Zim hospitals introduce a new e-Health system: How does it work?

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Chitungwiza Hospital eHealthIn an earlier article, we mentioned that the government was making strides towards establishing an electronic health record system. This was based on the experience we had of Mpilo Central hospital having set up an electronic system that was being used mainly for accounting purposes. It turns out the Ministry was working on something bigger.

The prevailing hardcopy system of health records is outdated and a nightmare. At the central hospital level, shortage of storage cabinets and folders has seriously hampered the ability to retrieve records and gather information for research. A trip to the records department to retrieve a patient’s old clinical notes can prove to be a Finding Nemo mission of swimming through an ocean of paper.

As an effort to catch up with rest of world as far as installing electronic health system, the Ministry of Health and Child Care has for the past year been working on a pilot project called e-Health at Chitungwiza Central Hospital.

After achieving ISO certification in 2008 Chitungwiza Hospital has realised many local and international opportunities. One of those opportunities was being selected as the pilot site for the Ministry of health’s e-Health project.

We managed to acquire some details of this e-Health system which is already up and running and set for official launch in the next coming days.

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At Chitungwiza hospital more than a hundred desktop computers were installed in every department and ward that act as access points to the system. Thanks to a partnership with TelOne as the internet service provider, a fibre optic link enables a fast connection to the central servers that are housed at ministry headquarters.

The system uses the SAP health software application. For the staff members to obtain Login access into the system, they have to be approved by ministry headquarters, as a security measure.

The system is being used to capture patient demographics, handle patient accounts and even clinical information such as blood pressure temperature and doctors’ notes! This enables the system to be a vital tool in disease surveillance.

Since it is still in its inception, they had to compromise to incorporate a dual system, of both hardcopy and electronic records. In the event of power outages and network interruptions the data is initially collected on paper to be entered later.

The dual system also extends to the wards were clinical information is written on paper to then be entered by the nurses after the doctor’s round. Future plans are to install Wi-Fi in the wards and source tablet devices for their staff to have mobile access the system! Another is to digitalize investigations such as X-rays, ultrasound scans and CT scans.

The e-Health pilot has certainly put Chitungwiza Hospital on the frontier of electronic health systems for the public health sector. The next probable sites of extension of the eHealth system will probably be Parirenyatwa or Mpilo central hospitals.

So what will this mean for the local tech community?

  1. This is a growth in the market for health IT personnel as more programmers and system administrators will be required. Chitungwiza hospital had to create 2 permanent posts for its IT department but are looking at hiring more. They are also inviting students to intern in their IT department at the hospital.
  2. The out of the box thinking of the hospital management enabled Chitungwiza to be the first central hospital to achieve ISO certification. The hospital has since established several public private partnerships of which the C.E.O Dr Obadiah Moyo is a big advocate of. They are open to partnerships with those that may have tech based solutions for hospital care and management that leads to improve quality of care and efficiency.
  3. For those interested in electronic advertising solutions, the hospital also installed several large multimedia screens that are connected to the internet that are being used to disseminate health related information and entertain people in the waiting areas.
  4. Other hospitals are interested in launching electronic health systems on their own but are discouraged by some exorbitant costs that would-be providers present. Chinhoyi Hospital was handed a quote of up to $60 000 for installation and $10 000 a year for system maintenance by a South African based company. The demand is certainly there, with the launch of this e-Health system it may even increase as others realise the benefits. It looks like some local service providers will have to step up and address that market.
  5. Internet access is key factor for the e-Health system to function. Therefore we wonder who will step up to the challenge to offer reliable fast wireless internet access to these hospitals that are seeking to catch up with the rest of the world.

This is a landmark development that the Ministry of health will be unveiling in the next coming days.

With the TechMedicine revolution headed to Zimbabwe, what sort of opportunities are you seeing as a techie and most importantly as a startup?

