Member Spotlight: Usman Raza Jan. 21-25

By Joaquin Blaya, PhD Moderator | 15 Jan, 2013

Hi everyone,
I wanted to introduce Usman Raza, who will be joining us as a guest moderator in the Health IT community for the next few months. Usman's experiences as a clinician, educator and program officer in Pakistan bring a unique perspective to the challenges we face in global Health IT. To start things off, we've invited Usman to join us for a Member Spotlight starting next week, to share more his work and thoughts on the current state of Health IT in Pakistan. Please join us in this discussion by sharing your own questions and comments for Usman.

Replies

 

A/Prof. Terry HANNAN Moderator Replied at 9:22 PM, 15 Jan 2013

To Usman. having worked in a resource poor environment (Kenya) and experienced first hand the difficulties with e-health implementations I look forward to any comments,experiences and solution you can bring to an environment that is even more difficult tha n Kenya. That is this poverty, limited resources, and a prolonged war.

Usman Raza Moderator Emeritus Replied at 11:40 AM, 21 Jan 2013

Thank you Joaquin for introducing and inviting me to member spotlight.

To give a little bit more detail, I started my career by training as a physician in Pakistan. Following some clinical work and teaching, I completed a Masters program in Health Policy & Management from Harvard. After coming back to Pakistan, I started teaching public health (http://chs.prime.edu.pk/final/) and got involved in a number of health and development projects (http://chs.prime.edu.pk/final/index.php/project-support-unit/projects.html) ranging from emergency medical relief to livelihood improvement schemes in the flood affected regions. In 2011, I joined the National AIDS Control Program (http://nacp.gov.pk/) of Pakistan to work in a Global Fund project (http://portfolio.theglobalfund.org/en/Grant/List/PKS) for HIV affected population across the country. Throughout my career, I have been observant of information system challenges and attempted to solve where possible.

In my current role as Program Officer at the National AIDS Control Program (http://nacp.gov.pk/), I am involved in implementation of Community & Home Based Care (CHBC) services for the HIV affected population in Pakistan. Within this job, I am also serving as a technical lead for the development of an online Management Information System for tracking service delivery information of our CHBC sites across the country. The system is functional but far from perfect, and we're making changes based on implementation experience. The system features data entry, reporting, a performance dashboard and some decision support for managers at CHBC sites. As is the case with many other data collection systems in the country, this one was also developed in parallel to other systems covering different sets of services. The next step will be an attempt to integrate these systems.

Before this job, I have worked in multiple roles at a medical school in the Community Health Sciences (http://chs.prime.edu.pk/) department at Peshawar Medical College. As part of a project, I was involved in developing an electronic disease reporting system for our medical clinics in flood affected areas. The system was based on DEWS (Disease Early Warning System) reporting system. I also got a chance to redesign the information flow of patient registration at an affiliated hospital which reduced the registration processing time from one minute to under 15 seconds.

The field of Health IT is in its infancy in Pakistan, however information and monitoring systems are nothing new to the public health sector. There are some initiatives attempting to utilize electronic and mobile technologies in health service delivery and data collection. At the same time many private hospitals are building their own EMR systems, often with little forethought about interoperability . Yet, the interoperability issue seems to be less glaring in the absence of any large health care financing mechanisms for public.

Looking forward to hearing your thoughts...

Best,
Usman Raza
Linkedin Profile <http://www.linkedin.com/in/uraza>

A/Prof. Terry HANNAN Moderator Replied at 5:18 PM, 21 Jan 2013

Dear Usman welcome. I have some questions for you that I hope will provide us with a better understanding of the health care delivery models in your work environment and ask you how you may be assessing possible solutions for HIT implementations in these areas.

1. Are the regions you work in - local/regional - serviced mainly by hospital based care or ambulatory clinics?

2. I note as a physician you have migrated to the important role of community reporting and emergency relief projects. How do you see the evolution of HIT being implemented at the patient interface level?
3. What are your current tools for patient care capture data and what do you see as the requirements for improving these?

4. Do you have estimates (actual statistics) on the availability and use of mobile technologies in the overall community? Also do you see these devices as having a significant role in health information management in Pakistan?

5. IF you have few doctors in regional areas as in most under resourced nations who delivers most of the care and what are the recording and storage mechanisms for health care data-now and planned for the future?

6. In the last paragraph of your introduction you state:
"There are some initiatives attempting to utilize electronic and mobile technologies in health service delivery and data collection. At the same time many private hospitals are building their own EMR systems, often with little forethought about interoperability . Yet, the interoperability issue seems to be less glaring in the absence of any large health care financing mechanisms for public.".

Do you see this situation as a potential failure point for HIT and do you have any suggested solutions?

