South Africa has a number of Health Information Systems (HIS) implemented, but how many are there exactly, what are they specifically used for, what’s their level of interoperability and just how efficient are they?

The researchers behind the National Health Normative Standards Framework for Interoperability in eHealth (HNSF) set out to find answers. The HNSF study focuses on systems in public healthcare facilities that are ‘patient-centric’, i.e. systems that record transactions specifically in support of patient administration and care.

The study found 42 systems currently in use across the country, with deployment ranging from one to 1085 sites. The majority of these systems are in the Western Cape (18) followed by KwaZulu-Natal (16) and Gauteng (15). Limpopo has the least, with only seven. The study also indicates that the majority of systems are only implemented in one province; those that are implemented in seven or more provinces are specialised in surveillance and monitoring.

The study observes that of the 42 systems installed, the majority of them are either a software application and/or a database. Browser-based systems were found to be not widely implemented, which may be due to poor access to broadband connectivity. It is also noted that outdated systems – MS-DOS based PDSX and Plankmed – are still in use, which according to the HNSF requires replacement as a matter of urgency. The study also made it apparent that a number of system operators did not know what operating system was applicable in the software applications that were in use.

There were found to be a number of patient-centric administrative processes – such as registration of visits and client statistical surveys – supported by the different systems. However, while support for the various processes is even between the various systems, less than 50% of the systems support typical patient administration processes.

The support for typical patient care processes – such as clinical visit notes and tracking pharmacy orders – indicates that capturing patient medical history is the most prevalent, with a relatively equal distribution for the other processes. However, less than a third of the systems in the survey support patient care processes and fail to support data collection on typical patient care processes.

The most prevalent security measure that the systems have in place is password protection and role-based access; encryption is used for confidentiality. However, the study indicates that less than 50% of the systems have such security controls in place. Access to the systems is predominantly monitored using database audit trails (24 of the 42 systems), while eight systems make use of operating system monitors.

Out of the 42 systems studied, 22 of them share information both in the local facility and externally, while 13 systems are standalone and do not share information locally or externally.

Even though a substantial number of systems (at least 17) share or exchange information with other systems, only six are based on international messaging and coding standards – of which four are based on IHE profiles. This means that for at least 17 of the 26 systems that do exchange information with other systems, they do not make use of standard-based messaging. An additional five of the 13 systems that do not currently exchange information with other systems are enabled to handle HL7 V2.X messages. This means that only 12 of the 42 systems are based on interoperability standards. The majority of the patient admission systems were also found to make use of ICD-10, procedure codes and UPFS as coding standards.

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