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Critical Issues and Challenges in Developing Mobile-Based Health Systems: Case of Tanzania

  • Applied Engineering & ByteWorks (T) Limited/The Nelson Mandela African Institute of Science and Technology
  • Tanzania Commission for Science and Technology

Abstract and Figures

Utilization of mobile devices worldwide is increasing every day. This has created an increasing demand for mobile apps, the development of which is not seamlessly without challenges. We conducted a research survey to identify and confirm the known challenges and issues that are faced by mobile app developers in their development work in developing countries particularly in Tanzania. This survey was done in three regions of Tanzania: Dar es Salaam, Dodoma and Arusha; because most of the mobile apps developers are located in these regions and eHealth information systems were used as a case for this purpose. Methodology used was literature, interview, questionnaire, and observation. This paper presents an overview of the identified challenges and issues facing mobile app developers and the proposed data exchange solution. These findings have justified our ongoing research on interoperability of multiple databases through a single mobile application.
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(IJCSIS) International Journal of Computer Science and Information Security,
Vol. 15, No. 3, January 2017
ISSN 1947-5500
Critical Issues and Challenges in Developing Mobile-Based Health Systems:
Case of Tanzania
Frederick Henri Chali1
PhD Cand: School of CoCSE,
Nelson Mandela African Institution of Science and
Technology, NM-AIST
Arusha, Tanzania
Eng. Dr. Zaipuna O. Yonah2
Senior Lecturer: School of CoCSE
Nelson Mandela African Institution of Science and
Technology, NM-AIST
Arusha, Tanzania
Dr. Khamis Kalegele3
Commission for Science and Technology, COSTECH
Dar es Salaam, Tanzania
Abstract - Utilization of mobile devices worldwide is
increasing every day. This has created an increasing
demand for mobile apps, the development of which is not
seamlessly without challenges. We conducted a research
survey to identify and confirm the known challenges and
issues that are faced by mobile app developers in their
development work in developing countries particularly in
Tanzania. This survey was done in three regions of
Tanzania: Dar es Salaam, Dodoma and Arusha; because
most of the mobile apps developers are located in these
regions and eHealth information systems were used as a
case for this purpose. Methodology used was literature,
interview, questionnaire, and observation. This paper
presents an overview of the identified challenges and issues
facing mobile app developers and the proposed data
exchange solution. These findings have justified our
ongoing research on interoperability of multiple databases
through a single mobile application.
Keywords-component; Multiple Databases; Data Exchange;
eHealth Systems; mHealth; mobile app.
One survey reports that about 40% of 7 billion people in the
world are using internet [1]. Another study recently reported
that, 80% among the internet users globally, own smart phones
and 47% of them own Tablets [2]. Due to the increasing
numbers of utilization of mobile devices, the world counts
more than 170 million mobile apps in use by 2015 [3].
Said it differently, the potential to utilize mobile phones in
developing countries is high. In 2012, about 70% of the global
mobile subscribers out of more than 5 billion, belonged to low
and mid income communities [4]. Banking and healthcare
sectors are leading the way on harnessing this available
potential in developing countries.
In mobile applications (mobile apps) development, challenges
such as testing and supporting, security, device proliferation,
development approach, etc. are some of the known challenges
that continue to face apps development works [5], [6] and [7].
To confirm if these challenges are real, a survey was
conducted in the health sector environment as a case
specifically to identify and confirm the known issues and
challenges in mobile apps development process focusing on
connecting to medical record systems implemented within an
environment having integrated multiple databases. The goal is
to propose a data exchange architecture that demonstrates the
need for connection/integration between a single mobile app
and multiple heterogeneous databases. Section II reviews the
status of eHealth and mHealth systems in developing
countries. Methodology used in the study is explained in
Section III; and review of major issues and challenges that are
generally facing mobile app development process worldwide
is presented in Section IV. Section V contains survey results
and the proposed data exchange component (DEC)
architecture between single mobile app and multiple
heterogeneous databases is introduced in Section VI. General
discussion of the findings from the study is presented in
Section VII. Finally, Section VIII carries the conclusion and
suggestions for further works.
