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<h2 class="hd hd-2 unit-title">Health Systems</h2>
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<h4><span color="#000000" style="color: #000000;"><span style="font-size: 14.6667px; line-height: 23.4667px; white-space: pre-wrap;">What is a Health System?</span></span></h4>
<p><span id="docs-internal-guid-b21e3e37-a903-1816-3add-18d082272a42"><span style="font-size: 14.6667px; font-family: Arial; color: #000000; vertical-align: baseline; white-space: pre-wrap; background-color: transparent;"><span style="font-family: 'Open Sans', Verdana, Arial, Helvetica, sans-serif;">The World Health Organization describes a health system as all of the organizations, institutions, resources and people whose primary purpose is to improve human health. The design of health systems draws on the expertise of multiple disciplines. For instance, economists and political scientists examine the impact of financial incentives and regulatory efforts; anthropologists, sociologists, and organizational psychologists study the effect of differences in community and organizational constraints on health services; and computer scientists, biologists, and engineers develop novel technologies to improve clinical, management, and communication challenges within health systems.</span> </span></span></p>
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<h4><span style="font-family: 'Open Sans', Verdana, Arial, Helvetica, sans-serif;"><span style="font-size: 14.6667px; color: #000000; vertical-align: baseline; white-space: pre-wrap; background-color: transparent;">Components of a Health System</span></span></h4>
<p><span style="font-family: 'Open Sans', Verdana, Arial, Helvetica, sans-serif;"><span style="font-size: 14.6667px; color: #000000; vertical-align: baseline; white-space: pre-wrap; background-color: transparent;"><img src="/assets/courseware/v1/777c5040e0a5f4c649fb90698469eefa/asset-v1:MITx+HST.936x+1T2019+type@asset+block/FIGURE_3_1.png" alt="" type="saveimage" target="[object Object]" preventdefault="function (){r.isDefaultPrevented=n}" stoppropagation="function (){r.isPropagationStopped=n}" stopimmediatepropagation="function (){r.isImmediatePropagationStopped=n}" isdefaultprevented="function t(){return!1}" ispropagationstopped="function t(){return!1}" isimmediatepropagationstopped="function t(){return!1}" width="950" height="533" /></span></span></p>
<p><span id="docs-internal-guid-b21e3e37-a903-c3a2-06ca-ba675408e31d"><span style="font-size: 14.6667px; font-family: Arial; color: #000000; vertical-align: baseline; white-space: pre-wrap; background-color: transparent;"><span style="font-family: 'Open Sans', Verdana, Arial, Helvetica, sans-serif;">When seeking to understand a health system, several broad questions may be useful to ask: What is the goal of the health system? How is the health system financed and managed? How do we measure performance of the health system? The answers to these questions vary considerably across countries and over time, based on economic development and shifts in political security and philosophy.</span> </span></span></p>
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<legend id="b4fe948f39b9460bb29b3e78435df597_2_1-legend" class="response-fieldset-legend field-group-hd">Which of the following governmental organisations may have important input into the development and implementation of a health system?</legend>
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<h2 class="hd hd-2 unit-title">What is a Health Information System?</h2>
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<h4>Health Information Systems</h4>
<p>A health information systems handles information relating to the health of individuals or to the activities of organizations within the health sector. They typically comprise multiple components that must work together cohesively for the system to be effective as a whole. This section outlines a programmatic approach to building national scale health information systems, starting with a thorough understanding of local policies followed by crafting eHealth strategies aligned with those policies.</p>
<p>Leadership then provides a governance framework to clarify what benefits should be achieved with acceptable risks and available resources. These benefits, risks, and resources are then forwarded to a program management team who supervise responsible entities to ensure their timely delivery. The ultimate goal of IT governance is to provide assurance to stakeholders that all activities in a complex national-scale health information system are aligned towards achieving the objectives of the national health strategy.</p>
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<h4>National Health Information System</h4>
<p>Foundation of a successful health information system on a national scale requires an eHealth strategy guided by active governance, supported by a clear enterprise architecture, and implemented with effective program management. These elements should be made transparent to all stakeholders to promote eHealth <span style="font-size: 1em;">adoption and to maximize its benefits.</span></p>
