The provision of high-value healthcare is the ultimate goal in the South African context, but how we're going to get there is the challenge.
Value in healthcare is simply ensuring better patient outcomes and more effective use of resources. Leon Wolmarans, Business Development Manager at Health Systems Technologies, believes a modular approach to healthcare IT is instrumental in delivering better value for patients, for healthcare providers and for the sector as a whole.
The South African healthcare sector is characterised by disparate organisational structures, management practices, patient mobility and payment models at various levels. Wolmarans explains the challenge faced: "If you consider the disparities between the types of IT resources that a rural clinic has at its disposal when compared to a private hospital in a city, it's easy to see how the concept of the two sharing any kind of information would be challenging, at best."
However, when the government's National Health Insurance (NHI) comes into effect, it will be essential for all healthcare providers to be able to share agreed information. Wolmarans says there are five layers to delivering high-value healthcare. While not all of these have to be implemented simultaneously, they are interdependent and mutually reinforcing.
1. Organise healthcare provision into integrated practice units;
2. Measure outcomes and cost for every patient;
3. Move to bundled payments for care cycles;
4. Integrate care delivery systems; and
5. Expand geographic reach.
"If you consider the changes the local healthcare sector has seen recently with the issuing of two new Bills to enable implementation of the NHI, which aims to make high-value healthcare more accessible for all residents, it's clear that private and public healthcare providers will be expected to collaborate, and this just won't be possible without implementing a health information exchange (HIE) that's inclusive of all participants in the healthcare sector."
All of the above rely on the implementation of IT platforms that are standards-based and are integrated with a national HIE.
The national HIE will allow for the sharing of agreed patient information between providers, subject to privacy, confidentiality, access and consent being managed by the HIE.
Wolmarans says: "Instead of ripping and replacing existing systems, we're proposing a health information exchange that provides healthcare providers with a consolidated view of relevant clinical data."
The investment in the heathcare providers' existing systems is protected because the data is standardised via an interfacing mechanism to make it available and accessible via the health information exchange.
Individual healthcare providers can add extra modules as they see fit to improve the collection of clinical data. Wolmarans clarifies: "A health information exchange would normally be put in place at either provincial or national level, and every qualifying healthcare practitioner that falls under it would be able to participate in it. Commonly found constraints at local healthcare providers, such as staff and IT skills levels, Internet connectivity, power supply and access to devices, mean each facility has a different degree of readiness to go digital. "If you implement the healthcare information exchange as an umbrella service, participants can engage at various levels.
"Using a flexible, modular concept for the solutions that participate within a healthcare information exchange enables hospitals and other participants of various levels of maturity, capacity and financial status to implement according to their individual profiles."
Three must-have qualities for this type of solution:
* Must be designed around a flexible modular concept that allows customisation;
* Must meet evolving operational requirements and comply with government and private funding and service delivery regulations; and
* Must be able to seamlessly integrate third-party systems, solutions and equipment using healthcare interoperability standards.
Factors such as increasing medical costs and emphasis on better administration, management and collection of revenue are driving the adoption of HIEs both internationally and closer to home, particularly at healthcare facilities in the Western Cape, says Wolmarans. "As the NHI comes closer to fruition, the benefits of participation in a health information exchange are likely to become evident to more and more hospitals, pharmacies and other providers, and this can only be achieved by digitally transforming their operations."