eHealth systems have revealed a greater potential to reach
large population for quality service provisions. It would easily
reach and serve the population of 55% of the developing
countries where the availability of enough health facilities and
health care services is too low [8]. WHO define e-health as the
transfer of health resources and health-care by electronic
means [9]. In [10], It is described that, e-health is the
application of Internet and other related technologies in the
healthcare industry to improve access, efficiency,
(IJCSIS) International Journal of Computer Science and Information Security,
Vol. 15, No. 3, January 2017
ISSN 1947-5500
effectiveness, and quality of clinical and business processes
utilized by healthcare organizations, practitioners, patients,
and consumers in an effort to improve the health status of
patients. It is also specifically described by Eysenbach, as an
emerging field in the intersection of medical informatics,
public health and business, referring to health services and
information delivered or enhanced through the Internet and
related technologies [11]. There are numerous definitions of
eHealth from different dimensions worldwide; others have
tried to extend the definition to any application of electronic
means into the healthcare services.
Delivery of eHealth by use of mobile app services results
into mobile health or mHealth. It is the utilization of mobile
apps for the purpose of enhancing provision of health services.
In [12], mHealth is described as the use of mobile phones for
the purpose of improving the quality of care and efficiency of
health services. Further Characteristics of eHealth and
mHealth systems are described in the following subsections.
A. Infrastructure and Benefits of eHealth and mHealth in
Developing Countries
Typically, Infrastructure that supports eHealth system
architecture include the following [13]:
a) Internet
b) Extranet
c) Intranet
d) Core Data Systems
e) E-Mail
f) Telecommunications
g) Hardware
Mobile health can provide relevant benefits to health
workers, health facilities, healthcare services etc. Modi,
identifies the following benefits [12]:-
a) Real time receipt of health-care information
b) Timely addresses health issues
c) Easy to track the prevalence of diseases and
its rate globally
d) Helps healthcare officials to be more
proactive on addressing health issues rather
than being reactive.
e) Feasibly addresses gaps in health-care in
remote areas.
f) Provides Health Education Awareness.
g) Raises treatment support and medication
h) Improves the performance of healthcare
i) Supports diseases surveillance.
B. Status of eHealth in Some African Countries
Table I summarizes the status of eHealth in some
African countries. The summary shows the evidence of
activity, planning or implementation of eHealth in those
countries in terms of national ownership, foundation
(Info-structure; the basic physical and
Health Process
- Evidence of = Ev
- Strong Evidence of = SEV
- Little Evidence of = LEV
- Planning = P
- Implementation = I
- National/Government Support = NS
- No Evidence of Planning or Implementation = NoEV
organizational structures and Infrastructure) and also health
process domain component where it describes the availability
of already running eHealth systems in a particular country.
C. eHealth and mHealth Systems in Tanzania; its
1. eHealth Systems
The application of computer systems in the health sector in
Tanzania started in the 1990s. Deployment of information
technology has brought revolution of the uses of computer
applications from simple formats to complex systems.
However, eHealth is not well and completely implemented in
developing countries; it has some challenges that technically
need special attention to address. In their survey, Busagala and
Kawono established challenges that are facing e-Health
systems in Tanzania. The challenges include poor
infrastructure for supporting health-care services, insufficient
budget for ICT, unreliable electricity supply and lack of ICT
skills for health-care workers [16].
2. mHealth Systems
In Tanzania more than 31 mHealth applications are currently
providing health services countrywide [17]. Among them, the
Commission for Science and Technology Tanzania Costech, 2014-
2017. (sponsor)
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(SOURCE: [17])
Data collection and reporting
Client education and behaviour change
Electronic decision support
Provider work planning and scheduling
Registries and vital events tracking
Electronic health records
Provider training and education
Provider to provider communication
user groups, consultation
Service use supply chain management
Financial transactions and incentives
Sensors and point of case diagnostics
(and Monitoring)
Human resource management
Tele consultation
most deployed applications are for data collection and
reporting. Currently there are 18 such applications,
approximated to be 58% of all mHealth applications in
Tanzania. Table II lists other applications that are also
deployed in Tanzania with their total number.
Some of the currently available mHealth projects in the
country are briefly described in the following paragraphs.
