Although Electronic Health Records (EHRs) have become an integral part of the country’s private healthcare system, the data contained in these records remain highly fragmented, making it almost impossible to get a clear picture of patients’ full health histories as they move between healthcare providers.

With most funders, hospitals and medical practices using different software- and practice management providers and systems, patients are forced to grudgingly fill in forms and providing the same information repeatedly whenever they see a new healthcare professional or are admitted to a healthcare facility.  Adding to healthcare providers’ administrative burden, the fragmentation often leads to repeat and unnecessary tests, missed information and possible medical errors, driving up costs and complicating efforts to speed up diagnoses.

What is a HIE?

Officially launched earlier this month, South Africa’s first Health Information Exchange or HIE provides the opportunity to address these challenges by pulling together data from the fragmented systems into a holistic patient health record that can be called up wherever or whenever a consenting patient accesses healthcare services.

Driven by non-profit organisation, CareConnect, the HIE enables interoperability between different systems, like medical scheme administrators, clinics, hospitals, rehabilitation centres, radiology practices, pathology laboratories and clinicians’ practice management systems. 

Its establishment is the culmination of a project that started six years ago when the country’s three biggest medical scheme administrators (Medscheme, Discovery Health and Momentum) got together with hospital groups Netcare, Mediclinic and Life Healthcare to discuss the viability and development of such a system as part of efforts to improve healthcare

In 2018, CareConnect was established to build the HIE based on an internationally recognised technology platform, called InterSystems HealthShare, which have been used in the development of HIE systems across the globe.  Funding for its development was provided by the participating funders and hospital groups. Since coming online last year, more than 3.2 million medical scheme members have given consent for their data to be shared on the HIE as part of the pilot phase.

While the HIE is currently only being used by participating funders and private hospitals, engagement has started with clinicians and other healthcare providers to start using it through CareConnect, and getting providers of EHR systems, and practice management and software solutions to doctors to connect their systems to the HIE, says CareConnect CEO, Dr Rolan Christian.

Adoption across the healthcare ecosystem

The eventual aim is to get all clinicians, hospitals, medical scheme administrators and other healthcare providers on board to use CareConnect in a bid to consolidate disparate patient data across the healthcare eco-system. Key for the system to work optimally, is to get adoption by all healthcare providers by getting them to understand the benefits of an integrated system,” Dr Christian explains .

“Currently, we are trying to establish what the issues are that prevent providers from integrating with the HIE,” he added, stressing the many benefits for both patients and healthcare providers.

These include:

  • Facilitating coordinated, quality care by providing healthcare providers with all relevant information available in real time, including tests, results, procedures, and medication to make informed decisions.
  • Saving money by avoiding duplicating testing, admissions, and procedures.
  • Saving time for providers as they don’t need to use different systems and applications for different funders and healthcare facilities.
  • Saving time during an emergency situation by enabling the healthcare service provider to access the patient’s demographic, clinical and scheme information.
  • Increasing efficiency by moving away from paper-based records

Patient consent and security of data

The main precondition for the sharing of the data is patient consent. No data will be shared without patients’ explicit consent, Dr Christian stresses, adding that patients also have the option of withdrawing consent if they decide to do so.

The HIE conforms to both local and international data security, privacy and confidentiality regulations, such as ISO 27001/27701 and POPIA.  

“Information always remains protected and may only be accessed by authorised users.  Sensitive information, such as health information, may only be accessed by medical practitioners when medically necessary and only with a patient’s consent,”  Dr Christian emphasised. 

Bridging the private-public divide

The HIE is currently only being used in the private sector, but Dr Christian believes that it will in time become a critical enabler for the private and public sectors to work together as the country moves towards universal healthcare through the NHI.

According to Dr Christian, CareConnect is engaging with the national Department of Health to find ways on eventual collaboration, starting with possible pilots in the public system, to show the benefits of the two systems working together in developing a hollistic and unfied patient record.

“We need to change this mindset that the sharing of data is anti-competitive and realise that it will actually support competitiveness through streamlining health business processes and improving efficiency and quality of care,” adds Dr Christian.

“HIE is becoming a policy imperative for many governments to address health system fragmentation and better coordination of care and is already being used by many advanced health systems in the world. While the CareConnect HIE is still in its infancy, the number of lives and transactions are constantly growing, with founding member organisations already beginning to derive value from the HIE through streamlined hospital admissions procedures and the introduction of new efficiencies into their systems,” concluded  Dr Christian.