190 © 2013 IMIA and Schattauer GmbH

Medical Informatics in O. Bouhaddou1, M. Bennani Othmani2, S. Diouny3 1 Hewlett Packard (HP), San Diego, California, USA 2 Medical Informatics Laboratories, School of Medicine, Casablanca, Morocco 3 Chouaib Doukkali University, Faculty of Letters & Human Sciences, El Jadida, Morocco

and a recent Institute of Medicine (IOM) Summary Introduction report recommend increased adoption and Objectives: Informatics is an essential tool for helping to The technologies collectively known as meaningful use, improve individual and transform healthcare from a paper-based to a digital sector. health information technology (health IT) population health, inspire trust in health This article explores the state-of-the-art of health informatics in share a common attribute: they enable the IT, empower individuals to use health IT to Morocco. Specifically, it aims to give a general overview of the secure collection and exchange of vast improve their health, and improve the health Moroccan healthcare system, the challenges it is facing, and the amounts of health data about individuals. care system – a rapid learning and advancing efforts undertaken by the informatics community and Moroccan The collection and movement of these data system [2]. government in terms of education, research and practice to will power the of the future. It Medical informatics is concerned with reform the country’s health sector. also has the potential to empower individuals the use of information in health care by Methods: Through the experience of establishing Medical and increase transparency; enhance the abil- clinicians. It is at the core, aligning IT with Informatics as a medical specialty in 2008, creating a Moroccan ity to study care delivery and payment sys- business and clinical objectives. Physicians Medical Informatics Association in 2010 and holding a first tems; and ultimately achieve improvements recognize that. As a result, medical infor- national congress took place in April 2012, the authors present in care, efficiency, and population health [1]. matics is becoming a medical specialty their assessment of some important priorities for health infor- North American and Europe have seen providing clinicians with career opportuni- matics in Morocco. real advances in the understanding of dif- ties to teach, do research, and implement IT Results: These Moroccan initiatives are facilitating collaboration ferent types of medical informatics applica- solutions that are used in a meaningful way in education, research, and implementation of clinical informa- tions. The growth of health IT and medical to address today’s healthcare challenges. tion systems. In particular, the stakeholders have recognized the informatics as a discipline are largely due to However, if there are advances in specif- need for a national coordinator office and the development of a advances in information technology in gen- ic communities, they have not yet made a national framework for standards and interoperability. eral, and to the fact that biomedical records general impact. Indeed, these technologies Conclusion: For developing countries like Morocco, new health IT data are now essentially unmanageable by are still under-utilized even in the develop- approaches like mobile health and trans-media health advertis- traditional paper-based methods. In addition, ing countries. For instance, in 2009 in the ing could help optimize scarce resources, improve access to rural health IT has been recognized as an essential US, only 25% of physicians have adopted areas and focus on the most prevalent health problems, optimiz- tool that can help address the major health Electronic Health Records (EHRs), only ing health care access, quality, and cost for Morocco population. challenges most countries face related to 15% of hospitals have implemented a hos- inefficient access, quality, and cost. Gov- pital information system, and only 7% of Keywords ernments everywhere realize the efficiencies patients have accessed their records online Medical informatics, Morocco, mobile health, developing that can be gained and have been making [3, 4]. However, these numbers are drasti- countries significant investments in health IT. Health cally increasing as a result of the significant care reforms are driving the evolution of the health IT stimulus made as part of healthcare Yearb Med Inform 2013:190-6 healthcare system toward a digital, data-driv- reform (‘obamacare’.) en, patient-centered, community-linked, new Health IT is beginning to make an impact model of payment-facilitated healthcare in developing countries also. In Morocco, system. For instance, legislation in the U.S. progress has been registered in the field of has established the Health Insurance Por- medical informatics in the areas of academic tability and Accountability Act (HIPAA), studies, research, and practice over the last the Office of the National Coordinator for several years [5, 6]. For example, a formal health IT (ONC), the Health Information medical informatics laboratory was cre- Technology for Economic and Clinical ated in 1997 at the School of Medicine of Health Act (HITECH) Act, and Meaningful Casablanca-Morocco, stimulated by several Use [1]. The recommendations from ONC health IT projects initiated in the 1980s in