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<p>Christopher Seebregts PhD<br />Professor, <span style="color: black;">Meraka Centre for Artificial Intelligence Research and Health Architecture Laboratory<br /></span><span style="color: black;">University of Kwazulu-Natal<br />South Africa </span></p>
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<h3 class="hd hd-2">National Health Information System </h3>
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<h4 class="TxNITextNoIndent" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">Developing a Country-wide eHealth Strategy</span></h4>
<p class="TxNITextNoIndent" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">Designing, developing, and implementing a country-wide eHealth strategy </span>is a large, complex task, usually beyond the reach of of any single organization. eHealth strategy should be considered in terms of the broader health strategy of a region, to avoid fragmentation of efforts. While integrating eHealth strategy into national strategies is ideal, some countries lack even a national health strategy, so this is not always an option. </p>
<p class="TxNITextNoIndent" style="mso-layout-grid-align: none; text-autospace: none;">Many ministries of health now accept the important role of information technology in health service delivery, but may not possess the expertise to advocate for and lead the activities required to initiate the necessary reforms.<span style="font-size: 1em;"> </span><span style="font-size: 1em;">It is typical for health technology practitioners to focus on facility-based information systems (hospitals, clinics, laboratories, pharmacies), and much rarer to find experts who have experience working on projects that directly serve the needs of an entire country.</span></p>
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<h4 class="TxNITextNoIndent" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">IT Governance Frameworks</span></h4>
<p class="TxNITextNoIndent"><font color="#000000">IT governance frameworks have been developed to provide guiding principles for the effective and efficient use of information technology within organizations. Two IT governance frameworks available as reference to countries planning on carrying out their national eHealth strategy are: ISO/IEC 38500 and COBIT5.</font></p>
<p class="TxNITextNoIndent"><font color="#000000">ISO/IEC 38500 is an international standard for corporate governance of information technology, published jointly by the International Organization for Standardization (ISO) and the International Electrotechnical Commission (IEC). </font></p>
<p class="TxNITextNoIndent"><font color="#000000">COBIT5 (Control Objectives for Information and Related Technologies 5) is a framework for "business framework for the governance and management of enterprise IT", developed by ISACA a professional association focused on IT governance. </font></p>
<p class="TxNITextNoIndent"><font color="#000000">ISO/IEC 38500 supports top-level decision makers (board of directors, executive, senior managers), while COBIT5 addresses the needs of the same but also extends to IT management and operations. </font></p>
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<h4>The National eHealth Strategy Toolkit</h4>
<p>In 2012, the WHO and the International Telecommunications Union (ITU) jointly published the National eHealth Strategy Toolkit. The three-part toolkit describes processes for defining a vision, crafting an action plan, implementing, and monitoring a national eHealth strategy. It is “an expert, practical guide that provides governments, their ministries and stakeholders with a solid foundation and method for the development and implementation of a national eHealth vision, action plan and monitoring framework”.</p>
<p>The toolkit specified seven common areas of a national eHealth strategy, providing a methodology for transitioning from vision to an action plan to monitoring. The areas are:</p>
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<li>leadership and governance</li>
<li>strategy and investment</li>
<li>services and applications</li>
<li>infrastructure</li>
<li>standards and interoperability</li>
<li>legislation, policy and compliance</li>
<li>workforce</li>
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<p><span style="font-family: 'Open Sans', 'Helvetica Neue', Helvetica, Arial, sans-serif; line-height: 25.6px;">Alvin Marcelo MD</span><br style="text-rendering: optimizeLegibility; line-height: 1.4em; font-family: 'Open Sans', 'Helvetica Neue', Helvetica, Arial, sans-serif;" /><span style="font-family: 'Open Sans', 'Helvetica Neue', Helvetica, Arial, sans-serif; line-height: 25.6px;">Professor, </span><span style="font-family: 'Open Sans', 'Helvetica Neue', Helvetica, Arial, sans-serif; line-height: 25.6px;">National Telehealth Center</span><br style="text-rendering: optimizeLegibility; line-height: 1.4em; font-family: 'Open Sans', 'Helvetica Neue', Helvetica, Arial, sans-serif;" /><span style="font-family: 'Open Sans', 'Helvetica Neue', Helvetica, Arial, sans-serif; line-height: 25.6px;">University of the Philippines</span></p>
