Last month I travelled up to Johannesburg to attend the Health Informatics of South Africa (HISA) conference, held at The Emperors Palace. The event was a great opportunity to learn more about the bigger picture with regard to the challenges South Africa faces in implementing effective health information systems.

I was surprised to find how political the debates were with regard to the major primary healthcare software packages and electronic record management. Very little consideration seems to be given to the usability of the many systems discussed. Presenters touted extensive feature lists while others complained about little budget for training and infrastructure. It seems that there is not much incentive for architects and designers to create these systems to be easy to use and appropriate for South Africa’s skills and infrastructure. Since there is such high cost and complex political persuasion in implementing a specific solution, departments seem to get locked in to long term contracts with specific providers. What I like about web 2.0 and Software as a Service (SaaS) is that there is always a risk that customers might leave for a competitor – this creates an urgent incentive to make the software really valuable and not just appealing at face value. Unfortunately with such large projects at district or national level, decisions need to be made up-front for long term commitments. From my little knowledge of the industry, it just appears that the software being created is overly complex and difficult to use.

A few speakers referenced the significant issues encountered during the NHS National Programme for IT in the UK, an endeavour claimed to be the largest IT project in history. Serious concerns have been raised relating to the scope, planning, budgeting, and practical value to patients of the initiative. Similar issues have also emerged during a recent health systems overhaul in Canada. Although concerning, these problems show that even without South Africa’s unique challenges, the task we face is daunting and we should be proud of what progress we are already making.

Another major theme looked into the quality and value of aggregated routine data obtained via the District Health Information System (DHIS). Caitlin Matson from Echo presented an excellent paper analysing the effectiveness of using aggregated DHIS data to evaluate the progress of a prevention of mother to child transmission (PMTCT) trial. I found this presentation particularly interesting as Caitlin highlighted many of the challenges we have also faced in using Mobile Researcher for managing study logistics for PMTCT projects. One of the major challenges she mentioned was how patients move between Primary Health Care clinics, their Community Health Centre Maternity Obstetrics Unit (MOU), the local hospital MOU and the District MOU as they move through Diagnosis, antenatal care, delivery and postnatal care. In conclusion, it was stated that PMTCT, Anti-Retroviral (ARV), tuberculosis (TB) and other similar interventions require patient level data, from a cohort that are tracked over time, rather than routine (aggregated) system data in order to effectively evaluate progress.

We had put together a paper entitled “An Information System for Good Start III – The Role of Web and Mobile Technologies in a Randomised Control Study” which I presented during an ICT session on day two. I had fifteen minutes to summarise the Goodstart Management Console (GSMC) and how it integrates to Mobile Researcher. The GSMC was designed to assist the Medical Research Council with a complex PMTCT trial through leveraging Mobile Researcher as a data collection platform and providing scheduling and reporting tools for managing participants, community health workers and their intervention schedules. If you’d like to learn more about the GSMC, you can read the case study online.

Overall, I enjoyed my time at HISA and came home with some interesting ideas, having met some smart people making great progress with IT for the health industry in South Africa.