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Rabat School of Medicine. In the laboratory are located in every district, and services There are also health care facilities that in Casablanca, a first position for a clinician rendered are free of charge. are not equipped or only partially functional, resident in medical informatics was created. The private health sector is a profit-mak- and there is an under-use of almost the entire In 2001, the first Assistant Professor position ing sector that is principally attended by health care system (average occupation rate in medical informatics was created at the people with sufficient income or those who is 56%). More than seven in ten Moroccans same school. In 2008, medical informatics have health insurance. It caters for the needs (71%) do not have access to a formal health was recognized as a medical specialty. There of 16% of the population covered by health care provider. The average number of med- are now several medical doctors doing their insurance [7]. ical consultations per year is 0.6 contacts residency in medical informatics. In 2009, For the most part, clinicians learn and per person in urban areas and 0.4 contacts the Moroccan Medical informatics Associ- practice in French in Morocco. in rural areas. Recourse to health care is ation (SMIMS) was created. In April 2012, strongly linked to the distance that must be the first national conference in medical covered to reach the health care center with informatics (CNIM12) was organized. 1.1 Quality and Access to the closer the center, the greater the average Developing countries can learn from number of consultations per inhabitant. the advances made in medical informatics Healthcare Services Morocco has a high prevalence of spe- around the world and adapt to their local The Moroccan healthcare system has been cific health problems, in particular in gas- situations or leapfrog them. We hope this instrumental in the improvement of the tro-intestinal diseases, respiratory diseases, paper will help promote medical informatics health standards in independent Morocco. hematology disorders. Certain infectious and as a new field of interest in Morocco. In a first For example, the infant mortality rate fell parasitic diseases are still prevalent like tu- section, our article gives an overview of the considerably between 1962 and 2004, from berculosis, certain perinatal conditions, and Moroccan health care system with a summa- 118 to 40 deaths per 1000 live births, while HIV and other sexually transmitted diseases. ry of the challenges it faces and the current from 1972 to 2004, the maternal mortality The Moroccan health care system is address- informatics efforts in education, research, rate fell from 631 to 227 deaths per 100 000 ing these challenges and improvements are and practice. Section two introduces the births. However, this apparent improvement noticeable, especially over the last decade. SMIMS and the CNIM12. In section three, is tempered by significant urban–rural we discuss challenges and opportunities for disparities. For example, life expectancy medical informatics in Morocco. In partic- at birth is higher in urban than in rural ular, how can Morocco leverage stronger areas. The infant mortality rate recorded in 1.2 Health Care Cost national and international collaborations rural areas is twice that of urban areas and Despite the fact that the financing of the and translate them into effective education, the maternal mortality rate is 30% higher health care system in Morocco increased research, and applications objectives of in rural areas, both infant mortality and to a global expenditure of 4.3 billion US health IT that benefit Moroccan citizens and maternal mortality constitute a major chal- Dollars at the end of 2008, namely 5.6% of the population as a whole. lenge for the Moroccan health care system. the Gross Domestic Product (GDP), it con- By 1999, over 93% of the children up to tinues to lag behind most of the countries in one year of age were vaccinated against the region. In 2001, Lebanon allocated the tuberculosis, 87% were protected against equivalent of 12.2% of its GDP to fund its Diphtheria, Pertussis, Tetanus, and Polio. health system, 9.5% in the case of Jordan and 1 Moroccan Health Care Infant mortality rates have decreased to 36 6.4% for that of Tunisia. Morocco’s national deaths out of 1000 live births. Life expec- healthcare system spends more than 33.6% System tancy has increased from 48 years in 1967 of its monetary resources on buying medi- The Moroccan health system includes to 71.8 years in 2008. Close to 82% of the cine and medical goods. Health promotion a public and private sector, and is cur- population has access to safe drinking water check-ups and external consultations total rently undergoing a number of reforms, and 