- Building a uniform and integrated a National Health Information System (NHIS) which caters for both the current public and private health sectors for the purposes of National Health Insurance is complex and requires a standardised approach. The Department has, over the past few years, worked on the development of the backbone and technology platform to enable the development and implementation of the National Health Information System:
“To date the building of the NHIS platform and architecture focussed on answering the following question WHO the user (Patient Registry) is who receives services - WHERE (Health Establishment Registry) they receive those services - FROM WHOM (Service Provider Registry) -FOR WHAT (Clinical, Diagnostic and Procedural Coding)”
- Critical to a successful NHIS is ensuring that each citizen and legal resident (USER) has a Master Patient Index (MPI) or Health Patient Registration number (HPRN). This number is the thread that will enable healthcare service providers and establishments to be able to access anywhere in the health system the correct and relevant patient information required to render a service. The National Department of Health built and implemented the Health Patient Registration System (HPRS) which creates and issues a unique number for the USER of health care services. This number is the number that will link all health service encounters within the South African health sector to a single person. Since 2014 extensive work was done to implement the HPRS in public health establishments and to conduct the relevant change management. To date (28 August 2023) we have implemented the HPRS in 3 220 public health facilities ( 3 136 PHC establishments and 84 hospitals). We are engaging with the private sector on the implementation of the HPRS and the use of the MPI as the unique identifier for patient information systems deployed in the sector. The HPRS will be the authoritative source for ALL demographic details of a USER and is the cornerstone on a portable electronic health record.
- WHERE a USER accesses health services is obtained from the Master Health Facility List (MHFL) platform. The MHFL provides for the identity of ALL health establishments and community-based health service points that provide health services in the country. The MHFL was used extensively during the COVID-19 pandemic for both public and private establishments (facilities). Currently there are 51131 establishments registered on the Master Health Facility List (MHFL) and there are continuous efforts to enhance the register. A Health Establishment Registry Technical Working Group with stakeholders from public and private sector was established in beginning of 2023 to review existing practices and make recommendations to the National Health Council for a standardised Health Establishment Registry data framework and its governance.
- Management of data regarding from whom a USER receives services (clinical professional) is in concept phase and the plan is for this system to be fully functional within the next financial year. All systems that currently maintain healthcare service provider information must be interfaced with this Service Provider Registry.
- Knowing what services were rendered at a health establishment for a USER is key to ensuring quality and efficiencies in the provision of health services. A Technical Working Group was established in 2022, comprising both public and private sector. Recommendations on Clinical Diagnostic and Procedural Coding of health services were made and tabled at the National Health Council. These recommendations will be published in the Government Gazette.
- Work has also been done on building a Health Information Exchange which is a platform that allows different computer systems to communicate in a clear manner ensuring that data can be exchanged across the system. The Health Normative Standards Framework (HNSF) for Digital Health were gazetted in 2014 and more recently 2022. These standards provide guidance for anyone developing systems within the South African health sector and are regarded as the minimum technical standards that must be included. Both the HIE and HNSF assist in ensuring that interoperability of health systems is upheld and maintained.
- Ultimately every USER must have a portable Electronic Health Record (EHR). Work has started on the development of a modular Electronic Medical Record (EMR) system, to be deployed in public health facilities, which contains data collected during care episodes and which send data to our EHR. The first EMR module, focussing on HIV and TB will be introduced by March 2023 while a fully-fledged EMR will take approximately 5 years.
- Integrated digital patient solutions are critical to a functional health system but require appropriate and quality broadband connectivity to function. Reliable electricity and connectivity require a government wide approach.