Start your answers with T1, T2, T3, T4 or CT for transcript purposes after the moderator prompts.
Both panel experts and attendees are encouraged to participate.
Transcript recorded by Symplur.
T1: Why do you think EHR is important?
T2: What do you think are barriers to implementing EHR in South Africa?
T3: What type of information do you think EHR should provide both HCP’s or patients?
T4: How do you think we can accelerate the implementation of EHR systems?
CT: Closing Thoughts – Is there anything you feel is important to add to this conversation?
Featured video: Ethical debate about patients who have access to their own data and tools for self-diagnosis via the World Economic Forum
What is an Electronic Health Record (EHR)?
The Electronic Health Record (EHR) is a key component of medical informatics. The Health Information Management Systems Society (HIMSS) defines an EHR as a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. In laymen terms, it is a software platform where we capture all of our health data electronically. Included in this record should be patient demographics, progress notes, problems, medications, vital signs, past medical history, immunisations, laboratory data and radiology reports. The EHR has the ability to generate a complete record of a clinical patient encounter – as well as supporting other care-related activities directly or indirectly – including evidence-based decision support, quality management, and outcomes reporting. HIMSS further explain the challenges of implementing a global electronic health record as being varied and that it will require standardisation among other criteria like interoperability.
Who owns your medical records?
Since the emergence of electronic health systems globally, one of the predominant questions patients have been asking is how they could record their medical data electronically if they aren’t given access to their information during and after healthcare treatment. The Promotion of Access to Information Act No 2. of 2000 (PAIA) main purpose is “To give effect to the constitutional right of access to any information held by the State and any information that is held by another person and that is required for the exercise or protection of any rights; and to provide for matters connected therewith”. These rights include access to medical records, however with consideration to certain risk criteria of an individual patient as highlighted in part 30 (1) of the Act.
Medical-legal attorney Tzvi Brivik from Malcolm Lyons and Brivik in Cape Town recently wrote an article reflecting on the PAIA in South Africa in relation to the potential of electronic health data where he states “PAIA makes it clear that a decision has to be made first before access to records can be granted yet a movement has been introduced where patients will have the right to view their medical records online which could be detrimental to their physical and mental well-being”. Many patients don’t know that their health data is currently destroyed after five years in both the public and private sector and it should be a cause of concern for individuals who wish to trace the origins of a disease, for example, a head injury which later results in a neurological condition. Tracking our data is also important to population health and the epidemiology of an emerging disease.
Electronic Health Records and Patient Empowerment
One of the biggest challenges I faced during my patient journey was a magnitude of paperwork. Most of it was accumulated from a medical-legal trial because I had a Road Accident Fund claim which resulted in fifty-three medical reports (600 pages). That didn’t include documentation from the hospitals and my surgeons, neither did it include tests and financial administration. Ironically, with all of that documented health data, doctors and providers weren’t reading it anyway, so it seemed pointless to have spent ten years collecting it. I didn’t blame them because walking into their offices with a telephone directory asking them to read it before surgery was a tall order.
I often wished they had better tools to gain a more holistic view of my medical history so that I felt more confident about the decisions we were making. Inevitably, after six years of surgical complications, I acquired antibiotic resistance (MRSA). Driven by the fear of more infection I compiled my medical-legal reports into a four-page summary and distributed it to multiple surgeons overseas asking them for direction. I managed to find them because they had websites, whereas many local physicians didn’t. Fortunately, a face transplant surgeon agreed to a Skype consultation where he explained the damage in detail. Empowered with the information I was able to choose the right treatment options locally more easily and within eight months and two surgeries, my facial reconstruction was finally successful.
One of the keys to my success was having access to my medical data because it enabled me to understand the complexities of the damage and how each tissue-specific expert played a role. My medical file also crossed not only between my surgeons but also between my payers. For example, the Road Accident Fund needed access to my medical information to confirm costs were accident related before they paid a claim. Another sector which requires access to medical records is education. My son who has an Autism Spectrum Disorder (ASD) also has to provide his medical history before a special needs school and the education department will consider a placement.
The HPCSA National Patient’s Rights Charter states that it is the patient’s responsibility to provide health care providers with relevant and accurate information for diagnostic, treatment, rehabilitation or counselling purposes. It further states that it is our responsibility to take care of the health records in his or her possession. Surely the government should redesign a system which enables patients to access those records more easily so that we can honour those responsibilities? Healthcare has always taken on a paternal role, but not all patients are created equal as the e-Patient whitepaper by Dr. Tom Ferguson explains. Some patients might not be able to understand or use their medical data immediately, but many patients can and it is imperative to recognise that it will be the foundation to how patients are equipped to manage their own health better to relieve HCP’s responsibilities and the system as a whole in future.
What are the current barriers to implementing EHR in South Africa?
There are many issues affecting the implementation of Electronic Health Records in South Africa and they vary dramatically between the public and private sector. Some of these barriers include access to Information and Communication Technologies (ICT’s), the digital divides, literacy, language, culture and cost of implementation or maintenance. MEDITECH South Africa recently wrote an article highlighting these diverse obstacles in public health from a ground-level, where they explain the idea of the “one patient, one record” approach which is being implemented in Botswana.
During this Twitter chat, we hope to explore diverse perspectives about EHR in South Africa. The discussion will be recorded by Symplur Analytics and made open to the public for R&D purposes. The chat is open to all stakeholders and both our panel experts and attendees are encouraged to participate. Join in by using the #hcsmSA hashtag. Community Etiquette is available to read here.
Dr. Sushanth is a result-oriented international sales & marketing professional with a proven track record of accomplishments. His key differentiators are his entrepreneurial thinking and ability to perform strategically under pressure. His areas of expertise have been in planning and leading “comprehensive growth” and “new market entry strategies” through direct and channel sales. He has successfully driven business growth in targeted markets through implementation of key projects by leveraging on his strong leadership skills and ability to build/guide top-performing sales / pre-sales / market intelligence/ channel partner teams. He is adept at communicating with senior management, channel partners, vendors, employees and internal departments to coordinate overall growth efforts. He has hands on experience in “new business development” and “new business incubation”.
Dr Jacob M. Poo is a medical doctor with BSc and MBChB both obtained at MEDUNSA (now Sefako Makgatho Health Science University). He has for over 20 years been active in the public sector and private sector. His public sector involvement ranges from being a correctional service medical officer to a medical manager in a mid-size district hospital and to his current role as a sessional Emergency Department doctor. In the private sector he has worked as a general practitioner and a management consultant focusing on public and private healthcare as well as the pharmaceutical industry. In his current role as a Corporate Account Executive and Healthcare Advisor for MEDITECH SA he focuses on assisting public sector clients to maximise the benefit from their HCIS investments through learning and implementing international best practice.
From his early days, Dr Poo has always regarded himself as an activist. His current passion is helping clients to select and deploy information technologies to assist them in achieving strategic alignment between the “big lofty goals” and the everyday clinical decision-making and patient experience. Patience, tenacity, focus and discipline define his approach to life and serves as a guide to his every interaction with clients.