Towards practical digital health designs: A single electronic health record for South Africa

Since announcing the implementation of a single electronic health record for all South Africans, the government has not yet informed healthcare facilities of how this would be accomplished. The siloed South African healthcare system would have to be redesigned to accommodate a single electronic health record. A systematic literature review conducted across three databases returned 9 790 results. By applying ten filters, 22 documents were eventually retrieved for analysis. The analysis showed that existing research focuses on healthcare architectures from a theoretical perspective. Therefore, the literature review revealed a practically based research deficiency and a lack of theoretical studies merged with practical cases. Seeking to enhance the understanding of designing a single electronic health record, the documents were analysed using a qualitative inductive content analysis technique, revealing that a single electronic health record cannot be formulated using a fully centralised architecture as this is not practical. A fully decentralised architecture, such as blockchain, is equally infeasible because this requires significant changes to the existing systems and infrastructure and would require re-skilling system builders. Since the South African healthcare architecture is already decentralised, hybrid architecture incorporating edge computing with clusters of systems and information that connect using middleware should be considered.