Jan B.M.

Goossenaerts1, Adesina Iluyemi2, Kaushalesh Lal3

1Pragmeta Knowledge Clout, Belgium ; e-mail: info@pragmetaknowledgeclout.be

2 Centre for Healthcare Modelling &Informatics, University of Portsmouth, UK
; e-mail: Adesina.Iluyemi@port.ac.uk
3 UNU/MERIT, Keizer Karelplein 19, 6211 TC Maastricht, The Netherlands; e-
mail: lal@merit.unu.edu
 Contents
 The Problem: the know-do gap in the health sector

 What is currently done about it?

 Can Global Health Enterprise Architecture help us doing

any better?
The “knowledge translation” Problem
GLOBAL FORUM FOR HEALTH RESEARCH’s Vision: "A
world in which the potential of research and innovation
is fully utilized to address the health problems of the
poor.“
know-do gap & innovation cycle problems
failing innovation cycles in biomedical R&D in low
income countries
 discovery – development – delivery
(CIPIH report , Dreifuss et al 2006)
 Case: improved vaccines for the infectious disease
meningitis (Roberts, 2008) exposes the many hurdles in
combating "southern" diseases.
 it takes too long for science & innovations to inform
clinical practice
Current plans and missions
Who? Global Strategy and plan of action on public
health, innovation and intellectual property was
endorsed at the 61st World Health Assembly, on
May 24, 2008 (WHA61.21)

CODATA’s Mission: "to strengthen international

science for the benefit of society by promoting
improved scientific and technical data
management and use."
What? How?
 Bring knowledge to those who can benefit from it!
 The media for bridging know-do gaps:
 by word of mouth
 by printing press
 by radio and television
 by computer
 by internet
 by mobile internet
Can we do better with ICT? .. !
 Internet
 Mobile phones
 One laptop per child
 Telemedicine
 Electronic patient record
 ….
 How effective do we deploy it?
The complexity is overwhelming
Forces
Healthcare
MOD DCAf Tribunals
Service
Prison
Healthcare
Estates
Management
Logistics
Grewal (2007)
Audit
Other
Government
Depts
Home
Office
Prison
Service

Courts
External
Management
Services
UK NHS
Commission Support
Police Services
DFES Home Office
Service
Contacts Independent
DeFRA
DWP Service
Young
Providers

& Science
Offenders
Teams Non-Statutory
Organisations
DoH
Connecting Private
for Health Hospitals

data
Direct Service
Public Delivery Links
v
NHS
Health Charities
NPSA
Research

not yet in
Patients
NICE Housing
Other NHS
Organistiaons
Schools
Information
Centre Higher /
Relatives Further
& Carers Local
Healthcare Education
Commission Authority
Services
PPA NHS - includes:
Primary Care Education
Acute Care Departments
Mental Health
& Ambulance Special
Drug
Services Education
Companies
Needs
Pharmacies Mental
Health Older
& LD Education
People
Psychology
Other Health Social Services
Prosthetics / Services Services
Appliance
Suppliers
Dentists
Chiropodists Children’s
Services
Domicillary
NHS Service
Adult
Opticians
Physio-
Care
Services Contacts
therapists
High-level Map
Collective action challenges
e.g. Stakeholders in vaccine introduction
(Mexico; Conway)
 International :
 GAVI Alliance,
 Pan Americal Health Organization (PAHO)
 UNICEF, WHO
 National:
 Ministry of Health
 Mexican Insitute of Social Security
 Insitute of Social Security and Services for Civil Servants
 Finance and legislature
 Local
 local medical and research experts
 Medical private sector
 Vaccine producer
 Peer Intelligence
PRM (Market, Science,

work-system
Roadmap,
Benchmarking,..)

reference model
- Pico level
- Micro level Problem
change
/Gap

methodology
- Meso level
- Macro level Register

Problem
Identification
Translation

Evaluation Analysis and

/ Monitoring diagnosis

Site
Specific Real site work system:
Health care system
PRM
s Africa

site specific Intervention

reference model Implementation

Plan of action
Design
 To Be
Scorecards
As is with
Pressurepoints

Transition
need
Contribution:
Roadmap & Option Exploration
a
HC Change HC Monitoring & HC Change HC Monitoring & socio-
System
· Establish
Programm
Evaluation
· Align Goal & Initatives
in Sociotechnical
System:
· Currently
Change
Evaluation
· Currently Fragmented
Goals & Initiatives
technical
transition
Enabled Landscape Projects are
approach for Contribution: Performed
change Guidelines for scorecards Singly &
projects Severally

HC Operations HC Operations
· Performing · Currently Under
· Increased Productivity Performing
Healthworkers · Low Productivity
· Reduce cost and time Health Workers
of healthcare · Lack of Health
education Workers
· Improved Knowledge · Poor Relation
Contribution:
Translation Knowledge Base &
Case Test of Open
architechture Contribution: Clinical Practice
&Methodology Stakeholder Awareness
 pico (Pi)

Human

Who is
Trainer
Patient
HealthWorker ParaMedWorker Physician MedicalTrainer Researcher involved?
micro (Mi)

