Development of a Digital Health Strategy for Te Marae Ora Ministry of Health Cook Islands
BACKGROUND
The Cook Islands Government is receiving technical support from the Asian Development Bank (ADB) to develop and implement electronic government (e-government) projects in the Cook Islands. Te Marae Ora Ministry of Health Cook Islands (TMO) was selected to pilot an e-government project to support digital health in 2019. This involved upgrading existing Information and Communications Technology (ICT) infrastructure and the existing patient information management system (PIMS) [MedTech32]. Common challenges experienced with health information systems (HIS) in the Cook Islands included fragmented ICT infrastructure, poorly integrated HIS and the wide use of traditional paper records, limiting the extent to which health professionals can share useful, accurate and timely health information. New ICT infrastructure and hardware to enable better internet and network connectivity and HIS use, is scheduled to be fully operational from 01 July 2021 onwards.
The Cook Islands National Health Information Strategy (2015-2019) ended in 2019 with limited capacity to implement the plan effectively. Many activities remain incomplete such as the establishment of a multi-sectoral HIS committee, training on international classification of disease (ICD) coding, and the establishment of a data warehouse. A rapid assessment on HIS in the Cook Islands, showed the Cook Islands scored more than 50% on five of six components of the Health Metrics Network, and less than 25% in one component – data management processes (collection, entry, storage, analysis, interpretation and dissemination of health data). Preliminary scoping and work on the new ICT infrastructure and HIS upgrade commenced in October 2019 with various projects involving: data cleaning on the PIMS, digitisation of all patient paper records and documentation of PIMS processes. These projects will be completed by June 2021, however data cleaning will continue as part of quality improvement processes.
The COVID-19 pandemic delayed progression on the development of a Digital Health Strategy. However, COVID-19 has implications for the design, development, and use of technologies. Therefore an urgent need for a greater understanding of roles in managing HIS and ICT, supports the prioritisation of this work to ensure safe and quality health services are maintained, while managing the pandemic.
A Digital Health Strategy will focus on ensuring the right information is available to the right people at the right time to support evidence-based decision-making by management and clinicians working across the health system. The strategy must establish the vision, aspirations and priority areas of work to optimise the use of digital technology in health care and social services. The strategy must also incorporate the special relationship the Cook Islands and New Zealand nurture which enables Cook Islanders to freely access the New Zealand public health system.
The current PIMS, (MedTech32) has been used in hospitals and health centres in the Cook Islands since 2004. MedTech32 has been a relatively user-friendly system that has stored data for hospitals such as patient admissions, consultation notes, laboratory and radiology results, and birth and death registration and immunisation status. A major challenge with MedTech32 was the lack of integration and interoperability with other information systems such as the pharmacy dispensary and inventory system (mSupply), human resources information management system, finance and public health surveillance systems. Other challenges included difficulties in extracting data, the lack of a well-trained workforce to use the system, and the absence of formalised processes and protocols to use HIS to develop evidence-based health policies, planning, interventions, practice and reporting. The Digital Health Strategy is expected to address these issues.
TMO is obligated under the Ministry of Health Act 2013 to ensure patients and users of health services can access their medical records and to maintain patient data confidentiality. The National Health Roadmap (2017-2036) vision is to see modern and integrated ICT including telemedicine linked across all levels of health, streamlined patient indexing and ensuring patient records are accessible locally and overseas. A Digital Health Strategy supports TMO’s digital transformation goals and the government’s e-government agenda.
PURPOSE/SPECIFIC OBJECTIVE OF THE ACTIVITY
Strategic goals under the National Government ICT Strategy 2019-2024 include creating a centralised database and ‘one-stop’ shop for government information. A Digital Health Strategy will support connecting health professionals within the Cook Islands and with health professionals in New Zealand, to provide quality health services for patients and efficient emergency responses for the population.
TMO is seeking technical support to design and develop a resilient and responsive Cook Islands Digital Health Strategy to document the visions and direction of digital health into the future and investments forecasted to achieve the vision. This includes finding ways to use new and emerging technologies to improve health care and enabling services through appropriate innovation and technology, while supporting cost reduction measures from efficiency gains. The strategy creates an opportunity for health professionals to provide patients with the highest quality of care and enables communities to use technology to help take control of their health.
TMO plans to establish efficient, effective and integrated digital health platforms integrating electronic medical records, information systems for the pharmacy, laboratory, radiology services, public health, oral health, human resources and finance. The strategy will enable users of health services to access their records from anywhere at any time using approved devices such as mobile phones.
- • Policy and legislative gaps analysis b) Broad HIS assessment including management and clinical leadership and technical aspects such as standards, coding and interoperability to achieve TMO’s digital health transformation goals
The purpose of the contract is to:
- Identify and assess policy and legislative gaps to implement digital health in the Cook Islands
- Develop a five-year Cook Islands Digital Health Strategy and Implementation Plan for TMO to provide a digital health environment that meets the country’s population health needs
- Confirm estimated costs for effective implementation of the Digital Health Strategy.
- Develop sustainable forward-looking practical strategy: The strategy should take consideration on digital health maturity and existing technology and it should be forward looking including a high level enterprise architecture.
