• 29 Sep 2016

    SpesNews Volume 135


    The previous version of the SpesNews introduced the changing landscape of patient monitoring and how remote patient biometric monitoring devices can assist in the creation of a highly efficient and optimised specialist practice. It also placed emphasis on the fact that patient healthcare information should ideally be located in the realm of the healthcare professional and that the healthcare professional should remain the custodian of the patient’s biometric information.


    A significant number of healthcare practices are enjoying the benefits of information obtained by these devices, but what is more important is how the information translates into clinical tools for the effective clinical management of a patient. While it may be good to know that a patient had a pulse rate of >120 bpm, it adds significantly more value when this can be linked to either the physical activity or emotional stress that the patient might have experienced at the time. False positives (and false negatives) can much easier be identified and appropriate measures introduced.

    The final outcome of the input from all of these biometric measurement devices would be to create and maintain a personalised patient biometric profile. In the personalised patient biometric profile, instead of a biometric measurement against a larger population that might be inappropriately  referenced,  in a very fit athlete a heartrate of 90 could indicate a significant problem if the  heartrate is normally well below 50 bpm. Under these circumstances, a platform that collates, summarises and flags these seemingly normal biometrics would prove invaluable. In essence, we could be referring to a variance in the measurement of biometric data as it would be applicable and appropriate on a personalised and individualised manner in an effort to determine patient well being.  


    With the advent of the National Consumer Protection Act, the Protection of Personal Information Act as well as the Promotion of Access to Information Act, the manner in which patient information can be assessed is clearly communicated. Punitive measures for breaching any of these Acts are far reaching and bound to have dire consequences in a healthcare practice.

    With the ability of the practitioner to access key healthcare information clearly defined, the responsibility to act in the best interest of the patient at some stage would become the focus of a healthcare intervention (or lack thereof) when litigation places the actions of any practitioner under suspicion. Biometric information would be incorporated into the patient clinical record to become part of the comprehensive clinical notes so often omitted in real world scenarios. Where biometric information are communicated in real-time to a healthcare professional, healthcare problems can be identified early and remedial measures instituted, leading to better clinical outcomes (with an expected reduction in the morbidity and mortality ratios for the practice). One can also reasonably expect less complications where clinical interventions are implemented earlier.


    Patients are actively being educated regarding their various rights, but less often regarding their responsibilities (see next article). This education is not always balanced and may be delivered aligned with alternative agendas (such as an effort to boost legal action against practitioners). Practices can however reduce instances of actions like these by adhering strictly to, at the very least, the following:

    •       Always obtain full informed consent. This includes clinical as well as      financial consent and the patient should sign agreement to the terms and conditions    of the practice
    •       Always practice within your current scope of practice and competencies
    •       Always ensure that you are aware of current practices and advances in clinical disease and health management
    •       Always keep thorough (and updated) clinical notes
    •       Always keep your practice personnel educated and trained.
    •       The practitioner ultimately assumes responsibility for the actions of his/her staff. This is especially important where sensitive patient personal or confidential information is involved
    •       Always consider alternatives to increase practice communication, efficiencies and processes without exposing the practice to any additional risks
    •       Always involve patients in healthcare treatment goals. Emphasise individual roles and responsibilities and review these regularly 



    An increasing number of medical schemes require their members to obtain authorisation numbers prior to the delivery of any healthcare related services. This forms part of the managed care interventions used by some schemes to mitigate risk and exercise control over the utilisation of benefits. In a bid to assist the patient, many healthcare professionals have assumed the responsibility of obtaining authorisation numbers on behalf of the patients. The unfortunate consequence is that the perception has been created that it is the healthcare professional’s task to apply for, and obtain authorisation numbers. This perception is incorrect and has, according to the HPCSA, been identified as one of the main causes for complaints against healthcare professionals.

     Practices are encouraged to ensure that patients understand that the responsibility for obtaining authorisation for treatment or services ultimately and always lies with the member of the medical aid and that it remains their responsibility to ensure that the authorisation obtained from their medical scheme covers the scope of their treatment and services to be rendered. Patients should communicate with the practitioner concerned, especially when there is limitation to the authorisation given.


    CMScript 8 (25 March 2015) specified that spinal stenosis without spinal cord compression, ischaemia or degeneration (myelopathy) with or without radiculopathy is not included in the PMB regulations and accounts should be paid at relevant scheme rules. The CMS Clinical Unit advises that this interpretation still remains in effect and that practices should be cognizant of this interpretation when lodging a spinal benefit related CMS complaint.

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