Finally welcome aboard GHDonline and for sharing you rich experiences and knowledge with us. Terry

Michele Meltzer Replied at 2:33 PM, 22 Jan 2013

Dr. Usman,
Have you developed any tools for teaching the local physicians and health care professionals. I am a member of a group of rheumatologists who are interested in promoting training in our specialty. We have partnered with physicians in Nairobi but the shortage of rheumatologists is so great that we have made limited impact. Have you or anyone in the group used online teaching to physicians/healthcare professionals/medical students? There are several new medical schools in Kenya.
Thanks,
Michele

Usman Raza Moderator Emeritus Replied at 1:48 AM, 24 Jan 2013

Thank you Prof. Terry for the warm welcome. Very interesting questions
indeed, and I've attempted to answer along with a background perspective:

1. Are the regions you work in - local/regional - serviced mainly by
hospital based care or ambulatory clinics?

Clinical case in Pakistan generally starts from ambulatory clinics, and
these by far are the most common source of care. However, hospitals are
consdiered by patients as the ultimate place for getting quality care
(which may be a false impreession). There are about a thousand hospitals of
varying sizes in Pakistan, few of which would have any form of electronic
information system, and much fewer would have something of an EMR. (
http://pjmhsonline.com/JulySept2011/costing_structure_of_public_hosp.htm)
The ambulatory clinics are much more in number, and are mostly single
physician practices, although larger cities are now seeing evolution of
group practices. Again, EMRs are only rarity in clinics. So in other words,
both hospitals and clinics present a largely unsaturated market for EMRs.
However, at the same time, I note that physicians have few incentives or
perceived benefits to adopting EMRs, apart from a general discomfort with
using computers.


2. I note as a physician you have migrated to the important role of
community reporting and emergency relief projects. How do you see the
evolution of HIT being implemented at the patient interface level?

One of the challenges in adopting EMRs or other digital systems here is
that there is little demand from patient side. While official 'estimates'
will suggest a literacy rate of above 50% in Pakistan, that hardly
translates into an ability to use electronic communication forms (mostly in
English). However, the cell phone technology is becoming ubiquitous and I
personally feel that at patient level, mHealth would offer more
opportunities for enhancing interaction of patients with the health system,
as compared with regular computer/internet forms.


3. What are your current tools for patient care capture data and what do
you see as the requirements for improving these?

There were two key systems developed as part of the current project where I
am working. There is a very basic MIS for collecting service delivery data
from Community & Home Based Care sites. This one involves data entry on
paper forms as a first step, which is later entered into an online form,
visually resembling the one on paper. Every site manager can see their
performance against targets, and a comparison with other sites. The system
collates information from all sites together to generate summary reports at
national level.

The other one is a more sophisticated EMR which was developed on the lines
of a Clinton Foundation supported software implemented in India. However,
this EMR has faced challenges in that it is too complicated and time
consuming for physicians and counsellors to operate, who therefore
requested that data entry operators be provided at each treatment center.
Currently we are looking into a complete redesign of this system to make it
easier to use and to collect only the essential information.


4. Do you have estimates (actual statistics) on the availability and use of
mobile technologies in the overall community? Also do you see these devices
as having a significant role in health information management in Pakistan?

Pakistan has he highest cell phone penetration in South Asia and one of the
highest in the world, with a teledensity of over 70% now. There has been an
almost dramatic increase in cell phone subscriptions from 5 million in 2003
to 123 million by end of 2012. Some statistics are available at
http://www.pta.gov.pk/index.php?option=com_content&view=article&id=269:teleco...
For this reason alone, anyone considering health IT work here should
seriously consider mHealth as a way of reaching millions of people.
Possibilities range from improving treatment quality (e.g. supporting
TB-DOTS) to creating micro-health insurance programes collecting payments
through cell phone balance (With most of the popualtion employed informally
in Pakistan, it is a challenge to create reliable tracking systems for
insurance programs, and cell phone subscriptions offer a promising
solution).

5. IF you have few doctors in regional areas as in most under resourced
nations who delivers most of the care and what are the recording and
storage mechanisms for health care data-now and planned for the future?

Just like other under-resourced regions/countries, we are also facing the
'internal brain drain' with more physicians (and higher qualified)
concentraing in big cities while majority (65%) population lives in rural
areas. In both rural and urban areas, the government run Basic Health Units
(BHU) and Rural Health Centers (RHC) are reporting disease data through two
systems: The DEWS (WHO supported Disease Early Warning System) and the DHIS
(District Health Information System which is slower and collects more
detailed disease data). Recently the WHO has introduced e-DEWS which
employs cell-phone based reporting from the field (
http://www.who.int/hac/crises/pak/pak_healthclusterbulletin_29jan.pdf).
This I believe is an excellent approach and will allow faster response to
disease outbreaks.

