonstrates the role of digital health in responding to viral diseases as fatal as Ebola:  Fighting Ebola with Information: Learning from the Use of Data, Information, and Digital Technologies in the Ebola Outbreak Response . The report discusses how data collection and analysis was critical to stopping the spread of a disease, and for communities how digital communication tools (as simple as a SMS) were used to provide the population with much needed information.  To contain Ebola, national and international actors needed precise and timely data to provide effective relief.  Yet the response initially struggled to fully leverage the power of digital technology to rapidly gather, transmit, analyze and share Ebola-related data in large part because technical, institutional, and workforce capacity were not robust enough.

Releasing the full benefit of digital technologies requires investing in human capacity, institutional policies and procedures, as well as the physical infrastructure that extends digital connectivity. Along with these structural changes, « quick wins » can be considered. Recommendations of the report suggest - among others -  the more consistent use of machine-readable forms, the use of digital data collection tools with the ability to capture data in both online and offline environments, and performing rapid communications assessments after emergencies to understand and address gaps in access to digital communications. 

Among the challenges cited in the report is the lack of standards and interoperability, a topic I addressed in my last blog on the recently released digital health report from the Broadband Commission working group.  Data silos whereby information is not recognized from one system to the next contributed to unclear and asynchronous information in the Ebola outbreak, complicating the response. Government leaders have a big role to play in setting standards to solve part of this fragmentation, as do the international donors who historically have funded competing and non-interoperable data systems. We see one path toward enabling greater harmonization of digital health investments in a recent initiative discussed by the heads of USAID’s global health bureau and development lab in this blog: Digital Health: Moving from Silos to Systems.

Florence Gaudry-Perkins

Within the word Biovision we have VISION — March 20th 2017

What is the VISION today in the medical world?
Three words can illustrate this vision :

During BIOVISION 2017 a big part of the program will address
Prevention: immunization and vaccine advocacy
Prediction: how to predict a potential disease through a knowledge of the genome
Personalization: thanks to the genetic, each disease is specific for each person We will come back later to fit exactly with some specific topic.

Robert Sebbag

The living organisms are humans , animals and plants This is our environment. — March 13th 2017

We know the responsibilities of the plants on allergy phenomenon; it is the same with animals , common diseases with humans are multiple This global approach is well define by the CDC ( central diseases center in the US ) one health "One health recognizes that the health of people is connected to the health of animals and the environment. The goal of one health is to encourage the collaborative efforts of multiple specialists " One exemple is Leishmaniasis: This parasitological disease is due to different parasites ( leishmania species) In the cutaneous form and in the visceral form we found an animal reservoir .

Rodents for some cutaneous form dogs for some of visceral form.
In Brazil for exemple in the northeast the dogs are the main reservoir of the visceral form; to fight the disease we have to detect the parasites in the dogs and treat the dogs and some time we have to kill the dog when we find the parasite.

We can take also the case of the bilharziose when some intermediary hosts of the parasite are mollusks .
A lot of others parasitological diseases due to worms are linked with animals ( cattle, porks...) a way to fight these diseases is to control ant to treat the animals.
We haven't to cut public health on slices ( salami policy....) it is why we need an holistic approach, I am convinced that Biovision 2017 will have this approach.

Robert Sebbag

Just hot from the press: a new report to accelerate digital health — March 9th 2017

I just recently returned from Mobile World Congress (attended by 100 000 people this year) where I am happy to say we released an important report for accelerating digital health “Digital Health: A call for Government Leadership and Cooperation between ICT and Health".

I was involved in this work from its inception all the way to contributing this fall to its writing and I am feeling very grateful to the Novartis Foundation and also Nokia for having co-chaired and supported what turned out to be a major collaborative effort with key actors and policy-makers of the global digital health eco-system. One of the reasons I believe this report will have an impact is that it is being released by the Broadband Commission for Sustainable Development which is a highly-influential body established in 2010 comprised of more than 50 leaders from across a range of government and industry sectors. ?

In brief, as the cycle of digital health evolves, there is a growing realization on the fundamental role governments have to play in advancing the use of technology for health. Fragmentation, data interoperability and lack of appropriate legislation and laws are still prevalent, and many of these challenges will not be overcome without stronger government leadership and improved cooperation and coordination between health and ICT authorities (typically ministries of Communication and eGovernment agencies).   To give you a striking example of what we mean by fragmentation; there are eleven different mobile health initiatives for maternal and child health funded by different institutions in Mali. Most of these institutions use their own tools and systems which are not interoperable with the current systems used by the national eHealth agency.

