Rx ICT

South Africa`s healthcare services aren`t looking well. In the public healthcare service, reports emerge regularly of patients queuing for hours or being turned away when life-saving treatment is needed. The poor get sick and die for lack of proper healthcare. Even wealthier patients with medical aid find themselves unattended or incorrectly treated. Doctors report that they are overworked and underpaid. Nursing staff say they cannot keep up with the demands made on them. Hospitals report that their budgets aren`t adequate.

ICT PROMISE

ICTs could change a lot of this. Healthcare ICTs can streamline healthcare operations, cut costs and improve patient care significantly. But it appears to have been slow to take off in SA. Players in this sector report that the local healthcare sector is slowly starting to see the benefits of ICTs in their space, and believe ICT adoption in healthcare will be driven by skyrocketing running costs, reports of medical errors, patients demanding better care, and the ever-growing need to move away from paper.

They say hospitals are slowly but surely implementing electronic medical records and various ICTs to enhance patient safety and run more efficiently.

In SA, much attention has been focused on healthcare ICTs like electronic patient records and tele-medicine. However, ICT has a lot more to offer the healthcare sector than just those. According to global research house MarketsAndMarkets, the global healthcare information technology market is expected to top $53.8 billion by 2014. Much of the growth will be due to demand for general applications such as electronic medical records, electronic health records, computerised physician order entry systems and non-clinical systems.

The researcher`s recent report on the healthcare ICT market noted: "Information technology offers solutions for almost all the segments covered under healthcare systems. Clinical trials management systems, clinical decision support systems and data mining systems cater to the need of clinicians. Hospital information systems, e-prescribing systems, ambulatory care management systems and patient management systems find wide applications in hospitals. Applications like EMR, EHR, CPOE and physician practice management systems are used by both clinicians and larger healthcare providers, to offer improved patient care. Imaging applications like PACS and RIS are used to manage images or patient scans. The inclusion of RIS and PACS in healthcare has helped in improving the workflow in hospitals. Increasing number of patients visiting hospitals and physicians has increased the demand of information technology applications in healthcare sector."

In a separate report, MarketsAndMarkets says the global top 10 medical device technologies market (much of which includes the use of ICTs) will be worth $454.3 billion by 2014.

The top ten medical device technologies that may use ICTs include diagnostic imaging, medical diagnostics (such as nanotechnology), non-invasive surgery technology (like medical robots), monitoring technologies (such as blood glucose monitoring), biomaterials (including bionic limbs), bio-implants (including neurostimulation) and tele-medicines.

But while much of the developed world is fast adopting the latest ICTs to make healthcare more efficient, SA`s adoption has been slower.

Richard Creighton, the regional manager: Sub Saharan Africa, Honeywell Building Solutions, says one reason why the health sector lags behind in deploying technology is because there are often conflicting priorities for available capital. "This leads to reduced levels for investment in new infrastructure."

A PERFECT WORLD

Creighton, who spoke at the recent Health Technology Africa Conference, in Johannesburg, says the health sector needs ICT to be an integral and fundamental part of its business strategy.

The future needs digital hospitals, where information, images and clinical know-how are all connected via IT. This connectedness, he says, will lead to greater efficiency and information flow, laying the groundwork for better patient care. "The digital infrastructure within these facilities provides the foundation for electronic health records within the hospital."

A truly digital hospital goes beyond advanced clinical systems and includes additional integration between IT, medical, communication and building technologies to create a real-time hospital information environment, he says.

According to Keith Bonsall, GM of the Hillcrest Private Hospital, in KwaZulu-Natal: "South African hospitals, both private and state, need to be bold enough to have a positive strategy for implementing bedside technology." However, Bonsall points out that the costs involved are usually a serious issue.

"The cost of technology implementation, hardware, software, and support is very high for most hospitals in South Africa." Upfront costs and post-implementation support of technology are also very high, and changing or integrating new systems with legacy systems is costly as well, he notes.