SMS for Life
It is an innovative mHealth project piloted in Tanzania
under public-private partnership. It helps to reliably
support availability of Malaria medication using mobile
phone services. The project is led by Novartis and
supported by several partners, each bringing specific
skills [18].
Birth Registration by Mobile Phone
This is a countrywide mHealth platform in Tanzania
that gives parents ability to register their children’s
births by using mobile phones. It allows a health worker
to send birth registration information such as baby’s
name, sex, date of birth and family details by phone to a
central database and finally a birth certificate is issued
free of charge in a few days [19].
Known as Mobile for Reproductive Health (m4RH), is
a low cost innovative system running in Tanzania,
Kenya and Rwanda providing information on family
planning. It is accessible from every mobile phone
through short message service (SMS) or “text
messaging” [20].
From the foregoing, it is hereby acknowledged that, mHealth
can have a profound positive impact in health sector. It shows
to have the ability to improve delivery of healthcare services
even in remote areas and can free other resources for
developing the country economy.
A. Literature Review
In depth literature review was conducted to enhance
more understanding of issues and challenges on mobile
apps development of e-Health systems from multiple
database integration point of view. More information was
collected from previous researches to gather a wide
knowledge about these issues and challenges, as presented
in Section II.
B. Sampling Technique and Data Collection
Data collection (including questionnaire, interview
and observation) was done in three regions: Dodoma,
Arusha and Dar es Salaam. Data were collected in
Dodoma from the HPSS government project based in
Dodoma [21]. In Dar es Salaam and Arusha data were
collected from 78 programmers in three mobile
development companies in total.
As a stimulus, mobile app utilization in health sector
brings about the question concerning the technical aspect on
the development of mobile apps for health care delivery. The
intention is to examine issues and challenges facing mobile
apps development in their integration with medical records.
The following section describes major issues and challenges
that are facing mobile app development process.
Identified from the literature review, is that there are a
number of issues and challenges facing mobile application
development processes worldwide. The identified issues and
challenges are concerned with design, security, user interface,
networking, development skills, context etc. Among all these,
security issues, user experiences, vendor and device
fragmentation are ranked to be the major ones [6]. These are
further described below.
A. Security Issues
Security in mobile app development is speedily
becoming a major concern. The primary concerns are:
data upload and download wirelessly using insecure
hotspots and from potentially insecure locations and the
sizes of devices make them easily misplace-able. The
degree level of security in mobile development in
enterprises or organization also depends on the nature of a
business. Bank application for instance, with bill payment
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feature needs more security measures than an information
data application [6].
B. The User Experience
Mobile user experience could be described as the
perception an end user has on a mobile product or service
[22]. Mobile devices are characterized by the smaller
display and different styles of user interactions. These
characteristics have an impact on interaction design for
mobile apps. The user experience has a strong influence
on application development. The developer has to
consider user demands such as user interface, running
speed of the application, etc in order for the end product
to be well accepted. During development, there are some
user experience factors that influence the process of
development; these factors are such as widgets, touch,
whether through stick or direct by finger, physical motion,
keyboard (physical and virtual) for designing user
interface, and the context dependencies, such as
proximity to other mobile devices and physical location
[23]. Device characteristics such as size and its version
are having a greater impact on the design of the
application. Developers need to consider on how to build
up an application that could highly meet user’s
expectations. The user experience could help make an
application more successful by maximizing acceptance
and usage.
C. Vendor and Device Fragmentation
Existence of multiple mobile application platforms
such as iOS, Android, Windows Phone etc., is one of the
big challenge in the development of mobile apps [5], [7],
[24]. These mobile Platforms, rather than Unification,
instead they are heading towards fragmentation [5].
Fragmentation in mobile apps could be grouped into two
1) Fragmentation across platforms
(Vendors/Platforms Fragmentation), this
includes a variety of mobile OS such as
Android, iOS, BlackBerry, Windows Phone
2) Fragmentation within the same platform
(Device Fragmentation) This includes
different versions of the same platform [7].
Each platform requires different and sometimes
separate skills to use in order to develop and deploy an
application successfully. This poses as a challenge during
development and force developers to base their
developing skills mostly on one platform.