75% has adequate sanitation. According 35.2% of spending. This spending is exac- including financial, hospital and insti- to World Bank 2004 criteria, Morocco is a erbated by the weakness of funds allocated tutional reforms. lower middle income country. to collective health prevention (drinking The public health sector provides 85% of Despite the Moroccan government efforts water testing, information, education and the country’s hospital beds and represents to reform the country’s health sector, the communication) [7]. the main employer of health professionals Moroccan healthcare system suffers from Collective financing of health expenses in Morocco. This sector deals particularly many inadequacies: insufficient human and is optional in Morocco and very limited. with the needs of poor and rural populations material means, uneven geographic distri- It mainly covers civil servants, and urban who are unable to afford the service offered bution of health cover and a very limited formal sector workers. Its coverage barely by the private sector. It is run mainly by health insurance. People living in poverty exceeds 16%. Direct payments by insurance government-funded (i.e., social security sometimes do not receive the care that ade- companies represent roughly 54% of total (called CNSS)) health centers or clinics that quately responds to their needs. health expenditure [7].

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Morocco allocates fewer funds to its - Centralized management and lack of mostly in France. At the time of writing of healthcare; its healthcare system is some- autonomy. Lack of transparency this article, only one laboratory in Morocco what poorly maintained and lacks the ade- - Lack of a policy to manage and develop - CMIL, a department of the Casablanca quate capacity to meet the demands for nec- human resources, resulting in deficiency School of Medicine and Pharmacy - has essary medical treatments. Also, there is a in managerial competence, technical been offering medical informatics courses disparity between urban and rural locations, resources to operate technical facili- as an integral class within the medical and between regions: 78% of the healthcare ties, and problems of absenteeism and school syllabus, during the 5th year of a budget goes towards urban hospitals and corruption 6-year program. It is offered within a mod- clinics, which has left rural medical services - Poor care quality and patient satisfac- ule called community health. In parallel, difficult to access and in many cases lacking tion, linked to lack of coordination the CMIL is responsible for a residency basic medical equipment and medicine. For with primary care provider program for physicians interested in the example, only two regions have two mid- - Absence of drug policies leading to medical informatics specialty. The resi- wives per rural birth centre. In other words, insufficient use of generic medicines; dency program takes 4 years and requires rural and distant areas of Morocco have by and no benchmark for care therefore 114 credit hours of education. The 114 and large remained behind the dynamism of no clarity in the policy for fixing pric- credit hours are comprised of 6 modules: the larger cities in terms of economic and es, charging for surgery biostatistics (19), epidemiology (26), human development [8]. • Deficiencies in specialized structures research methodology (6), information for geriatrics and absence of retire- technology (17), information manage- ment homes. ment (4), and health informatics (42). At 1.3 Moroccan Health System the end of this residency, candidates are board certified in medical informatics. Challenges At this point, there is no health informatics Morocco faces serious health care challeng- 2 Health Informatics in training program offered in Morocco for es. These can be identified as follows: non-clinicians, except for training seminars

• The first and most important challenge is Morocco that are open to all with topics like intro- the low level of the government budget There is a growing interest and activity duction to health informatics, biostatistics, allocated to public . level in health informatics within university research and critical review of medical lit- Despite the efforts undertaken by the hospitals and medical schools. However, to erature, production of multimedia training Moroccan government over the last five this date, there is one formal department of material, and others. years, public hospitals, representing more medical informatics within a medical school, than 80% of national bed capacity, only the one in Casablanca, called Casablanca receive 9.8% of insurance spending in the Medical Informatics Laboratory (CMIL). context of direct payments and 6.6% of One author is from this laboratory. 