Why hospitals should not be scared to go paperless

The newly signed Digital Health Act mandates public hospitals to end paper records and digitise all their services.

It’s both exciting and scary. On one hand, it means a patient can walk into any public hospital and have their medical records pulled up at the click of a button. It also makes the work easier for clinicians, such as doctors and nurses.

On the other hand, many medics are terrified of the changes. There is also concern your records are now more susceptible to hacking and theft.

The Aga Khan University Hospital started digitising paper records in November last year. The Nairobi facility has gone fully paperless. The hospital CEO Rashid Khalani explains what public hospitals should expect, the benefits and pitfalls. He spoke to the Star’s John Muchangi.

Tell us about your experience after ending the practice of paper records.

The healthcare setting has a lot of confidential information on patients’ health, their family and their next of kin. So we are the custodians of a lot of confidential data. That data has always been there. But the point is that it was always a paper-based system.

At the Aga Khan University Hospital, in the past six to seven months, we have started migrating to electronic health record system. And it's an Aga Khan Development Network initiative. The AKDN has more than 700 healthcare facilities globally. The idea is that we will migrate all of them to electronic health record system.

And we were the guinea pigs in Nairobi. We are the first to implement the electronic health record system. Now entire patient data and all the medical records, instead of being on paper, are electronic. It has cost us $12 million, call it Sh1.5 billion, just for this hospital and its outreach centres.

Electronic health record system is whereby the entire patient records are electronic. The clinical protocols are also embedded within the system, the pharmacy orders, the lab orders, the radiology orders and even the scans. Everything.

This ensures efficient and timely care because, let's say, if you are in a centre in Buruburu and you are transferred to the main hospital, you do not have to carry your paper files. Electronic data is available and the care can be accessed anywhere in the AKDN network. That’s also beneficial for the physician because they can access patients’ medical records electronically from wherever they want.

Research has shown that the timely and efficient care leads to better clinical outcomes. It also unlocks much potential for the patient because you can track their progress.

The second advantage is that all that data will allow us to do research because millions of patients are seen across AKDN health every year. So if you want to do research on, let's say, breast cancer, we can do that research. This hospital is a university hospital, so we have trainee doctors and nurses so that data will be available for their research and training purposes.

This will hopefully give better clinical outcomes over time.

One key concern with digital records is  the safety of this data. Could you address that?

All the data we have in this hospital is held in the servers in Nairobi, within Kenya. The second part is that we have been seeking advice from the Office of the Data Protection Commissioner. We are working hand in hand with this office to ensure we are not doing anything wrong or something which is outside of law.

This phenomenon is new for everyone and nobody can claim that they know it all. So we have to work with the regulator to ensure we are always on the right side of the law.

But as far as data is concerned, for our Kenyan patients, the data is here, and if it is required for research purposes as it happens all over the world, you anonymise the data.

That’s because the objective of research is not to identify the patient. The objective of research is to understand the underlying conditions and then go for intervention.

When do you expect all your centres in Kenya to be fully digitised?

Nairobi went live with the Meditech Electronic Health Systems back in November 2022. Now we are going ahead with the implementation for our sister institutions in Mombasa and Kisumu. So over the next 18 months, those hospitals will also be online. Over and above the main hospitals, the 50 outreach centres across Kenya are also on the same platform.

How valuable is this health data, because we are seeing a lot of wearables, even our phones collect a lot of health data?

There is a market shift in different industries. Look at hotel industry. The biggest hotel chain, Airbnb, doesn't own a hotel.

The biggest taxi companies such as Uber and Bolt don’t own a single taxi. We are seeing that shift in the healthcare as well, where artificial intelligence can predict diagnosis, looking at the scans, and reports more accurately than human eyes. But that shift can only happen when the records are electronically available.

AI is all about computing power, but once you have that data, then you can use the computing power to do research and use artificial intelligence for your interventions.

So this journey of electronic health records will help us in shaping the health industry across Kenya.

The President recently signed into law four health bills. How will these changes affect you?

As a hospital, we do believe in universal healthcare, and we have been great partners with the Ministry of Health. This hospital is now 65 years old. We have walked the journey with different administrations. So we are also looking forward to the new regulations and the rules that will govern the new institutions that will be created. But do I believe in this agenda? Absolutely yes.