This section presents the results of the survey that, in
general, confirm issues and challenges in mobile application
development to achieve connection/integration with multiple
heterogeneous databases remotely; particularly within
Tanzania as a case study.
The survey was conducted in three different regions in
Tanzania. These regions are Dodoma, Dar es Salaam and
Arusha. A total number of 78 mobile app developers in two
regions, Dar es Salaam and Arusha were contacted to respond
to the data collection tools (interview and questionnaire).
Statistics revealed that country wide there are approximately
541 businesses whose services are IT related services such as
Network Installation, hardware and software maintenance, IT
equipment supplies, IT consultancy, web hosting and mobile
app development. Among them, nearly 70% reside in Dar es
Salaam and Arusha (Fig. 1).
Approximately 70 businesses out of 541 (about 12.9%) are
doing mobile apps development (see Fig. 2). Since a large
proportion of these businesses are small and medium
enterprises (SMEs), it has been estimated that each has at least
3 developers on average. This accounts for 210 developers
countrywide; the number does not include freelancer
developers scattered in big towns and cities in the country who
are mostly fresh university and college graduates. Table 3
shows a summary of results that came out of the survey.
A. Platform Consideration and Device Fragmentation
Mobile applications run in mobile operating system (mobile
OS) platforms such as Android, iOS, Windows Phone, Black
Berry etc. Developers mentioned that they normally choose a
particular type of platform when they start the development of
the application. This is very important to them since
developer’s choice is based on own/individual competencies.
About 14% of them mentioned this.
Device fragmentation is one of the biggest challenges facing
the Tanzanian developers today. Developers, about 27%, show
this as their challenge. Because Android has the biggest share
in sub-Saharan countries, which include Tanzania [17], and
most of the developers are developing mobile apps based on
Android, 85% of them. The presence of different versions of
Android OS creates difficulty in developing a multiplatform
application. Vendor/Platform fragmentation challenge is not
faced by most of developers in Tanzania since most of them
are working on Android rather than other platforms, Figure 4
shows the details.
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Vol. 15, No. 3, January 2017
ISSN 1947-5500
Figure 1. Availability of IT related businesses in Tanzania
Figure 2: Distribution of IT related service businesses in
B. User Experience and Mobile Device Capabilities
User experience was also mentioned by developers as one
of the issues and challenges to the mobile app development
process. From the survey, 24% of developers mentioned this.
They utilize different application design tools and techniques
to build up an app. They commented that they sketch the UI,
database model, and User models etc as their techniques of
designing good and interactive mobile apps. Others said they
normally visit design samples from websites such as
materialup, dribbble, material pallet etc. to get a clue on the
current graphic, web designing etc. It is difficult to understand
the users taste and experience on the mobile applications.
They usually use adobe Photoshop for User Interface (UI)
design, UML tools such as use case, activity, state diagrams
etc as the tools for design. For simplicity and rapidness, they
use Java programming language since this language is used by
a wider community of mobile developers.
Mobile phone capabilities in terms of size, capacity, speed
etc, are also challenges mentioned on the development of
mobile apps. Developers also confirmed that they consider
capability of mobile device such as limited power and size
during development.
Database adapters and incompatibility
Handling BLOB objects/data
Multiple databases integration
Platform consideration
User Experience and Mobile Device
Device fragmentation
Vendor/Platform fragmentation
Other Challenges
Figure 3: Mobile OS choices of mobile app developers in
C. Multiple Heterogeneous Databases Integration
Databases are available in different types and technologies
eg. Oracle, MySQL, SQL Server, etc. For the developer to link
with only one among these external databases at a time with
mobile app is very possible and in normal practice is always
done. For instance when a developer intends to connect the
app with MySQL database, it is necessary to configure HTTP
POST library for the connection to be successful. When the
intention is to utilize SQL server database, then the developer
must download jTDS (JarFile, JDBC) Libraries, configure it
and then connection will be established.
However, a challenge arises when the need is to link two
or more databases of both the same or different technologies,
with a single mobile app so as they can share information all
together. Here, heterogeneity of the databases (Oracle,
MySQL, SQL Server etc) was pointed out to be a big
challenge. 21% among the developers said this.
The following sub-section presents current practices taken
by mobile app developers when connecting single mobile app
with multiple database systems.
