The health innovator

Western Cape Department of Health

The innovation

The eCCR (Electronic Continuity of Care Record) is a software application designed to integrate and digitise medical records for patients being discharged from public health facilities.

Winner of the Collaboratively Reimagining Care Award at the 2014 Inclusive Healthcare Innovation Summit

The action

Groote Schuur Hospital in Cape Town was the site of the first-ever human heart transplant in 1967. It also stands at the very heart of innovation in healthcare, in South Africa, and around the world. How appropriate, then, that it continues to set the pulse of progress in patient care, as the pilot site for a groundbreaking new application, the eCCR.

It was developed by a multidisciplinary team at the Western Cape Department of Health (DoH), faced with the challenge of too much paper and red tape. Why? Because healthcare takes its cues from the needs of patients, meaning medical records are essential. One of the most vital of these is the Continuity of Care Record, which tracks a patient’s progress through the system and allows for seamless transfer to other providers.

But poor record-keeping is a frequent and frustrating companion for public healthcare workers in South Africa. “It would drive me bonkers when I received a bad discharge summary, and had to start from scratch to figure out the patient’s needs,” says Dr Robin Dyers, Registrar in Public Health at Stellenbosch University and the Health Impact Assessment Unit of the Western Cape DoH.

As coordinator and champion of the eCCR team, he points to research showing that, due to poor communication between levels of care, only 25% of TB patients discharged from hospital actually arrive in primary healthcare. Discharging a child with TB from a hospital calls for a clinician to complete up to 10 different forms, says Dyers. Another headache comes in the form of missing or inaccurate ICD (International Classification of Disease) codes, required for insured and uninsured patients discharged from public hospitals in the Western Cape.

The solution

Developed by software programmer Shane du Plooy (who gave up many lunch hours at the Western Cape DoH to work on it), the eCCR is a computer application that integrates and standardises all necessary forms, making it easy to capture ICD codes, prescriptions and other data before discharge. This makes it a valuable resource to role-players across the spectrum of care. This was probably the greatest developmental challenge, says Du Plooy.

From pharmacists and finance officers to hospital managers and clinicians, a wide range of stakeholders’ needs had to be met. There were issues of ethics and data security, as well as compliance with national health standards and funding frameworks of major health programmes, such as HIV and TB. But in this delicate give-and-take, the guiding principle always remained the same: patient first.

“The eCCR provides the patient with a comprehensive summary of their stay in hospital,” explains Du Plooy, “as well as a description of the journey to achieving a desired health outcome.”

In addition to guiding patients towards health, the eCCR database is also a valuable tool for clinicians wanting to audit quality of care, and draw up disease profiles.

Initial results – at the Groote Schuur Department of Internal Medicine – have been very encouraging, with primary discharge ICD code coverage going from 10% to 100% for a sample of 40 records. Since the eCCR software is generic and scalable, it could easily be implemented at other healthcare facilities with computers and printers. It’s also intuitive enough to require only a 20-minute orientation for use in the field.

The lesson learned

Public healthcare is still a long way away from the ideal of the truly “paperless hospital”. But, by crystallising a need and then applying their energies to developing a solution, the eCCR team has shown that technology and knowledge can help ease the malaise of too much paper, bound up in too much red tape.

ALL THE WINNING INNOVATIONS IN HEALTHCARE: Nominations poured in. There were so many innovators to consider and commend. But, at the close of the first Inclusive Healthcare Innovation Summit (IHIS) in Cape Town 2014, a winner (or two) was finally chosen from the finalists in each of the five award categories. Meet the prize-winning people and projects here… Collaborative Reimagining Award: → Operation Sakuma Sakhe  → Electronic Continuity Of Care Record (eCCR) / Transforming the System from the Inside Out Award: → Parents Guidance Centre Reakgona  → AfriTox / Minding the Gap Award: → Umthombo Youth Development Foundation /Inclusive Technology Award: → Praekelt Foundation / Pioneering Approaches Award: → Kheth’Impilo

Adapted from the 2014 Health Innovator’s Review, compiled by Inclusive Healthcare Innovation, a joint initiative between the Bertha Centre for Social Innovation & Entrepreneurship at the University of Cape Town (UCT) Graduate School of Business, and the UCT Faculty of Health Sciences.