Standardizing Quality Care Across East Africa and South Asia

Episode Summary

In Part 2 of our series, Dr. Ahmed and Dr. Mativa discuss how Aga Khan University and Hospitals will leverage their EHR to ensure clinicians at remote regional outreach centers have the same access to patient records and decision support as those at the University Hospital, for consistent patient care and better management of chronic conditions.

Episode Transcription

Title: Standardizing Quality Care Across East Africa and South Asia

Guests: Dr. K. Nadeem Ahmed Chief Medical Information Officer, Aga Khan University

Dr. Boniface Mativa, Acting Chief Medical Officer, Aga Khan University Hospital Nairobi

Host: Christine Parent, Associate Vice President, MEDITECH


Dr. Ahmed: The technology is a tool to help us do these things because we are doing them now. Imagine we're doing it with both of our hands tied behind our back almost. It is very challenging but now we have some tools that will better allow us to care for these patients. We're very excited about those possibilities. 

Christine: Welcome to another episode of MEDITECH's Podcast. Today, we'll continue our discussion with Dr. Nadeem Ahmed, CMIO of the Aga Khan University and Hospitals and Dr. Boniface Mativa acting CMO at Aga Khan University Hospital, Nairobi. Last time, Dr. Ahmed and Dr. Mativa discussed the challenges Aga Khan University and Hospitals face in providing equitable access to care and the steps their university already takes to provide quality care. In this episode, we'll discuss the role MEDITECH's EHR will have in improving this access along with management of chronic conditions. Welcome gentlemen, it's great to have you back. 

How do you envision an integrated EHR rollout improving connectivity and access to care and in what ways will this contribute to better patient outcomes? 

Dr. Mativa: What we are thinking about and we are doing again very deliberately is to extend our specialist services and the diversity of services through to our outreach stations. You can imagine sending in specialists to take care of patients within areas that are about 700 kilometers out of the main hospital here. With a well-implemented EHR, that will help my doctors to see the full picture from diverse locations. From wherever you are, you are able to pick the history of the patient to review previous data, and connect with the present, and then plan for the future. It is very very key that we then provide that capability for doctors to be able to provide more holistic care. With EHR that is going to be possible. 

Because EHR is right in front of the doctors, they don't have to know to flip through a lot of paper to look for information. It is very key that the doctors begin to experience a more conducive and supportive kind of database or data documentation that then becomes easy to navigate, easy to read, and that reduces for us, it helps us reduce errors, because errors due to legibility and all that become an issue in terms of safety of health care. With an EHR that is well implemented, then we also get away from the challenges of timeliness of access to data. The EHR information is available at the click of a button. Therefore, that means doctors can access that information when they need it. The information is discrete, accurate, legible and of course, well preserved. It's also actionable. 

Then, you are able to build upon the same information and create quite a good repository of info on each patient. That is important. Like I said earlier, in terms of management of chronic diseases, we are able to create registries that would be very wholesome and supportive of the chronic disease management programs leading to better care for patients, more seamless coordination, ease of consultation, and interdisciplinary integration for patient care. For us, that is a big thing. 

Ease of access to information for patients is equally important at their personal levels because it eases referrals, it eases the generation of medical reports, for example, it eases the communication of diagnostic reports, your appointments, and everything. That, in effect, reduces the need to travel long distances to achieve comprehensive healthcare. Better information preservation is also possible. You can imagine when you have paper-based information, how vulnerable it is to damage, from fire, for example, from floods or the normal aging of paper itself. This, in itself, will give us better data protection. It gives us better protection of equipment and protection from damage and alteration. Information security becomes very key for us indeed. 

As far as we are concerned, once we have fully implemented the EHR and overcome the initial challenges of going LIVE, we are certain that the connectivity that it will afford us will certainly transform to improvements in patient care. 

Christine: Dr. Ahmed, anything to add? 

Dr. Ahmed: At the end of the day, there are two defining elements that the EHR will impact very significantly. Through connectivity, a connectivity to a single source of truth. We know regardless of where you practice, whether it's in the US, Canada, Europe, or in East Africa that data is knowledge, data is power, and data is care. At the end of the day, if your data doesn't match the chart that you're looking at with the data that the chart that another provider taking care of the same patient is looking at. If that data doesn't match, potentially you can have harm. 

For us, the biggest benefit of having an electronic health record is we can connect to one single source of truth for that data and if it's updated, it is updated for all. What everyone sees is the most updated version, for example, of a medication list that the patient takes at home. 

Connectivity is extremely important for physicians. We're not just talking connectivity to each other, connectivity to the patients, we're really talking connectivity to the data. Then, the second outcome of data is we don't want too much information being presented to the physician because then that becomes a lot of data noise. Data analytics is also a big part of all of this and how the data is being refined and presented in a way that the physician can understand, in a way that the nurse can understand, the pharmacist can understand, etc., and it goes on. Data analytics is extremely important and how that is being presented to our physician and our providers certainly must be filtered through the eyes of their physician colleague. 