The university this year admitted the first cohort of undergraduate medical students. How does that impact on patient care?

We were not a university hospital until 2004. When we became a university hospital, we started with the residency programme, the postgraduate medical education programme. The residency is a four-year programme that happens after MBCHB (Bachelor of Medicine, Bachelor of Surgery​).

We have started the MBCHB this year. It's a six-year programme. We are excited now there will be 20 year olds and 21 year olds within our university hospital roaming around.

Our patients will now have to understand that these are the doctors for tomorrow. These are the nurses for tomorrow. If you don't allow them to practise, who will be the doctors in years to come?

We are the only university hospital in the private sector, but there are public institutions that are teaching hospitals. Young doctors in Year 3 and Year 4 do go to the main hospital for the clinical learnings. Here, it's not happening this year, but in the next couple of years.

Is it difficult for you to secure specialists in different areas to teach at the expanded medical school?

I may be wrong, but I think we are the only hospital that employs full-time consultants. And now we have close to 120 or 130 full-time consultants in different disciplines, such as surgery, medicine, anaesthesia, obstetrics, paediatrics, radiology, pathology, haematology and oncology.

We don't call them doctors, we call them faculty because we are a university hospital. They have two jobs. First is to treat patients, but at the same time, they are teachers who teach the residents (postgraduate students) as well as the undergraduate students. So they have dual responsibility.

Is it difficult to get these consultants? Yes, absolutely it's difficult to hire or to get these consultants. But that's why we are a university hospital. That's why we are training doctors. We also have very many advanced fellowship programmes to increase the supply of these subspecialists.

Overall, do you face challenges in accessing the latest medical equipment, or latest drugs?

Generally speaking, no. But in the recent past, because of inflation and the devaluation of our currency, it has become costly. If you go back one and a half years, the Kenyan shilling was traded at Sh110 to a dollar. So if a medication was one dollar, it used to cost Sh110. Now, it's Sh150.

The cost of drugs and medical equipment — which, sadly, are not manufactured, in Kenya — has gone up. That's why I have been a big advocate of investing in the production of medical supplies and medical equipment within the country. I think the current government is working on those plans.

Can speak on your plans to start kidney transplants?

According to the Renal Association of Kenya, there are more than 6,000 patients on dialysis across Kenya today. Once a patient is on dialysis, it's a lifetime expense, and it's financially draining for the patients and the family. So we are starting a kidney transplant programme on a sustainable basis. Now, I think 90-95 per cent of the patients getting dialysis are being paid for by NHIF.

But if we can start a sustainable kidney transplant programme, it not only helps the patients and the insurers financially but also improves the quality of life of the recipient. But then we will have to work with many donor communities. We have to talk to many philanthropy organisations.

What do you mean by sustainable?

I mean low-cost. The sustainability in my mind is first is the financial sustainability. It should not be cost-prohibitive that patients cannot afford it. Second part is capacity. We want that clinical programmes are much based on the clinical capacity of the doctors, the nurses and the hospital.

We are trying to build the capacity as a university hospital. It is not our mandate just to bring a doctor from outside for two weeks to do the surgery and go away.

It is our responsibility to train doctors to deliver that programme. That is happening in pockets across Kenya. We will not be the first one, but we want to ensure that it is a sustainable programme.

Why do you think thousands of Kenyans still go to India and Pakistan for health services that are actually available in Kenya?

I think over a period of time, we as a country have done well. We have a very stable country, economic stability, and we have fantastic human capacity. We have kind of reversed the trend of outbound medical tourism. I think patients are getting more and more confident about the quality of care available in the country.

But we have to continue to train doctors and the nurses, so then there is consistency and there is sustainability. We have to invest in industrialisation so we are not importing medical supplies. That will also help reverse the trend of people going to other parts of the world because either it's cheaper or there is a trust issue.

We are actually seeing increasing numbers of patients from outside of Kenya coming to Kenya to seek healthcare. About 15 to 20 per cent of our patients come from regional countries, such as Uganda, Congo, Rwanda and South Sudan. Some are from as far as Malawi. They can actually walk to South Africa, but they come to Kenya because we are giving confidence to people that we have the human capacity in Kenya to treat those diseases.