2.2 Research the total health insurance spending [7]. The discipline of medical informatics The main projects that CMIL is involved • The second challenge is inequity of pub- within the university is defined by an in are listed below: International NetAdded lic spending. Rural and poor households article from the Moroccan Department Project (new technologies to avoid digital benefit less from public spending on of Education, Professional Training, and division in e-divided areas) whose purpose health compared to urban and better-off Research (article 1439-99, BO 4736). is to create research centers to disseminate segments of the population; hence, the This article specifies health informatics research results for the implementation of difficulty in accessing health care for as a university discipline. As to medical the European Community sixth framework the poorest and for rural populations. informatics, it has been recognized as a program. International EMISPHER Project The level of use of health care services medical specialty by Morocco’s secretary (Euro-Mediterranean Internet-Satellite Plat- is, in half the cases, linked to financial of health in July 2008 and is regulated by form for Health, Education and Research) support (Moroccan Ministry of Health the official act no. BO 5644, 2008. co-funded by the European Commission report 2007). in the frame of the program EUMEDIS. • High cost of private medical care and low It aims at promoting cooperation between coverage of health insurance. Mediterranean countries [6]. Another project • Lack of regulation in healthcare. Con- 2.1 Education involves the setup of a remote clinic that is sumers not sufficiently protected against Typically, medical students, doctors and completely dependent on telemedicine to potential abuse. other clinicians (e.g., nurses, pharmacists), operate [5]. • Poor management of public hospitals, and others (e.g., librarians, engineers, ep- Several new research projects are being which suffer from a range of inefficiencies, idemiologists) who have been interested initiated. They investigate innovations that making them unable to compete with pri- in health informatics had to self-train or address the problems and challenges raised vate hospitals. These inefficiencies include: enroll in a Masters/PhD program abroad, by the medical community. In particular,

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CMIL is collaborating with several univer- panies, service providers, mobile phone op- tion of this first conference was naturally sities including the engineering school of the erators, university sciences and engineering a challenge for the new SMIMS team. University of El Jadida, the dental school departments. However, when essential elements came of Casablanca, and the engineering school together, including the support of key of the University of Casablanca. There are leaders at the University of Casablanca also collaboration projects sponsored by the 2.4 Moroccan Medical Informatics and Ministry of Health, the conference site Moroccan Medical Informatics Association (given the low budget, it could only be a (SMIMS), such as the ‘e-App’ project with Association public site free-of-charge), the engagement an engineering school (Ecole Nationale de The idea of creating a Moroccan association of key speakers from Morocco, France and l’Industrie Minérale). of health informatics was discussed for sev- the USA, and the financial support of the eral years. Typically, these discussions would private sector (pharmaceuticals and health take place during international meetings IT vendors). Communication about the where Moroccan nationals and Moroccan conference was mainly through SMIMS 2.3 Practice experts living abroad would meet. French web site, personal contact lists, and a letter Over the last 4 years, there have been sig- pioneers, like Professor Marius Fieschi of to administration offices at several medical nificant investments in clinical information Marseille University, generously shared and engineering schools. systems made in particular by the 5 univer- their experience and provided excellent The aim of this-two-day conference was sity hospitals: University Hospital Hassan recommendations. However, it has been hard two-fold: First, to discuss current develop- II in Fes, University Hospital Mohammed to make rapid progress with communication ments of medical informatics in Morocco, VI in Marrakech, University Hospital Ibn across continents. A tipping point has been and second, to address local issues in Sina in , and University Hospital Ibn when a core team of national experts came health information systems. The Confer- Rochd in Casablanca. For example, CMIL together and volunteered their times for the ence brought together industry leaders, participated in the elaboration of the health cause. A charter was developed with nom- decision makers, educators and professors IT Master Plan for Ibn Rochd University ination of the executive office (Professor in the fields of healthcare, biomedical