- Provide a “strategy-driven” digital health implementation plan.
- Provide guidance on leveraging digital health for COVID-19 response (comprehensive digital health strategy including surveillance, Port of Entry surveillance and outbreak management among others)
DESCRIPTION OF ACTIVITIES TO BE CARRIED OUT
Under the overall supervision of the WHO Representative, and in collaboration with the Pacific Country Offices/County Liaison Offices and the country focal points and the Ministry of Health, the consultant will provide technical and operational assistance in developing Cook Islands’ strategy for digital health strengthening to guide implementation of national health plan.
Detailed scope of work includes but is not limited to supporting:
- Identify and assess policy and legislative gaps to implement digital health effectively
- • Assess HIS management issues (ICT infrastructure, configuration, security, integration and interoperability, databases, identification, coding, etc.) for hospitals and health centres.
- • Assess current technology and applications and feasibility/integration roadmap
- • Work with Policy, HIS and ICT staff and equipment vendors to understand how hardware components support the TMO ICT network
- • Review existing documentation of HIS hardware components used by TMO
- • Review existing documentation of HIS software components used by the TMO
- • Document the process for ensuring connectivity (troubleshooting guide)
- Develop a Cook Islands Digital Health Strategy
- • Conduct a cross-sectoral and environmental scan
- • Identify key stakeholders and subject matter experts for health information systems in the Cook Islands
- • Identify current issues which prevent intended use of HIS systems (system stability, business process)
- • Identify policy, legal and regulatory gaps
- • Identify the desired future state for HIS in the Cook Islands
- • Develop a high-level conceptual digital health architecture for the Cook Islands
- • Create a skills gap analysis to identify which factors interfere with a sustainable and effective HIS
- • Work with TMO staff to design roles and responsibilities for HIS operations in the Cook Islands
- • Assess current business requirements and technical specifications for a PIMS that supports HIS integration and interoperability with other country ICT platforms, including platforms used by New Zealand health service providers
- • Develop and finalise a Digital Health Strategy that includes: four key actions: 1. Leadership and Governance (Strategy and investment, infrastructure, standards and operability, services and applications, legislation, policy and compliance, workforce), 2. Foundations, 3. Solutions and 4. Change Management
Planned timelines:
- Start date: June 2021
- End date: April 2022
Technical Supervision:
- Responsible Officer: Katri Kontio, Technical Officer
- Manager: Dr Akeem Ali Acting Representative/Director, PSC
METHODS TO CARRY OUT THE ACTIVITY
- • Desktop review of all relevant material relating to the Cook Islands National ICT and Health strategies.
- • Conduct consultation workshops with key stakeholders including central/line ministries and non-government organisations operating in the Cook Islands health sector.
- • Conduct key informant interviews with TMO staff, contractors, partners and vendors.
- • Conduct technology assessment of current applications and infrastructure
- • Facilitate a final workshop to present different options and benefits to implement the Digital Health Strategy.
QUALIFICATIONS & EXPERIENCE
EDUCATION
- • Public Health and Health information technology/Digital Health expert. The health information technology (IT) expert will have around 7 years of relevant experience with relevant academic degree.
EXPERIENCE
Essential:
- • More than 15 years of working experience in the health sector and a strategic understanding ICT platforms and digital health strategies in the Pacific region.
- • Strong business (clinical and public health) and digital/ technical acumen with a demonstrable track record of success.
Desirable:
- • Previous experience in resource poor settings in public health, health information systems, health information management, and monitoring and evaluation
- • Previous international experience in digital health or similar role
- • Some work experience in the region or country
- • A medical science, public health or related health professional background is desirable
- • Work experience and knowledge of the health sector in the Pacific and New Zealand is an advantage
TECHNICAL SKILLS & KNOWLEDGE:
- • Excellent communication skills - written;
- • Excellent analytical, planning and organizational skills;
- • Ability to work in a team with limited supervision; and
- • Ability to work under pressure.
LANGUAGES
- Written and spoken fluency in English is essential;
COMPETENCIES
- • Building and promoting partnerships across the organization and beyond;
- • Moving forward in a changing environment;
- • Ensuring the effective use of resources;
- • Fostering Integration and teamwork; and
- • Communication in a credible and effective way.
ADDITIONAL INFORMATION:
Place of Assignment
Assigned to Suva, Fiji
Medical clearance
The selected Consultant will be expected to provide a medical certificate of fitness for work.
Travel (travel dates to be determined)
The Consultant is expected to travel according to the itinerary and estimated schedule below:
- June 2021 - December 2021 / Mobile to selected high priority PICs / As requested/needed for outbreak response activities
APPLICATIONS
Qualified and interested specialists should submit their CV {for individual contractors} or Company Profile {for institutional applications} and Expression of Interest {cover letter} to the Supply Officer through WP RO UNGM at < wproungm@who.int > by 10 June 2021.
The cover letter should outline how their experience and qualifications make them a suitable candidate for this position and should include their proposed daily consultancy fee and availability.
Please use Tender Notice No. 129594 as subject to all submission. Only successful candidates will be contacted.