Health

1. It is important to note that the fight against Covid- 19 Pandemic has disrupted and delayed many departmental service activities and projects related to digitising delivery and management functions.

The digitisation of patient records is a complex and medium to long term programme. The complexity on the journey to reach a stage where all patient records are digitised must be understood through understanding change management required for people, technology and processes and the challenge of introducing digitisation within a highly pressured environment with many competing challenges and the context of delivering patient care 24/7, 365 days a year and within the available resource envelope. 

Digitisation of patient records, is also not one process and system that needs to be implemented, as there are a range of patient care related applications and systems that have been developed and being developed over the years:

[a]  For patient administration, the Department uses the Clinicom system for hospitals that has been rolled out to all 51 hospitals and the PHCIS that has been rolled out across the Primary Healthcare Care platform.

For clinical investigations, the TrakCare laboratory system, owned by the NHLS, is available across the service platform for laboratory results while the PACS / RIS is a digital imaging system that has been implemented across 13 hospitals and 43 PHC facilities. A new five-year plan is being developed to confirm its further roll out.

Within Hospitals, we have developed an electronic health record [ECCR) which has been rolled out across hospitals since February 2016. 47 % of discharges are currently being done on eCCR. There is ongoing engagement with clinicians to improve uptake.

The Department has built an Emergency Information System [HECTIS] that digitises the patient information with our Emergency Centres. The system has been rolled out to 36 emergency centres to date and plans to complete its roll out across the platform by end of 2023/24.

The Clinical Appointment and Referral System [CAReS] is being developed and planned to be rolled out to health facilities by end of 2022/23 financial year. This system will enable the digital referral and booking of patient appointments. 

The Department also experimented with the scanning of patient records, as an interim measure towards an electronic health record in five sites using the ECM (Electronic Content management) system. [George, Khayelitsha, Mitchells Plain, TBH and Forensic Pathology Service]. The system was found to be costly and labour intensive and its further roll out halted. However, this will be reviewed for particular instances.

The Department has created a health data centre which draws on Patient related data from various systems tied to a unique patient number and creates a consolidated single patient view. This is work in progress. To date, 3500 clinicians [doctors and nurses] have been given access and 1135 are using the system. Training to improve uptake is ongoing. The Department is undertaking a series of workshops to distil user needs for electronic prescribing and thereafter options to develop or procure a system will be explored.

[b]  The Department has started a process to explore digitisation within corporate sector and engagements with each of the specific chief directorates has occurred and their needs are being enlisted. A process of prioritisation will follow and securing resourcing to address them. The Department is currently taking stock and resetting its roadmap for the next 3-5 years to align with the overall department’s Recovery and Reset strategy and the envisaged service redesign processes which will embrace new models of service delivery including Telehealth, more patient facing systems to give patients agency for their own health and many emerging innovative applications.  

 [c]  Although systems such as the Primary Health Care Information System has been in place since 2006, the process of digitisation is ongoing as more advanced innovations are explored and its feasibility determined, and we continue to adapt and evolve with the changes in technology.

[d] It is difficult to calculate total costs of due to the complex processes and systems in this regard. There are a combination of outsourced systems and in house developed systems and many of the inhouse technical resources work on multiple projects. 

[2] In depth information is provided of each system and where they have been implemented.