Hospital. It provided a strategic vision for Bennani being the first president and Dr. sciences, life sciences, pharmaceuticals, all health IT projects. Also, it identified Bouhaddou the president honorarium) and informatics and information technology specific requirements and solutions, with the name Moroccan Society of Medical from Morocco, France and the USA. Over an overarching alignment in real-time be- Informatics (SMIMS is the used French ac- 100 professionals attended the conference tween the flow of information to support ronym). The application for a not-for-profit with a majority of clinicians. Women were patient care (administrative, medical and organization was filed with the Moroccan ad- well represented. Over the course of two nursing) and medical education, with the ministration. A web site was created (http:// stimulating days, professionals shared physical flow of medical materials, medi- www.smims.ma) to describe the association research advances, information trends and cations, blood samples, etc. and activities goals, inform about upcoming events (e.g., new enabling technologies that are driv- related to the patients (e.g., prescriptions, congress in medical informatics), and allow ing healthcare management, biomedical exams, medical or surgery acts). The main new members to join. research, and healthcare delivery to new objectives of these clinical information SMIMS offers several education and heights. The National Medical Informatics systems can be grouped in three main training certificates, including introduction Conference 2012 featured five in-depth categories: to medical informatics, fundamentals of half-day workshops providing tutorials and 1) Documentation and data recording rela- biostatistics, aids to literature searches, dynamic discussions with leading experts tive to the various steps of medical care: guides to critical review of scientific evi- in healthcare and biomedical informatics. diagnosis, prescriptions, and results; dence, multimedia presentations, and others. The main recommendations that emerged 2) Information dissemination: health infor- The complete list of SMIMS offerings is from this national conference are as follows: mation exchange, e.g., drug prescription published on its web site. Also, SMIMS • Health informatics is becoming increas- must be exchanged with the pharmacy; has organized several training workshops ingly important to effective and efficient and for medical residents and physicians of the health care; 3) Support for administrative and medical public health sector. • To better integrate information system, decision-making: a dashboard allows sharing and exchanging information is analyzing medical activity, costs by necessary; patient, stay by patient, and other data 2.5 First National Conference in • The use of information system requires analysis metrics. the collaboration and involvement of all Health Informatics stakeholders (i.e. University Hospitals, Also, it is worth noting that there is interest The Moroccan Society of Medical Infor- Ministry of Health, decision makers, from other stakeholders to be involved in matics held its first national conference in professionals and the private sector); health IT, including pharmaceutical com- Casablanca, April 6-7, 2012. The prepara- • Medical informatics is an emerging

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discipline, with emerging career oppor- national health IT agenda and strategic plan. tunities. Therefore, more support should 3.1 National Collaborations This will set a timeline for the realization of be provided to support this emerging During CNIM12, the majority of the pre- the major initiatives needed by the country. It discipline; there is a need for interactions sentations were from the 5 academic health will also help develop synergetic resources among a wide range of people, including, care organizations and they clearly showed related to this important transformation, health professionals, IT professionals, the need for collaboration among these or- including policies, finances, workforce de- educators and administrators, who are, ganizations. There were instances where two velopment and change management. in many instances, playing pivotal roles or more university hospitals were developing as information systems are developed, software requirements for similar products implemented, adopted, and maintained; but were not aware of each other efforts. In • Development of plans for the introduction another example, one University Hospital 3.2 International Collaborations of medical informatics in the whole health had already deployed and addressed user In our increasingly global and inter-related system to cover education, research, and adoption challenges whereas another was community, the opportunities for interna- meaningful use in practice; about to deploy the same product but did not tional collaboration abound. Morocco has • Allocation of financial and human re- know how to make a good first impression and will continue to leverage this positive sources to support health informatics with its users and avoid resistance to change. effect of globalization and open access to plans. Promotion of public awareness to Perhaps, the development of a shared information. sensitize health care professionals and website where organizations could post their Health