6. In the last paragraph of your introduction you state " There are some
initiatives attempting to utilize electronic and mobile technologies in
health service delivery and data collection. At the same time many private
hospitals are building their own EMR systems, often with little forethought
about interoperability . Yet, the interoperability issue seems to be less
glaring in the absence of any large health care financing mechanisms for
public.". Do you see this situation as a potential failure point for HIT
and do you have any suggested solutions?

I think the issue of interoperability stems from lack of standards. Here we
have a situation where even the general hospital quality standards are only
beginning to show up in academic discussions. Because there are very few
hospitals implementing EMRs at this time, this doesn't seem like a serious
issue, but I consdier this a potential failure point which we will see may
be 10-15 years from now. Devolution of Federal Health Ministry in 2011 has
posed additional challenges, as the provincial/state roles are still
unclear. The way forward is clearly to begin with standard setting and
developing regulation mechanisms especially with respect to confidentiality
of information. Perhaphs solutions like OpenMRS could be a starting point.

Hoping to hear more opinions from members on these.

Best,
Usman Raza
Linkedin Profile <http://www.linkedin.com/in/uraza>

Usman Raza Moderator Emeritus Replied at 1:59 AM, 24 Jan 2013

Dear Michele,

Thank you for your response. It would be great to have this kind of
collaboration. To give you some background though, rheumatology in Pakistan
is still a young specialty. In most places, you will find an orthopedic
surgeon (or sometimes a medical specialist) delivering rheumatology care
(often with the involvement of a physiotherapist). Only the largest
teaching hospitals in major cities will have a trained rheumatologist
available. If the training is focused specifically for rheumatologists, you
might face a situation similar to Nairobi. But if the training could be
modified and reduced to something that could be useful to
non-rheumatologist physicians who have to deal with rheumatology cases
anyway, then we could be perhaps looking at a potentially large audience.
The number of medical schools in Pakistan is also increasing fast.

I know of a public health institute that is running a Masters in Health
Research involving some international faculty through online lectures.
Another similar project for clinical training was also conceived where I
was last working, however it did not materialize for various reasons. It
did include some in-person facetime as well (physicians from USA were to
travel to Pakistan for a short visit).

We can discuss this further and I can link you up with some institutes who
may be interested in this direction.

Best,
Usman Raza
Linkedin Profile <http://www.linkedin.com/in/uraza>

Michele Meltzer Replied at 10:32 AM, 24 Jan 2013

Usman,
Thank you very much. I was going to go to Aga Khan in Karachi but with the political situation
did not. My email: .
I look forward to hearing from you.
Michele

Usman Raza Moderator Emeritus Replied at 11:06 PM, 25 Jan 2013

Thank you Michele. Yes the political situation is rather volatile in some
areas. I am currently based in Islamabad and have good links with
hospitals/med schools in Peshawar. My email is I'd be
pleased to hear more about your work. One issue I've noticed with
clinicians is that they are often short of time and will not commit to
lengthy or time consuming programs.

Regards,
Usman Raza
Linkedin Profile <http://www.linkedin.com/in/uraza>

Joaquin Blaya, PhD Moderator Replied at 5:05 AM, 27 Jan 2013

We wanted to thank Usman for his willingness to participate in this Member
Spotlight. This week also marks a first for GHDonline, the first time we've
had a someone become a father during a Member Spotlight, so we wanted to
give a big congratulations to Usman for his newborn baby!

We also wanted to thank those members that participated and hope that this
will allow you to make more connections.

Finally, we wanted to announce that Usman will be joining us as a Guest
Moderator, along with Terry, so we will be hearing a bit more from Usman in
the coming months. Welcome!

Joaquin
____________________________________________________
Gerente Tecnológico, eHS (www.ehs.cl)
Moderador, GHDonline.org
Fellow, Escuela de Medicina de Harvard

Usman Raza Moderator Emeritus Replied at 4:39 AM, 28 Jan 2013

Thank you Joaquin and others. It's been a rather unexpectedly busy but
delightful week here with the new addition to the family. Michele and
myself are already in discussion off the forum regarding possible
collaboration on distance learning programs for physicians.

Best regards,

Usman Raza
Linkedin Profile <http://www.linkedin.com/in/uraza>

A/Prof. Terry HANNAN Moderator Replied at 4:48 AM, 28 Jan 2013

Usman, as you squeeze your informatics thoughts between sleepless nights and nappies please share with us so we can expand and discuss the topics you raise as for example the distance learning for physicians that you mention below. Terry

Sent from my iPad

Ken Mwai Replied at 2:48 AM, 29 Jan 2013

Hi Usman;
You said there are some initiatives attempting to utilize electronic and mobile technologies in health service delivery and data collection. Which are the most efficient methods used currently

Mike Bitok Replied at 3:16 AM, 29 Jan 2013

Hi,
I would wish to contribute in regards to the use of mobile technology in Health service delivery.I have in the recent past,been involved in a project that utilised mobile technology.We used android phones,which hosted an xml form,via ODK.The data collected would later be synced in to a server(OpenMRS) for production purposes.The processed data would then be used by clinicians & medics,data analysts and researchers.depending on their needs.

