The Role of Health Informatics in Mental Health Z Zingela Department of Psychiatry Port Elizabeth Hospital Complex 5 July 2013 HISA Conference 2013 NMMU

OVERVIEW A. Role and application of Health Informatics to mental health services B. *Health Practitioner needs C. *Patient and carer needs D. NHI & mental health informatics E. Other areas of application in brief

A. Role & application of mental health informatics  Central to the provision of mental health service is ICT support which is efficient, effective, user friendly and accessible at all levels of care when required  Providing access to all health professionals who need it while limiting any unnecessary sharing to preserve confidentiality.  Versatility to adapt to the level of complexity required depending on the level of care.  Crucial for monitoring psychiatric & psychological disease patterns and health indicators

B. Mental Health Practitioner needs  Recording and accessing patient & carer information, (incl. previous records)  Access to secure ICT systems to preserve confidentiality while allowing access for clinicians when required (e.g. password/ smartcard access). Should include audit trail of who accesses patient’s EHR.  Easy access to treatment and side effective monitoring (e.g. Li, Clozapine, metabolic profile)  Systems in place: PERSAL, Delta -9, LOGIS & BAS, Rx Solutions etc.

B. Mental Health Practitioner needs  Access to: electronic treatment guidelines (e.g. SASOP/ NICE), resource and knowledge material (e.g. Athens Account, Cochrane Library)  Communication between staff across all levels of care & across remotely placed areas, to allow access to clinical supervision & teaching (video conferencing)

C. Patient & Carer Needs  Confidential records and accessibility of info re their illness, carer contact details, care plans  Appointment booking system & management of waiting times.  Psychoeducation tools  Access to support groups  Information re available treatment options for their conditions  Information re local available services

C. Patient & Carer Needs  Effective& accurate billing and payment systems  Assistance (if needed) with remembering appointments and taking meds.  Electronic data base & monitoring systems for variety of Rx & side effects(e.g Li, Clozapine)  Info on pathways available to accessing all relevant treating professionals  Access to their records as part of Access to Information Act even while confidentiality is protected.

D. NHI & Mental Health Informatics August 2011 policy document on NHI  Goal – to promote equity and efficiency to ensure that all South Africans have access to affordable quality health care services irrespective of their socioeconomic status.  Phased in over a period of 14 years  Quadruple burden of disease challenges to be met by NHI includes non- communicable diseases of which mental illness forms a significant part.

D. NHI and Mental Health Informatics  Community health workers and (primary) district health services – 1 st point of contact with levels of care increasing as patients health care needs escalate.  An integrated ICT system which allows systems across levels of care to be linked is key to NHI rollout. Implementation will require a national EHRs which can be accessed across levels of care and throughout South Africa.

eHealth Strategy for SA  Focus is on access to “real time” info to assist in quick decision making  Enable integration between systems wherever appropriate.  Enforce common standards, norms and systems across the country.  Establish common data standards and terminology across information systems.  National Integrated ICT system integral to NHI with use across all levels of health care. (eHealth Strategy SA )  ICD-10 - fully implemented by all health care providers by1 January 2014.

G. Why Telepsychiatry makes sense in EC  Shortage of doctors & specialists  Large geographical areas with poor transport systems  Can help provide access to specialist & supervision of other professional staff long-distance  At its simplest a telephonic consultation & advice session between 2 health practitioners may suffice.

Limitations of application of Telepsychiatry in ECDoH  EISHKOM ≠ Reliable electricity supply  HELLKOM ≠ Reliable, affordable and fast internet connection, bandwidth availability  ECDoH related limitations – provision of tools and resources, financial constraints, persistent server and problems, availability of IT skills and support.

Potential Solutions 1. Mobile phone technology. More people have cell phone access compared to other forms of communication in SA. Mobile Instant messenger systems - potential application e.g. appointment booking and reminder systems, video consultations. (Lovelife HIV Counselling service via Mxit, WhatsApp, Viber, Tango). Limitation – Inflated provider costs. 2. Smart phones and apps. Limitation – cost of smart phones