IT collaboration covers educa- consumers; projects and lessons learned would help. tion, research and implementation projects. • Development of a Moroccan Framework Tools, processes, people skills information Historically, the main international ties have of Reference for standards and interop- categories could be posted to promote col- been with France. Online Master degrees in erability for health IT. laboration and pull resources together to Health Informatics in France offer stipends achieve greater successes. This would not to French-speaking applicants who can take SMIMS stated its commitment to be the hamper innovation, but rather bring togeth- the course from their country and only come home of clinical and non-clinical subject er teams to solve common problems more to France for the final examination. For matter experts in the field of medical infor- efficiently and more rapidly. instance, in 2010, many Moroccan students matics. One regular activity for the associ- Further, collaboration would be greatly completed successfully a Master’s in med- ation is to coordinate a bi-annual national facilitated if there was an office for a national ical informatics Online Graduate Program congress. The congress will help showcase coordinator for health IT projects, similar to elaborated by the University of Marseille, advances, identify common challenges and the US (ONC) [1] or French (ASIP) models. France, and coordinated by Professor Marius spur collaboration. This office would help all organizations, Fieschi. In addition, the Summer School SMIMS already announced the second public and private, adopt common standards of Corte in Corsica, France has also been national congress in medical informatics in for health IT so that information can move offering training opportunities for many May 2014 in Fes, Morocco. For Moroccan with patients as they move from provider to Moroccan informatics specialists, including informaticians, it will be an opportunity to provider, can be shared between public to pri- one of the authors. meet local and international experts and vate facilities, and can be re-used effectively Since 1988, French speaking countries develop relationships and collaborations. for population health. Standards are lacking have been organizing Medical informatics It will also be an opportunity to recognize and are needed for many entities including study days in French-speaking countries. local pioneers and centers of excellence, and identifiers for patients, providers, and fa- The aim of these scientific seminars is to thus, stimulate best practices in the country. cilities; structured medical terminologies; discuss the state of the art in medical infor- security, privacy and consent management, matics. This congress is held every 2 years and others. in a different French-speaking country. The For instance, the availability of a national proceedings are published by Springer. This 3 Challenges and Oppor- patient identifier strongly authenticated year, the group has joined the International to each Moroccan citizen would greatly Medical Informatics Association (IMIA) tunities for Informatics in enhance information sharing and security. Special Interest Group, and will benefit from Many studies have documented this [9]. A IMIA’s experience and outreach capabilities. Morocco Moroccan collaboration needs to put forth Joint projects can bring the strength In this section, the authors reflect back on the in- the policies, standards, and incentives to of multi-cultural students/faculty teams formatics challenges and opportunities in Moroc- drive development and adoption of this to work on Moroccan projects. Attempts co, on the lessons learned from the first national critical infrastructure element. to win grant support from USAID, The congress in medical informatics (CNIM12) and Eventually, working collaboratively with Millennium Challenge Corporation and present their own, subjective assessment of some public and private sectors, the office of Mo- others are underway in Morocco. To expand important priorities for the field. rocco national coordinator would define a beyond the North-South traditional allianc-

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es, SMIMS Board is trying to engage other Transmedia is a mass communication Medical informatics is already a medical organizations in sharing their experience. approach where integral elements of a story specialty in morocco. In 2008, legislation In particular, a few months back, SMIMS get dispersed across multiple delivery chan- was passed to make medical informatics a reached out to the American Medical Infor- nels for the purpose of creating a unified and medical specialty in Morocco. The fist lab matics Association (AMIA) after it created coordinated experience and impact. Mar- providing formal residency for this specialty its Global Health Informatics directorate, keteers use this approach in a diverse array is in Casablanca School of Medicine, under inquiring about ways AMIA can be in- of industries, in particular entertainment. A the