DEPARTMENT OF PUBLIC HEALTH MEDICINE

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ACADEMIC PROGRAMME: JOURNAL CLUB

2022

Electronic Health Record System In The Public Care Sector Of South Africa: A Systematic Review

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Panelists:

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Chairperson: Dr Khanyisile Tshabalala

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Presenter: Dr Mphonyana Raseobi

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Author: Mr Munyaradzi C Katurura

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Discussant: Dr Ronel Kellerman

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Closing Remarks: Dr Tumi Malatji

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contents

• Background
• Aim
• Research methodology
• Ethical considerations
• Results
• Discussion and recommendations

Clinical Informatics Journal Club 25 March 2022

background

The National Health Insurance (NHI)

For proper implementation of the NHIs, an electronic health record system needs to be implemented which will allow capturing, storing, and sharing of a patient’s personal as well as medical information as they move from one health care provider to another. Which enable easy access to patients’ past health visits

Different EHR systems from various vendors fail to work together since their database architectures are different.

Africa is still a developing continent with a lot of drawbacks that prevent the efficient establishment of EHRs.

Clinical Informatics Journal Club 25 March 2022

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aim

• Identify Critical Success Factors (CSFs)

Literature review to identify common barriers to a successful EHRs establishment in Africa, South Africa in particular

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Clinical Informatics Journal Club 25 March 2022

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Research Methodology

• Qualitative, interpretive approach
• Data collected through a systematic literature review- guidelines of hermeneutic framework
• Theoretical background: Socio-technical- environmental theory

Social subsystem- employees, need, attitudes, skills, values and knowledge they bring, reward system and organization structure

Technical- tools, devices and techniques

Environmental factors- rules and regulations

Clinical Informatics Journal Club 25 March 2022

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CONTINUES

Sourced from google scholar, science direct, PubMed library, scholar droid, ResearchGate, and the Association for Computing Machinery

• Inclusion criteria- all articles that addressed implementation of EHR in public health care, African based
• Published between 2006 and 2017

Forward and backward search strategy

Thematic analysis- to identify recurrent themes in the articles

Reciprocal translation method-

• findings of one study were compared for similarities

ETHICAL CONSIDERATIONS

• Ethical clearance- University of Fort Hare

Clinical Informatics Journal Club 25 March 2022

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RESULTS

• Data collection process

Adapted Preferred Reporting Items for Systematic Reviews and Meta-Analysis.

Out of 57 articles

Twenty –not African context

Seven-not specific to a particular African country

Twelve- did not address the implementation of EHR.

THREE –could not be acquired in full text

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Barriers to the implementation of EHRs

• Three major factors/themes
• Social factors
• Technical factors
• Environmental factors

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Clinical Informatics Journal Club 25 March 2022

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Social factors

• Two major themes in this category
• Issues of user training, skills, and commitment
• Lack of health care personnel with the necessary skills and knowledge
• Lack of career paths for health informatics specialists in the public health care sector
• Resistance and job losses
• issues of political influence
• Changes in government structures
• occurrence of political unrest

Clinical Informatics Journal Club 25 March 2022

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Technical factors

• Two major themes
• Lack of information technology (IT) infrastructure
• Lack of computers, printers, and networking equipment and uneven distribution
• Lack of Internet connectivity and electricity supply

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• Issues related to the cost of implementing
• High costs
• Lack of adequate funding
• Lack of long-term financial commitment
• Poor management of funds

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Environmental themes

• Three major theme categories
• Policies and Strategies
• no coordination and harmony
• Lack of specificity

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• Legislation and Regulation
• No legislation and regulation

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• Standards and framework
• Lack of standards and framework

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Discussion and recommendations

• Six critical success factors were identified

“ Factors of a strategy that must be achieved to meet the objectives of the project”

• Critical success factor 1- Incentivising the health informatics career field to attract and retain information and communication technology professionals

Recommendations

• Create a proper hierarchy for health informaticians similar to those found in the ICT fields
• Offer pay grade reviews and upgrades

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• Critical success factor 2: Encouraging

participation of all stakeholders in the development process of electronic health record systems.

Recommendations

• The government should develop a committee comprising all the relevant authorities
• The government should allow the developed committee to be the principal project owner for EHR implementation
• Identifying the points of resistance where commitment to the utilization of implemented EHRs may be lost

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• Critical success factor 3: Investigate and invest in alternative infrastructure facilities

Recommendations

• The government should collaborate with Internet service providers and work on repurposing some of the now obsolete technologies and hardware
• Investigating the feasibility of batch update systems, rather than real-time updating systems
• The government can invest in solar-powered and industrial diesel-powered electricity generators

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• Critical success factor 4: Allocating separate

budgets for e-health projects

Recommendations

• The government should allocate a budget specifically for e-health projects such as EHR implementation.
• Committee to administer the budget

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• Critical success factor 5: Developing context-relevant e-health implementation strategies and frameworks

Recommendations

• Government should embark on an in-depth investigation of the currently available resources
• Government should commission professional bodies to investigate the most feasible EHR implementation strategies.
• The same professional bodies should be tasked with the development of frameworks for designing EHR systems

• Critical success factor 6: Develop and implement legislation specific to electronic health record implementation and continued use
• Recommendations
• The government can facilitate the engagement of experts in the fields of law and health informatics to establish the type of information that will be collected and devise ways of ensuring that legislation is developed that secures such information.

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Conclusion

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• The study showed implementing e-health has barriers in Africa, which are multifactorial, six critical success factors were identified and recommendations were discussed. Since South Africa is planning to initiate NHI, for it to be successful, a precise patient record system should be in place. Only 15 articles were found to be suitable for African countries, which shows that either e-health is not well established or lacks research. Further research and solutions, should include health care workers, medical lawyers, and experts in health informatics regarding Electronic Health Record systems.

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Clinical Informatics Journal Club 25 March 2022

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Electronic Health Records Systems in The Public Health Care Sector in South Africa 25 March 2022

Thank You