A lack of IT infrastructure, staff resistance, limited budgets, competing priorities and the absence of mandated reporting requirements are some of the major obstacles to implementing Electronic Medical Records (EMRs), also known as Electronic Health Records (EHRs). Despite the challenges, Managing Director of VP Health Systems, Warren Lambert, believes that healthcare in Africa is ready for EMRs/EHRs and shared his key insights to successful implementation.
Lambert identified the value that eHealth applications could have in Africa after a number of years spent developing oncology applications for the NHS in the UK. He founded VP in 2005 to respond to the growing demand for effective chronic disease treatment management systems. Based in Kwazulu-Natal (KZN), VP worked alongside the KZN Department of Health (DoH) to develop an ARV monitoring programme that was shortlisted in the top 10 systems in a national audit in 2010, finished second behind eKapa.
“The decision to use one ARV monitoring system nationally meant that we had to reinvent ourselves so we took a decision to enhance our product offering to provide a solution for primary healthcare (PHC) and hospitals,” said Lambert. The result was an “evolving” integrated health management system for public hospitals and primary healthcare facilities to better manage patients, across all disease types and particularly HIV and TB patients. Since then, VP has added numerous modules and applications to their core offering, VEMR, to include hospital administration (OPD), Maternal and Child Health, Pharmacy, E&T, Dental, Mental and Pharmacovigilance among others.
Lambert believes that the failure of a system is in the application, rather than the system itself and working closely with customers to identify their specific needs is crucial. “There is no “one-size fits all” eHealth solution for South Africa because of the huge disparity in needs and IT infrastructure. Some facilities don’t know how to use or have 3G but are looking for cloud solutions; successful roll out hangs on whether the application is fully understood and whether constraints have been factored in as part of the design. We look at the healthcare workers at the lowest level and if they can’t access and use the information then the system won’t work,” said Lambert.
Earlier this year the Lesotho government chose VP’s VEMR System as a country-wide solution that is being implemented in all of its 16 hospitals. Throughout the implementation stage VP works closely with hospital staff through ongoing mentorship and training programmes. “As with many EMR/EHR roll outs – the instruction has generally come from top management and decision makers but that can lead to resistance from users on the frontline,” said Lambert who believes that adequate advocacy and training can’t be underestimated.
“The nurses were incredibly receptive and embraced their new computer literacy. The system also streamlined their workflow and improved efficiency because now all the information they need to produce registers is at their fingertips. We make a point of recognising their efforts and award them with certificates on completion of the training. It’s important that users of the system feel competent in using it and that competence is acknowledged,” said Lambert.
VP also has an EMR/EHR footprint in South Africa and was closely involved in the initial MomConnect pilot in KZN in 2011, a programme funded by UNICEF in partnership with the KZN DOH to reduce maternal and infant mortality. A follow onto this was the establishment of a National Pregnancy Register (NPR). “The VEMR generates triggers based on a condition or circumstance that results in a message being sent to the client by the service provider. I believe that EMRs/EHRs will play a much larger role in the national MomConnect programme in the coming years.”
In addition, VP is involved in the rollout of the National Health Insurance (NHI) pilots in the Northern Cape and KZN. This is a partnership between Health Systems Trust (HST), VP and the DoH in these provinces. “Our system is being used in the Northern Cape by Ward-based outreach teams (WBOT’s) to collect family data and in KZN, we’re currently implementing our system in all the hospitals and healthcare facilities that are part of the NHI pilot in three districts,” said Lambert.
VP took the decision to donate the VEMR System to several hospitals in KZN that were struggling with data management and patient volumes. “Our decision to donate the system was to help these hospitals improve patient experience by reducing waiting times as well as meeting quality reporting criteria to access funding but this highlights the desperate need to collect quality data from our public facilities that can be accessed, shared when necessary and “actionable” when searching for trends or insights,” said Lambert when asked about the lack of electronic data collection in state facilities. A key element of improving data collection and reporting is a project currently underway that will result in data populating the DHIS2, electronically, from the VEMR System.
Lambert describes their system as “practical, scalable and easy to use” but believes that the key to success for any vendor providing EMRs/EHRs solutions is not to focus on its “off the shelf” capabilities but to take a consultative approach: “Spending time with the doctors, nurses and administrators who will use the system to get an in depth understanding of what will make the system useful to them is the foundation on which to build a custom solution that responds to their needs,” concluded Lambert.