supervision of Professor Bennani. There volved in Morocco but has not received a movie will be released with a comic book, are currently 5 residents in the program, with reply yet. Also, through membership with animated cartoons, and a video game. The the first graduate to be delivered by 2014. IMIA, SMIMS hopes to shorten the path to health industry is starting to embrace trans- Having physician specialists in medical productive international collaborations by media storytelling techniques. For example, informatics will provide a critical compo- leveraging IMIA’s rich network of medical Walt Disney made a cartoon movie about nent of this work force. These specialists informatics specialists. malaria and mosquitoes. Also in recent will participate and often lead the efforts of years, health advertising has been used with acquisition or development, implementation, tremendous results to discuss the effect of evaluation, and continuous improvement of 3.3 The Exciting Opportunity of smoking, alcohol, weight management, electronic health records. In particular, they STDs, non-saturated fats on health. will help analyze and refine clinical process- Mobile Health The broad availability of mobile devices es that yield quality outcomes. It is predicted that by 2013, 95% of the can help public health programs reach both The challenges ahead are twofold: 1) entire world will have access to cell phones. providers and consumers, and be effective develop career opportunities for the new If a small village in Morocco has only 1-2 for individuals and population health, for dis- physician specialists in medical informatics, phones, the technology is still present. The ease management and for prevention and risk and 2) develop a formal examination and Mobile Health - revolution can have a tre- reduction campaigns. Furthermore, there are preparation program for medical informatics mendous impact on developing countries. many resources available to guide this effort. specialists. AMIA in the US took the lead in

Mobile Health is a game changer. As mobile For instance, the US National eHealth Col- developing core content for this subspecialty, telecommunication allowed developing laborative Patient Engagement Framework and published an outline in 2008 [13]. This countries to leap developed countries in is a model created to guide healthcare orga- core content includes four major categories: terms of social communication outreach nizations in developing and strengthening fundamentals, clinical decision making and and networks, it can also help developing their patient engagement strategies through care process improvement, health informa- countries significantly advance their health the use of eHealth tools and resources [12]. tion systems, and leadership and manage- IT [10]. It helps them extend their resources. The five steps or phases to engagement that ment of change. In parallel, education and For instance, the ratio of doctors to individu- make up the framework include “inform me,” communication efforts must be made to als is very low in Morocco. Mobile Health, “engage me,” “empower me,” “partner with accelerate the recognition of this specialty with simple text-based messages can help me,” and “support my e-community.” To re- throughout the health care sector. Ministry close this health care gap. alize the benefits of this exciting opportunity, of Health, public and private health care In South Africa, HIV awareness text a country must develop a central strategy and organizations, medical schools, and indus- messages produced a four-fold increase central team that will develop the network try partners should recognize the merit that in calls to the national AIDS line. Peru and communication within a framework that health IT specialists in general and clinical has a program where AIDS patients get a will emphasize standards for data acquisition informaticists in particular can bring to the text message reminding them to take their and information communication. success of health care IT knowledge and use medicine. Smart phones are revolutionizing in their settings. Africa healthcare [12]. Ugandan software SMIMS will help promote informatics developers are designing an app that could education and certification, through local radically change antenatal care in remote 3.4 Workforce Development efforts and international collaboration. areas and save hundreds of lives. The transformation of the health sector from In 2011, the U.S. Department of Health a paper to an electronic industry will require and Human Services announced two new a significant increase in skilled labor, knowl- mobile phone text messaging smoking edgeable about healthcare, information, cessation programs, QuitNowTXT and communication, and technology. Conclusions SmokeFreeTXT, as part of their Text4Health Health IT workforce development is Informatics is an essential tool for helping to initiative. Johnson & Johnson has a program, a broad effort targeting candidates with transform healthcare from a paper-based to a Text4Baby that provides education to preg- multiple backgrounds (e.g., technical and digital sector. Public and private investments nant women and new parents for 20 million clinical) and expertise at multiple levels in health informatics education and research, users around the world. (e.g., certificates to PhDs). as well as in support of practical implemen-

