Prof Vajira Dissanayake has been at the forefront of developing Biomedical Informatics research and education in Sri Lanka, both in the public and private sectors. In 2008 he established an MSc course in Biomedical Informatics at the Postgraduate Institute of Medicine (PGIM) at the University of Colombo. The course trains Medical Doctors and Dental Surgeons in Biomedical Informatics and, to date, has produced 84 MSc graduates who are now spearheading the implementation of eHealth throughout Sri Lanka.
We spoke to Prof Dissanayake about the decision to include clinicians as a primary mechanism in rolling out an eHealth strategy for better health outcomes for Sri Lankans. Prof Dissanayake will be opening Day 2 of the eHealthALIVE2016 conference with a keynote address about building capacity based on his experience doing so in Sri Lanka’s health system. Click here to get your tickets.
Tell us how you came to the decision to directly engage clinicians in eHealth through a formal postgraduate course in Informatics?
When we looked at the reasons why eHealth implementations were failing in the country, we realised that it was because of a lack of leadership within the medical profession itself to engage and work with ICT professionals on an equal footing. This led to the creation of the MSc course in Biomedical Informatics, with the overall vision of creating a new generation of leaders in Health Informatics in Sri Lanka. Our aim was to develop these leaders with domain expertise in healthcare and ICT, who could go on to spearhead the development and implementation of ICT in the Healthcare Sector working with ICT professionals and under the guidance of the decision makers at the highest level.
How has the course improved the health of Sri Lankans?
Graduates of the course have improved productivity, efficiency and decision making capacity within the health service through numerous ICT implementations that directly translate to better care for patients.
Can you give us an example of a graduate now providing eHealth leadership that improves health in Sri Lanka?
There are many projects, but the one that’s had the biggest, transformative impact is the eIMMR Project, or the electronic Indoor Morbidity and Mortality Reporting system. The system was created in 2009 by two students enrolled in the Postgraduate course, Dr Nadish Kariyawasam and Dr Buddhika Dayarathne, who went to the Medical Statistics Unit (MSU) of the Ministry of Health wanting to commence their MSc project. What they ended up pioneering was a real-time web-based information platform that would become the first system to be implemented in all hospitals throughout the country.
The doctors identified the need to improve data collection on admissions (morbidity) and deaths (mortality). At the time, this data was being collected manually and sent to the MSU to be compiled and generate reports. There are 624 hospitals in Sri Lanka and five to six million admissions every year, and of these admissions approximately 40,000 to 45,000 patients die. Collating this information manually was a time consuming and tedious process that meant data in the reports were up to six years out of date.
They created a simple system that captured essential data on a one-page web interface. All hospitals needed to start entering data was a computer and Internet connection. Over the next four years, the system was deployed in 180 hospitals capturing over 53% of admissions data throughout the country. It is expected that by the end of 2017 the system will be deployed in 70% of hospitals in the country and gather over 95% of all hospital data.
What were some of the barriers to implementation that they had to overcome?
An initial survey of facilities showed that only 22% of hospitals had computers and only 5.5% of those hospitals had Internet connectivity. Implementation hinged on investment in infrastructure, which came about in 2013 when we received funding from the World Bank to upgrade record rooms.
The second obstacle was training users on the system. There were 1,300 people handling IMMR data across the country and all of them needed to be trained. In2014 we arranged 25 workshops, one in each district of the country, and a two week medical coding training programme at the National Institute of Health Sciences. It was an enormous task but to date there are 738 users entering data onto the system daily and they’ve captured a total of almost four million records.
The biggest step forward we’ve taken by implementing eIMMR is realising a timely Annual Health Bulletin. Instead of taking decisions based on data that is out of date, we are closing that gap and by 2017, will produce a national report using 2016 data.
This is only one instance of graduates of the MSc course who have truly transformed the health system in Sri Lanka and the financial investment for the Ministry of Health to create the system was the total of the salary of two doctors. The effects on health services have been powerful.
Are there any other developments in the pipeline for expanding the Postgraduate course?
Building on its success, the PGIM will be starting a MD course in Health Informatics in the academic year 2016/17 and the graduates of the MD course would be Board Certified as Specialists in Health Informatics.
What can African countries take away from your experience in trying to use eHealth to strengthen and transform health systems?
Every country should take the initiative to develop capacity within the medical profession and empower them to lead ICT implementation, work hand in hand with ICT professionals to make ICT implementations in the health sector of their country meaningful and sustainable.
This year you will take up the Presidency of the Commonwealth Medical Association. What eHealth message will you carry with you into the role?
It’s the same message that has been one of my mottos: ‘Our aim is Health NOT eHealth’ – it’s the premise that applies to all countries that the overall aim is better health through eHealth, not technology for technology’s sake.
Prof Dissanayake will be opening Day 2 of the eHealthALIVE2016 conference with a keynote address about building capacity based on his experience doing so in Sri Lanka’s health system. Click here to get your tickets.