Johannesburg, 11 May 2020
Technology has a vital role to play in supporting healthcare delivery during a pandemic such as COVID-19, says Gerrit Henning, CEO of Health System Technologies.
Henning says data is being shared between the public and private sector laboratory systems, integrating information that was traditionally siloed, and enabling contact tracking and tracing at a national scale.This data is shared in real-time, as and when positive cases are identified.
The information shared includes contact information such as mobile numbers and physical addresses of individuals that have tested positive for COVID-19. The minister of health and the president have gone on record several times to explain how important it is in the fight against COVID-19 that contact tracking and tracing is performed efficiently, enabling healthcare providers to do focused screening and testing where possible outbreaks are looming. This allows ‘flattening of the curve’, ensuring outbreaks are contained, and the healthcare system isn’t flooded, ultimately reducing the mortality rate.
Henning says he’s unsure to what extent or how the shared contact information is being used further up the healthcare chain. “The data itself could be extremely useful in the data science space when combined with location data from cellular network providers. It’s possible to track where each person who tested positively for COVID-19 has been and who he/she has been in contact with, which means high-risk individuals could be informed, quarantined and tested.”
Naturally, says Henning, one has to address the issue of data privacy, but with encryption technology and anonymisation techniques, solutions could be architected to provide the required outcome and still ensure privacy and confidentiality.
As an example of this type of collaboration, he refers to initiatives by the Western Cape Government Health to share bed occupancy and emergency centre activity information from their hospital information systems as dashboards to the province’s emergency services (EMS). This allows EMS to determine which hospitals and emergency centres are inundated or over-crowded, allowing them to divert emergency vehicles to other hospitals and emergency centres that have capacity.
“Taking a patient to a healthcare facility with capacity from the onset could mean the difference between life and death, especially when COVID-19 peaks and the healthcare system is generally under pressure,” he says.
Where should technology be heading?
COVID-19 has highlighted the urgent need for a comprehensive business continuity planning and co-ordination effort for both government – at all levels and across its various departments – and the private sector. The pandemic has removed any doubt that may have existed on the inter-dependency of public and private sectors on a stable economy, underpinned by a healthy and active workforce. “We should be thinking ‘South-African continuity-planning’ rather than ‘government or business continuity-planning’.
“In order to design, plan and execute a holistic business continuity strategy for the country, it needs to make optimal use of the current data and information system assets at its disposal. The rich data assets that reside in siloed information systems, stored in different databases across the country, could be used to combat any future disasters of a similar (or even worse) nature than COVID-19, over and above helping to combat the effects of COVID-19 itself, which will be with us for years to come.”
Henning believes it’s possible to create a digital infrastructure that uses existing data assets and turns them into a real enabler for the country, its residents, its visitors and investors.
“We need a coordinated approach to consolidate the identified silos of data, subject to the necessary security and privacy provisions, to create a world-class analytic capability. Not only for planning based on historic analysis, but so we can model and predict future trends, risks, opportunities and disasters using the latest techniques available in data science, artificial intelligence and machine learning."
A digital infrastructure and architecture that will exist long after COVID-19 is needed to radically transform healthcare in South Africa. “However, this is much easier said than done, as it needs to address the known challenges that hampers sharing of information – such as trust, security, confidentiality and privacy – and ultimately the willingness for private and public sectors to work together towards a greater goal, underpinned by the question – who pays, and where does the money come from?”
The challenges notwithstanding, machine learning and predictive analysis are dependent on big data to be effective. If South Africa can find a way to ensure that data can be sourced widely, aggregated, correlated and turned into real value – the building of a central ‘nerve-centre’ is possible – enabling the prediction of future risks, and the management of existing issues and conditions, ensuring optimal safety and availability of the workforce, and a stable economy. “This vision should be broken down and realised in targeted areas, such as the NHLS or private sector, and then expanded upon.
“Ultimately the goal should be to use our existing data and technologies more effectively, and apply data science and machine learning techniques to ensure business continuity across all sectors, mitigating against the economic and social impacts we’re currently experiencing as a result of the COVID-19 pandemic.”
Henning believes the NHI (National Health Insurance) system might have made a difference during the current pandemic, depending on how effectively it was implemented and its underlying technology.
“At a technology and information system level, one would assume that a centralised NHI system would make it easier to acquire and use contact information for patient tracking and tracing, as an example. Or to use geo-coding techniques to locate affected individuals, based on addresses, laboratory examinations performed and diagnosis made. Or to determine outbreaks of a condition in specific areas. Or to use machine learning techniques to predict risks. My guess is that it will take considerable time for the public sector to establish the appropriate technology, and that once again the public and private sectors will need to collaborate to achieve a mutually beneficial digital infrastructure.”
Looking forward, Henning says the trend of moving away from paper towards the ultimate goal of a paperless electronic medical record (EMR) for patients needs to continue. “The ability to integrate EMRs across institutional and provincial and even national boundaries must be further developed and enforced, and EMRs themselves must mature in terms of the richness and quality of patient data recorded.”
Right now, the emphasis in EMRs (and practice management or hospital systems) is capturing patient data that allows a provider to produce a bill that will be paid by a medical aid, predominantly by capturing diagnosis coding, procedure coding and drug codes. These codes can be analysed by medical aid expert systems to enable or disable claims. “Very few EMRs in South Africa focus on capturing and coding patient history, family history, observations, findings, examinations and outcomes, all of which remain largely on paper yet need to be digitised to enable machine learning, predictive analysis and precision medicine.”
In conclusion, he says: “Should South Africa be able to legislate and enforce minimum requirements for EMRs, which could be consolidated as a national resource – in a nerve-centre approach – many potential health hazards could be mitigated.”