Dr Marlon-Ralph Nyakabau (MBChB) is young medical doctor who has conducted lectures before various esteemed professional bodies of doctors on the aspect of mobile medicine. He is an entrepreneur recently recognised as a 2014 Mandela Washington Fellow. He can be contacted on [email protected]

Dr Kudzayi Kutywayo (MBCHB) is a young medical doctor with an interest in the pursuit of medical excellence and bringing convenience to everyday practice of medicine through technology. His address is [email protected]



12 Comments

  1. Greg says:

    this is certainly a good step towards improving health delivery systems in zimbabwe. i wish a local company or entrepreneur could develop a ehealth system and sell it to government tat a discount. the system does not have to have continuous Internet connection, it can operate in a LAN or WAN. data is then synched to a main central database every now and then

  2. Shoutout says:

    A shoutout to Finding Memo for making it in the article.

    Now zvatichada iZimbo version inonzi Finding Nyimo

    1. Marlon says:

      Hahaha nice one

  3. kilotango says:

    not going to help much, when all GVT doctors go on strike soon

  4. Chenjerai says:

    mmmmm shamwari yangu kutaura chokwadi urikunyepera vanhu .Iwe uri doctor and you are on gvt program with USA .Youre not in touch with the gvt IT Systems ,unoita zvekuudzwa

    That’s a good PR attempt ,being someone in the core of this gvt IT Systems at the said ministry
    I will tell SAP is : 1.Too expensive 2 .Remote /internet based (which thing) 3.telemedicine is being resisted by the doctors themselves 4.

  5. Ed says:

    Going “e” is a good initiative. But the government needs to look and consult wider when they embark on software development projects. SAP is expensive for nothing. There are cheaper and more scale able options such as Dynamics AX, Dynamics Nav – which are done by Microsoft. With Microsoft its easy to empower local developers.

    Secondly, they should learn to separate tenders for business analysis from those for systems development. If those are done by independent organisations then you get a better product. The point is is the same company does both then there is no actual measurement of goals to be attained.

  6. Archivist Simbar says:

    you have noted shortage of cabinets, files as the major causes of retrieval, this is a result of funding issues. the very same ehealth system could be on its knees soon. Records management funding is not prioritised in most instituitions. it becomes even more costly running parallel systems, the paper records nd th e health sysytems so problem not solved

  7. Chambo says:

    Nurse: Oh no, magetsi aenda.
    Doctor: Internet haisi kushanda
    Patient: maiweee, ndofa kaniiiii

  8. Ronald Munjoma says:

    … the government was making strides towards establishing an electronic health record system.
    I disagree. The government is creating silos of important electronic medical records through the piece meal implementation of costly, closed and proprietary systems. Cases in point are the SAP for Health Project that you wrote about above (Chitungizwa General Hospital), the ePMS project – (http://nhis.mohcc.gov.zw/index.php?option=com_content&view=article&id=5&Itemid=70) which is a pilot of three different solutions for managing HIV and TB patients data currently installed in over 100 sites. CTC uses a Microsoft Access front end, comes in two separate systems one for ART and the other for Stock Management, IQ Care and Energy Plan runs on costly MS SQL databases (all local installs are using SQL Express which comes free of charge but with usage limitations). CTC stores user passwords in plain text.

    … having set up an electronic system that was being used mainly for accounting purposes.
    This is the sad truth with most electronic medical records systems implementation, people are only concerned about the billing side of things, the moment you pitch or want to push the clinical side of any systems you are mostly likely to face resistance. As a result most EHRs/EMRs end up been billing systems with no or very little clinical information.

    Your arguments about storing, retrieving and accessing paper records are very valid, but as medical professional I would have expected you to also argue from the continuity of care perspective. With the current paper and electronic based systems there is no continuity of care. Your paper record is kept in folder at the local hospital, if the hospital does have an electronic records system, the data is not shared neither is the system interoperable with other systems within the same hospital or different hospitals.

