Enabling Care Continuity using a Digital Health Wallet

Osebe, Samuel; Walcott, Aisha; Weldemariam, Komminist; Wachira, Charles; Matu, Fiona; Bore, Nelson; Kaguma, David; Mutahi, Juliet; Ogallo, William; Cintas, Celia; Remy, Sekou L.

doi:10.1109/ichi.2019.8904625

Cited by 3 publications

(6 citation statements)

References 12 publications

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“…In this regard, we identified the need to strengthen health systems in the Kenyan private and public sectors to support the management of hypertension and to ensure care continuity and quality within and across facilities. On the basis of the lessons learned from our research, we proposed a patient-centered platform, called the Digital Health Wallet Platform, which aims to improve the documentation and exchange of health data gathered during care provision by allowing patient-consented and mediated data sharing [16]. The platform is built on top of a blockchain network to ensure privacy and auditability of care provision.…”

Section: Recommendations Themementioning

confidence: 99%

“…This platform has 3 core components: a care management platform, a patient care wallet, and a clinical encounters app (Table 3). The care management platform manages clinical encounters and enables the patient-controlled exchange of health data via blockchain protocols while adhering to the Fast Healthcare Interoperability Resources (FHIR) version 3.0 standard [16]. It supports data sharing and guideline-based decision making in outpatient clinical workflows.…”

Section: Recommendations Themementioning

confidence: 99%

“…It supports data sharing and guideline-based decision making in outpatient clinical workflows. The patient care wallet is a mobile app where patients view their health records and can track who accessed their records [16]. It also enables patient-consented data sharing via a decentralized consent management blockchain system.…”

Section: Recommendations Themementioning

confidence: 99%

“…It also enables patient-consented data sharing via a decentralized consent management blockchain system. Finally, the clinical encounters app supports care providers through workflows and enables requests for patient consent to share health data between providers [16].…”

Section: Recommendations Themementioning

confidence: 99%

“…The architecture of the proposed platform is illustrated in Figure 1 and has been described in detail by Osebe et al [16]. End users access the system via specific apps on smartphones (for patients) and tablets (for providers).…”

Section: Recommendations Themementioning

confidence: 99%

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Addressing Care Continuity and Quality Challenges in the Management of Hypertension: Case Study of the Private Health Care Sector in Kenya (Preprint)

Walcott-Bryant¹,

Ogallo²,

Remy³

et al. 2020

Preprint

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BACKGROUND The rise of noncommunicable diseases in sub-Saharan Africa places strain on already stretched healthcare systems, that have traditionally focused on infectious diseases. Healthcare provision is fragmented, and there is a dearth of literature on the experiences, challenges, and solutions for improving the management of noncommunicable diseases in sub-Saharan private healthcare sectors. OBJECTIVE We investigated the management of hypertension in the Kenyan private healthcare sector to understand how a health information system could be used to address care continuity and quality challenges in the management of hypertension and other noncommunicable diseases. METHODS We conducted in-depth interviews and direct observations at 18 healthcare institutions in Kenya. We analyzed the data to identify the key challenges and proposed solutions to the challenges. We subsequently used the generated insights to propose the design of a digital health solution for enabling care quality and continuity at the study setting and similar ecosystems. RESULTS The private healthcare sector in Kenya is fragmented and faces challenges such as high cost of care, limited healthcare literacy, lack of self-management support, ineffective referral systems, inadequate care provider training, and inadequate regulation. Care coordination is hindered by suboptimal encounter data collection, limited view of patient histories, and little trust between care providers. Patient health records are siloed in multiple paper and electronic systems that lack integration. The proposed digital health platform system supports care coordination and continuity within fragmented healthcare systems by enabling patient-consented data sharing while ensuring that care providers in separate facilities have holistic views of the patient’s clinical and non-clinical history. CONCLUSIONS Health information systems can play a pivotal role in addressing the care continuity and quality challenges in the management of noncommunicable diseases in sub-Saharan Africa private healthcare sectors. Leveraging technology and processes to support patients managing chronic noncommunicable diseases in disparate clinical and nonclinical settings (e.g. at home and in support groups) is critical.

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Section: Recommendations Themementioning

confidence: 99%

Section: Recommendations Themementioning

confidence: 99%

Section: Recommendations Themementioning

confidence: 99%

Section: Recommendations Themementioning

confidence: 99%

Section: Recommendations Themementioning

confidence: 99%

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Addressing Care Continuity and Quality Challenges in the Management of Hypertension: Case Study of the Private Health Care Sector in Kenya (Preprint)

Walcott-Bryant¹,

Ogallo²,

Remy³

et al. 2020

Preprint

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Where There is No CISO

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Büttner

Gruschka

et al. 2022

Freedom and Social Inclusion in a Connected World

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Addressing Care Continuity and Quality Challenges in the Management of Hypertension: Case Study of the Private Health Care Sector in Kenya

Walcott-Bryant¹,

Ogallo²,

Remy³

et al. 2021

J Med Internet Res

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Background Hypertension is a major risk factor of cardiovascular disease and a leading cause of morbidity and mortality globally. In Kenya, the rise of hypertension strains an already stretched health care system that has traditionally focused on the management of infectious diseases. Health care provision in this country remains fragmented, and little is known about the role of health information technology in care coordination. Furthermore, there is a dearth of literature on the experiences, challenges, and solutions for improving the management of hypertension and other noncommunicable diseases in the Kenyan private health care sector. Objective The aim of this study is to assess stakeholders’ perspectives on the challenges associated with the management of hypertension in the Kenyan private health care sector and to derive recommendations for the design and functionality of a digital health solution for addressing the care continuity and quality challenges in the management of hypertension. Methods We conducted a qualitative case study. We collected data using in-depth interviews with 18 care providers and 8 business leads, and direct observations at 18 private health care institutions in Nairobi, Kenya. We analyzed the data thematically to identify the key challenges and recommendations for technology-enabled solutions to support the management of hypertension in the Kenyan private health sector. We subsequently used the generated insights to derive and describe the design and range of functions of a digital health wallet platform for enabling care quality and continuity. Results The management of hypertension in the Kenyan private health care sector is characterized by challenges such as high cost of care, limited health care literacy, lack of self-management support, ineffective referral systems, inadequate care provider training, and inadequate regulation. Care providers lack the tools needed to understand their patients’ care histories and effectively coordinate efforts to deliver high-quality hypertension care. The proposed digital health platform was designed to support hypertension care coordination and continuity through clinical workflow orchestration, decision support, and patient-mediated data sharing with privacy preservation, auditability, and trust enabled by blockchain technology. Conclusions The Kenyan private health care sector faces key challenges that require significant policy, organizational, and infrastructural changes to ensure care quality and continuity in the management of hypertension. Digital health data interoperability solutions are needed to improve hypertension care coordination in the sector. Additional studies should investigate how patients can control the sharing of their data while ensuring that care providers have a holistic view of the patient during any encounter.

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Enabling Care Continuity using a Digital Health Wallet

Cited by 3 publications

References 12 publications

Addressing Care Continuity and Quality Challenges in the Management of Hypertension: Case Study of the Private Health Care Sector in Kenya (Preprint)

Addressing Care Continuity and Quality Challenges in the Management of Hypertension: Case Study of the Private Health Care Sector in Kenya (Preprint)

Where There is No CISO

Addressing Care Continuity and Quality Challenges in the Management of Hypertension: Case Study of the Private Health Care Sector in Kenya

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