eHealth Standardization to meet needs of Developing Countries

2 ITU e-Health history  March 1994 –Buenos Aires, Argentina, first ITU World Telecommunication Development Conference approved the Question for study - TELEMEDICINE in the ITU-D Study Group 2.  30 June – 4 July 1997: First World Telemedicine Symposium for Developing Countries was organized by the ITU-D in Portugal.  ITU telemedicine projects in Uganda, Mozambique, Senegal, Malta, Georgia, Bhutan, Myanmar, Ethiopia  Resolution 41 of WTDC in 2002 in Istanbul, recommended to all countries to create national eHealth Committees or Task Forces for such cooperation and coordination. (Istanbul, 2002)

International Telecommunication Union It is due to the ITU effort the question about telemedicine/eHealth for developing countries was introduced and discussed for the first time during the First World Telecommunication Development Conference in Argentina in March The Conference approved Question 6 (in 1998 it was renumbered into Question 14) on telemedicine which was assigned to the Study Group 2 of the ITU Development Sector.

World Telemedicine Symposium The first World Telemedicine Symposium for developing countries was held in Portugal from 30 June to 4 July The Symposium was an ITU initiative, hosted by the Portuguese Telecommunications Administration through the Instituto das Comunicacoes de Portugal (ICP). It was attended by more than 57 countries and for the first time it was the case when telecommunication specialists were sitting together with doctors from the same country.

eHealth As usual for any innovative ideas, there are many obstacles starting with the reluctance of medical staff in developed countries to adopt a new way of servicing till the lack of knowledge about eHealth among medical professionals and administration in developing countries.

Where are the main obstacles for the implementation of eHealth ?” Lack of Government Policy related to eHealth. Lack of Technical Guidelines on how to start the implementation of eHealth services. Lack of financial resources for promotion, training and implementation. Lack of information on eHealth Economy and successful eHealth implementations in other countries.

eHealth standardization There is another main obstacle that concern both developed and developing countries – eHealth standardization which is extremely complex question. In spite of huge amount of money and manpower spent in this field, the result is rather poor particularly for the interest of developing countries. It is required special attention to meet their needs taking into account the condition of their fixed and mobile networks.

ITU Standardization Sector There are many generic standards developed by ITU-T used in eHealth applications for video coding, security, multimedia transmission, and languages for instance. International Standards for eHealth need to be based on already existing “mature and stable technologies” in developing countries rather than only on future advanced technologies.

Regional Asia-Pacific ITU meeting on e-Health This meeting was held in Tokyo, Japan, March 2011 and it was hosted by the Japanese Ministry of Internal Affairs and Communications (MIC). The meeting was attended by more than 50 participants from Japan, India, Bhutan, Pakistan, Thailand, Korea, Malaysia, Indonesia, Russia and Bangladesh.

Tokyo Call for Action (1) The meeting approved “Tokyo Call for Action - Speeding up the adoption and development of e-Health Standards to meet urgent needs of developing countries for improving access to healthcare services”. This document has highlighted that it is important to solve the problem with technical eHealth standardization as soon as possible.

Tokyo Call for Action (2) It is necessary to provide standardization of technical telecommunication platform for different types of eHealth services. ICT solutions for health and eHealth services, including mHealth as well, have been developed a lot, particularly in the last decade. However, the solutions are still much too often isolated islands of small-scale applications that are unable to communicate with other health systems and/or share information across geographies and technologies.

Tokyo Call for Action (3) Barriers to scaling-up small systems in developing countries prevent supporting a larger patients and care providers base. Decision makers are not necessarily able to assess the actual health situation, which in turn inhibits comprehensive planning, response and policy formulation.

Tokyo Call for Action (4) Technical standards will play a critical role in both achieving the public health benefits of aggregated patient data and providing solutions to requirements for security, privacy, quality assurance and interoperability. How to benefit practically from Cloud computing in developing countries?

Proposed Plan of Action Conduct a study to identify the challenges of adopting e-Health Standards in the context of both developed and developing countries in terms of cost of adoption, technical barriers, lack of incentives, lack of compliance mechanisms, lack of national e-Health Standards, etc. The study will also identify the requirements for e- Health solutions to be standardized and “Standardization holes” (which standards are missing and emerging standardization opportunities) based on mature and stable existing e-Health technologies specially those that are already successfully applied in developing countries.

ITU Plenipotentiary Conference 2010 The ITU Plenipotentiary Conference 2010 in Guadalajara, Mexico adopted a new Resolution 183 on “Telecommunication/ICT applications for e-Health” …calling ITU to give priority consideration to the expansion of Telecommunication/ICT initiatives for e- Health and to coordinate e-health-related activities between the Standardization, Development and Radio communications sectors and, in particular, to promote awareness, mainstreaming and capacity building in the creation of telecommunication/ICT eHealth standards, reporting findings to the Council as appropriate”.

ITU World Telecommunication Development Conference The World Telecommunication Development Conference (Hyderabad, 2010) also approved Resolution 65 on “Improving access to healthcare services by using information and communication technologies”, where it was stated “…to continue to promote the development of telecommunication standards for eHealth network solutions and interconnection with medical devices in the environment of developing countries, in conjunction with ITU-T and ITU-R in particular”.

Thank you very much for your attention

For more information, contact Leonid Androuchko 1, Vladimir Androuchko 2 1 International University in Geneva, Rapporteur, Question 14 – Telecommunication in Healthcare, ITU-D Study Group 2, Telecommunication Development Bureau, International Telecommunication Union 2 Inernational University in Geneva, Dominic Foundation, Switzerland

Introduction(1) The delivery of effective and affordable healthcare is a challenge that all countries face today, irrespective of whether they are developed or developing nations. The information and telecommunication industry has an opportunity to contribute substantially to global healthcare.

Introduction (2) There is no doubt that the introduction of eHealth services will be beneficial to all countries and in particular for developing countries where there are no resources to improve their healthcare systems using classical approach by increasing the number of medical staff and hospitals.

ITU Standardization Sector (1) ITU’s Standardization Sector coordinates the technical standardization of multimedia systems and capabilities for eHealth applications. The Sector has just released a new Technology Watch Report ( T/techwatch/Pages/ehealth-standards.aspx) that looks to the future of eHealth. The report observes that eHealth development will require more universal e-Health interoperability standards, and strategies to overcome technical infrastructure barriers and address privacy, security, and other legal requirements.

Proposed Plan of Action (2) Complement the study by bringing the users who adopt the standards with those who develop them in an “International Conference/Workshop on eHealth Standardization” to facilitate a better understanding of “adoption challenges” and how to address them and to confirm needed new standards. It is also help to find a solution by drawing attention of international community to this important issue.