5 July 2002

Top Story

Computerising hospital management and information systems offers Africa a number of potential benefits. Sceptics rightly protest:’how can you even think about computers, when everything else is in a mess and there’s no money’. Perhaps these two positions are not as far apart as they seem. If African healthcare is to improve, it will obviously require greater resources. But even with greater resources, it will need improvements in management and administration to be able to handle increased resources. People capacity and training are almost as important as installing "kit". This week Helen Mellor of Elan Technologies describes how it computerised a group of hospitals in South Africa’s Northern Cape and the potential impact on the work of the hospitals.


Elan Technologies’ integrated hospital information system, Oasis, was selected just over two years ago by South Africa’s Northern Cape Province Health Board to replace their existing paper patient records at hospitals across the province. The launch in March 2000 of the Oasis Electronic Patient Record System at the 514 bed Kimberley Hospital was rapidly followed by implementation at a further five hospitals, with the sixth South African Oasis site ­ Voortrekker Hospital, Calvinia - going live in May 2000.


At its inauguration, the Northern Cape Health Minister E.D.Peters commented that Oasis will "provide readily available clinical data to the health care professionals, to facilitate effective patient care and treatment". Ms Peters complimented the Province’s selection board for having found a system which provides a "user-friendly environment for health workers, resulting in better health care for our people".


Prior to the installation of Oasis across the Northern Cape, the only computerised system in place was an elderly, character-based patient registration system, Delta9, at Kimberley Hospital. As this system not was not Y2K compliant, the priority was to replace that system before 31 December 1999 with at least the same functionality of the old system. The other five hospitals relied totally on paper records. Following investigations into the Northern Cape hospitals’ systems and procedures, set-up of the system was performed. The entire customization of the system was achieved locally without any program changes needing to be performed within Oasis.


Since only Kimberley had an existing computer system, it meant that implementation had to include basic PC training for 50% of users and Windows literacy training for 95% of users before users could be trained in the use of Oasis. The 374,000 existing patients on the Delta9 system were converted and loaded into Oasis, retaining the same patient identification. This conversion, which took about 15 hours to extract, convert and reload into Oasis, was performed on the weekend prior to implementation. Changeover to Oasis at Kimberley was a week ahead of target. Downtime between shutdown of the old system and startup of Oasis was only 30 minutes. Roll out of Oasis to the Gordonia, Kuruman, Springbok, De Aar and Calvinia Outreach Hospitals was completed smoothly and on time over the next four months.


The core modules of Oasis implemented in the first phase were Master Patient Registration, Admissions, Transfers, Discharges, Patient Billing and Debtors. In order to provide meaningful Outpatient attendance statistics, it was decided to also implement certain of the Outpatient Booking module features. This has subsequently been very well accepted and also expanded to use more of the booking features.


The success of this implementation cannot be underestimated. Kimberley Hospital and its six Outreach Hospitals serves patients across the whole of the Northern Cape Province, an area so large that it take some patients up to seven hours travel to reach hospital.


Oasis now provides hospital staff with easily accessible information regarding patient admissions and an improved facility for administering hospital accounts. Further advantages are that doctors in the wards can quickly obtain results of tests and clinical notes which are almost immediately accessible throughout the hospital, while the management of patient bookings is streamlined. All of these contribute to a more effective treatment of the patient.


Northern Cape Health Department can be proud that every milestone set since installation of Oasis has been reached on time and within budget. The outcome of their procurement compares favourably with previous unsuccessful projects in other South African provinces (for example, one province has retendered to replace a system which remained undelivered 4 years into the contract) and provides a model for future health system procurements. Future plans


Following the success of this initial phase, the provincial Health Board is looking at ways of extending the functionality of their hospital information system. The Department of Surgery supplies a Surgical Team which regularly flies into each of the Outreach Hospitals and clinics. They will be the pilot for Phase II of the implementation which includes Theatre Management, Order Entry, Results Reporting and Case Note Tracking. Future developments under consideration at Northern Cape include the establishment of a Province-wide central repository of information.


There is considerable interest in implementing Elan’s internet based e-oasis system for deployment of the system to all hospitals and clinics with access to the province-wide network. Deon Madyo, CEO of Kimberley Hospital Complex is keen to implement e-oasis. Deon says that "the potential for improving disease management by providing clinicians across the region with access to province-wide electronic health records is a very real proposition, now that all our hospitals have standardised on the Oasis system to manage their patient records"


Elan Technologies is a British software company which specialises in developing advanced healthcare solutions. Their current customer base is in the United Kingdom, Italy, South Africa and the Middle East. Details of Elan’s products and services can be found on their website



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