Health

1. (a) The eCCR is a web-based application that can be access over the internet or Western Cape Government network by all registered users at all our facilities. The application is utilised at all 53 hospitals in the Western Cape to prepare discharge summaries. It is also utilised by the 183 WCG Primary Health Care facilities to access hospital discharge letters when patients misplace their eCCR printouts.

(b) Facility managers and clinicians report improved services for patients and an improved user experience with eCCR. The application assists health care workers by:

• Building a discharge letter in a standardised format for hospital in- patients. It Integrates several forms and processes, thereby reducing repetitive recording of patient information and improves communication of the care pathway to subsequent members of the multidisciplinary care team across the service delivery platform. Supporting clinical concept coding (e.g. ICD-10, ICD-9) to enable revenue retrieval and the procurement of services from the National Health Authority
• Incorporating the hospital discharge prescription – thereby improving legibility and standardisation of prescriptions for pharmacists to dispense more efficiently.
• Providing clinical decision support by providing clinicians with specific prompts for certain conditions (e.g. TB, Maternal Health, Child Health, Prevention of Mother to Child Transmission of HIV)
• Converting the application’s form category selections into clinical narrative in order to:
  • Reduce the amount of typing required by the clinician
  • Place specialised technical information into context and standardised format for health care workers who need to follow up on the patients’ care, thereby reducing the amount of time taken to decipher abbreviations and specialised medical jargon.
• Integration with the hospital Patient Administration System and automating the inclusion of administrative information on the discharge summary so that staff don’t have to re-write these (e.g., hospital and ward details, ward contact information, patient information, discharging clinician information). This also assists the continuity of care process when health care workers in primary health care have a query about further management of the patient.
• Assisting clinicians by indicating the nearest facilities to where the patient lives, through geocoding functionality
• Inclusion of functionality for sick certificates, additional letters to 3^rd parties (e.g. explaining a child’s health condition and care needs to school teachers where the technical language of a discharge summary is inappropriate)
• Improving patient health outcomes by strengthening continuity of care, thereby reducing the burden of disease on our facilities.

© Clients benefit from:

• Receiving an integrated hospital discharge summary that can be taken to or accessed from Primary Health Care to ensure the right treatment at the right place at the right time.
• Clarity on where they should present for follow-up, particularly when multiple clinics need to be accessed)
• Legible prescriptions -> reduced medicine error -> improved client safety
• Sick certificate(s) and letters for work/school as part of the discharge bundle
• Integrated timeous discharge planning has been proven, by Level 1 evidence, to reduce readmissions and the length of stay in hospital, thereby enabling citizens to return to their livelihoods sooner. ^{1, 2}
• Improved continuity of care and improved health outcomes

2. The eCCR integrates the recording of the patient diagnosis with an ICD-10 coding browser. This component of the eCCR has been formally supported by local research.^{3, 4} The quality of coding in the WCG hospitals improved significantly since 2010 when De Vries et al. found that only 6% of patient folders had the correct ICD codes.⁵ Internal metrics show a significant increase in coding coverage 69%- 76% across the province, and steady increase in the quality of disease-specific coding. Additional quality improvement interventions are planned to improve the user experience of ICD coding with a view to improving the coding completeness and accuracy. This will include the use of clinical data dictionary services to provide clinicians with user-friendly up-to-date terminology that they are accustomed to using in their settings.
3. The eCCR was developed to be a user-friendly and intuitive application for clinicians. There were initial training and orientation sessions at all hospitals and larger primary health care settings. However, the traditional practice of “hand-over” and local orientation practices of new staff have reduced the need for external trainers to re-visit the sites. This has saved on training costs to the department and freed up our staff to support other emerging eHealth initiatives. New users may also access a training video on the website, however, most have found the application easy to navigate as it aligns to the core steps of universal clinical practice.

       At the time of preparing this response, the eCCR was being upgraded to include:

• Functionality to capture clinical notes for outpatient visits
• Capture daily progress notes for in-patient visits
• A fresher modern look to the printouts
• Functionality to draw reports of clinical data

Future enhancements will include:

• Easier problem-list and procedure list management using a healthcare data dictionary (clinicians won’t have to navigate ICD codes anymore, as the system will link their problem lists to the right codes)
• Mobile device responsive interface

Retrieve and integrate lab results