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The need for an open and national medical database

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boy-health-cardRecently I accompanied a sick relative for a medical checkup at one of our government hospitals. It took over five minutes for the on call nurse to find her name in the register book and verify her appointment. If I were to take a wild guess I would blame it on the spidery hand that had been used to take down the patient’s details during the previous appointment. Then there was the size of the book: it is by far the largest book I have ever seen: close to half a meter in width and length. Why is it we do not have a national medical repository that every hospital, even, public hospitals can use?

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The benefits are self-evident and immense. A central repository that is not tied to one proprietary database software provider would ensure that you are able and free to move from one medical practitioner to another without losing your medical history. Consider for example the wealth of information contained in your yellow child health card like the one held above. Chances are if you are an adult like myself the card is already lost or at best an unreadable dog-eared mess. Or maybe you and your parents were careful but that hardly negates the fact that a networked database would be nice and much more easily accessible not to say hard-wearing.

What killed your great-grandfather (maternal or paternal)? We all know they were bewitched by their enemies who were jealous of them but what were the physiological causes of death. Was it lung cancer, leukemia, a freak aneurysm or Parkinson’s? Perhaps the diseases had a psychological twist like Alzheimer’s. Did your grandmother die of breast cancer? Does your family have a history of cancer, Alzheimer’s or Schizophrenia? These diseases are hereditary and knowing your family’s medical history would go a long way in determining the longevity and quality of life you are going to lead. True some of the diseases have no cure but most people would want to know how they are going to punch out and be prepared for the ordeal.Moreover medical research would be a lot easier if there was an organized database of our country’s medical history. How many people have HIV/AIDS? What is the leading cause of death in our country so that we can prioritize our resources and fight it?

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Establishing a centralized depository would be no small feat for a country without a single supercomputer. The government for some unknown reason continues to lag behind when it comes to implementing IT based solutions. And whenever they do they tend to be one of those ill-advised proprietary solutions that require Internet Explorer or some other weird requirement. This often results in vendor lock in and systems that are difficult to extend.

One way of solving the database problem would be to establish a private paid solution and I seem to remember a similar suggestion coming up during the 2011 ZOL Startup challenge.Besides the serious IT costs several other difficulties are likely to be encountered however, the least of which is convincing people to trust you and join your database. The second hurdle is to convince medical establishments to support and use your database which they would be hardly motivated to do unless there is a real incentive for them to do so. The third problem is convincing people to pay for using the database.

All these arguments point to the database being a public good like refuse collection and street lights. Everyone needs these but no one is willing to pay for them. Likewise everyone needs a database but either they don’t know it or they are unwilling to pay for it. Perhaps like me they do not know how to get one. For the meantime we are going to be stuck with this for a while longer.


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19 thoughts on “The need for an open and national medical database

  1. Good writing bt not feasible yet. Imagine from the land of plenty, UK, the gvt spent over £13 billion trying have a centralised health database and still failed: http://www.telegraph.co.uk/health/healthnews/8780566/Disastrous-11.4bn-NHS-IT-programme-to-be-abandoned.html.

    What we need first is our gvt departments to be digitised. That means people losing jobs and others with tech motive gaining new jobs. We all kno that this is going face stiff opposition from those benefiting from long queues and public suffering

    Then we need to provide infrastructure like connecting hospitals together and maybe GPs depending with security and vetting in place.

    Bt your mindset is heading towards good direction, l like.

  2. Good writing bt not feasible yet. Imagine from the land of plenty, UK, the gvt spent over £13 billion trying have a centralised health database and still failed: http://www.telegraph.co.uk/health/healthnews/8780566/Disastrous-11.4bn-NHS-IT-programme-to-be-abandoned.html.

    What we need first is our gvt departments to be digitised. That means people losing jobs and others with tech motive gaining new jobs. We all kno that this is going face stiff opposition from those benefiting from long queues and public suffering

    Then we need to provide infrastructure like connecting hospitals together and maybe GPs depending with security and vetting in place.

  3. I dont see the need to implementing such a system, especially when we lack ARV and other medications.

    1. To be fair MSF has been outstanding in distributing ARVs for free. The problem is certainly there but not as endemic as you would think.

