Health information technologies for improved continuity of care: a South African perspective

The fragmented nature of modern health care provision makes it increasingly difficult to achieve continuity of care. This is equally true in the context of the South African healthcare landscape. This results in a strong emphasis on the informational dimension of continuity of care which highlights the importance of the continuity of medical records. Paper-based methods of record keeping are inadequate to support informational continuity of care which leads to an increased interest in electronic methods of record keeping through the adoption of various Health Information Technologies (HITs). This research project investigates the role that various HITs such as Personal Health Records (PHRs), Electronic Medical Records (EMRs), and Health Information Exchanges (HIEs) can play in improving informational continuity of care resulting in the development of a standards-based technological model for the South African healthcare sector. This technological model employs appropriate HITs to address the problem of informational continuity of care in the South African healthcare landscape The benefits that are possible through the adoption of the proposed technological model can only be realized if the proposed HITs are used in a meaningful manner once adopted and implemented. The Delphi method is employed to identify factors that need to be addressed to encourage the adoption and meaningful use of such HITs in the South African healthcare landscape. Lastly, guidelines are formulated to encourage the adoption and meaningful use of HITs in the South African healthcare landscape to improve the continuity of care. The guidelines address both the technological requirements on a high level, as well as the factors that need to be addressed to encourage the adoption and meaningful use of the technological components suggested. These guidelines will play a significant role in raising awareness of the factors that need to be addressed to create an environment conducive to the adoption and meaningful use of appropriate HITs in order to improve the continuity of care in the South African healthcare landscape

A South African perspective on factors that impact on the adoption and meaningful use of health information technologies

Objective: Various benefits are associated with the adoption and meaningful use of health information technologies (HITs) in the healthcare sector. Despite the associated advantages with the adoption and use of HITs, the South African healthcare sector has been slow to adopt HITs, such as electronic record systems. The purpose of this study was to identify factors that should be addressed to encourage the adoption and meaningful use of HITs in the South African healthcare landscape.Design: A three-round Delphi study was conducted to identify such factors.Setting and subjects: The Delphi panel included 21 participants who were considered to be suitably knowledgeable about the acceptance and significant use of HITs in the context of the South African healthcare setting.Results: A total of 58 factors were uncovered by the participants. Consensus was reached on 42 factors that were considered to have a direct to significant impact on the adoption and meaningful use of HITs in the South African healthcare sector.Conclusion: The results of this study highlight factors that should be addressed to encourage the adoption and meaningful use of HITs in South Africa’s healthcare setting. These results indicate that a wide range of factors need to be addressed and involve a multitude of stakeholders.Keywords: health information technology, adoption, meaningful use, South Africa, Delphi stud

The assessment of acceptance and identification of barriers to use of electronic medical records by doctors in emergency centres in Cape Town, South Africa

Thesis (MFamMed)--Stellenbosch University, 2022.ENGLISH SUMMARY: Introduction: Millions of people in developing countries face serious health risks. It is believed that incorporating technology into healthcare is one way to overcome some of these challenges faced by developing countries. However, acceptance of electronic medical records (EMRs) into daily practice has been poor despite these potential advantages. In order to realise the potential benefits from EMR technologies, they must be adopted broadly and assimilated deeply across healthcare settings. The study aimed to assess acceptance and barriers to use prior to implementation of EMRs. Methods: The Unified Theory of Acceptance and Use of Technology model was used to assess technology acceptance. A self-administered questionnaire-based survey was sent to emergency centre (EC) doctors working in district hospitals in the Cape Town metropolis. Results: With a 73% (n=105) response rate, participants believed that EMRs would be both useful in their practice and improve their productivity. Almost 50% (n=51) of participants felt that they would find EMRs easy to use and approximately 60% (n=61) felt they would receive management support. However, the participants felt that the necessary resources would not be available for success, specifically a lack of financial investment, training and support as well as poor infrastructure and project management skills. Conclusion: The study overall indicates that the majority of doctors are willing to use EMRs in their daily practice. Barriers to successful implementation were similar to those found in similar studies conducted in other environments, and include financial, technical and change process barriers. There is a need to conduct further studies involving other cadres of staff including ECs where EMRs are already in use.AFRIKAANSE OPSOMMING: Geen opsomming opsommingMaster

Unlocking the Potential of Information Communications Technology to Improve Water and Sanitation Services: Summary of Findings and Recommendations

This study provides evidence on how Information and Communication Technology (ICT) can be used to leapfrong the water and sanitation sector towards more sustainable service delivery. It sought to not only document experiences of Information and Communication Technology use in the WASH sector, but also analyze them within the framework of enabling factors and barriers in terms of vision, process, customer/user, service delivery, human capacity, governance and finance

Factors influencing the adoption of mobile health monitoring and care systems by the elderly living at home in South Africa: a case of Buffalo City Metropolitan Municipality.

