The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The proper implementation of National Health Insurance’s (NHI) $100 million primary care phase is “almost impossible” without electronic medical records, the Medical Association of the Bahamas (MAB) president warned yesterday.

Dr Sy Pierre, responding to revelations that much of NHI’s information technology (IT) details are “unknown”, said electronic records were vital to tracking patient movement through the scheme and ensuring “continuity and quality of care”.

And he agreed that the absence of such a system created “obvious room for fraud and the gaming of the system” by both unscrupulous patients and service providers, given the inability of those overseeing NHI to monitor what was going on.

Notes from the January meeting of the Universal Health Coverage (UHC) Stakeholder Advisory Council reveal that virtually everything relating to NHI’s IT system still remains “unknown”.

While the bid process for the “core” NHI system has yet to launch, as the tender document is still being reviewed by the Attorney General’s Office, there was also no information provided on the “temporary IT solution” previously promised by the Government.

Dr Kevin Bowe, the NHI deputy project director, told Tribune Business yesterday that the NHI Secretariat would respond to this and other concerns. However, no reply was received before press time last night.

Dr Pierre yesterday emphasised that the absence of system-wide electronic medical records was a glaring deficiency in the NHI structure, especially since the Government’s recently-touted $18 million health information management system (IHIMS) will also not be ready for the May launch.

“In terms of continuity of care, electronic medical records are absolutely key,” the MAB president told Tribune Business. “You can’t have continuity of care, especially primary care, without it. It’s almost impossible to do without it.

“It’s far from ideal. There’s obvious room for fraud and lack of continuity of care. Gaming the system in that way [fraud] is definitely possible, and difficult to track.”

Dr Pierre said it was currently difficult to find paper records in the public healthcare system just days after a patient had been treated.

He added that a fully-functioning electronic medical records system was especially important in monitoring the quality, and continuity, or care for Family Island patients who had to visit Nassau for treatment.

The MAB president said physicians in their home islands, as well as in Nassau, needed real time access to information so they could know what treatments/care their patients had received from other doctors.

“We asked them about the IT system before Christmas, when they invited the primary care people to come and comment, and they would give them a date for physician and provider registration,” Dr Pierre recalled.

“We asked them then if registration was going to be electronic or if providers were going to have to sign up. They weren’t even sure of the software for signing up for physician registration. We haven’t even got to the point where the software is ready for physician registration yet.”

The UHC Stakeholder Advisory Council meeting notes seen by Tribune Business stated bluntly that no details had been provided by the NHI Secretariat and its advisers on the previously-suggested ‘interim IT solution’.

There was “no confirmation on execution of contract with vendor” for such a system, while the “implementation timeline and work plan” was yet another “unknown”.

Dr Pierre, meanwhile, conceded that the Government was likely to entice enough physicians to sign-up as NHI primary care providers when registration begins today - just as the UHC Stakeholder Advisory Council meeting notes had predicted.

The NHI Secretariat is holding a press conference today to unveil the registration launch, with Dr Pierre suggesting that the “economics” of each private doctor’s practice will dictate whether they sign up.

“If a physician is comfortable and doing well, and he has, let’s say 60 per cent or more private insurance, his incentive to provide care will not be very high,” the MAB chief told Tribune Business.

“But there are some out there who are not doing very well. They’re probably going to get enough physicians. I think they’re going to get enough to register and say they have enough doctors to provide for these patients.”

Dr Pierre, though, said the real issue under NHI was whether Bahamians would receive an improved quality of care, and not have to endure waiting times and queues, as a result of doctors having to treat larger patient populations.

“The question is what type of care are these patients going to get,” he told Tribune Business. “That’s going to be they key.

“Is it going to be a system impacted by fraud, and will patients get care? Hopefully, the system will not be worse than it is now, with long lines and people enduring waiting times. Is it going to lead to more taxation, reduced private insurance and shrink the private economy? I don’t know. It’s an unknown.”

Pointing to the Government’s poor track record in owning/managing businesses, Dr Pierre pointed to healthcare industry trepidation over its impending takeover of the sector.

“Government’s history is not one of efficiency,” he said. “Look at all our government institutions now; they’re neither efficient nor effective, and they’re talking about running an entire healthcare system.

“We on the ground know the problems and what these guys need to tackle, but they seem determined to push ahead with this thing. There are so many things that need to be tackled prior to this starting.”