[Column] Shiraaz Joosub: Sustainable interoperability and quality integrated public healthcare in South Africa
South Africa's public sector healthcare institutions do not have the budget needed to implement progressive e-health strategies, such as collating patient records across different facilities in a simple and transparent manner.
Current patient records in most public hospitals remain paper-based, leading to a lack of scalability and portability of records. This also includes the inability to integrate the management of patients, because data is not exchanged between facilities in a standardized way and from one region to another.
Inefficiencies exist in paper-based medical records, duplication of records, no protection of personal information, lots of errors and no integration of records from one facility to another. This means more time is allocated to administration versus clinical care and the result is lower standards of care and poor patient outcomes.
This also places a heavy burden on human resources to administer patient records, and a strain on supply chain management and patient administration. The repercussions include a high amount of write offs and bad debt related to medical supplies – as there is no effective track and trace or materials management, resulting in losses through theft or expiration.
The administration of public healthcare facilities is plagued with risks of bad debt related to the absence of track and trace of medical equipment and supplies. This will result in theft or expiration of stock, higher non-recoverable amounts as financial administration is purely dependent on manual human resource processes and associated errors including the lack of audit trail that would be provided by a tech-enabled facility.
Hence, patients are more drawn to these tech-enabled private healthcare organisations that can demonstrate more efficiency in patient care, security of patient information and better quality of care as more time is allocated to the patient versus administering paper records.
The revenue factor
The revenue of a healthcare facility has a direct relationship to the patient experience during a visit. This is further influenced by the quality of care received and the eventual visit outcome.
Technology has been shown to influence these variables of patient experience and treatment outcomes. Some examples include: shorter waiting times to discharge a patient as the need to manually consolidate the patients account and prepare a discharge summary is real-time with tech-enabled information systems is removed, track and trace of medical equipment provides optimised use and reduces the cost of care thus improving profits, tech-enabled clinical decision support at the point of care ensures patients receive best practice clinical care and eliminates the human error factor, the result of which is seen in lower malpractice suites.
Transparency in healthcare is particularly crucial to the patient and generally refers to providing information on a healthcare system’s quality, efficiency and consumer experience. It is with the intent to influence the behaviour of all stakeholders of the healthcare ecosystem to achieve better outcomes, in terms of quality and cost of care.
As we advance in healthcare and its innovation patients are becoming more vested in the decisions around their care.
This transparency is highly dependent on technology to provide information that allows a healthcare facility to improve patient outcomes. Research suggests that transparency can help a patient make informed choices when selecting a health plan, healthcare facility, or when choosing alternative treatments, although there are questions about how well and how often patients make use of such information and how best to present such information to the public.
Ideally, public health ecosystems should operate as an integrated delivery network of healthcare services. This is generally enabled through standardised business processes and normative standards that are adopted by all institutions that deliver public healthcare.
South Africa has embarked on developing its healthcare normative standards framework and has documented its e-health strategy, which will form the basis of healthcare interoperability throughout the country. These initiatives will complement the roll-out of the proposed National Health Insurance (NHI).
Towards sustainable interoperability
For South Africa to move to a sustainable interoperable model of healthcare delivery, it needs a healthcare interoperability framework that defines the normative data standards required to provide transparent healthcare services, as well as a unified integrated healthcare information system that can provide a standard scalable and portable electronic health record.
Furthermore, the country will require more skilled technology-savvy human resources to implement and manage the information systems that will empower healthcare providers and provide the transparency needed to treat patients more effectively, and regulations will have to be introduced that ensure continued quality management services with the appropriate governing committees.
An integrated system is also key to managing the current pandemic effectively. Most hospitals that have not undertaken their technology transformation journey are not equipped to virtualise their services, meaning they cannot plan elective procedures or acute care at a hospital site, as patients would be exposed to risks.
At the same time, track and trace will form the basis of understanding the state of the pandemic in South Africa and having visibility will allow caregivers to see whether the pandemic can be better managed, whether the curve of infections is being flattened, and whether life can return to some degree of normality – this can only be achieved through virtualised and interoperable technology.