Thembalethu HIV/Aids clinic in Helen Joseph Hospital is an example of how the use of technology in clinics and hospitals not only increases efficiency, but also helps pick up trends of resistance to treatment. The clinic, in the left wing of the hospital, is one of non-profit organisation Right to Care’s 36 sites, which cater for HIV/Aids patients, but what makes it stand out is its use of technology.
Since 2000, when chief executive Ian Sanne bought the clinical decision and patient-management system known as TherapyEdge (TE), the clinic has used it as its backbone for innovation. Put simply, the TE is a software system installed to manage all the clinic’s activities, including monitoring trends of patient response to medication. Each patient has to be registered into the system and allocated a “TE number”.
This allows a digital file, available to all staff with access to the TE, to be created and used each time the patient visits the centre. Sanne said the digital files ensure there is less risk of mistreatment because the doctors and nurses, and even the clinic’s pharmacy, have the patient’s medical history at the click of a mouse. Another advantage of having digital medical records, said Sanne, is that there is no risk of files getting lost.
Recently, the hospital integrated its system with the National Health Laboratory Service (NHLS), an innovation praised by Dr Itumeleng Motloung, the medical manager at Thembalethu. “Previously, patients would have to have a pile of papers showing their blood-test results, but that is not necessary anymore. After the NHLS has finished with the blood tests, the results appear on the TE and I don’t have to see a printout, I can get it from the digital file,” he said.
Beauty Moseamedi, the TE supervisor, said the clinic has a data capturing department that uploads all the patients’ details and performs quality checks to ensure that all the patients’ medical and personal details are correct. Because of that managed information, she said, the clinic’s data is so advanced that, “even if you ask me how many patients we are expecting on Christmas Eve, I can tell you”.
This, she said, is possible because all patients receive their doctors’ appointments before they leave the clinic and they are all uploaded on to the system. She said the TE also enables patients to transfer to any of the sites that use the system. “If a patient from another site runs out of medication while he or she is temporarily living closer to this clinic, the patient can come here and we can give the patient the medication. We call the site the patient normally attends and the information is verified in less than five minutes,” she said.
Patient information can also be digitally transferred. When a patient relocates from one of the TE sites, the clinic transfers the digital medical records, which can take between one and two days to complete. Another technological intervention, called TxtAlert (text alert), keeps patients in the loop about their appointments at the clinic. Run by the Praekelt Foundation, it sends reminders to patients.
This system is linked to the TE. It picks up the patient’s digital information, detects which patients are booked for what day and then sends them reminders. It has been working since 2007 and for patients like 27-year-old Refilwe Letsatsi (not her real name), who has to juggle the responsibility of raising a 10-year-old child and her job as a domestic worker, the system is useful.
Letsatsi admits to having forgotten a few of her appointments in the past. But the alerts have helped because they remind her about her appointments and allow her to reschedule them if needed. The system sends four reminders. The first is sent two weeks before the patient’s appointment, giving him or her the option to send a “please call me” message if he or she can’t make the appointment and needs to reschedule.
Another reminder is sent a day before the appointment. On the day of the appointment a message is sent to thank the patient for honouring the appointment or to notify him or her that the appointment was missed and that another should be made urgently. “I receive a lot of ‘please call me’ messages from patients. They know me well now. Some ask me why their medication looks different. Others ask me all sorts of questions they are too scared to ask doctors,” said Khumbuzile Dlamini, a TxtAlert counsellor.
However, sometimes the clinics do have problems with the computer system. Sometimes the computers are slow, freeze or crash. Sanne said that, through the use of TxtAlert, the hospital has managed to reduce the number of loss-to-follow-up patients (those who dodge their medication) from 30% to 4%”.
He said the TE system has also helped to manage the pharmacy’s drug stockpile and, most importantly, keep track of the whole operation of the clinic. “I believe the same system can be expanded to healthcare centres that deal with other chronic diseases,” he said.