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<legend id="a59e7da74551445b8a508f92415f34af_2_1-legend" class="response-fieldset-legend field-group-hd">Which of the following components would typically be a requirement of a national eHealth strategy?</legend>
<p class="question-description" id="description_a59e7da74551445b8a508f92415f34af_1_1"> Select all that apply:</p>
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<input type="checkbox" name="input_a59e7da74551445b8a508f92415f34af_2_1[]" id="input_a59e7da74551445b8a508f92415f34af_2_1_choice_0" class="field-input input-checkbox" value="choice_0"/><label id="a59e7da74551445b8a508f92415f34af_2_1-choice_0-label" for="input_a59e7da74551445b8a508f92415f34af_2_1_choice_0" class="response-label field-label label-inline" aria-describedby="status_a59e7da74551445b8a508f92415f34af_2_1 description_a59e7da74551445b8a508f92415f34af_1_1"> IT leadership
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<input type="checkbox" name="input_a59e7da74551445b8a508f92415f34af_2_1[]" id="input_a59e7da74551445b8a508f92415f34af_2_1_choice_1" class="field-input input-checkbox" value="choice_1"/><label id="a59e7da74551445b8a508f92415f34af_2_1-choice_1-label" for="input_a59e7da74551445b8a508f92415f34af_2_1_choice_1" class="response-label field-label label-inline" aria-describedby="status_a59e7da74551445b8a508f92415f34af_2_1 description_a59e7da74551445b8a508f92415f34af_1_1"> learning healthcare system
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<input type="checkbox" name="input_a59e7da74551445b8a508f92415f34af_2_1[]" id="input_a59e7da74551445b8a508f92415f34af_2_1_choice_2" class="field-input input-checkbox" value="choice_2"/><label id="a59e7da74551445b8a508f92415f34af_2_1-choice_2-label" for="input_a59e7da74551445b8a508f92415f34af_2_1_choice_2" class="response-label field-label label-inline" aria-describedby="status_a59e7da74551445b8a508f92415f34af_2_1 description_a59e7da74551445b8a508f92415f34af_1_1"> standards and interoperability
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<input type="checkbox" name="input_a59e7da74551445b8a508f92415f34af_2_1[]" id="input_a59e7da74551445b8a508f92415f34af_2_1_choice_3" class="field-input input-checkbox" value="choice_3"/><label id="a59e7da74551445b8a508f92415f34af_2_1-choice_3-label" for="input_a59e7da74551445b8a508f92415f34af_2_1_choice_3" class="response-label field-label label-inline" aria-describedby="status_a59e7da74551445b8a508f92415f34af_2_1 description_a59e7da74551445b8a508f92415f34af_1_1"> mobile health applications
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</label>
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<input type="checkbox" name="input_a59e7da74551445b8a508f92415f34af_2_1[]" id="input_a59e7da74551445b8a508f92415f34af_2_1_choice_5" class="field-input input-checkbox" value="choice_5"/><label id="a59e7da74551445b8a508f92415f34af_2_1-choice_5-label" for="input_a59e7da74551445b8a508f92415f34af_2_1_choice_5" class="response-label field-label label-inline" aria-describedby="status_a59e7da74551445b8a508f92415f34af_2_1 description_a59e7da74551445b8a508f92415f34af_1_1"> eHealth governance
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<input type="checkbox" name="input_a59e7da74551445b8a508f92415f34af_2_1[]" id="input_a59e7da74551445b8a508f92415f34af_2_1_choice_7" class="field-input input-checkbox" value="choice_7"/><label id="a59e7da74551445b8a508f92415f34af_2_1-choice_7-label" for="input_a59e7da74551445b8a508f92415f34af_2_1_choice_7" class="response-label field-label label-inline" aria-describedby="status_a59e7da74551445b8a508f92415f34af_2_1 description_a59e7da74551445b8a508f92415f34af_1_1"> enterprise architecture
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</div><p>Note: Make sure you select all of the correct options&#8212;there may be more than one!</p>
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<h2 class="hd hd-2 unit-title">Enterprise Architecture</h2>
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<h4>Health Information Systems and Enterprise Architecture</h4>
<p>Health information systems in low-resource settings vary widely in functionality and effectiveness. Often the systems are somewhat fragmented in terms of design and operation, as a result of successive projects that are not well coordinated or harmonized with the existing public health systems. A “bottom-up” approach to designing and implementing systems, as discussed elsewhere, may also contribute to fragmentation within a system.</p>
<p>Enterprise architecture (EA) is a common approach to developing systems that are more coordinated and integrated at a systems level. EA has been described as “a well-defined practice for conducting enterprise analysis, design, planning, and implementation, using a holistic approach at all times, for the successful development and execution of strategy.” EA offers methodology and reusable architectural assets to assist in approaching the development of complex, large-scale systems systematically, helping to create a set of health architecture components that can be reused globally.</p>