  4. I have always thought of the need for such a system and actually developing one, getting the relevant stakeholders on board, there are so many way to protect privacy of the individuals if need be, but its necessity far outweighs the privacy fears, because we need to know, what is happening health wise in our country to better provide healthcare to those in need,

    And doing the math it might not be as daunting as it seems, consider this you simply start by getting all the government hospitals to send stats of the ailments they have treated that week or month, via even text message, and you store those in a DB, at the end of say 6 months you know what most pple suffer from and where, then yu start assigning patients ids un related to their name, and sending it all to a central db, so at the end of some time you have an IDs medical history, then u push it up a bit, a doc can search an IDs medical history when provided the ID . . . and so on

    In the end we have a system in place be it 5 years or what.

  5. hospitals just need to be digitalised, just a couple of computers for every hospital. then save medical history on the computers. a central health database is not feasible even in america. there are also privacy concerns of having the medical information of people available in the public domain. A more feasible alternative after we have computerised our hospitals would be Portable Electronic Medical Record via flash drives.

  6. Too much at stake. Privacy, funding and abuse of the system. We dont even have decent eGvt in place. Majority of the websites/systems currently running or trying to run are in shambles. Why would such a project prosper with all the mess around for us to see? Plus if it goes to tender, we all know where it will go to. And who will fund it? Do we really need it? What are the benefits to the society? We cannot even supply free ARV drugs to the general populace. The basics of the health system don’t exist at all. So what the doctor knows the patient’s health history. Are the drugs available? Ambulances to ferry patients? The wards to admit the patients?

    We could have a credit checking system in place now to vet current and future debtors but 5 years ago we could because we did not have credit facilities in place in retail outlets. Econet can now push more mobile services to the general populace now because they have ground work in place to do so. But certainly not a health system to collect and store patient data from across the various many dysfunctional hospitals and clinics.

    Good idea but at the wrong time.

    1. We could have a credit checking system in place now to vet current and
      future debtors but 5 years ago we could because we did not have credit
      facilities in place in retail outlets.
      Not sure if you mean that we did not have facilities as-in service.

      Just to mention that a retail credit checking system (as-in process) was active and functioning very well until hyperinflation affected all credit-related purchases. I am not privy of what systems they used(if they did) and whether they were networked but it certainly was centralised. Remember the infamous “Black Book”? Zim was certainly way ahead in terms of financial organisation and we were just about to leap into the ICT revolution and then got hit by politics and the eventual decline of the economy.

      For financial services, the BAZ spoke of establishing a bureau last year. I’ve also heard of one or two privately held bureaus

  7. And why on earth should it be an open (I am assuming here you mean open source) database. Are you assuming that each doctor will run his own copy on his local machine? If its centralized it can be any database, proprietary or open source.

    1. By open I am referring to an RFC like system that is based on open standards and formats.

    2. By open I am referring to an RFC like system that is based on open standards and formats.

      1. RFC is popularly used to mean Request For Comments. I do not see how this would be a good idea for developing an open national database. Why not use easier to manage approaches like specifying data exchange formats, APIs etc. Otherwise the cost of managing the the design process using RFC without any deep national experience of collaborative software design would simply kill the project before it starts. Maybe you have a different explanation of RFC,

  8. There is a Government established body called the HPA. It is responsible for ‘licencing’ all health practices, and indeed collects reasonable amounts in fees for these licences. They could, if they so wished, ensure the establishment and usage of such a database, in fact they could enforce institutions to upload patient health information onto the database thus ensuring its relevance, but the already burdened patient will have to pay for the infrastructure to be so established and even the extra manpower and systems that would have to be established in health facilities to input the information into the database. It is worth pointing out that at the moment, medical personnel write patient notes in long hand, often almost deliberately cryptic, and these are stuck in files. Capturing these onto a database is no walk in the park and demands considerably more resources.

  9. Our government is hooked on paper. Until such a time when someone who’s passionate about modernising filing comes government, they will probably continue using paper until the second coming of the good lord Jesus. There’s a lot of things that need to be computerised – the Central Registry comes to mind. And it’ll require quite a few dollars to get the ball rolling.

  10. We will always see slow progress in IT because of the lack of appreciation of its benefits by the general populace. Vanhu havadi kubhadhara. As a result you won’t see me developing much here, I’d rather go kubhadhara and use my talents there ndowana kurarama.

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