Right from ancient times, physicians and health workers through the ages have always had a need to document patient history, drug doses and prescriptions. Whether on papyrus, scrolls or paper as we have today, the documentation of health information has always been a key component of quality healthcare delivery. Although the history of sub-Saharan African medicine is a little fuzzy, there is no denying the fact that human memory alone could not accurately store the health info of anything more than a small village. Health informatics has always been of great import, and that importance has never been as great as it is today.
We are on the brink of the fourth industrial revolution (the information age) yet we have not even been able to properly harness the positive effects of the second, chief of which was electricity. With our large population in need of quality healthcare, the current methods have proven insufficient to meet our healthcare needs.
We are in the midst of a health data crisis! The sooner we realize this, the better for everyone.
Enter electronic health records. EHR involves the use of computer software to gather, collate,analyze and store health data. It has been around for a while, since the 1950’s in fact, and since then many hospitals and doctors in the U.S (over 78%) and most of Europe (80% in the U.K) have opted for the electronic health record over paper records. The reason for the switch is quite obvious to industry experts:
- It improves efficiency of the healthcare delivery process.
- Saves cost in the long run.
- Provides important health data for monitoring and evaluation of current hospital policies
- Helps governments plan policies based on accurate data and not mere estimates
- Boosts the confidence of consumers in their healthcare provider.
- Improves the overall quality of the health system in general.
So why has EHR penetration not been widespread in Nigeria despite all these advantages? Well, the answer is manifold, but to summarize,
- High cost of installation and maintenance of equipment,
- inconsistent electricity supply,
- low levels of awareness of the advantages of EHR
- Abysmally low government funding of healthcare. Most of the healthcare facilities in Nigeria are government owned and the 2017 budgetary allocation for healthcare was about 50billion naira which is about $150million. That is less than $1 per individual!
- Reluctance of the health workers themselves to change their MO.
Does that mean it cannot be done here? Hell no. Nowadays people who say it cannot be done are often interrupted by people already doing it, so a few health companies have come to fill this need and have thus carved out a niche for themselves in our nascent Nigerian health-tech space.
- APMIS: This is a company that deploys technology to not just store health data but they also sync the entire healthcare process from patient history to paying of bills to radiology to notification of your next appointment. They are arguably the biggest players in the field today.
- Curacel: A Nigerian startup that has built an affordable and easy to use electronic health information management system for clinics in developing countries
- e-Health Africa: Is an international organization founded by Evelyn Castle and Adam Thompson. It’s based in Germany but has operations in Liberia, Sierra-Leone and northern Nigeria. They were able to successfully deploy low-cost, low-power equipment to one health facility in Kano and have been active in disease surveillance and notification for Polio and Ebola in the region through the use of openMRSsoftware.
- OneMedical: This is a strictly EHR company based in Lagos which aims “to make it possible for Nigerian healthcare institutions to go digital using their simple, instant and free* platform”.
- Swift Practice EMR: Based in Abuja, they have been able to serve a number of centers within the Abuja metropolis and environs.
This list is in no way exhaustive but players in this field are quite few and it can barely be said that an ecosystem exists today. Hopefully that will not be the case for too long. Last year, CERNER Corp.,the largest EHR company in the U.S posted a revenue of $2.67billion. There are opportunities. There are possibilities, and I choose to be an optimist.
So, is the case note in Nigeria going into extinction anytime soon? That is highly unlikely as still less than 1% of healthcare organizations in Nigeria today make use of technology for service delivery. However there are hopes that with the development of entrepreneurship around the problems of health informatics bedeviling the country today, we may begin to push the case note into the museum of modern medicine where it belongs alongside bucket latrines and anesthesia-less surgeries.
ODIAWA IJEWEME EDIKAN
DIGITAL HEALTH NIGERIA