In a setting of constant change and confusing terminology, telehealth continues to gain ground in both developed and developing countries within the overarching milieu of e-health. Evidence shows telehealth has been used in essentially all countries of the world, but is embedded in few. Uses and needs of telehealth vary between the developed and developing world; the latter struggles with both communicable diseases and noncommunicable diseases, and with very few resources. Common clinical applications include teleconsultation, telecardiology (transmission of ECGs), teleradiology, and teledermatology. Many telehealth projects exist throughout Latin America and the Caribbean, Asia, and Africa, but there is little published evidence and only isolated examples of sustained programs, although several sustained humanitarian networks exist. Application of mobile solutions (m-health) is on the rise in many developing countries. Telehealth is still not integrated into existing health care systems globally. Reasons vary: lack of proven large-scale operations, poor evidence base, inadequate implementation, lack of attention to the “soft side” of implementation (readiness, change management), and many others. For the developing world, reasons can be more pragmatic, including limited resources, unreliable power, poor connectivity, and high cost for the poverty stricken – those most in need. Telehealth is poised to improve health and health care in the developing world, driven by both altruistic and profit motives. But to have the desired effect, telehealth must address very specific and evidence-based health “needs” of each facility, region, or country; the shortage of health workers and specialist services; and the required skills upgrading and training, allowing the developing world to establish its own critical mass of experts. This will only be achieved by raising awareness, understanding, and ability regarding telehealth capability and limitations, and by the coordinated political and professional will of all those involved to guide public and private innovation and telehealth integration.

Background: Most developing countries, including Uganda, have embraced the use of e-Health and m-Health applications as a means to improve primary healthcare delivery and public health for their populace. In Uganda, the growth in the information and communications technology industry has benefited the rural communities and also created opportunities for new innovations, and their application into healthcare has reported positive results, especially in the areas of disease control and prevention through disease surveillance. However, most are mere proof-of-concepts, only demonstrated in use within a small context and lack sustainability. This study reviews the literature to understand e-Health’s current implementation status within Uganda and documents the barriers and opportunities to sustainable e-Health intervention programmes in Uganda.Methods: A structured literature review of e-Health in Uganda was undertaken between May and December 2015 and was complemented with hand searching and a document review of grey literature in the form of policy documents and reports obtained online or from the Ministry of Health’s Resource Centre.Results: The searches identified a total of 293 resources of which 48 articles met the inclusion criteria of being in English and describing e-Health implementation in Uganda. These were included in the study and were examined in detail.Conclusion: Uganda has trialled several e-Health and m-Health solutions to address healthcare challenges. Most were donor funded, operated in silos and lacked sustainability. Various barriers have been identified. Evidence has shown that e-Health implementations in Uganda have lacked prior planning stages that the literature notes as essential, for example strategy and need readiness assessment. Future research should address these shortcomings prior to introduction of e-Health innovations.

Introduction: Instant messaging (IM) is pervasive in modern society, including healthcare. WhatsApp, the most cited IM application in healthcare, is used to share sensitive patient information between clinicians. Its use raises legal, regulatory and ethical concerns. Are there guidelines for the clinical use of WhatsApp? Can generic guidelines be developed for the use of IM, for one-to-one and one-to-many healthcare professional communication using WhatsApp as an example? Aim: We aimed to investigate if there are guidelines for using WhatsApp in clinical practice. Method: Nine electronic databases were searched in January 2019 for articles on WhatsApp in clinical service. Inclusion criteria: paper was in English, reported on WhatsApp use or potential use in clinical practice, addressed legal, regulatory or ethical issues and presented some form of guideline or guidance for WhatsApp use. Results: In total, 590 unique articles were found and 167 titles and abstracts met the inclusion criteria. Twenty-one articles identified the need for general guidelines. Twelve articles provided some form of guidance for using WhatsApp. Issues addressed were confidentiality, identification and privacy (eight articles), security (seven), record keeping (four) and storage (three). Mandatory national guidelines for the use of IM for patient-sensitive information do not appear to exist, only advisories that counsel against its use. Conclusion: The literature showed clinicians use IM because of its simplicity, timeliness and cost effectiveness. No suitable guidelines exist. Generic guidelines are required for the use of IM for healthcare delivery which can be adapted to local circumstance and messaging service used.

