On Sept 24, I will be speaking at the Digital Health Canada Atlantic Regional Chapter Conference, where I will be joined by Walter Hurrell, Chief Information Officer of the Health Information Communication Technologies and Data Management Section in the Corporate Services Division of the Kingdom of Tonga’s Ministry of Health; and Pamela Wyatt, Principal Public Management Specialist (Governance) with the Asian Development Bank. The title of the 9:45 a.m. session is From Tonga to Truro: Applying single patient identifier and unified health record lessons learned from around the globe to the Canadian context.

Over the past few years, Gevity has been working in various capacities on a public health pilot project in Tonga that was initially focused on reproductive and maternal health, in coordination with the Tupaia project.

Last year, we were contracted by the Tonga Ministry of Health and the Asian Development Bank (ADB) to support the procurement of a health information system (HIS) to serve the entire country, which has a population of about 100,000. Tonga’s goals for the project include the implementation of a national health identifier and a single patient record, which will improve the patient experience by making their transitions throughout different parts of the healthcare system smoother; improve patient safety by ensuring providers have access to complete information and helping to avoid instances of duplicate records; and improve efficiency by reducing the number of duplicate tests and procedures that often occur in paper-based systems. Currently, different hospitals in Tonga may assign patients identifying numbers, but there is no coordination or centralization of those numbers across the country.

The Tonga healthcare landscape

Walter Hurrell, Chief Information Officer of the Health ICT and Data Management Section within the Corporate Services Division of the Kingdom of Tonga’s Ministry of Health, who will be joining our presentation at the Digital Health Canada Atlantic Regional Chapter Conference, explains that Tonga has five hospitals. The main referral centre (Vaiola Hospital) is on the island of Tongatapu, and there is a district hospital in each of the outer island groups. Primary health care is delivered by health centres and clinics in communities around the country. Some digital health technology is already in place, including a radiology information system/PACS, a medication inventory system and a patient administration system, but they’re mostly used at Vaiola Hospital.

“One of our biggest issues is that patients don’t have a single, central record,” he says. “In most cases, they have a separate chart or record at each health centre, hospital or clinic, and there is no single, national patient ID. This is a challenge especially when patients are referred to a different hospital or health centre from the one they usually visit – the clinician they are referred to often only has the information on the referral form, not the patient’s complete record.”

The biggest challenges to implementing a national identifier and a single patient record, Walter says, include technical issues related to the segregation and duplication of patient records that occur in Tonga's current health information system, and the siloed nature of the system. Other challenges relate to patient identification verification, and, as with all large projects, change management to encourage adoption of the new system. The costs are also a major consideration. To implement a national health identifier, the solution must be able to leverage the existing systems. The implementation across all five hospitals, 12 health centres and 34 health clinics is expected to take about two years, including the full implementation of the system and all training and change management.

Walter notes that this initiative is the first step toward further digitization of Tonga’s healthcare system.

“This is indeed the first major initiative that will open up opportunities to further implement technologies such as telehealth and virtual care,” he says. “The new solution is anticipated to provide capabilities that will allow healthcare to be delivered from remote areas via these new technologies.”

Building a replicable model

Pamela Wyatt, Principal Public Management Specialist (Governance) with the ADB, says the ADB funded this initiative with the goals of improving the reliability, quality and granularity of health data and to make it easier to use that data. Another goal is to implement a digital health system.

The recent expansion of broadband connectivity in the region makes this investment timely, she adds.  “The digital HIS will enable two-way communication between planned and existing health data systems, allowing for health information reporting that meets the needs of different users and decision makers, and the digitization of paper-based health data collection methods, including reporting of births and deaths. The creation of sex-disaggregated data will allow better tracking of progress toward Sustainable Development Goals (SDGs) 3 and 5 and inform gender-responsive health policies and funding. This project will demonstrate the benefits of delivering essential public services using a digital HIS to enable optimal health and gender outcomes.”

Pamela adds that the ADB hopes this project will become a case study and good example of how similar projects may be designed and implemented elsewhere in the Pacific and beyond. Some key features of this project have been the time taken to develop strong requirements and buy-in from not just senior management, but from all staff across the healthcare sector. “While often projects are rushed in this early phase, already we are seeing the benefits of truly bringing everyone along on the journey … and not just talking about it,” she says.

Gevity’s role in the initiative

Gevity’s role in this initiative was to develop the terms of reference for the HIS procurement (including comprehensive business and technical requirements as well as background and contextual information for vendors) and to support the evaluation of responses to the Request for Proposals. Our goal is to support the Ministry of Health and ADB in procuring a solution that is appropriate for Tonga’s needs and to ensure the solution is supported and sustainable.

As a technical requirements specialist, I worked with other Gevity team members to conduct site visits and talk to clinicians, staff, senior leadership and technical teams to better understand the need for and their capacity to use a digital health system (including the existing computing infrastructure, IT support, training and computer literacy), and then to build out technical and business requirements based on what we learned in our conversations with stakeholders.

It has been exciting to help lay the groundwork for Tonga’s transition from a mix of paper and digital records to a complete digital health record. All of us on the team look forward to seeing the project move toward implementation in the near future.

Why Canadian healthcare leaders should care

It’s fascinating to see the creative approaches taken elsewhere and to think about how we could map and apply them to our own challenges. Although Nova Scotia is more than 13,000 km from Tonga, the province (and other Canadian jurisdictions) shares a number of similarities with Tonga that make this initiative relevant to our healthcare system.

For one thing, like Tonga, Canada has many remote regions for which recruiting and retaining clinicians – particularly specialists –  and skilled IT staff is a challenge. We also both face the challenge of (largely) centralized healthcare provision, which means citizens living in rural and remote areas often have to travel long distances for care.

The Tonga initiative also highlights the importance of continuity of care both there and here at home, where a number of provinces and the federal government have embarked upon efforts to address the  problem of patients falling through the cracks as they move through different parts of the healthcare system.

And, just as it’s important for Canadian healthcare professionals to learn from other countries, we can also share our own experience with others as we move closer to realizing Canada Health Infoway’s vision of uniting industry, healthcare providers, provinces, territories and Canadians to ensure we have access to our health information and digitally enabled solutions to better manage our own care.