D. Current Practice on the Connection Between Single
Mobile App to Multiple Heterogeneous Databases
From the results of the conducted survey, it is confirmed
that, there is an existing challenge in mobile application
development on integrating a single mobile app with multiple
databases (multiple database integration). Also, It was
observed that, mobile app developers are comfortably and
easily connecting mobile apps with remote databases in one to
one connection fashion.
It was further observed that, currently, developers connect
a mobile app separately when they have a need to connect it to
multiple databases. Figure 4 illustrates the connection of
single mobile application to two different databases of two
different technologies, MySQL and SQL Server. A developer
will not be able to connect it (at the same time) in both
databases with a single connection. In this case, two different
connections (two pipelines for data flow) using two different
components must be established in order to meet this demand.
(IJCSIS) International Journal of Computer Science and Information Security,
Vol. 15, No. 3, January 2017
ISSN 1947-5500
Figure 4: Connection between mobile app and two heterogeneous
database systems
HTTP client, a client side HTTP transport library that
provides basic functions for accessing resource via HTTP
protocol [25], is used in the connection between mobile apps
with MySQL database. Jar file library [26] is used in the
connection between mobile application with SQL server.
Other libraries that serve the purpose for this connection are
such as DBO (database Object) and JDBC (Java Database
connector) [27]. All these connections regardless of
technologies connect to each database by utilizing PHP
functions to enable their connections.
Problems in mobile apps development stem from
versioning, Incompatibility and Open source [28]. The focus
of the reported research work is to build up a mechanism
where connectivity between these components (mobile apps
and multiple databases) will become more convenient and
seamless regardless of the technology the database is using.
The developer should be able to create mobile app on the
client side using same approach without being concerned
about the kind of database is connecting to. Figure 5
illustrates concept of desired seamless data exchange.
E. Existing Data Exchange Approaches for Single Mobile
App - Multiple Heterogeneous Databases/Information
There is much advancement in programming that currently
provide services to support development of mobile apps
working with remote databases/information systems. These
approaches do not deal with legacy/existing databases rather
they provide space to create or connect to the newly created
databases [29], [30], and [31]. Firebase is among these
approaches [32].
Figure 5: Architecture model for data exchange between single
mobile app and multiple databases
Some of these development efforts are such as, the REST
API (Application Programming Interface), a lightweight and
scalable API to support mobile development, which is
extremely easy to build, integrate, test, extend and maintain
[29]. The RapidSMS for extending system servers to sms
applications [30]. Another one is the HIE API, which resides
at the mid of Health Information Mediator (HIM) in the
Rwandan NHIS [31]. Firebase, a cloud based database service
that allows mobile app developer to store and sync data across
multiple clients. It provides client libraries that enable
integration with android, IOS etc. Data sync across all clients
in real time using NoSQL database [35]; [32].
In [36] authors report on a cross-platform enterprise
mobile framework implemented to provide development
environment for mobile applications at Intel enterprises. Other
frameworks such as MADP and MEAP are designed to
provide support to achieve the same goal [36]. These efforts
are already taking places worldwide.
As alluded to in the previous sections, multiple database
integration is one of the challenges facing mobile app
development such that mobile app developers are not able to
connect single mobile app with multiple databases. As a viable
approach, it is proposed to build up an eHR-DE/ data
exchange component (DEC) that will provide a connection
interface to mobile application on one side and on the other
side to multiple databases. The DEC provides a solution
toward multiple system interoperability and also provides an
interface to the already developed mobile app to connect to the
already connected multiple databases.
Three basic interoperability dimensions need to be
considered when developing interoperability solutions for
different systems, [33] and [34]. The three dimensions are;
barriers (conceptual, technological, organization), levels
(legal, organizational, semantic, technical) and concerns
(data, process, service, business).
From these interoperability dimensions, the reported work
addresses the technological barrier by establishing information
sharing between heterogeneous electronic health records and
single mobile app through data exchange framework. In the
interoperability levels, the focus is on the technical aspects. In
the interoperability concerns dimension, information is shared
among different databases i.e data interoperability as
illustrated in Fig. 6.
