Collecting, storing and accessing up-to-date patient healthcare data is without a doubt a recurring issue that plagues healthcare systems around the world.
The Healthcare Information and Management Systems Society defines interoperability as “...the extent to which systems and devices can exchange data and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data in a way that can be understood by a user.”
Interoperability in healthcare is what an executive summary of a report is for a reader. It reviews the entire information of the report and presents it accurately and concisely. Similarly, interoperability can be seen to be the process of collating patient information from multiple sources and presenting it to the healthcare practitioner in a summarised form. This makes it easier for a healthcare practitioner to access a patient’s medical history and use it accordingly. “An interoperable healthcare system is truly the holy grail of healthcare,” says Nicolette Mudaly, Product Manager at Altron HealthTech.
According to Mudaly, on a local level, when looking at a system within a particular healthcare practice or between a few organisations, such as a medical scheme and a practice, some form of interoperability does exist. For example, doctors within a practice can share information with each other as they use the same practice management application, or your GP can e-mail a referral letter to a laboratory or to a specialist.
However, this information sharing is less organised and therefore less shareable across a wider audience. “For instance, the transmission of test results and the sharing of x-rays may be achieved in a variety of different formats without a defined standard. So, assuming one doctor has the necessary system to “open” a patient’s x-rays, the format used is acceptable, but where a doctor does not have the right system, this could result in them not using the findings of the x-ray in the patient’s treatment plan or at times even sending the patient to redo the x-ray so they can obtain the results in a readable format. This shows the need for co-ordination and continuity of care and defining a common standard in which data is shared and stored, across the industry (ie, interoperability) is a way to get there,” states Mudaly.
Mudaly goes on to say that if interoperability can successfully be implemented, it will solve a substantial amount of the problems that currently exist within the healthcare space.
Just imagine – a connected healthcare systemthat ensures a patient will never have to fill in another form at a doctor’s office. Their complete medical history is included in a central database that can be accessed by their healthcare providers when required. This will not only save time and potential costs, for example, through the duplication of tests, but will also allow healthcare providers to base their treatment plans on the most up-to-date information and based on a patient’s complete medical history. This is in addition to other potential benefits of an interoperable system such as a better patient experience and a more efficient healthcare practice.
In theory, this sounds amazing, so why are systems not already operating in this way? According to Mudaly, one of the biggest problems facing the healthcare system in South Africa is structural. The fact is that the system currently operates in silos, with little collaboration across the different healthcare players that a patient interacts with, such as medical practitioners, diagnostic laboratories, and even medical schemes. Even though some medical records (demographic, clinical, billing and claims data) are digitally available, the sharing and collaborative use of this data is limited as there is little interoperability across the industry as a whole. Many studies have shown that the lack of interoperability contributes to higher healthcare costs, duplicated tests and procedures, and at times even poorer health outcomes, as practitioners do not have a patient’s holistic health record readily available, thus limiting their ability to properly diagnose and treat.
The current COVID-19 pandemic has created a great opportunity for the healthcare industry worldwide to promote interoperable systems. Currently in South Africa, as in other countries impacted by COVID-19, there is a wealth of patient information being collected and stored. Interoperable systems and a central repository of data such as a health information exchange could have greatly benefited the management of the COVID-19 pandemic and future outbreaks. For example, the industry may have identified COVID-19 risk factors more readily and treating doctors would have had more comprehensive data on which to base treatment decisions. The management of population health is a key priority of most healthcare systems and, according to Mudaly, interoperability could support this goal by allowing for the identification of disease clusters that could lead to better resource allocation within the healthcare system.
Even in areas of telemedicine, interoperability could have allowed healthcare practitioners a wider and potentially safer reach to patients. Currently, the HPCSA has changed the Ethical Guidelines to allow for practitioners to treat only existing patients through telemedicine channels. This is an understandable caveat in ensuring a health practitioner has existing knowledge of their patient, in order to properly treat a patient through telemedicine channels and without a physical examination. However, interoperable systems that give practitioners access to a patient’s complete medical history may have allowed for more patients to utilise telemedicine, as a doctor could have easily accessed a new patient’s previous medical history, thus giving them insight into a patient’s condition.
The world is seeing the rise of a more empowered and informed healthcare consumer that demands a lot more from their healthcare practitioner and their healthcare system in general. Accessing information, their medical records, and the ability to centrally store and share their own data obtained through personal health devices are now becoming the expected norms of patients and those who are not keeping pace, will fall behind. This interconnectedness is forcing healthcare systems to transform in a way that allows for the easy sharing, storing and accessing of data, which in turn allows for better and more transparent communication between everyone within the system. Interoperability is the glue that can make this reality.
There are many people wary of interoperability. For them, it has the potential to disregard the privacy of sensitive healthcare data, by making this data more widely available and accessible. However, to this Mudaly remarks that the privacy of healthcare data is a paramount factor regardless of the interoperability conversation. “It is important to note that privacy concerns can be solved through encrypted and protected databases and systems. Privacy will always be a consideration, but it should not be a constraint in creating a connected ecosystem that can lead to positive benefits generally, but especially in times of crisis.”
In setting the agenda for the transformation of the South African healthcare system, the recently updated Digital Health Strategy for South Africa Paper, acknowledges that the vision for a transformed healthcare system must be enabled by digital health, with specific mention of the key role that interoperability will play in this transformation. South Africa is in the fortunate position that we are at the beginning of our journey in developing our national health insurance system and reforming the healthcare sector to be more inclusive and collaborative. Transforming our healthcare system requires well thought through approaches that force the various stakeholders to rethink the problem curiously and boldly. It is clear that providing for interoperability can help us achieve the objective of making healthcare more accessible, affordable and effective.
There is still a very long way to go before we will see an effective interoperable healthcare system in South Africa, but with the support of government and all role players in the healthcare system, this has the potential to revolutionise the way we experience, interact and see healthcare in South Africa.
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