Introduction
Methods
Survey
Current levels of care | Desired Levels of care | Facilities | Description |
---|---|---|---|
Level 1: Community | Level 1: Community | The village, households, families, individuals | • Community-based health services |
Level 2: Dispensaries and clinics Level 3: Health centres | Level 2: Primary care facilities | Dispensaries, clinics and Health centres, maternity homes | • Disease prevention and health promotion services • Inpatient services for emergency clients awaiting referral, clients for observation, and normal delivery services |
Level 4: Primary care hospitals Level 5: Secondary care hospitals | Level 3: County hospitals | Primary care hospitals Secondary care hospitals | • Comprehensive inpatient diagnostic, medical, surgical and rehabilitative care, including reproductive health services • Specialised outpatient services • Hospitals managed by a county |
Level 6: Tertiary care hospitals | Level 4: National referral hospitals | Tertiary care hospitals | • Tertiary/highly specialised services, including high-level specialist medical care, reference laboratory support, blood transfusion services, and research • have defined level of self-autonomy |
Digital health system identification and interviews
Ethics
Results
Survey results
Department (number of facilities = 121) | |||||||||
---|---|---|---|---|---|---|---|---|---|
CCC | Inpatient | Outpatient | Pharmacy | Laboratory | Billing | TB | Maternity | MCH | Radiology |
106 (88%) | 8 (7%) | 46 (38%) | 28 (23%) | 28 (23%) | 31 (26%) | 8 (7%) | 5 (4%) | 10 (8%) | 8 (7%) |
Proprietary | Open source | Coding | data exchange | Common Modules | |
---|---|---|---|---|---|
Hospital Management Systems | n = 7 | n = 0 | ICD10 | HL7 XML DICOM SQL CSV | Registration, billing, outpatient-clinical, pharmacy, laboratory, finance, Human resources, ainpatient-administration |
CCC systems | n = 0 | n = 11 | • CIEL/MVP concept dictionary with reference to ICD10 and SNOMED-CT • CPT4 • RxNorm | HL7 REST API XML | Registration, laboratory and pharmacy results, |
Interview findings
Hospital interview findings
System acquisition
Manager H13: “And we used it mainly for collecting revenue, but eventually it was developed to take care of the other services, as the main-focus was the out-patient, where we were able to withdraw all the papers and we were able to use the computers to offer the services, [such] as clerking of the patients.”
System support, acceptance and user training
Hospital manager H4: “Mostly immediate but depends on the priority of the problem/where in the hospital the problem has occurred. Problems at billing and registration are dealt with a lot sooner than other areas.”
Usability
ICT Admin H4: “Government forms that require original hardcopy forms make certain reports from the system unusable. Manual copies have to be filled out, stamped etc for physical delivery to relevant government offices”.
Departmental communication and system interoperability
System user H11:” No, we don’t currently [re-enter data] we are not putting them back to the [system] neither are we putting it back to the [other system] because of those challenges. We get the information from the patient, you’ll have to have some extra time or another person doing the feeding [of data] to the other system, this is a challenge to us because of the second part [entering the data again] …. Already we raised the issues so the vendor for [system] and the vendor for [other system] are trying to work on that so that they can communicate”
Report generation and data issues
Hospital manager H6: “Diagnoses offered by the system sometimes don’t match with the clinician’s impressions. And they may sometimes just click anything close so that they can move onto the next item required by the system.”
Infrastructure
ICT manager H4: “No work around during system downtime during power black outs; patients have to wait.”
Vendor technical interviews
Data and reporting
Vendor 8: “But when you go and try to give that [unique patient identifiers] to the government facility you find there are some people who are against even changing the MCH [Maternal and Child Health] numbers so you find that normally when it is manual, they have the have the ANC [Antenatal Care – for mothers] number they have the CWC [Child Welfare Clinic] for kids. But the same kid will be treated now as an outpatient will be given another number. So, we are telling them when it comes to electronics normally, the only way you can control this person is by using one number.”
Support to facilities
Vendor 5: “But of course, you know sometimes some of them are really urgent. They just call us that there is a patient with a doctor, their medical report is not opening so how do we go about it. Either via TeamViewer or whatever else, I can log in and be able to sort it out.”
User related challenges
Vendor 8: “With the counties, because monitoring is near to the facilities these guys [system users] now are forced to work. Before, when health used to be managed from AFYA house[building where the Ministry of Health is located in Nairobi, Kenya], by the time you go to [location Y] it may take months, so these guys [system users] used to relax but nowadays once a project is set in place, the infrastructure is there, the staffing is done properly, you are given an option, you either use the system or look for an alternative.”
System related
Vendor 2: “There is no facility which is using all of them[modules], but for those who have ordered the full system, now they start with the most critical. You know you can do them in modules then they start like this: revenue, registration of patients and admissions then they go to these clinical areas, supply chain because they want to monitor commodities and others go to HR payroll and all that “
Legislation, governance and national programs
Vendor 8: “They have started, what has happened with [system X], they are piloting in [hospital]. Because you see [system X] was from a private [facility] now they are trying to customize into the government way of working. Now it is becoming a bit of a challenge to have and you see these reports take time. I know eventually they will do it, but you see they have been getting some reports and now they not getting them.”