Johannesburg, 16 Jan 2020
“Greater collaboration is required between all healthcare service providers in the country, specifically in the laboratory environment, for the much-mooted National Health Insurance (NHI) scheme to work properly,” says Martin Wilkinson, Director of Product Introduction, Strategy and User Adoption at InterSystems.
“When you consider that 70% of clinical decisions require a laboratory result, and that figure rises to 90% for people who are on a clinical care pathway (perhaps for a chronic illness), the critical role played by pathology laboratories becomes apparent.”
He queries why there has been a lack of collaboration thus far between the private and public sectors, but says that regardless, NHI initiatives will necessitate changes in the landscape of co-operation between these two sectors.
“Initially, this necessary public-private partnership could be quite a difficult relationship, and there’s no real clarity on how the NHI will affect laboratories. Everyone appears to have their own view.”
Wilkinson considers various scenarios and says it’s conceivable that the role of the National Health Laboratory Service (NHLS) and that of private sector laboratories in this new landscape may change. Consumers may have the option in future to choose whether to go public or private, depending on what tests are being done.
“Laboratories generally may have to offer more competitive pricing for pathology testing, but whatever happens, the NHI is going to be a major disrupter to pathology as a service,” he says.
Because so many people need to have tests done, pathology is at the heart of most healthcare services.
Inter-operability
Wilkinson believes that it is imperative to track patient movements between private and public healthcare facilities, and this will need to be addressed from a clinical record perspective. Normally, the patient’s history would be reviewed when test results are interpreted, but in the absence of a history, a decision will be made based on that single pathology test. If a patient has a series of tests done and they have been processed through a combination of public and private sector labs where the provider won’t have access to the patient’s previous test results, things can become complicated.
“This presents a dilemma clinically, as the interpretation of the tests may not necessarily be flawed, but they may not be as informative as they could be if they included a review of all of the previously related test results.”
Inter-operability between the systems in the private and public sectors in a state-wide health economy is an opportunity for improved clinical treatment, particularly for illnesses such as TB and HIV. Currently, the private and public sector have no view of one another’s patient records. If a Health Information Exchange (HIE) were to sit between all facilities, regardless of who owned the solution, it would help address this issue.
Wilkinson has seen HIEs implemented globally, allowing countries to share patient data very successfully between healthcare providers, and he believes that this could be an option for the NHI.
Unique patient identifier
In a drive to create a unique patient identifier, the Department of Health is implementing a Health Patient Registry Number, for which some South Africans have already been registered. However, the challenge is in both matching existing records to patients and identity management. A lot of healthcare services in SA are still paper-based, making it difficult to identify and track a single patient across different healthcare providers.
Because of this, it is not unusual for a patient to end up with multiple files that have no way of being linked. Having an IT system sharing data in the public and private sector is one way to solve this issue, enabling the clinician, with the help of a unique patient identifier, to reference a single record for the patient.
Wilkinson says: “If we manage to solve the identity management conundrum, then we need to consider how we’re going to retain the value of the information we have already recorded. There must be millions of clinical records in IT systems spread across various healthcare institutions, including a fair number of duplications. This means there’s no contiguous record of care where identity can be confirmed. The private sector has less of a problem because of the funding drivers to their services, but the state sector clinical records are potentially more of a challenge.”
The building up of computer-based clinical records is a byproduct of implementing IT, which most private sector medical practices have. Very few public sector hospitals have a full-blown information system, and those that do have technology generally find it outdated. The smaller hospitals and clinics are very paper-based; some even open a new file for every consultation.
“So, while the patient identity is key, there’s a legacy problem that needs to be addressed,” says Wilkinson. “With an increase in IT systems, the opportunity for duplication and electronic silos will be increased unless sound identity management, inter-operability and HIE infrastructure are in place.
“We’re sitting with a wealth of patient data across multiple systems and need to find a way to bring that together. This problem isn’t unique to SA; it’s a challenge globally.”
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