Data helps the medicine go down

23 August 2017

Technology that combines data from different sources is doing more than any spoonful of sugar to improve patient care in South Africa.


Med-e-Mass, a Bytes Technology Group company, is leading a medical care revolution in South Africa by linking electronic health records, personal health records and the data that is collected by fitness devices with Funders.
The result is a powerful dataset that improves the management of especially chronic conditions, such as diabetes, to the benefit of patients, medical schemes and the broader economy.
Dilip Naran, General Manager: Product and Development at Med-e-Mass, says that HEALTHone, which is a Electronic Health Record Application that enables practitioners to keep electronic patient records, has long been Med-e-Mass’ flagship offering. 
“In the private sector, the health records stay within the practice and the GP can draw reports to help him or her understand the population of individuals the practice looks after,” says Dilip. “The same system can be implemented in hospital groups with facilities across the country, enabling a powerful cross-referencing capability.”
About two years ago, Mediswitch launched the concept of a personal health record with LifeDoc, a digital platform for individuals to keep track of their own health. The system was designed that personal records could interface with electronic record, giving GPs a view of the information in the personal record. 
Dilip points out that there is a clear distinction between the information in the two records. “The personal record contains, what we call, unverified clinical information,” he says. “When you take your blood pressure at home, for example, your GP doesn’t know whether the device you use is properly calibrated, hence it is classified as unverified.” 
The third element is the information recorded by the fitness devices individuals wear. A slim band around your wrist tells you when to move, records your steps, and monitors your heart rate and blood pressure.
This data is aggregated into the device provider’s cloud from where it can be retrieved and linked into a person’s personal and electronic health records.
“The combination of the three sets of data is a detailed record of a person’s health, which is far more powerful than the snapshot provided by a doctor’s visit two or three times a year,” says Dilip.
Furthermore, the doctor can set up the practice system to react if, for instance, a patient’s blood glucose levels test too high. It can send the patient advice on how to manage the situation, or even an alert to take action. 
“With our tools the information that comes into a patient’s health record is filtered,” says Dilip, “The number of steps someone walks in a day is not necessarily relevant for the doctor to know.”
The role of funders
Excellent as all this may sound, Med-e-Mass discovered that the individual take-up of personal health records is very low in South Africa – as is the case internationally. So-called untethered records are in practice not as appealing as in theory. “Having learned this lesson, we are now making a tethered system available,” says Dilip. 
Tethered health records are, as the name suggests, tied to a bigger entity, such as medical schemes, corporate employers or organisations like the Centre for Diabetes and Endocrinology. 
In South Africa, medical schemes are emerging as pivotal players in the three-way data system. “Fragmented care is one of the biggest issues we have here,” explains Dilip. Doctors in different practices and areas may treat the same disease differently, whereas funders want patients to be taken care of in a standardised way, and as effectively as possible from the outset. Diabetes, for instance, is not expensive to treat when it is managed effectively. It is when the patient ends up in hospital that the costs skyrocket.
Funders therefore want to identify high risk patients, set up a care plan, and incentivise the doctor to abide by it. Data is the key to this process. Reliable data that is collected consistently and efficiently gives the doctor good information to work with, and the funder a view of how effective it’s treatment plan is. 
Med-e-Mass now has the technology to make it all possible. “The apps we provide are repositories for data, and our tools collect, aggregate and import it into electronic health records,” says Dilip. 
The market response suggests that Med-e-Mass has hit the healthcare nail on the head. Discovery, Medscheme and the Centre for Diabetes and Endocrinology are on board already, while a rollout of HEALTHone and Lifedoc to 90 practices (which inludes around 500 practitioners), impacting some 300 000 patients, across the country is about to start.
Looking towards the future, a social media component through which individuals with the same condition can share information with each other is on the cards. “It will open up a whole new venue for data collection and research,” concludes Dilip.
“Our technology opens up a constructive discussion between doctor and patient based on real valid data.”
The potential of technology for public healthcare 
During 2016, Med-e-Mass won the contract to implement electronic health records in the City of Johannesburg’s primary healthcare clinics. These 80 facilities service a total of about three million people. 
The system is essentially the same as HEALTHone for the private sector, but includes an identity verification element that simplifies life for patients. A fingerprint on a biometrics device verifies the patient at every interaction point, unlocking his or her clinical information and ensuring that the right people receive the right treatment and medication. 
“The beauty of the system is that a woman who lives in Alexandria but works in Randburg can now go to the clinic closest to her, verify herself biometrically and access the care she needs,” says Dilip. “The clinics are also operating far more efficiently and their patient load is being spread more evenly throughout the day. Slowly but surely we are putting the days behind us where people queue from 04:00 in the morning and then still return home emptyhanded.” 
As is the case in the private sector, change management is a huge component of the implementation process. “Many healthcare practitioners and admin staff are comfortable with pieces of paper in a file,” says Dilip. “It is challenging, but we are making headway.”
Med-e-Mass hopes that other Gauteng metros and the provincial clinics will follow Johannesburg’s example in the near future.