The gradual increase of elderly people around the globe necessitates intensive dialogue amongst government, the healthcare sector and elderly communities as per MPAA 2002 resolutions. Literature identifies technology as the enabler to drive the facilitation of improved living conditions beginning with an affordable, accessible and integrated health information system (HIS). The attainment of a better quality of care to meet the elderly’s needs requires the re-engineering of current modalities. The diverse nature of South Africa is more suited to a people-based rather than a process-centric approach currently in existence. Access barriers, affordability, the digital divide, lack of government buy-in, and fragmented HIS are considered major impediments to adoption of mobile monitoring and care systems (MMCs) for the elderly’s healthcare. Given the complications brought about by the Covid-19 pandemic, the adoption of MMCs cannot be more pronounced. However, despite available literature regarding elderly issues in both developed and developing countries, the elderly plight has still not been considered a national priority. The main purpose of this research was to investigate why elderly people do not adopt MMCs to improve their quality of life, with MMC technologies as a general area of research. The main objective of the study was to develop critical success factors to improve the adoption of MMCs by the elderly living at home. This would potentially alleviate the burden on healthcare resources and also improve the elderly’s quality of life. Primary data collection took place from 21 February to 28 February 2020 in Buffalo City Metropolitan Municipality. Semi-structured interviews were conducted with 15 participants comprising one male and 14 females who represented the elderly Black, Coloured, Indian and White people. This qualitative research tool and purposive sampling method were chosen in order to fully capture the participants’ experiences in the home environment, which excluded those living in frail care or step-down facilities or state institutions. Despite the sample size being small and not being generalizable, it delivered rich information which provided a deeper understanding and fresh insights into the landscape of the elderly and their healthcare needs. The interviews were recorded, transcribed and analysed thematically. The study found that elderly communities are not entirely averse to adoption of MMCs but challenges like affordability and chronic shortage of technical skills prove to be impediments to adoption of MMCs for the elderly’s healthcare. The lack of standardisation and data governance pertaining to data sharing in HISs also serve to exacerbate the matter. The study, therefore, recommends collaborative engagements amongst government, business and the elderly to facilitate the availability of affordable and accessible ICT infrastructure for the elderly communities. Improved adoption of MMCs carry the potential benefit which emanates from the assumption of a pro-active role by the elderly and optimising available MMCs thus reducing strain and freeing-up healthcare workers to concentrate on core duties. The onus thus falls on the healthcare sector to revise the available strategies which seek to enhance the quality of life of the elderly people living in the home environment.Thesis (MCom) (Information Systems) -- University of Fort Hare, 2021

Factors influencing the adoption of mobile health monitoring and care systems by the elderly living at home in South Africa: a case of Buffalo City Metropolitan Municipality.

The gradual increase of elderly people around the globe necessitates intensive dialogue amongst government, the healthcare sector and elderly communities as per MPAA 2002 resolutions. Literature identifies technology as the enabler to drive the facilitation of improved living conditions beginning with an affordable, accessible and integrated health information system (HIS). The attainment of a better quality of care to meet the elderly’s needs requires the re-engineering of current modalities. The diverse nature of South Africa is more suited to a people-based rather than a process-centric approach currently in existence. Access barriers, affordability, the digital divide, lack of government buy-in, and fragmented HIS are considered major impediments to adoption of mobile monitoring and care systems (MMCs) for the elderly’s healthcare. Given the complications brought about by the Covid-19 pandemic, the adoption of MMCs cannot be more pronounced. However, despite available literature regarding elderly issues in both developed and developing countries, the elderly plight has still not been considered a national priority. The main purpose of this research was to investigate why elderly people do not adopt MMCs to improve their quality of life, with MMC technologies as a general area of research. The main objective of the study was to develop critical success factors to improve the adoption of MMCs by the elderly living at home. This would potentially alleviate the burden on healthcare resources and also improve the elderly’s quality of life. Primary data collection took place from 21 February to 28 February 2020 in Buffalo City Metropolitan Municipality. Semi-structured interviews were conducted with 15 participants comprising one male and 14 females who represented the elderly Black, Coloured, Indian and White people. This qualitative research tool and purposive sampling method were chosen in order to fully capture the participants’ experiences in the home environment, which excluded those living in frail care or step-down facilities or state institutions. Despite the sample size being small and not being generalizable, it delivered rich information which provided a deeper understanding and fresh insights into the landscape of the elderly and their healthcare needs. The interviews were recorded, transcribed and analysed thematically. The study found that elderly communities are not entirely averse to adoption of MMCs but challenges like affordability and chronic shortage of technical skills prove to be impediments to adoption of MMCs for the elderly’s healthcare. The lack of standardisation and data governance pertaining to data sharing in HISs also serve to exacerbate the matter. The study, therefore, recommends collaborative engagements amongst government, business and the elderly to facilitate the availability of affordable and accessible ICT infrastructure for the elderly communities. Improved adoption of MMCs carry the potential benefit which emanates from the assumption of a pro-active role by the elderly and optimising available MMCs thus reducing strain and freeing-up healthcare workers to concentrate on core duties. The onus thus falls on the healthcare sector to revise the available strategies which seek to enhance the quality of life of the elderly people living in the home environment.Thesis (MCom) (Information Systems) -- University of Fort Hare, 2021

