Integrating and safely sharing patient data: If you snooze, you lose

Photo: Dr Rolan Christian, CEO of CareConnect 

Collecting and sharing patient data across multiple healthcare practitioners and institutions have many benefits for patients, healthcare practitioners and healthcare systems. It can improve the coordination of care, speed up diagnosis and treatment, increase efficiency, reduce medical errors, and decrease healthcare-related and non-healthcare costs significantly. However, issues such as privacy and security concerns, a lack of interoperability between data collection systems and healthcare providers’ reluctance to share data or get involved in the digitisation of patient information have been major obstacles to integrated patient information systems.

But as more and more countries move towards the implementation of universal healthcare (UHC) systems, the sharing of patient information in a secure way has become paramount to providing coordinated, effective, quality care, improving outcomes, deploying scarce healthcare resources to where they are needed the most and curbing escalating healthcare costs.

Since the early 2000s various local companies, funders and even government have introduced some form of electronic data collection systems such as electronic health record (EHRs) to make the availability and sharing of patient information easier. However, the lack of interoperability between these systems not only added to healthcare practitioners’ administrative burden but also failed to achieve the main goals of improving care and outcomes with the Health Market Inquiry’s report raising serious concerns about the fragmentation of care and the lack of integration and transparency in the private sector.

According to Dr Rolan Christian, CEO of CareConnect, South Africa’s first private sector Health Information Exchange (HIE) system, the country is at a crossroads when it comes to sharing patient data as it moves towards a universal healthcare system. Sharing the platform with Dr Ntuthuko Bengu, a panellist of the HMI and founder and CEO of Alchemy Health Technologies at a recent IHRM webinar on the role of Health Information in care coordination, Dr Christian explained how health systems in countries such as the US, UK and China have already benefited from the use of HIEs.

“It has enabled the sharing of information between public and private sectors by providing a single online entry point for healthcare providers and funders to access relevant patient information, reduced the duplication of tests and procedures, improved the speed, quality and coordination of care, and cut costs.”

In the US, providers and funders are now recognising HIE as a fundamental healthcare utility, a building block of effective care and a key tool in making informed decisions about patient care.

Dr Christian emphasised that an HIE system is not an IT or technology project but a clinically driven business with a focus on collecting data and using it in innovative ways to support clinicians and patients, improve patient satisfaction and encourage its adoption by all role players in the delivery of health care.

Established in 2016 as a not-for-profit organisation, and formally launched last year, CareConnect’s HIE facilitates the confidential, electronic exchange of clinical and other information among authorised organisations. These currently include hospital groups Mediclinic, Life Healthcare and Netcare and medical scheme administrators, Discovery Health, Momentum Health and Medscheme. In April this year, it has grown to 4,2 million people having given their consent to have their information uploaded on the system and be shared and used in hospital or medical scheme settings. 

One of the interesting findings up until now was that more than 600 000 of these people are currently visiting multiple providers and facilities. Without an interoperative system, the data of these people wouldn’t travel with them as they access different providers and facilities, possibly leading to the duplication and even triplication of care, prolonging time to diagnosis and treatment and adding to costs.

“It is a travesty if information is available about a patient’s condition, what medication they are using and what tests and scans they have had and it is not used when a person shows up later at another facility with the same condition,” Dr Christian remarked.

“What we have seen across the industry is that once implemented, HIE does reduce complexity, and even though not reducing fragmentation completely, it helps to optimise and improve health processes. The more we increase data sharing and usage, the more value it has because you can only improve what you can measure,” he observed.

Getting everyone onboard 

In his presentation, Dr Bhengu warned that clinicians and other healthcare professionals who are still operating “outside the digital environment” could find themselves out of business soon.

But the move towards getting everyone on board is not an easy one and requires collaboration from all role players in both the private and public sectors, he stressed.

“The industry has to think and look at itself and say, what are the issues hampering safe integration of information,” Dr Bhengu noted, adding that while EHRs were the first steps in collecting and sharing data, they have become more of a burden than an aid to patients and practitioners.

“There are too many companies running EHRs that don’t talk to each other. At which point is this supposed to help us and where are the efficiencies we are striving for if clinicians have to open a new EHR every time they see another patient?”

He referred to research conducted in the US that showed how EHRs have added to practitioner burnout.

“It found that one of the reasons for burnout relates to the fact that when consulting, practitioners have to focus on the information on the computer and enter the patient’s new information while having to listen to the patient at the same time to avoid having to go back after-hours to add the new data.

“What we need is a user-friendly set of tools that will encourage practitioners to get actively involved,” Dr Bhengu advised, adding that this needs to happen sooner than later.

“South Africa has a high number of older practitioners who will be retiring shortly and feel that it is too late to participate. Industry needs to find ways of meeting them halfway in getting onboard. If not, their clinical data that are now sitting in paper-based will be lost to the entire system,” Dr Bhengu concluded.