Lagos-SHIP Project and Nigeria’s Need For Electronic Health Records
Nigeria and its component regions lack interoperable electronic health record systems which according to the World Health Organisation, can boost universal health coverage in countries. Oluwatobi Odeyinka writes on an initiative of the Lagos State government to digitise the medical records of all residents and allow seamless exchange of data across all medical facilities in the state. He explores the solutions promised by this initiative and the concerns of residents and experts regarding its implementation.
Kofoworola Olufemi was rushed to a hospital for an emergency in March 2024. Her husband was away at work, and there was nothing her six-year-old daughter could do when her life hung in the balance. Her Neighbour rushed her to a nearby private hospital in the Agege area of Lagos State.
The hospital attendants asked if she had a card with them, and when they were told she was a new patient, they requested a cash deposit to “open a record” for her and immediately run tests.
Without a pre-existing relationship with the hospital, Kofoworola was forced to navigate a time-consuming process of paperwork and deposits while she groaned in pain. Valuable hours ticked by as her neighbour scrambled to contact her husband for payment, and nurses ran helter-skelter to administer first aid and run tests.
“If I had been taken to our family hospital, most of the tests they conducted would not be necessary, as I had results for them in my records, and they would have also seen some previous treatments” she reflected later.
Kofoworola’s harrowing experience highlights the often-devastating consequences of Nigeria’s fragmented healthcare system, characterized by administrative hurdles and lack of infrastructure.
Ibukun Adewale’s grudge against Nigeria’s health sector is that she can’t keep track of drugs she has used without having to keep bottles of syrups and packs of tablets. The prescriptions she received from the doctors are written in such a way that only pharmacists “or the doctors themselves can read”. She wished they were documented digitally so that she could keep track.
“One time my doctor prescribed medication to me via a WhatsApp chat and I had an epiphany! I could read the prescription myself and I could refer to it in the future!”
Electronic Medical/Health Records
The health sector’s dependence on technology is growing but many developing countries including Nigeria lag in fusing technology in their healthcare sector. Experts have asserted that electronic health records (EHR) and electronic medical records (EMR) are revolutionising healthcare in developed countries by facilitating seamless data exchange, improving clinical decision-making, and enhancing patient engagement.
An electronic medical record (EMR) is a digital version of a patient’s medical history, including diagnoses, medications, tests, allergies, immunizations, and treatment plans. Stored on computers, EMRs can be accessed by healthcare providers treating the patient and help guide care decisions.
EMRs are often used interchangeably with electronic health records (EHRs), though they differ in scope and accessibility. While EMRs are used by specific medical practices, EHRs track a patient’s health across multiple practices and can be shared with other healthcare professionals, pharmacies, and emergency facilities. EMRs can also integrate with medical devices that automatically transmit data into the system.
The value of digital medical records
The digital storage and exchange of health records enhances health information, reducing duplication of tests, and delays in treatment.
It should be noted that some private hospitals and public tertiary hospitals have electronic medical records that enhance healthcare services.
Kehinde Olawunmi recalls her experience at the Garki General Hospital in Abuja, describing it as “fully digitised.” She explained that with just her reference number, her file was readily available on the screen of any physician or professional who needed to attend to her.
Through EMR/EHR, Mrs. Olawunmi’s diagnosis, test results, and predictions were available at the Garki General Hospital. Many patients also enjoy similar provisions in private hospitals, especially in Lagos. However, these electronically saved data are only available within a hospital and shared within. Patients who change hospitals have to get their records manually and transfer them to the new hospital. If they are taken to a new hospital in the case of an emergency, they are subjected to a series of tests that would not have been conducted if they were in their registered hospitals.
The lack of electronic health records at the national level contributes to delays and duplication of tests by patients.
Lagos Government Introduces Digital Public Health Records
In a bid to fill this gap, the Lagos State Government has launched the Lagos State Smart Health Information Platform (Lagos SHIP), a digital public infrastructure that joins all health touchpoints (hospitals, pharmacies, diagnostic centres, etc) in both the public and private sectors.
The platform created through a partnership between the Lagos Ministry of Health and Interswitch eClat, is expected to digitise and integrate all health data into a single, comprehensive platform for seamless access to aid decision-making in public healthcare.
On the Lagos-SHIP website, it is stated that “The platform creates a seamless flow of patient data between healthcare providers, ensuring timely and efficient care for every individual. By eliminating delays and streamlining access to information, Lagos SHIP will transform the healthcare landscape by making access easier, and enabling better collaboration.”
It will revolutionise healthcare delivery in the state
Professor Mohammad Aminu Mohamma, the President, Medical and Dental Consultants Association of Nigeria, said the initiative will revolutionise healthcare delivery in Lagos State.
Prof Mohammad who is a Consultant Paediatric Surgeon at the Aminu Kano Teaching Hospital and Bayero University, Kano State, disclosed that electronic medical records have been adopted in “tertiary hospitals and most private hospitals in Kano”. He noted that adopting it across a state as the Lagos state government plans with Lagos-SHIP will make more hospitals go “paperless” and enhance healthcare delivery in the state.
“Electronic medical record is important because it allows everybody (health workers) to have access to the records of the patient wherever you are seeing the patient physically or not.
“Even if the patient is seeing 10 different doctors, they will have access to the records at the click of a button. So based on that, it is important that records are digitised.
“Apart from the expenses associated with printing and writing, people can easily enter their records and review their records remotely.
“Also an expert can be anywhere and attend to the patient; he can review the records and give advice based on what is there.”
He added that electronic medical records are as important as physical infrastructure in the health sector.
Apart from making healthcare more accessible and faster in the state, the government could also rely on the health records of residents in making policy decisions for the betterment of the public.
“Lagos SHIP would empower the government to plan and coordinate health services across all levels. By collecting and analysing data, we can better understand the health-seeking behaviour of Lagosians. This is crucial because we can use the data for policy definition and to apply resources to certain places. Lagos SHIP is not only for patients care but also for guiding policymakers,” the state Commissioner of Health, Prof. Akin Abayomi said.
Both Prof Mohamma and Mitchell Elegbe, the Founder & Group CEO of Interswitch compared the initiative to the digitization of payments which started in Nigeria about two decades ago.
“It is just like in those days… people can’t imagine that banks will operate the way they do or that instant payments could be possible. Now, many people do not even know where their bank is (located),” Prof Mohamma said .
For Mr Elegbe, “22 years ago, we set out with a clear vision; to solve social problems in Nigeria, starting by digitizing the use of cash, making it available to Nigerians just-in-time. This latest epochal concession agreement with the Lagos State Government to develop and manage the revolutionary Smart Health Information Portal (Lagos SHIP) is one of the unfolding initiatives along that strategic roadmap, in line with Interswitch’s aspirations to be embedded at the heart of social services transformation.”
Concerns About Implementation
The major concerns surrounding the implementation of the Lagos-SHIP project and electronic health record systems, in general, are power and internet connectivity.
Millions of Nigerians face energy poverty as the country fails to generate enough electricity for its large population. Hospitals at primary and tertiary levels often experience power outages that endanger the lives of patients.
Earlier this year, the Lagos University Teaching Hospital (LUTH) experienced a power outage that lasted about three days after it was disconnected from the power grid by the electricity distribution company over debts owed.
Prof Mohamma said for the initiative to work effectively, the state government and the private sector have to invest in power, gadgets, and internet connectivity.
“Power is the most important, then availability of the gadgets and connectivity,” he said.
This report is produced under the DPI Africa Journalism Fellowship Programme of the Media Foundation for West Africa and Co-Develop.
