CEO at Connected Care and IT Director of the Independent Practitioners Association Foundation, Dr Anton Prinsloo, talks about his work helping South African doctors adopt eHealth and the importance of designing systems in conjunction with clinicians.
Tell us how you got involved in eHealth.
I’ve been a GP in private practice since 1994 and got involved with the IPAs 20 years ago. I took an interest in the organisation because they represent the business interests of doctors, as opposed to SAMA who traditionally looked after socio-political interests.
I always believed that IT could play a much bigger role in making our practices more efficient. Through the IPAs we founded Connected Care to look after the IT interests of doctors and to engage with healthcare software suppliers, doctors and medical schemes about how to make it easier for doctors to adopt eHealth systems. We also provide governance on critical issues like access to information and sharing of information.
Connected Care’s aim is to bring the digitally-enabled doctor to the table by connecting the doctor with the company that wants to engage with them on issues centred around clinical information, electronic health records (EHRs) and eHealth.
Talk to us from the doctor’s perspective about the move towards technology enabled connected care?
The majority of South African doctors in private practice still use paper to capture patient notes in a consultation. Unfortunately, very few initiatives that aim to replace paper – like EHRs – actually make the doctor more productive and it’s one of the reasons that eHealth adoption has been so slow.
Ultimately, if we want buy-in from doctors, we need to demonstrate the value in implementing eHealth solutions and part of that value proposition is enabling them to be more productive than they currently are while also eliminating paper. Using a typical EHR available in the market takes roughly 30% longer to use which is extra time doctors can’t afford.
That’s why we developed MediNotes™, an “electronic paper solution” that lets doctors keep their typical preference for capturing patient notes by hand. MediNotes™ runs off a tablet and stores the hand written patient notes in a digital format together with clinical information and diagnosis, medicines lists, vitals, test results, ICD-10 codes, etc. That information can then be exchanged between third party or legacy IT solutions so there is a digital flow of information that doesn’t require additional time from the doctor.
So you’ve given us the overview of the biggest barrier to eHealth adoption but what are some of the other barriers that are specific to SA?
I think the barriers to adoption are similar worldwide. Age is definitely a barrier in SA; the average age of doctors is about 56 years old and some older doctors never learnt to type because their patient notes were always hand written.
Another barrier is eHealth solutions that weren’t developed taking the doctor’s workflow into account. For example, a lot of doctors don’t even have a computer on their desk so whether it’s a web based or locally stored solution it disrupts the doctor’s workflow when they have to walk to reception to access a patient file.
There’s also the issue of administrative burden. There are 90 medical schemes in South Africa with 20 different administrators, and numerous IT initiatives coming from these funders. The problem is that the doctor is expected to adopt and use all of these solutions depending on what scheme the patient is a member of. If we look at the billing industry, for example, there are 30 different companies that provide billing software for doctors and then there are IT solutions that exchange information between the practice and the medical scheme. The doctors don’t see the integration in the backend; he just sees the frontend that he’s working with. Similarly, the medical schemes are indifferent as to what billing software is being used; just as long as they can get the information in a certain format.
Medical schemes should take the same approach when developing IT tools to collect clinical information from medical doctors. They don’t need to own the frontend and currently, doctors can’t adopt one frontend and speak to different medical schemes. Each medical scheme is building its own solution which means the doctor needs to remember dozens of different usernames and passwords to access information and learn different applications- surely a barrier to adoption.
Ideally, we would like medical aid funders to build their own EHRs but allow for third party integration. We’ve taken the first steps to backend integration with Medscheme, BestMed, Medihelp, CareCross and EOH with our National Sign-On platform which allows doctors to access various disparate bits of clinical information with a single username and password.
What would you say to doctors who resist the use of technology?
If as a doctor, you agree that our health system is broken and needs to be reformed, then you should accept that the transformation is only going to happen through technology and innovation that can help us to change the way we think about and carry out healthcare. It doesn’t matter what interface or solution you use, eHealth is a necessary disruptor of a system that isn’t working.
Our message to doctors from Connected Care and the IPA Foundation is to get a computer or tablet on your desk that can enable you to capture and use clinical information to improve your patient’s health and that integrates into your work flow. There are various EHR solutions available, and you should talk to your colleagues about their experiences. Start engaging with what’s out there not just because you don’t have a choice, but because it’s what is best for your patients. If we can realise better patient management, we can make real strides in changing the healthcare system in this country.
How do you want doctors and other health practitioners to engage with the IPA Foundation and Connected Care?
We want to encourage software suppliers to come and speak to us before they start designing solutions so that we can share first-hand experience with them of the barriers to entry when you go into private practices from a doctors perspective and give them some insights so that when they develop a product, it’s more likely to be something that doctors will want to use. We don’t need to own it or integrate it with MediNotes, but we see our role as a bridge between the gaps that exist between doctors and IT.
We are also there to offer support to doctors and their evolving role in modern healthcare as patient focused practitioners and tech enabled business owners.
What’s your vision for healthcare in SA?
In short, I share the same vision as many South Africans whether you’re a politician, practitioner or a patient- we need an efficient, quality healthcare system. I believe that the mechanisms to this healthcare reform starts with doctors who’ve embraced IT to deliver patient-centred preventative care and reformed their practices to form an integral part of the wider, national patient management strategy whereby systems are interoperable and patient records are accessible across private and public facilities.
We all know about the global shift of patients to consumers. Similarly, we will see a shift from general practitioners to coordinators of care whereby eHealth plays a fundamental role.