The NHIS and information technology – Where to from here?

The long awaited Green Paper on the National Health Insurance Scheme (NHIS) released in August had many interested parties scrambling frantically for a copy to read. Most importantly, the aim was to understand the contents to form a constructive opinion and build a possible scenario around the future of health care in SA.

The document provides direction, but is thin on detail. It forces the reader and every responsible contributor in the IT industry to sit back and interpret what it could mean by constantly reading between the lines, digging back in history to study previous press releases, tenders awarded and withdrawn. One obvious question is whether there is possibly something more behind the fact that some of the health care tenders were withdrawn after the deadlines were met? Were they merely government-orchestrated pure fact finding operations to see what the IT sector could do or would be able to deliver?

Let’s consider the real issues facing our specific industry. Firstly, no Government can begin a roll out phase of a high-profile, publicly scrutinised project without ensuring the selected IT infrastructure is 100% appropriate and that staff is sufficiently skilled and trained to correctly enter, interpret, and manage data fed into the different IT systems.

Secondly, no national data centre can operate or deliver a useful Management Information System (MIS) without correct and timely data captured in a well-structured format. This would need to allow proper interpretation at the source as well as on a centralised national level while all being fed from servicing points countrywide.

The IT infrastructure of the private healthcare sector (paid for with private funds) has made significant investments in IT systems over the years and is well positioned to support the NHIS.
Unfortunately, the current public systems are poorly maintained, under-resourced and not bolted onto a data infrastructure that covers SA.

A combined/symbiotic setup will need a national interoperable integrated IT solution. This would link every privately owned computer solution, publicly developed and implemented Hospital Information System (HIS) solution, central procurement systems, and distribution centres, all connected to ‘’talk’’ to each other.

On the ground, protocols have to be embedded within every operating system. Other essentials are well-defined costing and stock management systems together with online ordering. In addition, centralised procurement and managing of consignment stock will have to be running very smoothly to ensure stock does not become stale, overstocked or under supplied. There is nothing worse than a missing file that contains crucial clinical data, or not having stock at hand when a life is at stake.
What will this take from the IT suppliers of the country? Just as in the US, IT interoperability is the biggest obstacle that confronts or limits a national view of the country’s health. SA is not different, nor is it actually in a much better position. It does however, have a well-managed and well-functioning private IT industry, which has cut its teeth in supplying IT systems to the medical fraternity for the past 25 years.

Already approximately 14 000 medical doctors, 2 500 pharmacies and every private hospital in the country operates on IT systems. Some of these have all the features a first-world country requires for IT accreditation such as:

  • Patient recording.
  • Patient validation.
  • Patient adjudication.
  • Patient diagnosing.
  • Recording of clinical data.
  • Electronic pathology results.
  • Proper stock management modules, dispensing and electronic scripting online.

These features are all part of our daily job. Together with a national ‘Cloud’-type switching backbone network used to facilitate exchange of data, these features enable the privately held IT solutions providers to ensure that public IT systems and the 4 000-odd non-computerised primary care clinics can also be accommodated in this ‘spider-web’.

If the IT industry starts now, it can roll out the well proven clinical care solutions to ensure that staff gets to grips with the day to day usage of proper computerisation – patient record systems, stock management, dispensing as well as electronic transfer of data /referrals between providers, hospitals and clinics.

Moreover, by bringing the roughly 2 500 private pharmacies on board we have an IT servicing network in virtually every corner of the country capable of connecting, exchanging and interchanging data, MIS, seasonal trends and topical in-time disease management.

I do not for one moment say this is all plain sailing; fact, the principle of working together to allow for data sharing, exchange and collation of data is daunting. However, Government does not have to reinvent the wheel. The solution in my view is some form of partnership with the private sector.

Monday, October 3, 2011