C_educ_est C_risk_pool
C_hospital CM_educ_est C_med_research

Company
macro (Ma) meso (Me)

Agency

A_Gov A_educ_min A_NPHI

United Nations Unesco WHO

Charting the worksystem:
local area – delivery focus
Pi_life_S Pi_healthwork_S
«uses» Pi_TreatmentDeliver
Pi_HealthyLivingLea
Pi_TreatmentPartici
y Pi_research_S
rning
pation

Pi_TreatmentDeliver Pi_Research
yLearning

«uses» «uses»

«uses»
Mi_Edu_S Mi_MedRese
<<System>>TreatmentPathRepository arch_S
Mi_MedEdu_S
Mi_Hospital_S
Mi_MedicalResearch
Mi_HealthyLivingTea
ching
Mi_TreatmentService MiPMEL_
s CareCureDeliveryEducation
 --knowledge provide-- globe area
Me_Nation_Edu_S Me_Nation_Medical_S Me_Globe_Medical_S

Me_Nat_KnowledgeStr
eaming <<System>>NatEduProg

<<System>>MedicalKnowledgeRepository
*
<<System>>RAGuidelineRepository <<System>>GuidelineRecommendations
*
*
*
Me_Globe_Edu_S «uses» Me_ProvideTreatment «uses»
Me_MakeResAwareGuid Defs
MeM_MedicalKnowledg
elines
eProvision
Me_GlobKnowledgeStr
eaming

<<System>>GlobEduProg

«uses» «uses»
«uses»
«uses»
<<System>>MedicalGuidelineRepository

Macro-Nation
Macro-Global
MaG_GlobalPublicGoo
MaN_NationalPublicG *
dsProvision
oodsProvision *

A_Gov
United Nations
Pi_life_S Pi_healthwork_S
Pi_TreatmentDeliver
Facilitate: Scan Globally –
Reinvent Locally
«uses»
Pi_HealthyLivingLea
Pi_TreatmentPartici
y Pi_research_S
rning
pation

Pi_TreatmentDeliver Pi_Research
yLearning

(ref. J. Stiglitz)
*

«uses» «uses»

«uses»
Mi_Edu_S Mi_MedRese
<<System>>TreatmentPathRepository arch_S
Mi_MedEdu_S
Mi_Hospital_S
Mi_MedicalResearch
Mi_HealthyLivingTea
ching
Mi_TreatmentService MiPMEL_

- the pathways from

s CareCureDeliveryEducation
*

Me_Nation_Edu_S Me_Nation_Medical_S
*
Me_Globe_Medical_S *
science data to
Me_Nat_KnowledgeStr
health outcomes?
eaming <<System>>NatEduProg

<<System>>MedicalKnowledgeRepository
*
<<System>>RAGuidelineRepository <<System>>GuidelineRecommendations

Me_Globe_Edu_S
*
*
* -bi-directional
«uses» Me_ProvideTreatment

interactions
«uses»
Me_MakeResAwareGuid Defs
MeM_MedicalKnowledg
elines
eProvision
Me_GlobKnowledgeStr
eaming

<<System>>GlobEduProg
… as foundation
«uses»
«uses»
«uses» «uses»

<<System>>MedicalGuidelineRepository
for improved
Macro-Nation
Macro-Global health outcomes
MaG_GlobalPublicGoo
MaN_NationalPublicG *
dsProvision
oodsProvision *

A_Gov
United Nations
 Contextual Determinants
Problem map
Hospitals have limited means to
improve their processes, including
the productivity of their health
Institutional
workers
Poor access to high
quality content Social-Cultural

Lack of customization
Standards
Lack of regulations that nurture:
open educational resources Hospitals cope with Health workers
and innovative educational scarce human resources have limited or no Distal Determinants
materials for the poor Classical training model access to
takes too much time specialist
Private/Public and money knowledge
Issue Health workers have
Para professionals have limited or no access
minimal means to comply to guidelines
To treatment prescriptions Lack of medical
schools
Lack of para professional
health workers Proxal Dterminants
Social constraints
Poor Quality Health restrain people form
Hospitals must
Services seeking medical help
cope with scarce
medical supplies
People are ignorant of
preventive living habits
Lack of customization
Hospital facillities are Standards
often sub-standard People are ignorant of Poor access to high
Lack of customization available medical help quality content
Standards
Lack of customization
Hospitals have limted Poor access to high Standards
Population’s
knowledge of, or access to quality content
Health
medical guidelines

People have insufficient means

to buy cure and care Lack of clean water
Lack of food
People have minimal
High prevalence of
means of survival
infectious diseases

Environmental

Wonders, 2008
(TU/e MSc.) Economical
Further work
 inform/support WHA61.21 strategic plan
 contribute to collaborative diagnostics and
collaborative therapeutics
 for related literature see: http://www.citeulike.org/group/4365
on Integrative Expertise for Global Health
 on health in the “society-wide” architecture context:
http://www.pragmetaknowledgeclout.be/global-health