Since February 2015, the Ministry of Health and Child Protection, with the help of financial partners, designs, develops and tests an electronic health record. (DSE) system, named “Impilo”. This aims to reduce the current burden of collecting paper-based data on health workers and ultimately improve the quality of care in public health facilities.
After conducting pilot projects in rural and urban areas, the government has announced that it will now embark on a nationwide deployment. The goal is to deploy Impilo in 5 central hospitals, 7 provincial hospitals, 30 district hospitals and 384 clinics across the country. Training sessions for health workers have started in provincial hospitals across the country, in pursuit of a goal of full deployment by December 2023.
The ministry has adopted an SIS enterprise architecture with an interoperability layer. Impilo’s architecture is based on the Open Health Information Exchange (OpenHIE) architectural best practices, where captured data is stored and accessed from standardized repositories through a central interoperability layer.
The heart of Impilo is the interoperability layer. This facilitates the exchange of messages between all the components of the architecture. Impilo is deployed as a web application and mobile application
Looking at the system, several opportunities for tech entrepreneurs present themselves.
1. The open HIE
Impilo is built around the OpenHIE framework following the principles of enterprise architectures. This incorporates scalability as the system can add more functionality over time as the interoperability layer has adapters for plug-ins to various systems. This creates room for third-party health applications to integrate into the system, allowing them to export or import health information. It means an electronic health record (DSE) used in a private hospital could exchange information with Impilo to allow continuity of care for a patient moving from private to public or vice versa. This is good news for providers of the national electronic health record system who are currently competing for market share among private hospitals and clinics. The opportunity created by the exchange of health information extends beyond the health sector. An insurance company, as part of the underwriting process, may import health information from Impilo to determine a life insurance policy. There is huge potential for room 3e party developers to operate, just as Impilo was 100% made locally.
2. Maturity model
The HIMSS Electronic Health Record Adoption Model (EMRAM) is one of the models used to measure the level of advancement of patient information management systems. By rating Impilo at this scale, the DSE can be considered to be at level 2 or 3. This means that there is room for a lot more functionality to add. This includes a clinical decision support system (CDSS), a radiological information system (LAUGH) with a full complement of PACS (Image archiving and communication system) and business intelligence analysis. Forward-thinking entrepreneurs should invest in developing solutions to deliver these functionalities that rely on Impilo as the foundation. Instead of building a complete EHR from scratch, they can choose to focus on perfecting a CDSS or data analysis application as a single plug-in.
Impilo’s role is a huge company that needs a lot of infrastructure to build and maintain it. Procurement processes will hopefully be updated to allow private actors to provide hardware or offer technical support services. Network engineers will be needed to configure local area networks and wireless access points. The Ministry of Health announced that it has also partnered with the Global Fund through the United Nations Development Program to launch and maintain a national broadband connectivity project in the country’s 350 major health facilities. , depending on the volume of patients. There is also a need for emergency power in these health facilities. It is an opportunity for solar and renewable energy entrepreneurs to do business.
Health records contain very sensitive information, therefore, data security and privacy are of the utmost importance. As Impilo is deployed nationally, it is necessary to patch all security vulnerabilities in the software to ensure that the central data center is managed securely and databases are backed up securely. This requires contractors who specialize in data security, as improving the security of the system will be an ongoing effort.
5. Big data
The national electronic health record system will create a reservoir of valuable health information as it will longitudinally track an individual’s health information from birth to death. It’s Big Data! Data engineers and analysts can therefore use it to conduct health research. Instead of researchers spending hours rummaging through paper archives, a fast and intelligent search algorithm can be used. There will be a demand for custom search tools to dive into the data pool and extract the required information.
6. Noncommunicable diseases
The architecture of Impilo allows the addition of modules in order to bring continuous improvements. One module that is needed is a module on noncommunicable diseases which not only focuses on treatment but also integrates prevention. Non-communicable diseases include diabetes, cardiovascular disease, and cancer. These take over from infectious diseases such as HIV, tuberculosis and malaria. Noncommunicable diseases are the new battle front. The hope in this battle is that these diseases will be largely preventable through lifestyle changes. This requires a robust module on Impilo which could synchronize with an activity monitoring application. This could export information about a patient’s exercise to the EHR, allowing clinicians to track their patient between visits. The third-party application could then import clinical information such as medication or diet prescribed to the patient and then adjust the exercise routine.
Smart health devices capable of digitally sending health information directly to the Impilo database will be needed. This ranges from IoT-enabled Bp thermometers and machines to continuous monitoring devices that transmit real-time information such as oxygen saturation, blood sugar and ECG. They are necessary extensions of the EHR to reduce human error, make healthcare more proactive, and make the entire healthcare process paperless. Medical device vendors will need to shift towards providing more of these smart gadgets as the EHR will make full use of them.
8. Artificial Intelligence
EHR systems are the foundation of AI applications in 2 ways. They provide digital data for the development of machine learning algorithms and also provide a ready hosting platform for AI applications. Deploying Impilo then lays the foundation for AI applications such as clinical decision support solutions that help prevent human error and ensure treatments follow approved guidelines and protocols. A wide application of AI is in the field of radiology where it was used to detect abnormalities on mid-digital scans. AI can alleviate human resource shortages by taking on certain functions that relieve pressure from health workers. AI could be used to automate the writing of clinical documentation and prioritization of patients based on the severity of their symptoms.
Impilo’s code will be made Open Source as a gesture to allow integration. However, for digital health entrepreneurs to take advantage of these opportunities, they will need to conform their solutions to the standards used by the Health Information Exchange for full interoperability. Some of the standards used by Impilo are HL7, CDA, CCD, ICD, LOINC, DICOM, SNOMED and RxNorm for drugs.
It took some time, from development to nationwide deployment. Partly because the government chose to build a solution from scratch. As Impilo matures, we hope that private sector solutions will be allowed to connect to the system for faster deployment and realization of system benefits.