Supporting Underserved Communities through Equitable Access to Care

Episode Summary

Many patients across the underserved communities of East Africa and South Asia lack equitable access to quality care. Dr. K. Nadeem Ahmed, CMIO of Aga Khan University and Hospitals and Dr. Boniface Mativa, Acting CMO at Aga Khan University Hospital Nairobi share how their organization is on a mission to change that.

Episode Transcription

Title: Supporting Underserved Communities through Equitable Access to Care

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: When we actually look at the broader network, we're talking not 650,000 patients a year; it's actually closer to 8 million, it's not 50 clinics; it's closer to 500. It's not one hospital; it's closer to 27. 

Christine: Welcome to another episode of MEDITECH Podcast. We're the leader in healthcare technology, empowering you to be a more informed healthcare consumer and provider. Hear the latest from our friends and colleagues on topics we think you should know about. 

Today I'm joined by two physician leaders at the Aga Khan University and Hospitals, a global leader in research, education, and medical care and among the largest private healthcare providers in East Africa and Pakistan. Dr. Nadeem Ahmed is the Chief Medical Information Officer at the Aga Khan University and with him is Dr. Boniface Mativa acting Chief Medical Officer at Aga Khan University Hospital, Nairobi. Dr. Ahmed and Dr. Mativa will discuss the role the Aga Khan University Hospital plays in ensuring all patients in their region have equitable access to quality care and their vision on how an integrated EHR can help fulfill that mission. 

Welcome, gentlemen. So let's dive into the questions we have. What are some of the challenges you're currently facing connecting patients to their care, especially in those rural and underserved regions.  Dr. Mativa? 

Dr. Mativa: Being a lower-middle-income level country Kenya of course, experiences a lot of challenges in terms of adequacy of healthcare, and for a long time since the foundation of this hospital in 1958, we have been more on a paper-based kind of medical record system and that has given us great challenges in terms of managing information. This hospital has a central campus in Nairobi, and that again has a huge presence in the region by way of about 50 outreach stations or outreach medical centers. Now from all these centers, patients either leave the main hospital and obtain care from the centers or come from the centers and are referred to the hospital for care, so you can imagine the amount of information that is either generated at the main campus or is generated at the outreaches. And so doctors providing care to these patients require to be able to access that information. As long as that information remains paper-based, then we'll have a challenge of portability and access across the entire healthcare network.

Christine: So what is your strategy for overcoming these challenges?

Dr. Mativa: So we are present both in Kenya, both in the region in terms of the Horn of Africa in terms of East Africa, that is Tanzania and Uganda, so to serve that region better and to be able to create seamless availability of healthcare information that is key for good and coordinated care of patients. EHR will come in handy, and it will help us to get closer to the communities to serve them better and for healthcare providers to be able to access wholesome information that should help in better decision making. 

Now, we are striving to provide world-class care within our environment, challenges notwithstanding, and part of those challenges that we are hoping to solve around the aspect of access. Then we hope by providing information that is seamless and accessible online, we should be able to reduce costs of access because patients can then be taken care of at whatever care point within the network, and of course, we hope to be able to increase the accuracy of information that relates to care. The burden of chronic conditions like diabetes, cancer, heart disease, hypertension, etc., is rising significantly, and the value of chronic care, the value that information and data plays in chronic care is critical, so creating a comprehensive chronic care system is critical to us. 

Christine: Now that's perfect. You talked a little bit about the numbers that you see on an annual basis and you know the concept of using that big data really to enhance that quality process is really spot on and goes to a lot of your mission at your organization as well. So, Dr. Ahmed, I understand your focus extends beyond East Africa to encompass the whole of Aga Khan University and Hospitals. How do you see having this central database of patients improving the quality of care at a global level?

Dr. Ahmed: I'll take Dr. Mativa's comments in regards to the numbers and expand a little bit further because Nairobi is our benchmark as far as the first one to go LIVE. Nairobi is the first hospital that will kind of set the stage and help establish the standard that the Aga Khan University and broader network wants to create and maintain over the years, and when we actually look at the broader network, we're talking not 650,000 patients a year; it's actually closer to 8 million, it's not 50 clinics; it's closer to 500, it's not one hospital; it's closer to 27. So when we talk about really establishing that base, Nairobi is pivotal, but that will expand way beyond the region of Nairobi. 

But the theme is consistent with, as Dr. Mativa mentioned, it is lower-middle-income countries that we're talking about. Given the development of electronic health record and the infrastructure that's required for an electronic health record to be successful, so we're establishing that for Nairobi and beyond, and once we do that, our rural patients in the outreach areas will benefit because now we have a strong base on which data is founded. We can use that data not just to help improve the care of our own patients but also pharmaceutical companies and other organizations say hey how does a patient population in Nairobi look, what what are the conditions that is challenging them the most, and how is it best to address that because it might be different than how it's addressed in Virginia for example. 

