A Generic Quality Assurance Model (GQAM) for successful e-health implementation in rural hospitals in South Africa.

Although e-health can potentially facilitate the management of scarce resources and improve the quality of healthcare services, implementation of e-health programs continues to fail or not fulfil expectations. A key contributor to the failure of e-health implementation in rural hospitals is poor quality management of projects. Based on a survey 35 participants from five rural hospitals in the Eastern Cape Province of South Africa, and using a qualitative case study research methodology, this article attempted to answer the question: does the adoption of quality assurance (QA) models add value and help to ensure success of information technology projects, especially in rural health settings? The study identified several weaknesses in the application of QA in these hospitals; however, findings also showed that the QA methods used, in spite of not being formally applied in a standardised manner, did nonetheless contribute to the success of some projects. The authors outline a generic quality assurance model (GQAM), developed to enhance the potential for successful acquisition of e-health solutions in rural hospitals, in order to improve the quality of care and service delivery in these hospitals.

Guidelines to encourage the adoption and meaningful use of health information technologies in the South African healthcare landscape.

There are various benefits associated with the adoption and meaningful use of health information technologies (HITs) in the healthcare sector. Despite these benefits, the South African healthcare sector has been slow to adopt HITs such as electronic record systems. The purpose of this research project was to formulate guidelines to encourage the adoption and meaningful use of HITs in the South African healthcare landscape. A three-round Delphi study was conducted to identify factors that should be addressed to encourage the adoption and meaningful use of HITs in the South African healthcare landscape. The Delphi panel included 21 participants that were considered to be suitably knowledgeable regarding the area under consideration. Consensus was reached on 42 factors that were rated as having a direct to significant impact on the adoption and meaningful use of HITs in the South African context. These factors were further analysed to formulate 20 guidelines that indicate that there are a wide range of factors that would have to be addressed involving a multitude of stakeholders.

Citizens and personal health records - the case of Nelson Mandela Bay.

This paper explores citizen attitudes towards personal health records. The study was conducted in the Eastern Cape Province of South Africa. A cross-sectional design was used and structured questionnaires administered by data collectors. Most respondents (90%) believed it to be important to extremely important for their healthcare provider to have their complete medical records. Less than half of them (42%), however, believed that the healthcare provider did have their complete medical record available to them. Nevertheless, 69% do not keep a medical record as a way to address this concern. Most of them (84%) were not aware of the existence of electronic tools to capture a personal health record prior to participating in the survey. Concerns relating to the use of online PHRs were identified as privacy (58%), lack of time (27%) and a disinterest in computers (22%). It was found that the existence of a medical chronic condition is a strong predictor of keeping a medical record (albeit mostly in paper-based format).

A socio-technical approach to continuity of care and electronic records in the South African context.

Paper-based techniques of record keeping are contributing greatly to the discontinuity of patient care among healthcare providers. To achieve continuity, access to the information contained in medical records collected by various healthcare providers is necessary. To improve the sharing of information contained in these medical records the use of electronic methods of record keeping as opposed to paper-based records becomes very important. Even though the benefits of using electronic methods of record keeping are widely documented, the majority of South African healthcare practitioners still use paper-based methods. This paper describes an explorative study to determine barriers to the adoption of electronic records in the private primary care sector of South Africa. An interpretive approach using a socio-technical systems theory perspective was used to conduct the study. Based on the analysis of the socio-technical subsystems in the South African context it was revealed that there is not sufficient information available on the barriers to adoption of electronic records and further research will be necessary to identify the barriers to the adoption of electronic records.

Trust--can it be controlled?

Trust is an important component in the security of an information system. The advent of the electronic health record (EHR) and the health information system (HIS) have raised it to greater prominence. These systems and their intended benefits are rendered less effective through a low level of trust between the stakeholders. The potential reciprocal relationship between accountability and trust is investigated. A literature study examines both concepts and their interrelationship. The accountability and audit controls provided by the NIST SP 800-53 security guide and the ISO 27799 security standard are extracted, collated and expanded to strengthen the accountability mechanisms within an HIS security program. A dedicated set of accountability controls (NIM) which is specific to the healthcare environment is produced. It is proposed that through the strengthening of the accountability function of the HIS, its level of trustworthiness may be improved.

Advocating a Quality Assurance Model for the Implementation of E-Health Solutions in Rural South Africa.

This companion-discussion paper advocates the need for a quality assurance model for successful acquisition of e-health solutions in rural healthcare centres. We argue that the quality of the entire system is highly influenced by the quality of the processes used to acquire, develop, implement and maintain it. Central to these processes is the incorporation of user participation that adopts a 'bottom-up' rather than a 'top-down' approach. We present a selection of literature of relevance to the research work in progress, with a view to understanding ways in which quality assurance methodologies can be used to add value and ensure high quality care and service delivery in rural South Africa.