Background: Significant investments have been made towards the implementation of mHealth applications and eRecord systems globally. However, fragmentation of these technologies remains a big challenge, often unresolved in developing countries. In particular, evidence shows little consideration for linking mHealth applications and eRecord systems. Botswana is a typical developing country in sub-Saharan Africa that has explored mHealth applications, but the solutions are not interoperable with existing eRecord systems. This paper describes Botswana’s eRecord systems interoperability landscape and provides guidance for linking mHealth applications to eRecord systems, both for Botswana and for developing countries using Botswana as an exemplar. Methods: A survey and interviews of health ICT workers and a review of the Botswana National eHealth Strategy were completed. Perceived interoperability benefits, opportunities and challenges were charted and analysed, and future guidance derived. Results: Survey and interview responses showed the need for interoperable mHealth applications and eRecord systems within the health sector of Botswana and within the context of the National eHealth Strategy. However, the current Strategy does not address linking mHealth applications to eRecord systems. Across Botswana’s health sectors, global interoperability standards and Application Programming Interfaces are widely used, with some level of interoperability within, but not between, public and private facilities. Further, a mix of open source and commercial eRecord systems utilising relational database systems and similar data formats are supported. Challenges for linking mHealth applications and eRecord systems in Botswana were identified and categorised into themes which led to development of guidance to enhance the National eHealth Strategy. Conclusion: Interoperability between mHealth applications and eRecord systems is needed and is feasible. Opportunities and challenges for linking mHealth applications to eRecord systems were identified, and future guidance stemming from this insight presented. Findings will aid Botswana, and other developing countries, in resolving the pervasive disconnect between mHealth applications and eRecord systems.

The use of WhatsApp in health care has increased, especially since the COVID-19 pandemic, but there is a need to safeguard electronic patient information when incorporating it into a medical record, be it electronic or paper based. The aim of this study was to review the literature on how clinicians who use WhatsApp in clinical practice keep medical records of the content of WhatsApp messages and how they store WhatsApp messages and/or attachments. A scoping review of nine databases sought evidence of record keeping or data storage related to use of WhatsApp in clinical practice up to 31 December 2020. Sixteen of 346 papers met study criteria. Most clinicians were aware that they must comply with statutory reporting requirements in keeping medical records of all electronic communications. However, this study showed a general lack of awareness or concern about flaunting existing privacy and security legislation. No clear mechanisms for record keeping or data storage of WhatsApp content were provided. In the absence of clear guidelines, problematic practices and workarounds have been created, increasing legal, regulatory and ethical concerns. There is a need to raise awareness of the problems clinicians face in meeting these obligations and to urgently provide viable guidance.

Background: mHealth presents innovative approaches to enhance primary healthcare delivery in developing countries like Botswana. The impact of mHealth solutions can be improved if they are interoperable with eRecord systems such as electronic health records, electronic medical records and patient health records. eHealth interoperability frameworks exist but their availability and utility for linking mHealth solutions to eRecords in developing world settings like Botswana is unknown. The recently adopted eHealth Strategy for Botswana recognises interoperability as an issue and mHealth as a potential solution for some healthcare needs, but does not address linking the two. Aim: This study reviewed published reviews of eHealth interoperability frameworks for linking mHealth solutions with eRecords, and assessed their relevance to informing interoperability efforts with respect to Botswana’s eHealth Strategy. Methods: A structured literature review and analysis of published reviews of eHealth interoperability frameworks was performed to determine if any are relevant to linking mHealth with eRecords. The Botswanan eHealth Strategy was reviewed. Results: Four articles presented and reviewed eHealth interoperability frameworks that support linking of mHealth interventions to eRecords and associated implementation strategies. While the frameworks were developed for specific circumstances and therefore were based upon varying assumptions and perspectives, they entailed aspects that are relevant and could be drawn upon when developing an mHealth interoperability framework for Botswana. Common emerging themes of infrastructure, interoperability standards, data security and usability were identified and discussed; all of which are important in the developing world context such as in Botswana. The Botswana eHealth Strategy recognises interoperability, mHealth, and eRecords as distinct issues, but not linking of mHealth solutions with eRecords. Conclusions: Delivery of healthcare is shifting from hospital-based to patient-centered primary healthcare and community-based settings, using mHealth interventions. The impact of mHealth solutions can be improved if data generated from them are converted into digital information ready for transmission and incorporation into eRecord systems. The Botswana eHealth Strategy stresses the need to have interoperable eRecords, but mHealth solutions must not be left out. Literature insight about mHealth interoperability with eRecords can inform implementation strategies for Botswana and elsewhere.