The discovery of writing skills made it possible for man to remember disease and how to manage it.
Results of that 2 000-year-old discovery are the institutions of knowledge we see today that now form the pillar of present-day health care practice.
In the 20th century, we saw the marvel of the antibiotic penicillin and in the 21st century, we have mapped the human genome and medical practice is set to be revolutionised.
However, the 20th and 21st centuries are characterised by missed opportunities in terms of quality and equitable access to health care, particularly in Africa. The health system faces huge challenges including the lack of human and financial resources, inequity in access to health services between the rich and poor on the one hand, urban and rural on the other, all of this in a background of high disease burden.
In curative services, sick patients spend hours to be served, same processes are repeated over and over, paid for services get lost and prerequisite services are not done, compromising the quality and escalating the cost of health care. In preventive services, we see massive epidemics of conditions otherwise easily controlled, such as cholera outbreaks; there is limited information available at point of decision making. With a well-managed information system, we can control most of the cases that follow a first case of cholera.
This can and must be improved. According to the World Health Organisation, advances in Information and Communications Technologies (ICTs) offer unprecedented opportunities to improve public health worldwide.
In Africa, the opportunities that ICTs offer are taken advantage in other areas such as telecommunication and banking sectors, but not enough in health.
Yet, the potential impact to improve individual care and public health could be profound.
So what can ICTs do to strengthen the health system and improve quality of care? E-health or the application of ICTs to health has proven where implemented, to significantly improve quality of individual care and the public health system management.
E-health tools include the use of mobile phones to provide health care to ordinary citizens.
This information can be about the whereabouts of a doctor in your area or about how to manage your condition.
Through mobile phones we can schedule appointments and have access to the results of our medical conditions. We can translate the paper record into an electronic format to come up with an electronic medical record system (EMR system).
The introduction of an EMR system for patient care could facilitate the exchange of information between doctors, pharmacists and laboratory specialists and also reduce unnecessary repetitive processes when a patient moves between health providers.
Also, the availability of health information on the Internet provides for better training opportunities to health professionals and provides for more patient empowerment to understand and manage health conditions. Finally, ICTs can strengthen public health monitoring, for example in real-time disease monitoring providing the right information at the right time for decision makers.
Through an EMR, practitioners and patients can easily have access to knowledge about various medical conditions. Patient-centred information systems with discussion forums and peer groups can assist in providing information that would otherwise take years to access.
If the EMR systems are well integrated into the public health information system, conditions such as cholera can easily be picked up as soon as the first signs and symptoms are noticed from the point of care.
Here is a fictional situation on how all this will work out: A rural area resident gets a severe diarrhoeal disease after drinking contaminated water. He has on him a mobile phone and he has enough credit to just SMS or connect to the Internet. He sends a question via SMS about his condition to a health knowledge centre hosted at the College of Health Sciences.
The response tells him that his symptoms closely match those generally associated with cholera and he panics he might have it.
The knowledge centre also informs him that there is need to take oral rehydration solutions and urgently seek medical attention.
He then sends an SMS to the local doctor's patient management system and is automatically confirmed for the appointment.
After the visit, the doctor indeed sends the specimen to the laboratory for analysis and it is confirmed cholera through an automatic exchange between the laboratory information system and the doctor's system.
In addition to treating the patient immediately, the doctor is informed by his system that cholera is a notifiable disease and it must be reported to the Ministry of Health and Child Welfare National Health Information System with co-ordinates of where the case occurred and at what time.
The above scenario, which is realistic, is a two-edged sword. It is powerful in responding well to an emergency and facilitating the co-ordination of the different health care sectors.
However, it raises also a number of other issues. How can one be sure that the patient information that is kept by the doctor or the laboratory system is not shared with third parties, thus raising the issue of privacy?
In addition, how can one ensure that if the patient decides to use another doctor the information stored in the first doctor's system could easily be shared with the second and this under the control of the patient, raising issues of interoperability between systems and data ownership.
In the last few years, like most African countries, Zimbabwe has witnessed progress in the ICTs sector with the building of large telecommunications infrastructure providing better Internet access and penetration rates even in remote areas.
In addition, several initiatives and implementations of systems exist in e-health with several to come.
We have in place a mobile phone reporting system; health care practitioners are at various levels of implementation of ICTs systems in their business practice. Doctors have some form of EMR, pharmacists have had computerised systems for quite some time and laboratory scientists are at various levels of computerisation.
However, without co-ordination these systems will tend to be islands of information that do not share information across their different business domains.
This creates the challenge of what are called vertical systems or silos of data. From system to system patient data will have to be repeated as none have a common information sharing platform.
In order to enhance this process therefore, these systems must be encouraged to "talk to each other".
In order to ensure then that as a country we move ahead with a well-co-ordinated e-health implementation that provides quality health care to all, here is the Call To Action to all stakeholders: We must address each of these components:
- Leadership and Governance: Ministries of Health, ICT, Transport and Communications, and private sector must come together with a common vision on e-health and lead.
- Infrastructure: We must have adequate power supply strategies, increased and low-cost connectivity, and build fairly advanced data centres.
- Standards and Interoperability: We need to develop a unique patient number that is applicable across the entire health sector. Doctors must agree on summary clinical record to share patient information. Pharmacists must support the development of an electronic prescription (e-prescription) template. Medical aid societies must come up with a standard national billing format applicable to all practitioners, and the Ministry of Health must circulate how other systems can send data to its main disease surveillance systems.
- Workforce: We must train our health workers in computer literacy, and our computer graduates in understanding and supporting robust health systems.
- Legislation, Policy and Compliancy: In order to ensure security of systems and privacy of individuals we must develop detailed data protection and regulatory frameworks.
- Strategy and Investments: Government and the private sector need to start looking seriously on how we can invest wisely into this process and come up with some return on investment strategies.
- Services and Applications: Software developers need to work on the wide range of tools required to make up a world class e-health system that is a marvel of many.
This call to action must form the basis of the national vision: A National E-Health Vision.
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Autor(en)/Author(s): Tungamirirai Simbini, Hazel Makowa and Hassene Sidatt
Quelle/Source: AllAfrica, 24.08.2012
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