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Establishing Partnerships to Promote
eHealth in Developing Countries:
Lessons from Africa
William M. Tierney, M.D.
Andrew S. Kanter, M.D., M.P.H.
Hamish S.F. Fraser, M.B.Ch.B.
Christopher Bailey
Until lions have their own historians, histories of the hunt will always glorify the hunter.
African Proverb
Information is care.
Donald M. Berwick1
President and CEO, Institute for Healthcare Improvement
Introduction
Although health care is considered a service
profession, most of what clinicians do is manage
information. They collect data (take a history,
perform a physical examination, read reports,
look up laboratory data, read x-rays), record data
(write visit notes, operative reports, prescriptions,
and diagnostic test results), transmit data (via
telephone, paper or electronic charts, and e-
mail), process information to arrive at a likely
diagnosis (or hierarchy of possible diagnoses),
and initiate treatment. This initial chain of
information management is then followed by
additional cycles of data collection, management,
and processing to monitor and adjust care. Thus,
information is not a necessary adjunct to care, it
is care, and effective patient management
requires effective management of patients’
clinical data. According to Gonzalo Vecina Neto,
head of the Brazilian National Health Regulatory
Agency, “There is no health without
management, and there is no management
without information.” 2
If a clinician or practice has responsibility for
more than a few hundred patients, effective
management of clinical care requires some form
of computerization. One would never think of
running a bank without computers, yet banks
manage significantly less information than a
hospital or a busy clinic or practice. Moreover, a
financial transaction is explicit and unchanging
whereas clinical data are fuzzy (does the chest
x-ray show pneumonia?), changing (vital signs
and most laboratory results), and often
contradictory (a patient may have a normal
electrocard