A Canadian company bidding to provide an integrated health information system in The Bahamas said it could be "extremely risky" for the government to forge ahead with National Health Insurance (NHI) without having such an "informatics" system in place, arguing that it would enable much-needed accuracy in forecasting the likely costs involved.
Populus Global Solutions (PGS), a Fredericton, Canada-based company, provides a software product called ACSIS, which aims to allow governments to harness the power of the vast quantities of data arising from interactions between patients and their physicians as well as correspondences between physicians and other entities such as pharmacies, labs and hospitals.
In doing so, it intends to allow this data to be collected on a more timely basis and utilized more easily for evidence-based decision making by those in the health sector.
Populus Global Solutions is currently participating in a request for proposal (RFP) issued by the Public Hospitals Authority last year. The company's CEO, Tristan Rutter, said that implementing these types of "health informatics" in The Bahamas could have a major impact on the success of the roll-out of an NHI plan, such as the one which the Bahamas government has indicated to move ahead with in 2016. Rutter also believes the implementation could encourage better cost control.
This, he suggested, is due to the more informed forecasting it could enable and the ability of the system to contribute to reducing the incidence of serious disease that would require most costly healthcare interventions.
"The ideal, particularly as The Bahamas gets closer to the ideal of a National Health Insurance scheme, is that the more comprehensive and accurate the total data set is, the more reliable the forecasting on National Health Insurance will be. A lot of people would say health informatics is the penicillin of our generation: the notion is there is no miracle cure in the pipeline, sadly, to fix everything that ails us...(so) the next step for us is about using better data to deliver more quality services."
PGS states that it aims to achieve three core objectives: improving public access to the healthcare system, improving health outcomes, and enhancing fiscal efficiency - essentially value for money spent by the government and the public on healthcare in both the public and private system.
"In The Bahamas, I can see a topline of, I think, somewhere in the region of $300 million spent a year in the public sector and I think there's a number not far off that in the private sector. When the government looks at that, the question is, 'How are we doing?' We know costs are going up and know more and more people are getting more things like hypertension and diabetes.
"So when you start to look at National Health Insurance plans, the risk with it is if you are going to get into this type of program - and there's all types of reasons why you should - it becomes extremely risky if we don't know what is most likely to happen, if you don't know what is the biggest threat to the
health sector. As you move into a NHI system, that's the kind of data you need to know. With NHI you say you are going to create a basket of services, based on certain conditions, to be offered to certain qualified residents. Depending on which services you put in or take out, depending on how citizens qualify or don't, the price of the system goes up and down.
"The key point is at some point you're going to say we're going to have a consumption tax or a payroll tax or whatever it is (and) the government or tax payer needs to know are we putting the right amount in the piggybank to match the basket of services. Trying to manage it without the appropriate information is an extremely difficult task."
Clinical encounter
The ACSIS system enables the gathering and sharing of information among segments of the healthcare infrastructure, starting with the first visit to the doctor/clinician.
"It all comes down to that transaction which is that clinical encounter...you need the ability to aggregate that data in support of evidence-based decision making," said Rutter.
Each patient will be assigned an electronic record and, once a patient sees a doctor, information can be automatically transmitted to the pharmacist, to the drug dispensary and the lab, with appropriate privacy safeguards, PGS asserts.
Consequently, comprehensive data is gathered, which can share the types of illnesses that are being diagnosed and at what levels, as well as how they are being treated and to what effect; this information can be analyzed to facilitate more strategic and effective policy-making, Rutter suggested.
The company has rolled its system out in St. Lucia, St. Vincent and the Grenadines and Belize, and will do so in Barbados in the next 12 months.
Rutter said: "Belize went live in 2007 and they've proven they've improved access. People have got healthier and they've saved money. The biggest thing is that the World Health Organization has essentially said that what Belize has done is trade very expensive hospital care for inexpensive community-based care. So when we get ahead of these chronic non-communicable diseases, like diabetes, we can detect these conditions and keep people on their treatment protocol.
"Belize had hypertension as the third-highest cause of death in 2007; by 2011 it was the 12th; they saw fast results."
Journal
Evidence in the International Journal of Medical Informatics supports the company's contention the implementation of the "Belize integrated patient-centered country-wide health information system" (BHIS) appears to have had an impact on mortality and been related to the stabilization of healthcare expenditures in that country.
"Hypertension-related deaths dropped from first cause of death in 2003 to ninth by 2010. Public expenditures on healthcare steadily rose until 2009 but then declined slightly for the next three years. Conclusion: For modest investment, BHIS was well accepted nationwide and, following deployment, mortality in the eight BHIS disease management algorithm domains declined significantly and expenditures on public healthcare stabilized.
"The BHIS is more than an electronic medical record or health information system but rather is an electronically facilitated health improvement system with feed forward loops (embedded patient management algorithms) to assist health care providers in making better care decisions and feedback program review loops to assist health system managers to make better health care system decisions," states the report in the journal.
It adds that the program was implemented in 2007 at a cost of $4 per citizen. In Barbados, the company will roll out the project for (U.S.) $2 million.
'Costs went flat'
Rutter said: "We put it in [Belize] in 2007, by 2009 costs went flat and stayed there for three to four years. If you were to look at that and say what happened if they stayed in the previous trend, costs would've gone up by about 25 percent. Realistically it's about whether we can make people healthier and slow down these major cost escalations."
He added: "The Bahamas is at a really interesting point as you start to contemplate this scheme. You are not alone in that, but you are going to make some big decisions that you'll live with for an awfully long time. If done right, I think it can be remarkably successful. But everyone needs to be responsible."

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