Is Sri Lanka ready for Digital Health? Yes, but we need the political commitment to make it happen
View(s):My column last month on how Google Loons and a Cloud Based Health Record System can transform healthcare in Sri Lanka attracted much attention.
I received emails from across the world, all positive. It was even posted on a LinkedIn group ‘Healthcare Board’ with the caption “Is Sri Lanka ready for Digital Health?” My answer to that is, “Yes we are, but we need the political commitment to make it happen, it is too important to leave it in the hands of a few enthusiastic health administrators who struggle to obtain the necessary support.”
Why do I say that we are ready? A decade ago, when we embarked on the journey on developing human resources for eHealth in Sri Lanka, it was unimaginable to think of doctors accessing the Internet during their ward rounds, to access information relevant to patient care. Two years ago when my wife was the consultant paediatrician at Maderigiriya Base Hospital, 225 km away from Colombo, every doctor in her unit had a smart phone. At this rate, there will be no health care worker without a smart phone in hand in another five year’s time. It appears that we are using digital technology for everything else in our day-to-day life, even in the wards, except for healthcare. That is not all: Sri Lanka’s healthcare workforce is unique. University education in Sri Lanka is conducted in English. So, the medical and other categories of health workers are English literate.
We maintain all our manual health records in English. It is compulsory that Medical Consultants serve at least one year abroad (usually in the UK or Australia) before they are board certified as consultants, a unique system not found anywhere else in the world. They are exposed to what is going on in the best of centres in the world. Their frustration when they come back is with our systems still lagging behind. They are eager to drive change. So then, why have we lagged behind? In my view, we have lagged behind for two reasons.
The first is the lack of suitably qualified people to divert the change and to serve as the interface between non ICT savvy medical administrators and ICT professionals. It is no secret that the healthcare system in Sri Lanka is driven by doctors and that the healthcare agenda is by and large determined by powerful medical trade unions. In the past, when it came to implementing systems in the healthcare sector, the doctors did not know how to communicate their requirements to the IT specialists and vice versa. The end result of that was that systems that were developed did not meet the needs for which they were built in the first place. So they were fast abandoned.
I always say that a disease called ‘pilatitis’ is endemic in the country. That is because most ICT projects are destined to end as pilot projects. This situation is now changing with the commencement of the MSc course in Biomedical Informatics at the Postgraduate Institute of Medicine in 2008. To date, 84 have graduated from the course in four batches, one batch every year in the past four years. Approximately 75 of the MSc Biomedical Informatics trained doctors and dentists are now working as Health Informaticians in various institutions coming under the Ministry of Health. Some of them have even been hired by world renowned centres such as the Centers for Disease Control (CDC) in Atlanta, USA. They are filling the above-mentioned void that existed in the past. The impact they have made is enormous and one could see that if one were to attend the eHealth Asia 2015 (http://www.ehealthasia.org) conference happening in Colombo on October 13-14, 2015.
That is not all; the PGIM will be starting the MD in Health Informatics course in 2016. So, by 2019, Sri Lanka will have board certified Health Informatics specialists. The second country in the world to have this system after the USA! What is unique about our system will be that it would be a separate speciality of its own while, in the USA, it is a sub-speciality. The second reason why we lagged behind was that the top medical administrators were not ICT savvy, and as a result the systems that were implemented by ICT savvy administrators were doomed to fail when their tenure came to an end because usually they are replaced by someone who was not ICT savvy. This continues to happen today. Therefore, we cannot leave ICT implementation in the hand of a few enthusiastic individuals anymore. We have to move forward with a national Digital Health initiative with the political commitment at the highest level. Can we do this? I believe we can.
It is in this context that the eHealth Asia 2015 conference organised by the Health Informatics Society of Sri Lanka and the ICT Agency of Sri Lanka in collaboration with the Asian eHealth Information Network, on October 13-14, 2015, has become important. It is the forum at which Health Informatics professionals, the government (Ministry of Health and the ICT Agency), the ICT industry, and international development and technical partners, such as the World Health Organisation and UNICEF, will come together to map out the way forward. The round table on the “Future of Digital Health in Sri Lanka,” to be held at the end of the first day, is the forum in which to discuss your views. I wish to invite everyone to participate in the conference and contribute and become a part of the Digital Health revolution in Sri Lanka. To me, it is not a case of ‘if it will happen,’ but it is a case of ‘how soon.’ That would of course depend on the momentum that we create at eHealth Asia 2015.
(The writer is the President, Health Informatics Society of Sri Lanka; the Past President, Sri Lanka Medical Association; the President-Elect, Commonwealth Medical Association; and a Fellow of the National Academy of Sciences of Sri Lanka. He can be contacted via vajirahwd@hotmail.com).