Furthermore, the management of change, especially when it comes to nurses, doctors, and other stakeholders, requires money, says Bonsall.

A hospital should also consider the degree of in-house support versus the outsourcing, cost and resource implications when adopting technologies, he advises.

Bonsall says the shift to accepting IT in hospitals is being driven by nursing resource shortages, which cause concerns over quality of service. Information technology also helps nurses by reducing their non-nursing activities, so they can focus on their primary tasks.

"The need to manage potential patient care risks and incidents more effectively is very important when a health facility is looking at error reduction," he points out. There is a need for consistency and a "least people interventional" approach to clinical monitoring, so risk can be managed, he explains.

Another driver of change, spurring the adoption of electronic patient records in hospitals, is the demand for accurate and timely clinical information by both doctors and nurses. In a hospital, the ideal system is one that is integrated, notes Bonsall. "When all systems are fully integrated they all talk to each other." This helps facilitate immediate and accurate access to patient data - doctor diagnosis, response to changes in patient condition, treatment plan, drug scripting, and Web access.

MADE IN SA

At the recent Health Technology Africa Conference and Exhibition, in Sandton, exhibitors demonstrated a range of technologies designed to make healthcare more efficient and cost-effective. Many of them were designed locally, with South African needs in mind.

For example, there are Web-based doctors` practice management systems that log patient data, manage accounts and even follow up on payments from medical aids, cutting admin costs and leaving the doctors free to focus on what they should be doing - attending to patients.

Synchramed offers such a system, even including VOIP communications and a wireless network in partnership with Vodacom Business, to allow a doctor to run his or her entire practice with just the help of a receptionist.

Paul Nagle, MD of Securlogic, demonstrated his desktop facilities management system, designed to monitor building functions throughout a facility such as a hospital, setting off alarms and generating alerts to the relevant people if any system malfunctions. The system sends e-mails and/or SMSes to the relevant people, escalating the alert if a response does not occur within a predetermined time.

There are digitised radiography systems such as the solution by Lodox, which can complete a full body x-ray in under 13 seconds, delivering accurate, immediate scans in a fraction of the time it usually takes.

Other systems, such as Agfa Healthcare`s IMPAX, can convert analogue x-rays and scans to digital to allow for complex, 3D imaging and modelling. Its systems also integrate with hospital patient records systems, streamlining workflow and records management.

Agfa Healthcare national IT sales manager, Sandile Nkonqa, points out that digitised records such as these are easier to manage and more accurate than the old film x-rays. For one thing, they don`t get lost, because the system is integrated with the hospital`s patient record database.

But currently, only about 30% of the market is using digital radiology. Low uptake, says Nkonqa, is partly due to the higher cost of skills involved, but also because of the demands systems like these make on the network. "Plus, old radiologists often don`t want to use computers," he says. The younger generation sees the benefits of digital radiology, though.

iNathi Syscare offers a range of biometric patient records systems for use in primary healthcare. Operations director Steve Fitzpatrick says the locally-developed systems are in use in several community clinics, and are saving nursing sisters and their patients a great deal of time. Over 72 000 patients already have their records in the system. They simply place their finger on the biometric reader to call up their records, prescriptions and other information, allowing them to be treated and processed in a fraction of the time it used to take with paper-based records.

Another ICT boost for the healthcare sector is online information and communications. Sushanth Pillai of MEDpages, a directory of medical practitioners across SA, notes that pharmaceutical companies see efficiencies and bottom line benefits in using listings such as these, while patients can use the directory to easily find relevant doctors in their area.

Another online directory and hub, Med-Bay, launched last year by brothers Michael and John Burk, will allow doctors to track their required continuing professional development points, saving them a great deal of time and effort. Later, says Michael Burk, they will also be able to interact in forums on the site.

Local players are developing better and more appropriate solutions for the South African healthcare sector all the time. While all of them are designed to improve efficiency, reduce errors and ultimately save money, it remains to be seen whether the healthcare sector will make a significant swing to e-enabled healthcare in the near future.