Johannesburg, 26 Mar 2018
A single view of every patient. That's the ideal state in both public and private healthcare. An integrated system that brings together the patient's medical history for his or her entire life into a cohesive system that can be accessed by every single healthcare provider in the country. Every test ever performed, every x-ray taken and every drug ever prescribed. As well as the healthcare outcome for that patient, and how much it all cost. This will become particularly relevant once the National Health Insurance (NHI) fund comes into play, mooted for 2025.
Leon Wolmarans, business development manager at Health System Technologies, says there's a global trend towards interoperability in healthcare, where IT solutions from different providers are able to integrate in the interests of sharing data. "The advantage in being a late adopter of this healthcare trend," says Wolmarans, "is that South Africa can benefit from gains made elsewhere in the world and ensure it invests in proven technology that is able to integrate with existing hardware and software solutions."
The World Health Organisation has identified access to current and quality information about patients, their treatment, their outcome and cost, as key to improving the overall level of healthcare delivery. In practice, this is often difficult to achieve, particularly for patients being serviced by numerous healthcare providers, says Wolmarans.
"The only way to ensure access to reliable patient data is through the implementation of a core, interoperable IT platform that enables more patient-centric care, uses common data definitions, encompasses all types of patient data, makes medical records accessible to all parties involved in care, includes templates and systems for each medical condition, and that enables easy access to information, ideally to be implemented at each healthcare facility in South Africa."
While the latter statement may seem somewhat ambitious, this type of platform is currently being rolled out at public hospitals across the Western Cape, with 54 hospitals and 110 pharmacies currently having access to a centralised database of 13 million patients.
"When the NHI is enacted, its success will depend on hospitals across the country having interoperable IT solutions which provide a comprehensive common view and that make it possible for government to measure patient care outcomes and cost. This is because the NHI is based on the premise of value-based healthcare, in which healthcare providers are paid based on patient health outcomes."
Implementing this new model will require fundamental restructuring of how healthcare is delivered, says Wolmarans. An integrated IT platform is just one of six elements that are integral to the success of such a strategy:
1. Organise into logically integrated practice units per specialty;
2. Measure outcomes and cost for every patient;
3. Move to bundled payments for care cycles;
4. Integrate care delivery systems;
5. Expand geographic reach; and
6. Build an integrated IT platform.
"The IT platform underpins all of the other requirements," he continues, "as without seamless access to the necessary data, none of the other elements can be implemented."
The scope of implementing such a platform at every healthcare facility in the country is formidable, and this is why interoperability is so key to its success. "Interoperability and the ability to integrate systems and software prevent rip-and-replace and, instead, make the most of existing investments in technology and intellectual property. It also enables a modular approach to deployment through the concurrent use of existing technology. Interoperability also enables either a concurrent or a phased implementation within different facilities, depending on budget and IT solutions already in place."
The patient is at the centre of this new breed of healthcare ecosystem, linked to doctors, specialists, hospitals, community care, other patient groups and even those who pay for their care (ie, government) by this interoperable healthcare delivery system. Data such as physician notes, images, orders for drugs or laboratory testing can all be accessed in a single interface by all of the healthcare workers that are involved in treating that patient.
Patient confidentiality is ensured through the use of unique patient identifiers, instead of the person's name and date of birth, to access information on the system.
"However, in order to enable this level of interoperability in South African healthcare, we need a medium- and long-term plan with a supporting budget, as well as a unique identifier for each individual," concludes Wolmarans.
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