In the design architecture (DEC) shown in Fig. 7, a data
exchange package/component is introduced to connect
multiple heterogeneous databases to a single mobile app.
(IJCSIS) International Journal of Computer Science and Information Security,
Vol. 15, No. 3, January 2017
ISSN 1947-5500
Figure 6: EHealth data exchange (DEC) deal with technological barrier,
data interoperability concern and technical interoperability level.
Utilization of developed DEC will be such that: a mobile
app developer will download the DEC then connect a
developed mobile app into it through an interface provided by
the component. The component contains PHP and PHP/ODBC
connectivity technologies that provide connection interface to
the developed mobile application. The mobile app is
connected to the DEC through http/url connect. The provided
interface on the other side also has provision to connect
multiple databases.
Interoperability is one of the challenges existing in the
healthcare domain worldwide. “Interoperability is the ability
of different ICT systems and software applications to
communicate, to exchange data accurately, effectively, and
consistently and to use the information that has been
exchanged” [37]. In [38], it is reported that, lack of
coordination at all levels of systems development contribute
about 62.5% on the source/causes of interoperability problem
among eHealth systems in Tanzania. Another source is the
common use (in hospitals and other healthcare facilities) of
open source systems that were not specifically designed to
meet multiple databases interoperability context and
environment and were not created with integration focus in
Achieving interoperability from mobile developers’ side is
also an existing challenge. The process of integrating two or
more health information systems through single mobile app is
not easily achievable. Multiple database integration through
mobile app is one of the ways to achieve interoperability of
existing eHealth systems. This is now confirmed to be one the
challenges facing mobile app developers.
Figure 7: Data exchange (DEC) architecture connecting single
mobile app with multiple databases.
The main focus of the reported ongoing work is to
establish/enable interoperability of existing fragmented
eHealth systems through mobile apps. In [39], a lists of
solutions is provided that can be adapted to achieve complete
interoperability in healthcare. Connection of legacy (existing)
systems to healthcare network is among the solutions listed.
This is in line with the hypothesis that “mobile app
development could support interoperability of existing/legacy
multiple eHealth systems”.
The architectural model presented in Section V provides a
possibility toward achieving interoperability in eHealth
systems. The DEC architecture proposed in Section VI shows
how the integration between single mobile app and multiple
databases could be evidently achieved.
Reported survey results show that, health sector in
Tanzania is characterized by fragmented electronic health
information systems (eHealth Systems) with significant
barriers to the effective sharing of information between
healthcare participants [40]. The eHealth strategic plan of
2013-2018, describes that, infrastructure building blocks is
one of the strategic objective for eHealth development. The
report provides a reason to continue researching on the kind of
required infrastructure to enable electronic sharing of health
information across the Tanzanian health sector. The strategic
plan shows the need and importance of implementing health
information exchange that leverages mobile technologies [40].
In this paper, we have identified and confirmed issues and
challenges facing mobile application developers in developing
countries focusing on connecting multiple eHealth systems to
a single mobile application. Benefits and eHealth
infrastructure in developing countries have been reviewed. A
DEC architecture for solving the interoperability problem
between a single mobile app and multiple databases has been
presented. Also discussed is the interoperability challenge
among eHealth systems. It is suggested that multiple database
integration through single mobile app is a possible solution
towards mitigating the interoperability challenge. Some of the
identified and confirmed issues and challenges in mobile app
development in Tanzania are; Platform Consideration and
Device Fragmentation, User Experience and Mobile Device
Capabilities, and Multiple databases integration. These results
are subsets of issues and challenges that are facing mobile
developers in developing countries particularly in Tanzania.
They serve to justify the need for wider efforts to be
undertaken by mobile app developers and other stakeholders
especially government to provide better environments to the
mobile apps development processes in Tanzania.
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... In [16] a survey method was used to identify challenges facing mobile app developers during the process of interconnecting multiple eHRs as a way toward alleviating the interoperability problem. Data were collected and analyzed through questionnaires, interviews and observations. ...
... In [16], the authors propose the use of DEC as a solution component toward eHRs interoperability through a single mobile app. Figure 6, presents the DEC architecture's building blocks. ...