<p>EA has been proposed as a possible approach to designing and developing health information systems for global health. The rationale is that the tools and techniques included in the EA approach will help address certain design issues currently limiting the application of HIS in low-resource settings, including:</p>
<ol>
<li>lack of standardization, including the use of standards for data storage and interoperability</li>
<li>minimal interoperability between individual applications developed for single solutions</li>
<li>limited reuse of existing applications that are often engineered around a single application use case</li>
<li>lack of data integration as a result of different conceptual frameworks and lack of use of standards</li>
<li>poor data quality, often resulting from lack of effective data use locally as well as poor data entry tools and training.</li>
</ol>
<p>Enterprise architecture provides a methodology and reusable architectural assets that can assist in the development of complex, large-scale systems systematically and holistically, and can potentially create reusable architecture components for global health projects.</p>
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<p>Alvin Marcelo MD<br />Professor, National Telehealth Center<br />University of the Philippines</p>
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<h3 class="hd hd-2">Enterprise Architecture</h3>
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<p><span style="font-family: 'Open Sans', 'Helvetica Neue', Helvetica, Arial, sans-serif;">Christopher Seebregts PhD</span><br style="text-rendering: optimizeLegibility; line-height: 1.4em; font-family: 'Open Sans', 'Helvetica Neue', Helvetica, Arial, sans-serif;" /><span style="font-family: 'Open Sans', 'Helvetica Neue', Helvetica, Arial, sans-serif;">Professor, Meraka Centre for Artificial Intelligence And Health Architecture Laboratory</span><br style="text-rendering: optimizeLegibility; line-height: 1.4em; font-family: 'Open Sans', 'Helvetica Neue', Helvetica, Arial, sans-serif;" /><span style="font-family: 'Open Sans', 'Helvetica Neue', Helvetica, Arial, sans-serif;">University of Kwazulu-Natal</span><br style="text-rendering: optimizeLegibility; line-height: 1.4em; font-family: 'Open Sans', 'Helvetica Neue', Helvetica, Arial, sans-serif;" /><span style="font-family: 'Open Sans', 'Helvetica Neue', Helvetica, Arial, sans-serif;">South Africa</span></p>
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Unit Exercise
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<h2 class="hd hd-2 unit-title">WHO-ITU National eHealth Strategy Toolkit</h2>
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<h4 class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">WHO-ITU National eHealth Strategy Toolkit</span></h4>
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<p class="TxText" style="mso-layout-grid-align: none; text-autospace: none;"><span style="mso-bidi-font-size: 12.0pt; color: windowtext;">The toolkit specified seven major areas in a national eHealth strategy and provided a methodology for transitioning from vision to an action plan to monitoring, which are outlined in the following figure.<o:p></o:p></span></p>
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<p>Leadership and governance covers all components of the WHO-ITU Toolkit, including “strategy and investment,” “legislation, policy, and compliance,” and “workforce” . The three components of “services and applications”, “standards and interoperability”, and “infrastructure” are stacked, to represent the interdependency of these components. To keep the stack aligned, an enterprise architecture may serve as the blueprint documenting how the health and business priorities of a country can be translated into technology solutions, and how they relate with each other.</p>
<p>Managing the enterprise architecture is a key process in the COBIT5 framework. The process ensures there is a disciplined approach to ensuring the business architecture and requirements are aligned with the data, application, and technology architectures.</p>
<p>One of the key functions of governance is to define and mandate an enterprise architecture for the national eHealth strategy. This architecture serves as a reference point for many stakeholders in the health sector, giving them confidence that compliance will ensure they will benefit from participating in the national eHealth program. Thus, it is highly advisable that a clear and published process for defining the EA is adopted and followed.</p>
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<legend id="ef58d63707404aab8baff8856f3f6cb5_2_1-legend" class="response-fieldset-legend field-group-hd">The two IT governance frameworks available as reference to countries planning on carrying out their national eHealth strategy are:</legend>
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