Public sector

Healing ailing infrastructure

ICT has a potentially game-changing role to play in health, but has been hobbled by delays in setting policies and standards. The wait has been long, but there could be some glimpses of light at the end of the tunnel.  

16 May 2013

Health is the one non-negotiable a person needs to live a happy and fulfilled life: just ask anybody who lacks it. We’re fortunate to live at a time when medical advances are able to cure many ailments and prolong life. However, the challenge for a developing country like South Africa is to make these advances available to its large population – of which many rely on an overstretched state-funded healthcare service. It’s no mistake that the National Development Plan identifies access to healthcare as a vital component of a decent standard of living. ICT has long been recognised as a way for governments to bridge the gap between the public and private healthcare systems, both by maximising access to top-flight medical skills and equipment (see the sidebar on telemedicine), and by enforcing integrated, digitised business processes across a fragmented landscape of hospitals and clinics. Technology has the ability to eliminate the terrible queues that force ill people to journey to medical facilities before dawn, to ensure that the right medicines are stocked in the pharmacy, and to make a top oncologist available via video-conferencing to a patient in Kuruman, Northern Cape.Technology for life and death, one could say.  Good intentionsCitizens are fed up. Many have seen loved ones die unnecessarily, or suffer the indignities and inefficiencies of a low-tech system barely able to cope. No wonder there’s so much pressure on the Department of Health’s CIOs. For years, they’ve suffered the frustration of having budgets available to make the public system more efficient and effective, but been unable to spend it while the CSIR develops norms and standards and the Minister approves a formal regulatory framework. Mojalefa Lekoto, the Gauteng Department of Health’s CIO, is ready for action. “I like problems because I want to solve them. There are numerous things that need to be fixed, especially at hospital level. It’s about service delivery and improvements. Take e-scripting, for example, and the huge difference it would make to pharmacy queues if we integrate what happens in the consulting rooms with the pharmacy, so prescribed medicines are available post-consultation by the time the patient reaches the pharmacy.“I came here to find an ailing IT infrastructure,” he says. Disparate systemsLekoto has his prescription ready: “First make the infrastructure current and then come up with systems that will run on it. Then add people. There’s no point in having an effective system if the people using it are computer-illiterate. We know there are [computer] literacy problems and it’s about change management, and not just of our doctors and nurses.” He believes disparate systems in different provinces and a lack of integration compound the problem. Patients move around and no medical records follow them. He questions whether it was the right decision to stop everything until standards have been established.He believes, however, that the CSIR is 70 percent ready and mentions a timeline of mid to late 2013, at which point budgets will be allocated and CIOs can get cracking on upgrading. He agrees that the tender process will add further delay, but says that if government gives provincial CIOs leave to go ahead and start putting their infrastructures in place, things could be speeded up enormously.“Ultimately, we have to centralise, but in the meantime, we can start integrating the same products and solutions,” Lekoto says. “Centralising will also go a long way towards preventing corruption, such as patients going from hospital to hospital and getting medicine anywhere. With 400 clinics in Gauteng Province, almost the same in Limpopo, and the Western Cape even bigger, imagine how much money we can save picking up a person abusing the system!” Patient managementLekoto is optimistic. “I’m hoping for a substantial budget, with government understanding the strategic importance of IT and how it can save money. Once infrastructure is in place, telemedicine, centralised patient record management and so much more will be possible,” he says.“We’re already upgrading and integrating better technology ready for a decision on the platform. There’s also nothing preventing us from developing our own system, and I believe it would be better that we hold the intellectual property. We have the skills, with fresh skills coming through the ranks all the time through training programmes being run by the private sector.” At present, focus is on ICT projects that are already up and running at some of the larger hospitals, while technologies previously in the private domain are already making a difference to patient care. These will be rolled out to smaller and rural clinics.There are signs of light on the horizon for ICT in public healthcare, but it remains to be seen if dawn will truly break.  All dressed up but nowhere to go: Telemedicine waits in the wingsTelemedicine in the public sector to give access to medical expertise, like everything else at the moment, is limited by what infrastructure is in place and the confirmation of the regulatory framework. However, if it can be implemented, there’s limitless potential on how it can shape South Africa’s healthcare.Already full steam ahead with a plethora of mobility solutions, Vodacom Business’ mHealth Services executive head Maruis Conradie believes telemedicine technologies have proved that putting mobility tools in the hands of a medical workforce replaces tedious administration with proper data flows within totally secure datacentres. However, he cautions that without the doctors, nurses and specialists to man it, even the best IT system will fail.“There are four pillars that will make this possible,” he says, “starting with connectivity infrastructure like virtual private networks, hosting and cloud services. We already have the basics and in some cases we need nothing fancier than just broadband.”Pillar two, Conradie continues, comprises protocols and requires the centralisation of ICT into a formal framework, including specifications for proper hospital management information systems. “There’s a lot happening, not just in South Africa but also worldwide, both public and private,” Conradie says. “It’s a complex challenge to get right. We need to look at different systems talking to each other, rather than enforcing one health information system.”The third pillar involves sending data from a remote clinic, either through video-conferencing or carrying out a consultation over the phone. Broadband is vital here. “Fourth is mobile health, using a device in either the hospital or clinic to capture and manage information. In order to offer this, we invested in a company called Mezzanine, which provides its platform to all operators. Through them, we’ve been able to carry out many tactical projects in South Africa and Tanzania.“There are lots of dependencies and it’s dangerous to put a time frame at present, but we’re definitely moving in this direction,” Conradie enthuses.   

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