Full-text available
Electronic Health (eHealth), especially in the form of electronic health records (eHRs), has proved to be helpful in health care services both in urban and remote areas. However, many of the systems are fragmented and work independently. Therefore, apart from their benefits, these systems are stand alone and as such they face some operational challenges. One of which is interoperability among the eHRs. Early efforts to interoperate eHealth systems, suggest that a single mobile application that can access multiple integrated eHRs is among the viable solutions on the way to eHRs interoperability. The proposed data exchange approach offers a mechanism to integrate a single mobile application with multiple eHRs while mitigating the interoperability problem. The design work builds on the results of a survey previously done to collect preliminary requirements of the data exchange system. System design techniques were used to design this system. In this paper, an architectural system design of an eHealth data exchange that can mitigate the interoperability challenge is presented.
... Mobile Health (M-Health) System The mobile health (M-health) is one among the emerging components of eHealth in many developing countries (Hall 2017; Davey, et al, 2014) particularly Tanzania. According to the Global Observatory for eHealth (GOe), defined mobile health (m-Health) as "medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices" (Modi, Shruti 2013; WHO (2011) cited by Davey, et al, 2014).As a rapidly growing application of mobile technologies, m-health has become a promising tool in improving the well-being of people in remote and locations with poor resource(Brinkel, et al, 2014;Chali, et al, 2017;Davey, et al, 2014). In realizing its potential, the Tanzania government and other stakeholders have continued played the tremendous effort in providing the access to basic healthcare services to its citizens from diverse areas, the community, and social groups(Chetley 2006; TZ EHealth strategy, 2013; URT 2013 as cited by Nyamtema, et al, 2017; Busagala et al, 2013; Kiberu et al, 2017). ...
Full-text available
The paper is a literature review in nature with the aim of reviewing the current status of adoption and use of the eHealth and challenges of the eHealth system in Tanzania. A broad literature search was conducted to offer a narrative overview of an e-health system from wide ranges from international journals, conference reports, organizations" websites, and reports. The inclusion and exclusion process results in a total number of 67 articles (60%) were included for review. The review shows that there are countless initiatives and development that has been taken in the adoption and use of e-health system as a way to improve the health sector across the country. This has been demonstrated by a number of eHealth systems in the country such as health information systems, teleconsultations, e-learning platforms, teleconferencing, m-health platform, electronic health record, and telehealth system. However, the review reveals that still there are a number of challenges facing the health sector including lack of infrastructure, inadequate ICT related knowledge and skills, governance structure, compliance with eHealth standards and systems interoperability. Further, the researcher suggests that there need to boot the process of development of a national electronic health record system which leads to an integrated system of patient management nationwide, the formulation of E-legislation which permit the intercountry exchange of patients, data and inter-jurisdictional practice of medicine. Furthermore, the research proposes the e-Health readiness, awareness and assessment of the implemented system as a future research area.
Full-text available
Information and Communication Technologies (ICTs) play significant roles in the improvement of patient care and the reduction of healthcare cost by facilitating the seamless exchange of vital information among healthcare providers. Thus, clinicians can have easy access to patients' information in a timely manner, medical errors are reduced, and health related records are easily integrated. However, as beneficial as data interoperability is to healthcare, at present, it is largely an unreached goal. This is chiefly because electronic Health Information Systems used within the healthcare organizations have been developed independently with diverse and heterogeneous ICT tools, methods, processes and procedures which result in a large number of heterogeneous and distributed proprietary models for representing and recording patients' information. Consequently, the seamless, effective and meaningful exchange of patients' information is yet to be achieved across healthcare systems. This paper therefore appraises the concepts of interoperability in the context of healthcare, its benefits and its attendant challenges. The paper suggests that the adoption of a standardized healthcare terminology, education strategy, design of useable interfaces for ICT tools, privacy and security issues as well as the connection of legacy systems to the health network are ways of achieving complete interoperability of electronic based Health Information Systems in healthcare.