Responsible AI in Africa

This open access book contributes to the discourse of Responsible Artificial Intelligence (AI) from an African perspective. It is a unique collection that brings together prominent AI scholars to discuss AI ethics from theoretical and practical African perspectives and makes a case for African values, interests, expectations and principles to underpin the design, development and deployment (DDD) of AI in Africa. The book is a first in that it pays attention to the socio-cultural contexts of Responsible AI that is sensitive to African cultures and societies. It makes an important contribution to the global AI ethics discourse that often neglects AI narratives from Africa despite growing evidence of DDD in many domains. Nine original contributions provide useful insights to advance the understanding and implementation of Responsible AI in Africa, including discussions on epistemic injustice of global AI ethics, opportunities and challenges, an examination of AI co-bots and chatbots in an African work space, gender and AI, a consideration of African philosophies such as Ubuntu in the application of AI, African AI policy, and a look towards a future of Responsible AI in Africa. This is an open access book

Engendering the meaningful use of electronic medical records: a South African perspective

Theoretically, the use of Electronic Medical Records (EMRs) holds promise of numerous benefits in healthcare provision, including improvement in continuity of care, quality of care and safety. However, in practice, there is evidence that the adoption of electronic medical records has been slow and where adopted, often lacks meaningful use. Thus there is a clear dichotomy between the ambitions for EMR use and the reality of EMR implementation. In the USA, a legislative approach was taken to turn around the situation. Other countries such as Canada and European countries have followed suit (in their own way) to address the adoption and meaningful use of electronic medical records. The South African e-Health strategy and the National Health Normative Standards Framework for Interoperability in eHealth in South Africa documents both recommend the adoption of EMRs. Much work has been done to establish a baseline for standards to ensure interoperability and data portability of healthcare applications and data. However, even with the increased focus on e-Health, South Africa remains excessively reliant on paper-based medical records. Where health information technologies have been adopted, there is lack of coordination between and within provinces, leading to a multitude of systems and vendors. Thus there is a lack of systematic adoption and meaningful use of EMRs in South Africa. The main objective of this research is to develop the components required to engender meaningful use of electronic medical records in the South African healthcare context. The main contributors are identified as EMR certification and consistent, proper use of certified EMRs. Literature review, a Delphi study and logical argumentation are used to develop the relevant components for the South African healthcare context. The benefits of EMRs can only be realized through systematic adoption and meaningful use of EMRs, thus this research contributes to providing a road map for engendering the meaningful use of EMRs with the ultimate aim of improving healthcare in the South African healthcare landscape

Electronic health record system in the public health care sector of South Africa: A systematic literature review

Background: South Africa is planning to implement the National Health Insurance (NHI) scheme in the near future. The NHI is intended to improve the accessibility of quality health care services for all South African citizens. For the NHI to achieve this objective, an electronic health record (EHR) system to register and track patients who visit different health care providers will have to be developed. Aim: To identify critical success factors for the implementation of EHRs in South Africa’s public health care sector. Setting: This study reviewed studies on EHR implementation in African countries published between 2006 and 2017. Methods: The study made use of a systematic literature review to identify barriers to the implementation of EHRs in the public health care sector. Results: Fifteen articles were included in the study. The study identified technical, social and environmental barriers to the implementation of EHRs. The barriers could further be broken down into lack of supporting infrastructure; user training and commitment; political influence or strategy; legislation and regulations; and the lack of a framework for implementation and management of EHRs. The study suggests six main recommendations for the successful implementation of EHRs in South Africa’s public health care sector. Conclusion: The study recommended investing in alternative infrastructure facilities, incentivising the health informatics field to attract and retain information and communication technology professionals and to encourage the participation of all stakeholders in the development process to develop context-relevant e-health implementation strategies, legislation and frameworks. Government should also allocate separate budgets for e-health projects