    For example my 4 year old daughter has
    1. Birth record at Bainnes Avenues Clinic
    2. Growth records from different council clinics – at least traceable through the red child clinic card
    3. Two different, unlinked electronic and paper records with CIMAS – one at Chinhoyi Street and the other at Rowland Square.
    4. Paper record at 24 Hr Emergency
    5. Electronic Record at PSMI Five Avenue – luckily I got a print out after nicely asking from the attending doctor.
    6. Electronic (patient number) and paper records at Pari

    At 4 years she has at least 6 medical records unlinked, inaccessible, how they do you achieve continuity of care?

    the Ministry of Health and Child Care has for the past year been working on a pilot project called e-Health at Chitungwiza Central Hospital.

    This pilot project or any other e-health initiative are bound to fail unless the following prerequisite things are put in place (the list is not exhaustive and in no particular order):
    1. National ICT Policy
    2. National e-health policy and strategy
    The policy will spell out things like:
    – nationally agreed upon Unique Patient Identifier (UPID) for life
    – interoperability standards
    – data sharing standards e.g HL7, FHIR …
    – patient privacy issues
    – agreed upon international coding standards to use for diagnosis (ICD9/10, SNOMED ….), coding standards for billing
    3 . Infrastructure – electricity, internet connectivity,
    4. skilled Human resources – developers, sys admins, doctors and nurses with computer appreciation skills and who can use the systems
    .
    .
    .

    the list can go on and on

    the central servers that are housed at ministry headquarters.
    I will be more inclined to an on-premise hosted solution which syncs and back up to a central server.

    This enables the system to be a vital tool in disease surveillance.</quote?
    Do you care to explain how SAP for Health is been used in disease surveillance? Is it linked to DHIS2?

    The next probable sites of extension of the eHealth system will probably be Parirenyatwa or Mpilo central hospitals
    I doubt it, the two hospitals have heavily invested (financial, system change over, change management, staff training, data transfer ….) in the existing electronic medical record system. What are the benefits of SAP for Health to justify the switch from their current system?

    Chinhoyi Hospital was handed a quote of up to $60 000 for installation and $10 000 a year for system maintenance by a South African based company.
    Was this quote to computerize the whole hospital and provide an entire electronic medical records systems – from Outpatients, ADT (Admit, Discharge and Transfer), Surgery, Billing, Obs and Gyna, Radiology, Oncology, Paeds …. if that is the case then that amount is too little.

    Most of the locall EHR/EMR projects that I am aware of cost at least a million dollars with one hospital group reported to have forked out $5 million for their system.

    Having said of this, what should have the government done:
    1. Come up with a comprehensive e-health strategy and policy
    2. Evaluated existing systems been used and implemented locally
    3. Looked at the option of using Free Open Source Solutions
    4. Learn from other countries who have been there and have successfully done it (and done it using Free Open Source Software) – Kenya: https://sites.google.com/site/kenyahealthinformatics/ Rwanda: http://emr.moh.gov.rw/ Jamaica: http://blog.gnusolidario.org/2013/09/jamaican-ministry-of-health-adopts-gnu.html

  9. Khal Drogo says:

    I view this as a total waste because 23rd Century Systems teamed up with Africom to provide a cloud based ERP (SAP Business One cloud) they needed to just add any additional module (HIS) on the already exisiting ECC 6.0 Platform and I hope the SAP HIS (Hospital Information System) was implemented by a local company, otherwise it was a rip off with the South Africa based company.

    1. Ronald Munjoma says:

      The system was implemented by Twenty Third Century Systems (TTCS) as part of e-government.
      I am reliably informed that the implementation failed a couple of times, requiring a re install in one of instances.

      If I am not mistaken this is the Second implementation of SAP for Health in Africa, the first one been in SA.

      Truth be told none of the TTCS employees have experience with SAP for Health, this is a trial and error project.

  10. Muhammed Sidheeq says:

    E-Health is a good idea. Cloud based Hospital Information Systems could help both Hospitals and Patients in an effective way. The great flexibility of a Cloud Based Hospital Information System is, Patients could track their journey and medical records at any time and also could rate their doctors.

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