Allied Technologies : Technology that solves healthcare headaches

21 May 2014

From the outside, Eyethu Yarone looks much like thousands of other clinics across our country. On the inside, however, the partnership between a visionary doctor and Bytes Healthcare is bringing about a revolution in healthcare in South Africa.

Eyethu Yarona is the first and only clinic in Gauteng, and possibly South Africa, where patients' clinical histories are captured electronically. At the press of a button, the consulting doctor or nurse can display a patient's record on a computer screen. With every visit to the clinic, the record is updated and expanded. Test results are scanned in and become part of the record. Over time, a picture of the patient's health trends develops and healthcare professionals can increasingly treat complaints not as isolated incidents but against the backdrop of a holistic clinical picture.

The technology that enables this approach is Med-e-Mass' HEALTHone practice management system. The man that drives it is Dr AK Tshabalala.

A man on a mission

Dr Tshabalala first encountered the Med-e-Mass billing system in the early 1990s when he was in private practice in Tembisa. Following a stint in Canada where exposure to an efficient and caring primary healthcare system opened his eyes to what is possible, Dr Tshabalala returned to South Africa. He was appointed at Lanseria International Airport as the first port health doctor in the country.

In 2009, Dr Tshabalala became involved with the Rhema Hands of Compassion Clinic, at that stage the only health facility serving the numerous informal settlements around Lanseria. With the original Med-e-Mass billing system still on his laptop, Dr Tshabalala started compiling a register of patients who came to the clinic. It was an extremely basic list, reflecting not much more than names, ages and where the patients came from, but it was a giant step forward in terms of mapping the clinic's catchment area.

In 2010 Rhema announced that it had funds for a new clinic. In conjunction with the affected communities and the Gauteng Department of Health it was decided to build Eyethu Yarona in the Thabo Mbeki informal settlement. During this time, Med-e-Mass introduced Dr Tshabalala to HEALTHone, its complete patient management system. "I immediately understood how this system can change the country," says Dr Tshabalala.

Based on trust and their long association, Dr Tshabalala and Med-e-Mass MD Gideon Brits came to an agreement. Eyethu Yarona was not an official HEALTHone pilot site and there was no contract between Bytes Healthcare and the Gauteng Department of Health, but the two men built their cooperation on a shared vision of how technology could change primary healthcare.

Implementation and results

Dr Tshabalala migrated his existing database into HEALTHone and, with Med-e-Mass' help, started training the clinic staff on using the system. These days the receptionist registers patients on the system and captures basic information so that the record can simply be called up by the doctor during the consultation. Staff, such as immunisation nurses, have scribes that capture information while the nurse is busy with a baby. In addition, one of the cleaners at the clinic has been trained to capture pupil information on the system following clinic visits to the local schools. Even the security guard has a role to play. He registers patients and their time of arrival, enabling the clinic to determine how long people wait before they are served.

On the strength of all the information at his disposal, Dr Tshabalala could implement changes that have improved the efficiency of the clinic and the quality of care it provides. One of the biggest benefits is that poor filing and illegible handwriting no longer scupper patient care. Another is the holistic approach to patient care. In the public health system patient care is often divided into smaller, independent activities, e.g., family planning, TB and HIV/Aids. As a result, the people looking after a woman during her pregnancy might never know that she also suffers from TB. "Our electronic health record recognises all these specialised clinics, but they are all summated under one health record," says Dr Tshabalala.

To support the HEALTHone implementation, Med-e-Mass donated 13 computers to Eyethu Yarona. Recently, Med-e-Mass agreed to also sponsor data capturers at the clinic to help convert historic records and to help the staff to keep up with the ever-growing number of patients. The data capturers are sourced from within the community" says Gideon.

The Eyethu Yarona experiment is proving that technology is not a luxury but a necessity that will enhance the most vulnerable members of our society's access to basic healthcare. It also shows that one person can make a difference through partnerships, passion and sheer force of will.

The Eyethu Yarona clinic:

• Serves a population of 50 000
• Has 7 200 active patients
• 11 workstations
• 3 doctors
• 6 nurses
• 3 administrators

More about HEALTHone

HEALTHone is an electronic patient record system. This mature, comprehensive, powerful, flexible, portable and standards-based system is currently in use in Ireland, Belgium, France, Switzerland, South Africa and the USA. It stores clinical information in a secure and confidential electronic system and can integrate a practice or a hospital with other providers, such as pathology laboratories.

At Eyethu Yarona, HEALTHone has been customised to receive automated input from GPS devices in order to plot geographical information. It also records the national Department of Health (DoH) clinical indicators and has been adapted to meet DoH requirements for HIV counselling and testing (HCT), anti-retroviral therapy (ART) and the treatment of TB. The system has a unique functionality to report on outcomes related to ART treatment, HCT, TB and other conditions in relation to patient demographics.

Dr Tshabalala is successfully demonstrating to the DoH how technology can be used to meet the needs of the community. For this Eyethu Yarona has been commended by the national DoH.