The build or buy dilemma
With the publication of the NHI Bill and its presentation in Parliament, the NHI is back in the news. It raises the question, what sort of IT systems will be required to ensure the success of a project of this size?
It is self-evident, in order for the government's National Health Insurance (NHI) to succeed, it needs to implement technology that will allow it to identify patients, providing secure repositories of healthcare data that conform to the consent rules prescribed by the POPI Act.
For the NHI system to deliver on its vision, public sector healthcare needs to be able to identify its patients, and currently, only one province can do this. “That’s one of the major challenges that a national health system faces,” says Henry Adams, Country Manager at InterSystems.
Know your patient
When you consider that there are close to 50 million public healthcare patients and another nine million people using private healthcare, the scope of the challenge becomes apparent. Adams says: “The sheer number of individuals involved requires the effective implementation of proven enterprise IT systems to support the delivery of healthcare services. Until you know who the patient is, it’s chaos. Private healthcare knows who its patients are within a health group, but doesn’t typically share any information wider than that, nor is there a functioning central patient index.
It’s not about just spending money on solutions, says Adams, it’s about partnering with solution suppliers that already operate in the larger healthcare system space providing design, planning, implementation and support services.
It’s very much a build-or-buy philosophy, but the global trend is to buy tried and tested solutions that are fit for purpose but sufficiently flexible to also enable some development. “If you’re going to do things at scale, you need to do it properly. You can’t just patch an assortment of solutions together. There are proven platform solutions available that can deliver interoperability and there’s no need to build one from scratch.” Adams also questions the longevity of built solutions versus bought ones.
In South Africa – and the public sector specifically – there is a strong push for open source software owing to the mistaken belief that it will be cheaper to acquire, implement and support. However, this is far from the truth in healthcare.
“You have to ask yourself, is the software that you’re considering compliant with local and international healthcare-specific standards around interoperability? Does it have the required secure data handling protocols that have been developed over many years? While South Africa has produced its own standards on healthcare interoperability based on the international standards, these are evolving so rapidly that it’s possible that we haven’t kept pace.”
Another solid point made by Adams is that if you want to deliver clinical healthcare at scale, the solutions need to be built on proven high-quality enterprise platforms, in accordance with trends around the world. “It's critical when building large systems that they support specific protocols around managing the interoperability of healthcare data, you can't just build it all on Web services. “Today, particularly in the interests of a successful NHI, we need to bring all of the different providers together and enable them to share certain data where it’s appropriate.
“It all comes down to the tenet of healthcare having a financial side and a clinical side. You need software systems that underpin both aspects, which support specific protocols around managing the interoperability of healthcare data and which enable the financial and clinical sides to talk to one another.”
Where is SA on the journey?
"The success of the NHI is completely dependent on the ability of the clinic or provider to produce a bill for each patient. If they can't produce a bill, they won't be paid.”
He says: “There are a few pilot sites, 10 districts that have been identified, but these are largely looking to use open source or perceived low-cost products. As mentioned, this is never a good idea if you want to deliver clinical services at scale.” The NHI is something that needs to be done at scale from an IT point of view. The plan is to provide citizens with better access to healthcare, improved outcomes and control of costs, and IT must support and enable that business plan.
He concludes: “The challenge of delivering quality healthcare is a global conundrum; it's not unique to South Africa. It makes good business sense to look at global best practice and gain an understanding of the complexities of the global healthcare delivery models.”