Regional hospitals struggling to embrace e-referral system

Kampala, Uganda | THE INDEPENDENT | Regional Referral Hospitals are struggling to embrace the E-referral system, despite the Ministry of Health painting a magnificent picture of how they are transitioning regional referral hospitals from the paper-based system to a more efficient electronic system.

Dr Daniel Kyabayinze, the Director of Public Health, says that the system aims to improve efficiency and access to specialised care by streamlining the referral process and facilitating information sharing.

He told URN in an interview that all doctors need now is someone’s National Identification Number (NIN) and they will know their medical history and the kind of treatment they have been receiving at different government-run facilities.

He says this system, which has been rolled out throughout all the  regional referral hospitals across the country, was initially tested at Kiruddu National Referral hospital, and the results were immense, as apart from archiving medical history, it’s helping them track,.

However, at these hospitals, this system met with suspicion by some health service seekers present a mixed picture with concerns of not just unreliable connection but demands for money by some health workers for patients to access their medical records.

At Kiruddu hospital, a patient who spoke to URN on condition of anonymity revealed that when he was being referred to Uganda Cancer Institute two weeks ago, medics asked him to pay to access a soft copy of his results.

Referral is difficult. You are not given any result forms when you do tests; they keep them in their computer. For blood tests, the doctor wanted one hundred thousand dollars to give me copies of my results. When I went for the biopsy results, again, they asked for money. I gave them forty thousand”, he reveals.

While these challenges exist,  for doctors, the e-archiving system is a welcome initiative by health workers and hospital administrators.  At Masaka Regional Referral Hospital, Charles Tumushiime, the Masaka Hospital Principal Administrator, says they were connected to the network in 2021, under a project by the Global Fund Facility and have since connected the different departments on a digital network.

Tumushiime explains that once a patient is entered into the system, they are allocated a unique number that can be used to trace their records through the network, which makes treatment quicker and efficient within the hospital.

Elsewhere, however, this system is not yet yielding. In Northern, for instance, our reporter visited Lira Regional Referral Hospital, where Dr  Andrew Odur, the Acting hospital director, describes the process as “a rough and bumpy start” as the system is far from achieving the initial aim of having all hospitals on the network access patients’ records at one central location.

“What is working is the use of an electronic data capture system so that when you go to the pharmacy, it is just a click and the name will be splashing on the other side for you to be served,  not again moving with papers.”

At Kabale Regional Referral Hospital in Kigezi sub-region, a quite similar picture is painted. Officials there say, while they want the e-system, they can not let go of the paper system as yet.

Moses Chelogoi, the hospital’s Principal Radiologist, says the introduction of the system has eased and quickened the interpretation of images taken from radiology departments. He says the images are sent to the Teleradiology Centre in Mulago for interpretation using a digital system instead of transporting them by road.

Jude Collins Busingye,  the hospital’s Laboratory Manager, says that the laboratory, outpatient and inpatient departments, and drug stores are already connected to the system, and this has improved efficiency; however, access is not guaranteed.

He says frequent power outages in the Kigezi region disrupt internet connectivity, in the end delaying data transmission and ultimately affecting timely patient care.

Referral stuck despite electronic archiving 

All hospitals surveyed for this story, including Kiruddu, where the system started, cannot share the results with other hospitals, even as Kyabayinze maintains this is being done.

Health workers at Arua Regional Referral Hospital testify that they have never shared medical history electronically outside the hospital despite the Electronic Patient Management System being introduced in 2024.

According to Bosco Alionzi, the Senior Records Officer at Arua Regional Referral Hospital, since its introduction last year, the National Electronic Patient Referral Hospital has not functioned, forcing them to resort to Local Maternity and Newborn Services (LMNS).

According to Alionzi, the LMNS uses the WhatsApp platform for easy coordination in referral cases that require quick preparations for Mothers and Children, adding that in the absence of the e-patient referral system, they now call the specialised doctors on phone and inform them of any national referrals before the patient reaches them with the hard copy of the referral form.

As a solution, experts advise the Ministry of Health to roll out the e-system at once, right from the lower facilities, as it defeats the purpose for regional referral hospitals to be connected and yet lower facilities where patients initially get diagnosed from are still stuck with papers.

Tumushiime appeals for the extension of the network to lower health facilities and district general hospitals, where most patients are referred from, to ensure efficiency throughout the health service delivery chain.

“We would wish to have the patient registered from the point of origin, such that they can only present their number here. That way, we can also fully operationalise our referral systems, as opposed to having patients who begin seeking health services from the referral hospital and ignore the nearest lower-level facilities,” he says.

The same sentiments are shared by  Dr Stephen Legesi Pande, the Moroto regional referral hospital director, who says that although the electronic system is functional, external factors such as poor weather conditions sometimes interfere with system performance. According to Pande, while the hospital has made significant progress in digitising services, delays are still being experienced in accessing patient information and processing services.

Pande explains that in Karamoja, they cannot completely abandon paper-based referral and archiving and have resolved that the use of National IDs remains optional for patients, as some come from remote areas and don’t have access to formal documentation.

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URN