Digital health : a live healthcare console for public health in Gauteng, South Africa

Abstract

Access to quality, real-time information can enable a healthcare system to achieve tactical objectives, such as providing quality patient care, and strategic objectives, such as allocating scarce resources. Digital health systems can be used to connect disparate information-rich sources, combine appropriate information, and communicate information to key decision-makers. Even though digital health interventions, such as Gauteng’s new health information system, have been implemented, stakeholders like hospital managers and emergency medical services do not have access to shared real-time information. A Live Healthcare Console was conceptualised during this research as a system that could be used to combine appropriate information and make it available to healthcare stakeholders. New digital health systems must first be designed based on the objectives of the healthcare system to achieve this concept. Therefore, this research aims to propose a new practical design model along with a supporting theoretical model to design the Live Healthcare Console. A literature review was conducted in three phases using elements of a systematic literature review. The merits and constraints of the public healthcare system were first determined, which led to an understanding that digital health interventions could support the Department of Health’s objectives. The second phase established that the public healthcare technology architecture does not adequately accommodate combining and communicating information to key stakeholders. This resulted in a need to identify a model that could be used to design the Live Healthcare Console. The third phase of the literature review established that none of the five evaluated digital health design models were contextually relevant to the South African public healthcare system. This resulted in the construction of the Design Model for a Live Healthcare Console version 0.1. The researcher conducted thirty-one semi-structured interviews with participants, such as technology managers, hospital managers and emergency department personnel from the public healthcare system. The interviews were qualitatively analysed using an interpretive approach comprising three cycles of coding. Codes were associated with each other to form networks, which led to the identification of six themes (Combine Information, Connect Systems, Communicate with People, Contain Threats, Collaborate with Healthcare Teams, and Cooperate to Achieve Strategic Objectives). This process fuelled the creation of the Design Model for a Live Healthcare Console version 0.2. Version 0.2 was then tested with a subset of the original participant group to formulate version 1.0. This research contributes a practical design model which could be used or further refined by the Department of Health to implement a Live Healthcare Console to assist with the management of scarce healthcare resources. This research also produced a theoretical conjecture supported by a theoretical model, which describes how the six themes could leverage existing technology resources to optimise public healthcare system management.