Guest post by SPM member Vanessa Carter. See bio at end.

In many countries globally, the e-Patient revolution has raised many significant questions about the role of empowered patients in an integrated health system, particularly with expanding access to Information and Communication Technologies (ICTs). South Africa is still experiencing extensive gaps in our digital divide. However,  we are in the process of working towards building infrastructure that supports connectivity under the UN’s Sustainable Development Goals (SDGs).

A recent survey  suggests that 52% of South Africans were using the internet in 2016 and that 16.1 million people use smartphones, which is set to grow exponentially to 21.9 million by 2021. IT web  recently reported that   the South African government’s SA Connect project s should   deliver widespread broadband access to 90% of the country’s population by 2020.

Further, a CDC article describes how South Africa is faced with a dire shortage of qualified health workers. Currently, 40,000 medical practitioners serve 51 million people in the population and 75% of them work in the private sector. The article further explains how global and local mentorship programs are being used to train mid-level medical cadres.  This they believe will help to close many gaps.

The question of whether an e-Patient can contribute towards a sustainable system will also depend on multiple issues like their preference for paternal care, access to patient education provided by reliable resources such as their doctors or government, and their relationship with their providers.

In a recent #hcsmSA Twitter chat we discussed the role of e-Patients in sustainable health systems and developing countries like South Africa with our community members and our panel expert Nancy B. Finn.

The chat focused on the following questions in an attempt to understand what some of the requirements are to cultivate the “ultimate e-Patient”. Our transcript can be read here. Nancy and the panelists provided the following answers:

T1: Why are e-Patients important to Sustainable Health Systems?

Empowered and engaged patients are critical to themselves because they understand what it means to manage their own health conditions, communicate effectively with their healthcare providers/workers, follow through on seeking care when it is needed, adhere to prescribed medications, and, in general contribute to their own welfare and in some cases, contribute to the well-being of the general population. Empowered and engaged patients also have the savvy and interest in helping to keep costs down; raise the health literacy of all those individual with whom they come in contact; teach others how to be e-Patients, advocate for important health positions that impact all patients, and work in partnership with the health system to benefit themselves and others.

T2: How do you think we could accelerate the e-Patient revolution?

1. Education – we need to find ways to raise the health literacy of the general population so that they understand their health choices, communicate more intelligently with their health providers, work more aggressively to engage in preventive health measures and teach friends and family to do the same.   As they become more adept in understanding the health system, these e-patients also play a role in advocating for needed changes in their specific health system.

2. Digital Communication Technology is now available and provides the enabling tools to help patients monitor and manage their care and raise their own health literacy and the literacy of others.

3. mHealth -There are more than 5 billion mobile phones worldwide. 500 million smartphone owners are using health care apps to communicate messages and improve health understanding among health workers and their patients. By 2018 there will be 3.4 billion smartphone and tablet users and more than half would have download mobile health apps. M-health engages patients in their care; reinforces communication between patients and health care workers as well as provides innovative ways to resolve health issues

4. Short Message Systems (SMS) – Texting educational messages to patients to educate them about such issues as HIV/AIDS, or help pregnant mothers understand how to take care of themselves during the pre-natal stage and how to take care of themselves and their newborn babies to reduce the incidence of infant and maternal mortality are ways in which digital tools have clearly helped people maintain better health under difficult circumstances. For example, Pilot program SMS sent in local language to a million mobile phones in South Africa reminding people where to get test kits for use in the privacy of their homes reduced the stigma of having to get to a clinic to request a kit and over time reduced the number of diagnosed cases by many thousands of individuals.

¼ of world’s population are anemic: 42% are pregnant women, 30% non-pregnant women and 47% are preschool age children. SMs addresses the challenge of how to reach these groups and educate them in good nutrition habits. SMS call centers broadcast text messages that can reach far into the most remote areas with daily advice and reminders, using hundreds of cell phone apps on nutrition and weight tracking and management

T3: How can we convince providers (HCP’s and health IT) about the value of an e-Patient?

We convince them by showing them the benefits.  When providers work in partnership with patients who are empowered and engaged, and begin to see the positive results that follow e.g. better understanding and adherence to medication advice; this makes a difference.  It also fosters positive change when everyone on the team understands what their responsibilities are and what to do.

T4: What are the barriers to cultivating e-Patients?

Language, culture, diversity, lack of understanding, poor education/health literacy are some barriers.
The UN report on the Sustainable Development Goals SDGs from now until 2030 wrote that “Ensuring healthy lives and promoting the well-being for all at all ages is essential to sustainable development” This is the goal for all developing and developed nations.

Although there have been significant strides made and we have increased life expectancy, reduced some of the common killers associated with child and maternal mortality and increased access of many developing nations to clean water and sanitation which has helped to reduce malaria, TB, polio and the spread of HIV/AIDS, there is a lot more to be done.  Through education, and the expansion and availability of digital tools to enable some of the easy ways to reach and envelop larger populations, we can continue the momentum toward a society where there is full participatory medicine in practice, at all times.  This is no easy task and will take many more years to reach critical mass.  However, each time a new e-Patient interacts with their health system we take another step towards that goal.

Vanessa Carter is a design thinker and entrepreneur with 20 years in advertising and 10 years of patient experience in the private and public health sector in South Africa. (Read her story here). She is an international  speaker and digital health activist, and the  founder of #hcsmSA (Health Care Social Media South Africa) which is a virtual health 2.0 community whose members meet monthly in a TweetChat recorded by Symplur analytics.