Health Management System (HMS²)

Government

The specific problem that we aim to address is the ineffective collection of health-related data and the inability of health professionals to leverage the data to inform targeted actions that improve patient care and health facility management. A study evaluating the data governance maturity of government departments in the Eastern Cape Province found that there was a lack of institutionalized data governance in government departments, with insufficient procedural quality practices and poor data quality. Health systems generate large amounts of data daily. However, in South Africa, this data is not collected efficiently or effectively used. Most data collection processes are in paper-based format, data systems are fragmented, and data collected is of poor quality. Furthermore, decision makers do not effectively analyze or utilize the data leading to missed opportunities where data could be used to improve patient care and the management of health systems.

The scale of the problem is observed across provinces in South Africa. An evaluation of the data quality of the routine health information system in the public health facilities in the Eastern Cape Province found that the data quality was poor, with missing and inconsistent data, and inaccuracies in data reporting and record-keeping (SS Thabethe, 2022). A more generalized study looking at the general maturity of governance structures in the Eastern Cape found that there was a lack of institutionalized data governance in government departments, with insufficient procedural quality practices and poor data quality (O. OlaitanI et al., 2019). To varying degrees, the challenge with data is experienced in all the 711 public health facilities in the Eastern Cape, this impacts the care that the 7 million people who use these facilities receive.

The specific factors within these challenges that HMS² addresses are to improve the data collection processes, data quality, system integration, and data utilization. Additionally, it is crucial to highlight the importance of transitioning to an Electronic Health Record (EHR) system. The adoption of an EHR system streamlines data collection, enhances data accuracy, and facilitates better integration of health information across facilities, ultimately improving patient care and health system management.

Furthermore, HMS² aims to intervene in assisting with medico-legal claims against the Department of Health. By implementing robust data collection processes and ensuring data accuracy through an EHR system, HMS² aims to provide reliable documentation that can support the defence against medico-legal claims. This intervention not only contributes to the improvement of patient care but also safeguards the Department of Health against legal challenges, ensuring accountability and trust in the healthcare system.

HMS², serves as an electronic health management platform tailored for use within public health facilities. It represents a significant departure from traditional paper-based systems, transitioning towards an integrated digital health ecosystem with real-time data accessibility. HMS² encompasses a variety of modules designed to streamline the patient journey within healthcare facilities, from initial registration to electronic prescriptions and patient discharge. Additionally, it includes modules aimed at enhancing support services such as human resources and revenue management.

At its core, HMS² establishes an electronic medical record for each patient upon registration into the hospital's master patient index. Key modules within HMS² include the patient administration module, facilitating seamless patient registration and recording of inpatient admissions, outpatient visits, and emergency encounters. The Outpatient Department (OPD) management module enables electronic booking and management of outpatient visits and clinical encounters, while the ward management module oversees inpatient admissions, transfers, discharges, and reporting. The revenue module allows for electronic billing and account generation to efficiently manage patient fees and revenue streams.

HMS² integrates with existing health systems, including the Health Patient Registration System, National Health Laboratory Services, Cardiotocography, digital radiology, and medical aids, through electronic data interfaces. It is browser-independent, compatible with all major browser platforms, and operates on a role-based access system. Various roles, such as registration clerk, ward clerk, nurse, clinical doctor, finance clerk, finance manager, and hospital manager, dictate user access to specific modules.

Developed in-house, HMS² is an open platform system fully owned by the Eastern Cape Department of Health. Its architecture is based on a LAMP stack, offering an object-oriented solution with technologies like XML and Java. Currently hosted on Azure as per our agreement with Microsoft, the system maintains flexibility for hosting on alternative platforms, ensuring independence from specific commercial products. Through HMS², a comprehensive database is established, incorporating various information sources and a central register of patient details, augmented by unique patient identifiers to mitigate duplications.

HMS² serves both the population utilizing healthcare services and the healthcare workers operating within public health facilities in the Eastern Cape. In this region, there exists a significant challenge pertaining to the ineffective automation of patient administration, clinical patient management, and health-related data collection and utilization. This issue profoundly impacts the quality of care received by the approximately 7 million individuals who rely on these facilities, as health professionals struggle to leverage data effectively for informed decision-making in patient care and facility management.

Through the implementation of HMS², a shared electronic health record system is established, facilitating seamless access to patient information within and across healthcare facilities. Health professionals gain access to real-time data, empowering them to make well-informed decisions that directly enhance patient outcomes. Moreover, the system streamlines data collection processes, leading to improvements in data quality, system integration, and data utilization. Consequently, this comprehensive approach fosters enhanced health facility management and more efficient allocation of resources, ultimately contributing to the overall improvement of healthcare delivery in the Eastern Cape region.

The team comprises individuals with diverse skill sets, including ICT specialists, system developers, and training facilitators. Systems development and implementation coordination is led by Anton Strydom, who brings with him 19 years of extensive experience as the Senior IT Manager in the Eastern Cape Department of Health (ECDOH), the team has a proven track record of integrating ICT and health technology to enhance the quality of patient care. Leveraging their expertise and insights gained from years of practical experience, the team embarked on the development of HMS², an in-house solution tailored to address the specific challenges faced within the ECDOH.

