A comparison of different approaches towards a computerised information system for primary health care in the Free State

Abstract

English: This study is undertaken in the light of the current importance of the Reconstruction and Development Programme (RDP) and the SA government's commitment to better primary health care (PHC) for everybody. Primary health care services in South Africa should be rendered as effective and complete as possible with the manpower available. The government should therefore have exact knowledge about the current health situation in the country in order to make pro-active provision for better health services in the areas that need it most. Nursing management should thus have access to periodical reports regarding the incidence of epidemics, certain notifiable diseases, the death rate, general housing conditions and much more. It is therefore of the utmost importance that the service providers should capture and process statistical data accurately. This study firstly analyses the current situation with regard to data capturing, processmg, presentation and utilisation. The analysis refers to the manual system of patient carried records, tally sheets as well as the available infrastructure. Nursing management in the Free State has a long term vision to implement a database system to service all fixed and mobile clinics. A complete patient record will be kept by the system and the complete clinical history of a patient will be available at each consultation. With such a system all the regular and ad hoc reports can be processed easily and accurately. This study firstly analyses the current situation with regard to data capturing, processmg, presentation and utilisation. The analysis refers to the manual system of patient carried records, tally sheets as well as the available infrastructure. Nursing management in the Free State has a long term vision to implement a database system to service all fixed and mobile clinics. A complete patient record will be kept by the system and the complete clinical history of a patient will be available at each consultation. With such a system all the regular and ad hoc reports can be processed easily and accurately. This study focuses on the process of computerising pnmary health care services. Some theoretical background on systems analysis and development are provided and thereafter three alternative approaches towards computerisation are proposed and investigated. For each of these proposals a prototype system was developed. The first prototype is based on a patient record approach and includes a complete set of health indicators as well as other demographic and clinical data. The second prototype is based on a minimum data set that leads to more user-friendly system. Thirdly a prototype system that is not based on a patient record but on head-count-approach was developed. This system· resembles the current manual system of tally sheets. The three alternatives are compared with regard to the issues of practicality, flexibility, ease of use, accuracy and completeness of statistical reports and efficiency of time utilisation. It is concluded that the flexibility of a patient-record approach, a_lthough more time-consuming, is preferred to a head-count approach. Furthermore, the ease of use of the s~cond alternative in a developing country with mostly computer illiterate nurses makes it a much more feasible approach than a more comprehensive system. Ways in which a computerised system can be implemented in an environment with limited hardware resources are also investigated. The study concludes with a proposed model for the computerisation of primary health care in the Free State.

Afrikaans: Die studie is ondemeem in die lig van die huidige belangrikheid van die Heropbou en Ontwikkelingsprogram (HOP) en die SA regering se verbintenis tot beter primere gesondheidsorg (PGS) vir almal. PGS-dienste moet so effektief en volledig moontlik gedoen word met die beskikbare mannekrag. Die regering behodrt insae te he omtrent die huidige gesondheidsituasie in die land om dienooreenkomstig pro-aktiewe voors1enmg te maak vir beter gesondheidsdienste in die gebiede wat dit die nodigste het. Verpleegdiensbestuur behoort dus toegang te he tot periodieke verslae aangaande die voorkoms van epidemies, sekere aanmeldbare siektes, die tempo van sterftes, algemene behuisingstoestande en baie meer. Dit is daarom uiters belangrik dat diensverskaffers statistiese data akkuraat moet versamel en verwerk. Die huidige situasie met betrekking to dataversameling, verwerking, voorlegging en benutting word eerstens ontleed. Die studie verwys na die handstelsel van pasientkaarte, merkkaarte sowel as die beskikbare infrastruktuur. Verpleegdiensbestuur in die Vrystaat het 'n langtermyn visie om 'n databasisstelsel te implementeer om in alle vaste en mobiele klinieke toeganklik te wees. 'n Volledige pasientrekord sal deur die stelsel gehou word en die volledige kliniese geskiedenis van elke pasient sal by elke konsultasie beskikbaar wees. Met so 'n stelsel kan alle gereelde en ad hoc verslae maklik en akkuraat gegenereer word. Die studie fokus op die proses van rekenarisering van primere gesondheidsdienste. Teoretiese agtergrond met betrekking tot stelselontleding en ontwikkeling word verskaf en dan word drie altematiewe benaderings tot rekenarisering voorgestel en ondersoek. Vir elkeen van die benaderings is 'n prototipe stelsel ontwikkel. Die eerste prototipe is gebaseer op 'n pasientrekord benadering en sluit 'n volledige stel gesondheidsindikatore sowel as ander kliniese en demografiese data in. Die tweede prototipe is gebaseer is op 'n minimum datastel wat lei tot 'n meer gebruikersvriendelike stelsel. Derdens is is 'n prototipe stelsel ontwikkel wat nie op pasientrekords gebaseer is nie, maar op 'n koptelling- benadering sodat dit eintlik 'n gerekenariseerde merkk:aart is. Die drie altematiewe word m.b.t. aspekte soos praktiese uitvoerbaarheid, buigsaamheid, akkuraatheid, volledigheid van statistiese verslae en effektiewe tydsbenutting vergelyk. Daar word tot die slotsom gekom dat die buigsaamheid van die pasientrekord-benadering, alhoewel meer tydrowend, verkies word bo 'n koptelling-benadering. Verder is die gevolgtrekking dat die eenvoud van gebruik van die stelsel wat op 'n minimum datastel geskoei is, dit 'n veel meer haalbare benadering maak in 'n land soos Suid-Afrika met meestal rekenaar-ongeletterde verpleegpersoneel. Wyses waarop 'n gerekenariseerde stelsel ge'implementeer kan word in 'n omgewing met beperkte apparatuur en netwerkinfrastruktuur word ook ondersoek. Die studie word afgesluit met 'n voorgestelde model vir rekenarisering van primere gesondheidsorg in die Vrystaat.