The development of SysCare - a case study

The development of SysCare was initiated by iNathi Technology Holdings when grave concerns about the current state of patient management in South African clinics aroused.

Issues that needed to be attended to were:

a) System security: Patient records are generally stored manually in storage cabinets in files. Access to the system should be restricted to ensure the privacy of patient records.

b) Service quality at clinics: There was no standard for monitoring the quality of services delivered at clinics.

c) Time spent on data capturing: All data captured manually had to be captured on a daily basis by health workers and then recaptured by administrative staff for a global view of the clinic activities. Clinics close their doors two hours earlier than necessary for the data capturing to take place. Precious hours of providing healthcare are spent on data capturing.

d) Fraud at pharmacies: Patients tend to "clinic-hop" and obtain drugs from as many as six different clinics daily for the purposes of reselling or to feed addictions. Health workers have no records of patient activity at other clinics and cannot prevent patients from obtaining more drugs than allowed.

e) Duplicate patient information: Patients can easily identify themselves differently with each clinic visit. There may exist an x-amount of identities for a single patient. This contributes greatly to the fraud mentioned above. It is also a concern to health workers that one of the patient`s identities does not contain all the patient`s previous medical records.

f) Incomplete patient information: There is a lack of a single patient record view from which all the patient`s medical records can be obtained.

g) Inaccurate patient information: Responsible medical decisions cannot be based on incomplete or duplicate patient information. This could lead to inaccuracy in diagnosis and further patient records.

iNathi Technology Holdings proceeded to develop a patient record system to not only ensure complete patient information, but also to ensure that patient information captured by the system could be effectively distributed to all clinics in the country. This would ensure that patient records are not duplicated in multiple clinics as well as to provide complete information on patient records at all clinics.

Initially we were more focused on what the industry required of a clinic management system on a higher level. But it soon ended in near-disaster when we realised that it was not in this area that the great need for a solution was required. The solution needed to be end-user oriented to cater specifically for health workers and patients. It was here that we changed our approach completely.

The approach taken in the development of SysCare was to develop a system from an end-user`s perspective. JAD (joint application development) sessions were held with health workers being involved from the project initiation through to the implementation thereof. Health workers were given the opportunity to indicate exactly how the system should function and even had an input in the layout of the application.

Visits to health clinics on a regular basis ensured that SysCare caters exclusively for the everyday activities and situations in health clinics. Close interaction with health workers ensured that iNathi Technology Holdings could make informed decisions and provide effective reporting systems according to what is generally required for statistics purposes.

To ensure that the system will capture the correct information and that the system will also serve as a guideline for providing proper healthcare, primary healthcare textbook methods for diagnosis and patient management was used.

SysCare, after being developed, was rolled out at an Ekurhuleni clinic for a trial period of three months, during which SysCare was undergoing an intensive end-user test. Within a short period of only four weeks, over 10 000 patient records were captured. This proved the acceptance by end-users as well as system usage and the adaptation from a paper-based system to the electronic SysCare system.

After three months, the product proved to be successful and the request to roll-out at other Ekurhuleni clinics followed soon after. SysCare was then further developed to include biometrics in the form of fingerprint identification as well as a new HIV module. iNathi Technology Holdings is in the process of rolling out SysCare in the KwaZulu-Natal region.