A/Prof. Terry HANNAN Moderator Replied at 4:21 AM, 29 Jan 2013

Mike, do you have any documentation that I(we) could read on your work. I am very interested in mHealth and its applications and in particular with patient empowerment. Terry

Mike Bitok Replied at 4:55 AM, 29 Jan 2013

My focus was more on the implementation and administration of the project.However,with the links below,you should be able to get heads-up on the project.

http://code.google.com/p/ampath-odk/
https://wiki.ampath.or.ke/plugins/viewsource/viewpagesrc.action?pageId=35849817

For further information,on how it works,i can do a separate write up/alternative am open for skype chat session to brief you further.

Usman Raza Moderator Emeritus Replied at 11:48 AM, 3 Feb 2013

Hi Ken and everyone else.

Sorry for the slow response; like Prof. Terry said, I'm squeezing this
between sleepless nights and nappies :)

In practice the most effectively implemented project I know of is the
e-DEWS (electronic Disease Early Warning System) in Pakistan that is being
backed by WHO. While this project requires use by health care providers and
managers, the relative ubiquitousness of mobile phones compared to
computers suggests that mobile based technologies will be penetrating much
faster than other technologies. I say this because even the less educated
and rural communities are active users of cell phones now.

Indus Hospital / IRD Reasearch <http://irdresearch.org/ehealth> have also
successfully implemented several initiatives; the one on TB has been
mentioned several times on this forum but they are doing other interesting
projects as well.

Healthcare (industry) I believe is generally slow in catching up with the
available technology. For example, banks have already leveraged the cell
phone technology to the extent that people in rural areas of the country
are now able open and operate bank accounts using just a phone, pay utility
bills through the phone, do money transfers and so on. Sometime back we
used to think these advancements would take a long time in reaching rural
areas but the cell phones have essentially proven to be a disruptive
technology.

Best,
Usman Raza
Linkedin Profile <http://www.linkedin.com/in/uraza>

Usman Raza Moderator Emeritus Replied at 12:42 PM, 3 Feb 2013

P.S. Regarding the online courses for clinicians, I wanted to bring back
one point from my offline discussion with Michele: we talked about MOOC
initiatives and I am wondering if anyone on this forum has had experience
with 'clinical content' in Coursera/MOOC type of design? It would be
interesting to know how practical this is.

Regards,
Usman Raza
Linkedin Profile <http://www.linkedin.com/in/uraza>


On Sun, Feb 3, 2013 at 9:48 PM, GHDonline (Usman Raza)
<:

>
> Usman Raza replied to the discussion "Member Spotlight: Usman Raza Jan.
> 21-25" in the Health IT community.
>
> Reply contents:
> "Hi Ken and everyone else.
>
> Sorry for the slow response; like Prof. Terry said, I'm squeezing this
> between sleepless nights and nappies :)
>
> In practice the most effectively implemented project I know of is the
> e-DEWS (electronic Disease Early Warning System) in Pakistan that is being
> backed by WHO. While this project requires use by health care providers and
> managers, the relative ubiquitousness of mobile phones compared to
> computers suggests that mobile based technologies will be penetrating much
> faster than other technologies. I say this because even the less educated
> and rural communities are active users of cell phones now.
>
> Indus Hospital / IRD Reasearch <http://irdresearch.org/ehealth> have also
> successfully implemented several initiatives; the one on TB has been
> mentioned several times on this forum but they are doing other interesting
> projects as well.
>
> Healthcare (industry) I believe is generally slow in catching up with the
> available technology. For example, banks have already leveraged the cell
> phone technology to the extent that people in rural areas of the country
> are now able open and operate bank accounts using just a phone, pay utility
> bills through the phone, do money transfers and so on. Sometime back we
> used to think these advancements would take a long time in reaching rural
> areas but the cell phones have essentially proven to be a disruptive
> technology.
>
> Best,
> Usman Raza
> Linkedin Profile <http://www.linkedin.com/in/uraza>
>
>
> On Tue, Jan 29, 2013 at 12:48 PM, GHDonline (Ken Mwai)
> <:
>
> >
> > Ken Mwai replied to the discussion "Member Spotlight: Usman Raza Jan.
> > 21-25" in the Health IT community.
> >
> > Reply contents:
> > "Hi Usman;
> > You said there are some initiatives attempting to utilize electronic and
> > mobile technologies in health service delivery and data collection. Which
> > are the most efficient methods used currently"
> >
> > --
> > View this post online:
> > <
> >
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> > >
> >
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> --
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> >
>
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