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The use of HL7 in South Africa

Publication date: Aug 20, 2009

There is an increasing interest in HL7 by private healthcare providers and insurers in South Africa. HL7 isn't used widely at this point in time - this may change because of an ever increasing requirement to exchange healthcare related data.

Within the HL7 community we haven’t heard an update about the use of HL7 in South Africa for at least 5 years. At that time there actually was a South African HL7 organization, but somehow interest waned and the organization was effectively shut down around 2003.

I’ve been told that this occurred at nearly the same time as a marked increase in interest in HL7 by private healthcare providers. PHISC (Private Healthcare Information Standards Committee, an accredited standards organization for private healthcare, with representatives of providers, insurance companies and the government) . In 2005 SABS (the South African national standards body) asked HL7 about it becoming the local HL7 organization. HL7 doesn’t actually allow that – the local organization has to be a not-for-profit organization where all stakeholders can participate.

In august 2009, at the request of Medi-Clinic, a private hospital group of about 50 hospitals in South Africa, we provided an overview of both HL7 version 2 as well as HL7 version 3. They also asked representatives from Discovery Health, an insurance company that’s very active in the private hospital sector, to join the training.

View of the Cape mountains in the Stellenbosch area.

Medi-Clinic has a couple of reasons to be interested in HL7: their PAS solution is a custom solution developed by their own IT department. Medi-Clinic are in the process of installing off the shelve software solutions in its hospitals. If these applications already have a messaging interface, it will be HL7 version 2. There is an interest in HL7 version 3 as well – even when it is recognized that right now there won’t be a lot of applications that will support HL7 v3 out of the box. Medi-Clinic does support a number of services which allow third parties to query/access demographics data as present in the PAS systems provided by Med-Clinic. This may well be replaced by a v3 model. The Medi-Clinic PAS focuses on the administrative aspects of hospital encounters – adding support for medical data will involve enhancing the current data model. The HL7 v3 RIM (and or: specific domain models) are seen as a possibility to enhance the application data model.

Manette, system architect for Nursing and Clinical applications at Medi-Clinic, did not expect HL7 standard to be this comprehensive, and expressed the hope that CDA could be used as a replacement for all kinds of forms.

The interest of Discovery Health is mainly in the area of Hl7 v3, and the use of HL7 v3 as a data model (RIMBAA) within clinical repositories. If at all possible they’d like to skip HL7 v2 and move directly to v3. There’s not a lot of history regarding existing v2 implementations in South Africa, therefore it may be possible to leapfrog v2 and move directly to v3. This will also depend on what the software vendors are going to support.

When asked, there don’t seem to be any special South African things that may not be present in the HL7 v3 standard. There obviously are challenging aspects, such as the fact that there are 11 official languages, the fact that a sizable portion of the population resides in the country illegally, and the lack of postal addresses in ‘informal settlements’ (shantytowns on the edge of town) – capturing the patients’ cell phone number (everybody has a cell phone) is much more important than the actual address.

In general the maturity level of Medical Records keeping is still relatively low: they are mostly limited to one single hospital encounter. Creating a lifetime electronic healthcare record will be a challenge – maybe in South Africa the insurance companies can play a role in establishing them. Private healthcare will probably be a leader in th adoption of HL7 (and: IHE) standards in South Africa .. maybe PHISC could play a role in re-establishing a local HL7 organization in South Africa – amongst other things to create national implementation guides to ensure interoperability between all healthcare providers in South Africa.


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