SA - 54 million population
Life expectancy isn't great, way below targets
High infant mortality rate
Health care is poor compared to the amount spent
Two systems, public and private - 50% funds to each
84% of the poulation is served by the public system, 16% by the private, despite 50/50 spend split
NHI busy being implemented
The dream: Integrated quality care for all
Important to integrate things like social services, preventative care and lifestyle mangement into the healthcare system
This increases the quality of the services offered
Provider continuity is important
Strong case for interop - can't offer integrated care without sharing health information
Interop is critical for an NHI
Report published a few years back listing issues with healthcare
Priority 3 - Standards and interop
HNSF created - systems required to conform to this to be properly interop
Largely tech agnostic, although it does assume some architectural designs
Significant problem - exchange of information between systems
Some key flows identified - Child and maternal health included
Took existing standards, such as HL7
Considerd scalability and connectability
Considered specific health functions required
Displayed diagram - Some sections are isomorphic to the OHIE diagrams
Govt blocked all procurement of new health systems - HNSF should pave the way to remove this roadblock
Can't be static - have to keep updating
Next phase - out of scope items, such as mobile health, and refreshing the existing framework
Create reference implementations
Provide architectural guidance to implement at national scale
Assist with procurement
Missing: compliance testing facility. Unsure how to implement, would love feedback.
Any national scale interventions need a robust governance and regulatory framework
SA has strong requirements around protection of information - POPI etc.
Questions:
Framework isn't prescriptive internal to systems, only cares about interface points.
Important not to stifle creativity in health systems - how to certify is definitely an outstanding question
Lessons - need very senior support to implement a project of this scale (this was a senior minister's pet project)
- important to map out a national plan
- Need to take into account existing standards - everything from scratch would be ludicrous
Strong recommendation - Try to build on top of existing systems
Unsure how new standards would be incorporated. It's intended to be a living framework, so it's intended to be refreshed as new tech comes along. Should be refreshed every ~2 years.
SA is a wild mix of infrastructure extremes. Priority 8 on the aforementioned report describes ongoing infrastructure requirements. HNSF doesn't prescribe what comms tech to use.
In some cases, HNSF has made no difference, since the decision lies with provincial DOH. Some systems have seen a lot of activity around implementing HNSF.
Governance and leadership responsibility probably lies with the NDOH.
This can be used as a reference for other countries to use to implement their own versions. Maybe wait for v2 refresh, incorporates some important new things.
Standards selected were based on use cases, taking into account existing standards. Some parts needed to take government mandates into account.