Full-text available
One of the key problems in healthcare informatics is the lack of interoperability among different healthcare information systems. Interoperability can be investigated in different categories in the eHealth domain, such as the interoperability of the messages exchanged between healthcare applications, interoperability of Electronic Healthcare Records (EHRs), interoperability of patient identifiers, coding terms, clinical guidelines and healthcare business processes. Furthermore, all these categories can be investigated in two major layers: syntactic interoperability layer and the semantic interoperability layer. This paper describes the concepts involved in eHealth interoperability; briefly assesses the current state in some of the countries in the world and discusses the technical issues to be addressed for achieving interoperability.
Conference Paper
Full-text available
This paper provides an overview of important software engineering research issues related to the development of applications that run on mobile devices. Among the topics are development processes, tools, user interface design, application portability, quality, and security.
The health-care system in Ghana is similar to those in other developing countries and access to health services for remote communities is extremely limited. In July, 2010, the Government of Ghana launched the national e health strategy. A number of international organizations have initiated various pilot projects, including disseminating and collecting data, education initiatives and telemedicine. In addition, several institutions and organizations are dedicated to the promotion of e-health and a range of Web-based health consultancy services have begun. The main objective of this study is to provide an overview of eHealth activities in Ghana. It was a daunting task, not least because of the need to gather information on eHealth projects and initiatives in Ghana, as there is no existing repository of such information. Through literature search in Africa journals online, Hinari, Medline,, Journal of Telemedicine and e-Health, Journal of Telemedicine and Telecare, Journal of Medical Internet Research and Interaction with eHealth experts, followed up with some of the authors' for directions to other projects, and following the references in some articles. A total of twenty-two (22) pilot projects have been identified in Ghana. Mobile devices in use range from PDAs to simple phones and smart phones. The key findings of this research are that there are about 22 eHealth project at various stages of implementation in Ghana. Some of these projects have wind up and others are still being implemented. Mobile devices in use range from PDAs to simple mobile phones and smart phones. Most of the projects have been donor initiated. Data collection started in March 2010 to June 2013. Although eHealth seems to have a limited role in Ghana at present, there is growing interest in the opportunities it may offer in terms of improving the delivery and access to services, especially in remote locations. Recommendations for further research are provided.
Conference Paper
Rwanda, one of the smallest and most densely populated countries in Africa, has made rapid and substantial progress towards designing and deploying a national health information system. One of the challenging aspects of the system is the design of an architecture to support: interoperability between existing health information systems already in use in the country; incremental extension into a fully integrated national health information system without substantial reengineering; and scaling, from a single district in the initial phase, to national level without requiring a fundamental change in technology or design paradigm. This paper describes the key requirements and the design of the current architecture using ISO/IEC/IEEE 42010 standard architecture descriptions. The architecture is based on the Enterprise Service Bus architectural model. We also describe a partial implementation of the architecture, and give a preliminary analysis based on our experiences.
Sustainable development, although a widely used phrase and idea, has many different meanings and therefore provokes many different responses. In broad terms, the concept of sustainable development is an attempt to combine growing concerns about a range of environmental issues with socio-economic issues. To aid understanding of these different policies this paper presents a classification and mapping of different trends of thought on sustainable development, their political and policy frameworks and their attitudes towards change and means of change. Sustainable development has the potential to address fundamental challenges for humanity, now and into the future. However, to do this, it needs more clarity of meaning, concentrating on sustainable livelihoods and well-being rather than well-having, and long term environmental sustainability, which requires a strong basis in principles that link the social and environmental to human equity. Copyright © 2005 John Wiley & Sons, Ltd and ERP Environment.
E-health--any electronic exchange of healthcare data or information across organizations--reflects an industry in transition. Even as its form and structure continue to emerge, e-health is being used to change business and medical practices, affecting every facet of the American health experience. Business, medical, social, and technological factors are converging to make wide-scale, continuum-based care functionally achievable perhaps for the first time. The Internet clearly drives the development and adoption of e-health applications; standing alone, it has the reach, the infrastructure, and the acceptance to achieve widespread change. As the public grows increasingly Internet-enabled, healthcare organizations have an opportunity to cost-effectively reach a large part of the U.S. population. The sheer breadth of e-health, the many options available to healthcare organizations, and the relative immaturity of the applications in most areas make navigating the spectrum of possibilities a clear healthcare management challenge. Deciding how to incorporate the demand for e-health has extensive technological, organizational, managerial, and ethical implications. [Accessed: 19
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