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tation projects are necessary to develop the The creation of a national office or com- 4. ONC Data Brief AHA 2011. http://www.healthit. necessary workforce and infrastructure to mittee is essential to help with standards, gov/media/pdf/ONC_Data_Brief_AHA_2011.pdf. Last accessed on Feb 10, 2013 address the difficult problems and roll out interoperability, and facilitate health IT 5. Bennani Othmani M, Diouny S, Boumalif O. products that are usable and useful to im- adoption with providers and consumers. The Application of a Telemedicine Management prove patient outcomes. This office will help identify priorities System: The Case of a Moroccan Hospital Unit. The Moroccan healthcare system suf- and provide policy and grant support to Assistive Technology 2012;24(3):209-13. fers from insufficient budget, an uneven address national complex problems, like 6. Bennani Othmani M, Diouny S, Balar K. Med- ical informatics in Morocco: Casablanca Med- distribution favoring urban areas, and poor development of a national patient identi- ical Informatics Laboratory. Yearb Med Inform management and workforce skills. Les- fier, or a security framework, or a national 2007;138-40. sons learned from and collaboration with Mobile Health program. Also, internation- 7. Country health information, World Health Orga- developed countries can help developing al partners and collaborations should be nization (WHO), http://www.who.int/nha/ countries like Morocco leverage existing actively sought and can be found through country/en. Last accessed on Nov 25, 2012 8. World Health Organization (WHO), http://www. advances in health informatics to address programs like IMIA and ‘informaticists who.int/workforcealliance/knowledge/PPE_Mo- these challenges. In the last 2 decades, without borders’. rocco_CaseStudy.pdf. Last accessed on Nov 25, Morocco has made significant progress that In particular, for developing countries 2012 parallel the technology advances in other like Morocco, new health IT approaches like 9. Dick RS, Steen EB, Detmer D, editors. Institute domains, including electricity, internet, mo- mobile health and transmedia health adver- Of Medicine. The computer-based patient record. Washington: National Academy Press; 1997. bile phones, hospitals networks, and others. tizing could help optimize scarce resources, 10. Kahn JG, Yang JS, Kahn JS. ‘Mobile’ health Medical informatics is now a medical spe- improve access to rural areas and focus on needs and opportunities in developing coun- cialty in Morocco and already several phy- the most prevalent health problems, opti- tries. Health Aff 2010;29(2):252-25. sicians are engaged in residencies that will mizing health care budget for better access, 11. Simon SK, Seldon HL. Personal health records: mobile biosensors and smartphones for devel- provide them with the in-depth knowledge quality, and cost to all Moroccan citizens. oping countries. Stud Health Technol Inform and experience to help lead efforts in their 2012;182:125-32. health care organizations and at the national 12. US National eHealth Collaborative – Patient En- gagement Framework. http://www.nationalehealth. level. Medical students are taught basic References org/patient-engagement-framework. Last accessed computer skills, critical literature review, 1. U.S. Office of the National Coordinator for on Nov 25 2012. and biostatistics. A two year old Moroccan Health IT strategic plan http://www.healthit.gov/ 13. Gardner RM, Overhage JM, Steen EB, Munger Medical Informatics Association (SMIMS) policy-researchers-implementers/health-it-strate- BS, Holmes JH, Williamson JJ, et al. Core content is promoting health IT education and col- gic-planning. Last accessed on Nov 25, 2012 for the sub-specialty of clinical informatics. J Am 2. Institute of Medicine Report: Best Care at Lower Med Inform Assoc 2009;16(2):153-7. laboration among clinical and non-clinical Cost: The Path to Continuously Learning Health specialist of health IT. SMIMS inaugural Care in America. http://iom.edu/Reports/2012/ national congress on health informatics Best-Care-at-Lower-Cost-The-Path-to-Continu- Correspondence to: took place April 2012 and the next one has ously-Learning-Health-Care-in-America.aspx. Omar Bouhaddou already been announced for 2014. Visited on Nov 25, 2012. PO Box 3351 3. Murphy J. State of the Association slides AMIA Rancho Santa Fe, CA 92067 More national coordination and collab- Chicago 2013 keynote presentation .http://www. USA oration are needed to realize the promises amia.org/amia2012/updates. Last accessed on Feb Tel (cell): +1 801 755 3263 of a digital healthcare system in Morocco. 10, 2013 E-mail: [email protected]

IMIA Yearbook of Medical Informatics 2013