South Africa intends implementing the National Health Insurance (NHI), which aims to unite the presently fragmented healthcare system.
Currently in its design phase, a critical component, as highlighted by president Cyril Ramaphosa during the State of the Nation Address on 6 February, is the design and implementation of a single electronic health record (EHR) for all South Africans.
The benefits of a single EHR can be extraordinary as medical professionals could view their patients’ entire history, enabling them to make more informed decisions about treatment plans. Additionally, key decision-makers will be able to analyse and report on South Africans’ health statuses, permitting other downstream uses of the data, such as predictive analytics of healthcare trends.
Successfully implementing a single EHR nevertheless requires a comprehensive end-to-end design. The five considerations below have been provided as potential enablers of a comprehensive design:
Connecting disparate systems
Records from the public (across different provinces) and private (across several organisations) healthcare systems must be combined to provide a 360-degree view of the patient. This means that all the related systems need to be connected using agreed-upon data exchange standards, also referred to as “interoperability standards”.
The connecting of relevant health information systems will facilitate the movement of data.
The Federated Health Information Architecture proposed by the Department of Health must therefore reflect these linkages even if this is done at a high level.
Combining of data
The connecting of relevant health information systems will facilitate the movement of data. Systems that are disconnected and systems that are still paper-based (sometimes referred to as “data islands”) will be unable to digitally contribute to smooth information flow and may even obstruct patient care in cases of data incompleteness. The designs should therefore highlight mechanisms for the inclusion of such data.
Accessibility of data
The number of searches, hits and downloads of patient records will affect the performance of the overall system. Furthermore, clinics in remote locations may not have the necessary bandwidth capacity to retrieve patient records before a system time-out.
The inability to access an EHR can conversely result in the deterioration of patient-care services. Clinics in remote locations should, therefore, be equipped with adequate infrastructure to promote system connectivity. Additionally, overall system performance, which is sometimes measured in million instructions per second, must meet the anticipated demand.
Cyber security
South Africa has, unfortunately, caught the attention of cyber criminals who have already exploited the public and private healthcare system. A single EHR is easily positioned as a potential target for cyber criminals.
The compromising of the national EHR would have an even greater effect than that of the National Health Laboratory Service (NHLS) hack of 2024. Apart from ensuring acceptable cyber security standards, cyber security awareness among the healthcare system users must also be promoted.
Disaster recovery plan
The compromising of the NHLS systems should now be viewed as a learning experience. The negative effects on the affected patients’ health due to the absence of a disaster recovery plan may never be completely understood.
An adequate disaster recovery plan should therefore be precisely designed and rigorously tested prior to the implementation of the single EHR to prevent further health-related consequences for patients.
The single EHR for all South Africans as announced by the president will contribute to establishing the NHI, which aims to provide a fair distribution of healthcare resources. The record itself will also assist medical professionals in providing quality and timely healthcare.
The five considerations listed above are, however, not an exhaustive list and should be expanded upon to facilitate the designing of the single EHR.
System designers must therefore aim to create a single EHR for all South Africans that is complete, accessible, secure and can withstand a potential disaster. Lessons from South African and international cyber attacks could provide the necessary impetus for a holistic and disaster-proof system and should be used to inform the overall design.
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