The Role of EHRs in Advancing Healthcare: Part 1 - Policy Landscape of Health Information Systems

The integration of Electronic Health Records (EHRs) into health systems has revolutionised how healthcare is delivered, monitored, and evaluated. Beyond being digital repositories of patient information, EHRs are a viable means to monitor the patients’ outcomes, the performances of health providers, and ensure the efficient use of public funds. EHRs used in a digital health information eco-system draws on from many different sources and partners. The use of EHRs increases the quality of healthcare delivery, accessibility of health services including improved financial risk and sustainability of health systems to deliver universal health coverage.

There is comprehensive literature showing that EHRs enhance the quality of healthcare delivered by increasing adherence to guidelines, increasing disease surveillance, and minimising medication errors (Wright, O'Mahony, & Cilliers, 2017). Furthermore, electronic patient record systems (EPRs) can reduce the amount of time nurses spend on documentation in hospitals. Due to EHRs limited successful implementation worldwide, there is insufficient evidence to draw strong insights about their ability to improve the quality and safety of patient care and there is also a lack of evidence about their cost-effectiveness (Wright, O'Mahony, & Cilliers, 2017).

However, despite their potential, the successful implementation of EHRs worldwide remains inconsistent. This has resulted in limited evidence about their cost-effectiveness and their ability to universally improve patient care quality and safety.

Challenges also persist when EHRs are introduced in settings where healthcare workers lack digital proficiency, or when systems are misaligned with clinical workflows. While secondary tasks like research and billing may become more efficient through centralised data access, primary clinical work can face disruptions (Wright, O'Mahony, & Cilliers, 2017).

This article examines the policy landscape shaping the adoption of Health Information Systems (HISs), focusing on the global and South African contexts.

Global Policy Initiatives

The global community has long recognised the transformative potential of digital health information systems. In 2005, the World Health Organization (WHO) spearheaded initiatives to encourage countries to adopt long-term resolutions for implementing such systems.

Two of the key objectives included:

• Creating a policy environment conducive to digital health innovation.

• Guiding governments to invest in and strategise for digital health integration.

These resolutions provided a foundational framework for countries aiming to modernise their healthcare systems through digital solutions.

South Africa’s Digital Health Policy Landscape

South Africa’s journey towards a comprehensive digital health framework has been marked by evolving strategies and challenges.

• The 2010 eHealth Plan:

  The National Electronic Health (eHealth) Committee introduced a 5-year plan in 2010 in line with these global developments. However, this initiative was not implemented due to its perceived resource demands, which stakeholders deemed unsustainable (Zharima, Griffiths, & Goudge, 2023).

  
  

• The 2012 eHealth Strategy and 2019 National Digital Health Strategy:

  Subsequent policies adopted a more consultative approach, placing greater emphasis on digital consumers and smart devices. Both of these policies highlighted resolutions for nationwide electronic health records (EHR) and proposed roadmaps to guide the implementation of health information systems on a shared platform (Zharima, Griffiths, & Goudge, 2023).

Despite their aspirations, these strategies faced criticism for their ambitious scope and limited practicality within a 5-year timeframe. Stakeholders called for costed roadmaps with prioritised actions tailored to provincial contexts to bridge the gap between policy and implementation (Zharima, Griffiths, & Goudge, 2023).

Challenges in HIS Implementation

South Africa’s HIS landscape reflects the complexities of digital transformation in healthcare:

1. Fragmented Systems: HISs in South Africa are diverse, often supporting specific tasks (e.g., billing) or roles (e.g., aiding nurses in care delivery). However, a lack of interoperability has resulted in isolated information silos. These silos hinder data sharing, duplicate activities, and create reporting discrepancies (Wright, O'Mahony, & Cilliers, 2017).

   
   

2. Financial Constraints: The financial burden of establishing and maintaining robust ICT infrastructure remains a significant barrier. Many provinces report varying levels of eHealth maturity, with underdeveloped systems struggling to integrate into a cohesive national framework.

   
   

3. Policy Limitations: Experts have identified gaps in existing frameworks, particularly the Health Normative Standard Framework (HNSF). This framework, developed by the Council for Scientific and Industrial Research (CSIR) and the National Department of Health, aims to standardise HISs across public and private sectors. However, concerns about its relevance and practicality in local contexts persist. Stakeholders argue that the framework lacks the detailed, context-specific guidance required for effective implementation (Zharima, Griffiths, & Goudge, 2023).

Conclusion

While policy efforts like the National Digital Health Strategy and HNSF demonstrate South Africa’s commitment to digital health transformation, their implementation has been hindered by resource constraints, fragmented systems, and insufficient tailoring to provincial needs. To address these challenges, South Africa must adopt a pragmatic approach, focusing on costed roadmaps, prioritised action points, and stakeholder collaboration at all levels.