For anyone interested in scaling digital health, I therefore highly recommend the read of this report: “Digital Health: A call for Government Leadership and Cooperation between ICT and Health". Beyond its key recommendations, the report developed case studies in 8 countries that managed to advance effectively the digital health agenda. Those countries are: Canada, Estonia, Malaysia, Mali, Nigeria, Norway, the Philippines and Rwanda. They all provide key insights and lessons which other countries can leverage from. Although not many countries have yet analyzed the impact of digital health on their systems, it is notable for other governments to see that Canada recently estimated that their investments in digital health generated savings of $15 billion since 2007.

ITU and WHO established a very comprehensive National eHealth Strategy Toolkit back in 2012 which many governments have already used around the world.  Let’s hope this report will do both:   motivate countries that did not yet develop such strategies, and support those countries that already developed their strategies and are moving towards the complex task of implementation

FOR FURTHER READING I RECOMMEND THE BLOG OF Ann Aerts, the head of the Novartis Foundation; “ Time to Advance Digital Health: A Call for Government Leadership” as well  as an article from  Mobihealthnews published on March 1st “Government leadership, collaboration needed to implement digital health strategies around the world, report says

Florence Gaudry-Perkins

Let me talk about Biovision & Digital Health — February 27th 2017

Like Robert, I have had the privilege to be a part of Biovision for some time, and more specifically on the thematic of Digital Health in the past years. It is a fascinating field with many experts claiming the health sector is about to go through a profound transformation due to digitalization. More than a billion people still lack access to basic health care and the WHO estimated in 2013 that there was a global shortage of over 17 million healthcare workers, mostly in Africa and Southeast Asia. I confess that the aspect that has made me particularly passionate about digital health is how it will improve access to information and care in countries and areas where shortage of health infrastructure and health workers is particularly prevalent.

It is wonderful to see that Digital Health is becoming an increasingly important pillar of Biovision. In April, there will be a panel again on the Digital Patient as well as a workshop the day prior which will focus on the importance of impact evaluation. Moreover, Biovision is being held in conjunction to SIDO, a leading international event dedicated to the Internet of Things where 6.500 entrepreneurs, manufacturers, startups and technology actors will be present. The dual event will undoubtedly enrich the conversations around the impact of technology on health at Biovision this year.

Digital health includes subcategories such as mobile health (mHealth), health information technology (IT), wearable devices and sensors, telehealth and telemedicine. Very briefly, digital health can: reduce inefficiencies, improve access, reduce costs, increase quality, and make health care more personalized for patients.

Dr. Eric Topol, one of the foremost experts on Digital Health, says “Medicine is about to go through its biggest shakeup in history.” I could not agree with him more. In one of his recent books The Patient Will See You Now, he details how the mobile revolution will trigger a democratization of healthcare where patients take a bigger role in their own well-being. For example, a smartphone equipped with the right apps and connected to sensors can today eliminate many visits to the doctor’s. Digital monitors and sensors (which can also be put into your bloodstream) can collect health data on any physiological metric: heart rate, blood pressure, blood glucose, body temperature, sleep habits, eye pressure, brain waves and more.

To start off this short series of comments on digital health as we prepare for the next Biovision, and for those of you interested in finding out more here is a recent article : Digital Healthcare in 2017: Prepare for Good News
Disruption of the healthcare industry is at a level that many predicted but few understood. Yet, here we are facing 2017, with more amazing news. Moving to a more value-based model has meant greater focus on preventative medicine, patient-centered and patient-powered care, and reduced costs. Much of this is the result of new technologies within hospitals and surgery centers. But a great deal of it comes from wearables, remote monitoring, telemedicine, and a revolution in EHR — Electronic Health Records.

And for the francophone readers out there, this one is also interesting : SANTÉ : UNE RÉVOLUTION QUI VA AMÉLIORER NOS VIES TOUT EN ÉTANT MOINS CHER!
Croire que le domaine de la santé du fait de son mode de fortes relations humaines va pouvoir échapper au phénomène de la révolution numérique, c'est occulter les changements en marche : la machine de l'innovation disruptive a bel et bien démarré.

Florence Gaudry-Perkins

Let me talk about Biovision — February 13th 2017

Since the first Biovision in 1999, I had the privilege to participate each year to this forum and I can see today the positive evolution. The Biovision particularities are multiple.

  1. Lyon was chosen instead of Paris; this city is well known for it history in biomedical sciences: like vaccine industry with the family saga of Merieux; but also the place of animal health industry and also the famous P4 laboratory so useful for the research of emerging infectious diseases like Ebola, SARS and many others Lyon has also a very important university.
  2. Biovision since the beginning gave the opportunity of a strong networking, beyond the scientific cession the informal meetings outside the conference are frequent.
  3. Biovision has attracted many biotech companies from all around the world and mainly from Boston in the US.
  4. Each year the topics treated reflect the new trends in medecine and biology.

Biovision 2017 will tackle the main concerns science has to face

Every week Florence and I will come back on each topic to deepen the most important points.

Robert Sebbag