NHI needs massive overhaul of digital medical records in South Africa

The National Health Insurance (NHI) plan requires a significant overhaul of South African medical records to fit within a common, shared Digital Health Platform in the country.

D-Day has come for South Africa regarding the controversial bill, with President Cyril Ramaphosa set to sign it into law on Wednesday, 15 May 2024.

However, before the NHI can be effective, government has said that developing a national Digital Health Platform and expanding digital inclusion is essential.

According to the Department of Health’s National Digital Health Strategy for 2019 to 2024, South Africa’s digital health platform will include establishing cloud infrastructure and “an environment for supporting sophisticated data science activities”.

“This platform will include the creation of reusable frameworks and artefacts that promote success,” it says.

The health department says the Digital Health Platform will help coordinate and provide technical resources to support a range of activities, with the aim of achieving:

  • Overall quality and continuity of care;
  • Adherence to clinical guidelines and best practices;
  • Efficiency and affordability of services and health commodities by reducing duplication of effort and ensuring the effective use of time and resources;
  • Health-financing models and processes;
  • Regulation, oversight, and patient safety from increased availability of performance data and reductions in errors; and,
  • Health policy-making and resource allocation based on higher-quality data.

The department also highlighted several of its priorities relating to the NHI bill.

This includes establishing a complete electronic health record to help with patient management and digitising health systems and business processes.

“That will include digitisation of various health systems to improve efficiency and quality at an institutional level for human resource, and medicine access,” it said.

Conceptual overview of South Africa’s Digital Health Platform, adapted from the ITU’s Digital Health Platform Handbook.

South Africa must also establish an integrated platform and architecture for the health sector information system to ensure the interoperability and linkage of existing patient information systems.

Introducing a Digital Health Platform is complex and costly, so risk management is critical to its successful implementation.

The department highlighted several risks that could apply to the project, including cybersecurity threats, resistance to change, and insufficient funding to procure digital health solutions.

Regarding cyber threats, the department plans to establish a cybersecurity policy.

“It will include developing the required leadership and decision structures to build effective threat assessment and mitigation strategies,” it said.

To address resistance to change, the department wants to get buy-in from critical stakeholders, and it will work with the National Treasury to tackle challenges with funding.

However, the department notes that connectivity is a prerequisite for digital health and other social development initiatives.

“Connectivity will therefore be addressed as a national imperative, with a definitive, sustainable solution, at scale, across the entire government,” it says.

“Adequate bandwidth provides opportunities for sharing connectivity with employees and clients, via free Wi-Fi and other methods, which will be transformative and support citizens to embrace the opportunities of the fourth industrial revolution.”

To this end, South Africa must establish a health network to provide digital health broadband connectivity in conjunction with specific government departments.

It must also establish a cloud service for health and conduct a Health Information System baseline assessment across the sector to determine the availability of infrastructure, its location, functionality, and connectivity.

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NHI needs massive overhaul of digital medical records in South Africa