We have governance structures in place that certainly myself and Dr. Mativa work with. We have committees, clinical committees set up to make sure that this data is being presented in a fashion that is meaningful, not meaningless to them because there's a lot of data out there. I'm an orthopedic surgeon. There are certain things I want to look at. If I'm an endocrinologist or if I'm a cardiologist. If I'm seeing someone else's data, I might not be the best to decipher it because maybe that's not my specialty. Data analytics and how that data is being reported is a big part of it. Then, being able to connect to it and update it so that others can see it transparently is really the biggest benefit for AKU on having this electronic health record. 

Christine: Dr. Mativa, you spoke about some of your challenges around chronic conditions. How do you see your EHR supporting early detection and treatment of those conditions? 

Dr. Mativa: In the context of chronic conditions, indeed, early detection and treatment becomes the gamechanger in the sense that most chronic conditions either metabolic or otherwise tend to insidiously cause plenty of complications in terms of organ and system damage. Picking them up early then becomes the secret towards preventing complications, preventing disability, as well as death. How do we see the EHR contributing to this kind of care? 

One is as we said, “EHR will certainly improve for us the timeliness to access of information.” You would appreciate that a patient who is seen several times within our system is likely to be a patient for whom progressive and trended information is actually generated. By being able to review the complete picture, you'll be able to detect problems when they're just beginning to arise. For example, when your blood pressure just begins to rise when your functions begin just to change, when your tumor markers begin to change. Therefore, you are able or even when a screening test that was previously normal then becomes abnormal. That timeliness in terms of access to that information from every point of our network, then becomes important for early detection of problems and of course initiation of interventions. 

Now, this is very important because by providing that capability, then it means that the same standard tools that we have used to improve the quality of care, the capacity for disease detection at the main hospital, then become accessible in the remote medical centers or in the remote outreach centers. Now, this is exciting that, therefore, means from a far-flung medical center a physician sitting in there has almost as much chance of detecting a chronic condition of the onset of a potentially chronic condition as they would if they came to the main hospital. Look at that. They don't have to travel any physical distance but they get the same quality. Therefore, we are able to prevent either the progression of a chronic disease, or even pick it at the outset and begin to take care of that. Like I earlier said, we are keen to again extend specialist services throughout our network in terms of making it available at the outreach stations. 

Now, you can imagine sending a specialist to an outreach station and denying them information that would be so critical for care decision-making. EHR takes away that. We are able to make that available to them. Remember, clinical care is actually information-based. I would have to take a history. I would have to review previous data in terms of diagnostics. I would have to look at previous care, I mean previous data, in terms of screening tests done, and so the specialists become a lot more useful in terms of picking these conditions in terms of initiating care and in terms of even referring those that are complex that may require care at the main hospital as it were. This becomes a very very important thing. This access to medical records and our capacity then to create disease-specific registries, then gives us an edge, in terms of providing wholesome care and creating a very comprehensive chronic disease care program. That will be actually very responsive to the trends we see in terms of increasing metabolic and chronic disease profile for our patients. 

Christine: Dr. Ahmed? 

Dr. Ahmed: There's a saying that I have to say here. I think it very much applies. Prevention is better than cure. Certainly, when it comes to these chronic conditions are there any that we can prevent, such as, let's say for example Type 2 Diabetes? Are there certain things that we can look at? Are there certain factors? It could be lifestyle factors that the physician in the outreach center has now reported some type of diet that the patient is taking which was not a healthy diet, for example. Small things like this can have a big impact on a patient's health over the long run.

Being able to have a registry as Dr. Mativa mentioned that identifies some of these elements so that we can reach out to these patients before they are diagnosed with a condition and hopefully prevent or at least lengthen the amount of time before they actually have the disease onset is very important in many cases. Then, for those patients that do have chronic conditions, how do we keep them from becoming acute? For that heart failure patient, how do we make sure that they are capturing those daily weights? It goes beyond an outreach center. Our strategy is ultimately to have home monitoring of some type. Remote monitoring devices are not a new thing in the west. Certainly, when it comes to East Africa and Pakistan and beyond. These are things that are already being done but not in a very coordinated fashion. EHR will help us coordinate it better. 

When we talk about challenges to chronic conditions and how we can detect them earlier, manage them better, the technology is a tool to help us do these things because we are doing them now but imagine we're doing it with both of our hands tied behind our back almost. It is very challenging but now that we have some tools that will better allow us to care for these patients we're very excited about those possibilities. 

Christine: Thanks for listening. Tune in next time as we conclude our series with Dr. Mativa and Dr. Ahmed as they discuss Aga Khan University and Hospital's role in providing world-class research and the important role technology will play in improving quality of care across the region and beyond. Stay informed and subscribe to MEDITECH Podcasts and be sure to check out our resource page for links from this episode. We'll talk to you next time.