Furthermore, the team has benefited from collaborative support from non-governmental organizations (NGOs) such as CHAI SA, contributing to the refinement and optimization of HMS². This collaborative effort underscores the commitment of all stakeholders to collectively address the pressing issues surrounding health data management and patient care delivery in the Eastern Cape region.

HMS² is presently in the Growth stage, having become an established solution, yet it remains in a continuous state of iterative improvement. It has been successfully deployed in 36 hospitals, 2 community health centers, 3 primary health clinics, and 3 EMS centers within the Eastern Cape, along with 10 district hospitals in the Free State. To date, over 6,000 healthcare workers have received training on HMS², and approximately 5 million patients have been registered on the platform.

The system is dynamic and evolving, consistently adapting to meet the evolving needs of our healthcare facilities.

We are submitting our application to Solve because we recognize the immense value of being part of a network of peers who can offer us inspiration, guidance, and support as we continue to develop and refine our solution, HMS². By becoming active members of the Solve community, we aim to forge connections with experts and innovators in both the healthcare and technology sectors, who can provide us with invaluable insights and feedback on our approach to enhancing electronic medical records and health data management in public health facilities.

Moreover, we firmly believe that robust monitoring and evaluation practices are essential components of establishing an impactful measurement framework. This framework will enable us to gain deeper insights into the effectiveness of our solution and identify areas for enhancement. Through our participation in the Solve community, we aspire to access resources and expertise that will aid us in developing and implementing a comprehensive monitoring and evaluation framework. This will empower us to systematically track our progress towards our impact goals, ensuring that we are effecting meaningful change in the lives of the individuals we serve.

HMS² stands out for its innovation as it harnesses digital technology to enhance the efficiency, quality, and accessibility of healthcare services. This system has been meticulously designed to tackle challenges prevalent in various healthcare settings, including urban, rural, and deep rural facilities. By offering an integrated digital health ecosystem that encompasses the entirety of the patient journey and auxiliary services, HMS² presents a holistic solution that can be tailored to the unique requirements of healthcare providers. Ultimately, this customization capability leads to tangible enhancements in patient care and health facility management.

The theory of change underpinning HMS² centers on the transformation of health data management through digitalization, integration, and automation. By leveraging technology to refine data collection processes, elevate data quality, foster system integration, and facilitate enhanced data utilization, HMS² aims to equip healthcare professionals with the necessary tools and insights to deliver more effective and efficient patient care. This, in turn, is anticipated to result in improved health outcomes for the population served by public health facilities in the Eastern Cape Province.

Transitioning from a predominantly paper-based environment to an integrated digital health ecosystem is at the core of HMS²'s strategy. This transition streamlines data collection and management processes within public health facilities, thereby eliminating manual data entry errors, reducing paperwork, and enabling real-time access to accurate and up-to-date patient information.

Comprising various modules that cover the entirety of the patient journey, HMS² ensures the efficient capture and management of every aspect of patient care. This holistic approach enhances care continuity, minimizes duplication of efforts, and enhances overall patient experience and outcomes. Moreover, by centralizing and standardizing patient data, HMS² empowers healthcare providers with a comprehensive view of each patient's medical history, treatments, and outcomes, thereby enhancing care coordination and decision-making.

In addition to patient care modules, HMS² incorporates modules designed to optimize support services provision. By enhancing these support services, health facilities can operate more efficiently, allocate resources effectively, and improve overall operational performance.

The impact goals for HMS² are aimed at, enhancing patient records management, data collection processes, data quality, system integration, and data utilization within public health facilities in the Eastern Cape Province, with the overarching objective of improving patient care and health facility management.

Under the first impact goal, which focuses on improving data collection processes, our objective is to streamline these processes, making them more efficient, accurate, and user-friendly. Progress towards this goal will be assessed by monitoring the implementation of HMS² across health facilities.

In addressing the goal of improved data quality, our aim is to enhance the accuracy, completeness, and consistency of collected data. We will measure progress by tracking the number of patients registered on HMS².

Regarding improved system integration, our objective is to seamlessly integrate HMS² with various health data systems to facilitate enhanced communication, data sharing, and real-time access. Progress will be evaluated by monitoring the expansion of HMS²'s integration capabilities.

In terms of improved data utilization, our aim is to empower healthcare professionals to leverage data effectively in informing targeted actions for enhancing patient care and health facility management. Progress towards this goal will be assessed through metrics such as increased system utilization by health professionals, enhanced data-driven decision-making, and improvements in patient care and facility management outcomes.

To gauge progress towards these impact goals, we will utilize a combination of quantitative and qualitative data. Quantitative metrics will include indicators such as the number of trained health workers, the proportion of health facilities adopting HMS², and the integration of external systems. Qualitative feedback from health workers and patients on system usability and effectiveness will also be collected through methods such as surveys, interviews, and focus groups. Regular evaluations will be conducted to assess the system's impact, identify areas of success, and pinpoint areas requiring improvement.