So those are the key things that we are hoping to accomplish by having an electronic health record primarily serving our patients in these regions but then furthermore broadening the care to the broader region and really healthcare as a global effort is going to be attained as well through this effort, so we're really excited. 

Christine:  That's fantastic. And those numbers are staggering that you shared with us. It really is a big footprint about that broadening of care and going into the next question it tacks on to what this is all about is that a major part of the Aga Khan University's mission is to improve the quality of life for all citizens. So what are some of the ways you're doing that now?

Dr. Mativa: Indeed yes, we focus on improving the quality of life for all citizens, so not just the community we serve but beyond that community, there has been a continued investment in human resource. As we speak, being a tertiary teaching hospital, we literally have every specialty on campus, and we run a multiplicity of subspecialty services almost to you know the finest you would expect anywhere within the globe. And this is key and was foundation to our commencement of the medical college that now we are very proud of because out of it we are training very well qualified nurses and doctors who then impact our services because we retain some of them but more importantly, we release lots of them into the market and they continue to impact the communities, the country, and the region some even have gone beyond the continent and work in other parts of the world. 

Now, what have we done in terms of quality over the years? This has been again, a very deliberate journey which we would say formally began in 2003 where we said we have invested sufficiently in quality we have good infrastructure, we have good technology, we have good human resource, now we need to create a kind of validation for our quality programs. And that was the point at which we first got ISO Certification in the year 2003, and we have been certified since conforming fully to the standard set there. 

In 2010, we set out to also create a certification recognition for our pathology services, and we got that through the South African Agency for Certification Centers, and we've remained certified through the years since 2010. 

Our biggest statement about quality then came with our commitments towards Joint Commission International accreditation. In 2013, we became the first hospital in the region to be certified or to be accredited to the Joint Commission, and we've remained accredited since. 

Now, after doing all that, we asked ourselves what more we need to do, and we decided being a medical college and being a premier healthcare institution in the region, we could as well create condition or clinical care program specific certifications, so to speak, creating centers of excellence. So from last year, we began that journey, and we first began with a focus on heart disease, so we got our initial certification in myocardial infarction, again scoring a first in the Sub-Saharan Africa for that accreditation, and this year in May, again I'm very proud to report that we got certified for acute primary stroke, again our first in the continent. We have continued to focus on that, and I have gone further to have our pathology services certified by the American College of Pathologists, again a first in the region, and now we are focusing towards attaining a similar certification by the American College of Radiology for our imaging services. 

As you can see, it's been a very deliberate journey, it's been a very deliberate investment in quality and patient safety, and we continue to focus on it with unity of purpose. We've remained very true to our core values, optimizing the impact of our services to community through a continuous presence within the region and an expansion in access. We have continued to focus on quality, we've kept our services as relevant as possible to the community and regional needs, and so to speak, then I would confidently say we remain on track to becoming actually the premier tertiary teaching hospital in this region and beyond.  

Christine:  Congratulations to you, and obviously, it has a big impact on your region and your community. So Dr. Ahmed, is there anything else you want to add?

Dr. Ahmed:  I would even say beyond the region of East Africa and Asia, Aga Khan University and the network under which it works is a trailblazer. We are the first of many wonderful endeavors. Nairobi and the commitment and the accreditations that Dr. Mativa has mentioned is one example that can be repeated, and we've seen from other sister hospitals of ours within the network, such as in Karachi as well, many firsts on many levels, so from that standpoint it is an exciting organization. And so when we talk about our mission, it is a much grander vision than we imagined but at the end of the day myself as a physician, and I can say Dr. Mativa as a physician, and all of us clinicians and providers, it all starts with the first patient. It all starts, it's one patient at a time, but the broader mission of improving healthcare in the community is such an important element of what we do. Ensuring how that's done is through standardization to a high-quality level. 

There are organizations that help us through, such as Joint Commission giving us accreditation, so if we do these things we can at least feel rest assured that we are following a high standard that is recognized not only by our patients but by other institutions as well. And as Dr. Mativa highlighted, the work is deliberate; it's not by accident. So we're doing a lot of these things with much focus, we're putting certainly resources into this, and the electronic health record is to help bring all of this together so that we can continue and have a much more powerful tool to continue providing the high level of care and the quality of care that we are striving always to achieve.

Christine:  Thanks for listening. Join us next time as Dr. Mativa and Dr. Ahmed discuss the role an EHR will play in helping Aga Khan University and Hospitals provide timely access to care and better management of chronic conditions. Stay informed and subscribe to MEDITECH Podcast and be sure to check out our resource page for links from this episode. We'll talk to you next time.