The foundational technology underpinning HMS² is a LAMP stack (Linux, Apache, MySQL, and PHP). This stack represents a widely-used open-source solution renowned for its stability, scalability, and user-friendly nature. Our system is intricately built upon this stack, delivering an object-oriented architecture that is both modular and easily extendable, thus facilitating seamless integration of new features and functionalities without disrupting the existing codebase.

Complementing the LAMP stack, we leverage various other technologies to augment the system's capabilities. For instance, XML is utilized for storing and transmitting data in a standardized format, ensuring compatibility with diverse systems for efficient data processing. Additionally, Java is employed for constructing the backend of the system, providing a robust framework for handling intricate business logic.

Presently, HMS² is hosted on Azure, Microsoft's cloud computing platform. This strategic choice enables us to harness the scalability and reliability inherent in Azure's infrastructure, thereby ensuring uninterrupted availability and responsiveness of our system. Nonetheless, it is pertinent to highlight that our solution is not bound to Azure, affording us the flexibility to migrate to alternative hosting providers should the need arise. We firmly believe that this independence is paramount in safeguarding our solution against reliance on any specific commercial product. This autonomy enables us to adapt swiftly to evolving market dynamics and technological advancements, thereby perpetuating the relevance and efficacy of our solution over time.

The Solution team consists of four system developers who ensure that HMS² interfaces with existing hospital databases and oversees the maintenance of the system.

One ICT specialist conducts site readiness assessments at facilities before the training team arrives.

Two full-time lead training facilitators who are responsible for conducting training sessions for all hospital staff members on the functionalities of the HMS².

Four part-time trainers who support the implementations. 

The initial planning of the solution began in 2011 at Frere Hospital Eastern Cape, in 2020 the system was piloted at the field hospital in Port Elizabeth the following year the system was officially adopted by the then provincial Head of Department: Health, Dr R Wagner.

The Eastern Cape Department of Health, particularly the HMS² team, places a strong emphasis on cultivating a diverse, equitable, and inclusive workplace environment. Our team embodies a rich tapestry of backgrounds, experiences, and perspectives, encompassing expertise in both public health and ICT domains. Comprising a blend of seasoned specialists and emerging talents, we prioritize mentorship and skill transfer to foster continuous growth and development.

Furthermore, our team is characterized by a balanced mix of gender and racial representation, reflecting our commitment to diversity and inclusion. We actively nurture a culture of openness, collaboration, and mutual respect, where all team members are encouraged to communicate freely and contribute their unique insights. Discriminatory behaviours and attitudes are swiftly addressed, and we celebrate the distinctive contributions of each individual.

By embracing diversity and fostering an inclusive environment, we aspire to create a workplace where every team member feels valued, supported, and empowered to thrive. Together, we are united in our mission to advance health and well-being for all.

At the Eastern Cape Department of Health (ECDOH), our business model revolves around providing comprehensive healthcare services to the residents of the Eastern Cape province. Our primary focus is on catering to the diverse population within the region, ensuring that all individuals have access to essential healthcare services.

We offer a wide array of healthcare products and services, encompassing primary healthcare, specialist medical services, emergency care, maternal and child health services, mental health support, and preventive health initiatives. These services are delivered through a network of healthcare facilities, including hospitals, clinics, and community health centers, supplemented by outreach programs and collaborations with other healthcare organizations.

The overarching goal of the ECDOH is to ensure that people have access to high-quality healthcare that is both affordable and responsive to their diverse healthcare needs. Our revenue model primarily relies on government funding allocated to healthcare services, supplemented by revenue generated through patient fees and health insurance reimbursements. We continually strive to optimize resource allocation and operational efficiency to ensure the sustainable delivery of healthcare services while maximizing their impact on the health and well-being of the population.

Ultimately, our business model is driven by a steadfast commitment to providing value to communities by delivering quality healthcare services that address healthcare needs and contribute to improved health outcomes and overall quality of life for residents of the Eastern Cape province.

The successful implementation and ongoing operation of HMS² across 53 health facilities, with approximately 5 million patients registered on the platform and over 6,000 healthcare workers trained, serves as a testament to the unwavering commitment of the Eastern Cape Department of Health (ECDOH) towards sustaining HMS². These investments, both in terms of financial resources and human capital, underscore our dedication to harnessing technology to enhance healthcare delivery and management in the Eastern Cape. Moreover, the prioritization of HMS² in the province's budget plans, with funding allocated until 2026, further demonstrates our steadfast support for the continued success of the platform.

To ensure the long-term viability of HMS², we are actively exploring avenues for financial mobilization, including seeking additional funding from governmental sources, international donors, and private sector partnerships. By securing supplementary funding, we aim to bolster our financial resources, enabling sustained investment in the maintenance, enhancement, and expansion of the HMS² platform. In tandem with finance mobilization efforts, we are implementing rigorous cost optimization measures to ensure efficient resource utilization and minimize unnecessary expenditures associated with HMS² operations. This includes leveraging in-house human resources for development and training purposes.

Through the balanced implementation of finance mobilization strategies and meticulous cost optimization measures, HMS² has proven to be financially sustainable, and we are confident in its continued sustainability moving forward.