Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 32722
Data Integrity: Challenges in Health Information Systems in South Africa

Authors: T. Thulare, M. Herselman, A. Botha


Poor system use, including inappropriate design of health information systems, causes difficulties in communication with patients and increased time spent by healthcare professionals in recording the necessary health information for medical records. System features like pop-up reminders, complex menus, and poor user interfaces can make medical records far more time consuming than paper cards as well as affect decision-making processes. Although errors associated with health information and their real and likely effect on the quality of care and patient safety have been documented for many years, more research is needed to measure the occurrence of these errors and determine the causes to implement solutions. Therefore, the purpose of this paper is to identify data integrity challenges in hospital information systems through a scoping review and based on the results provide recommendations on how to manage these. Only 34 papers were found to be most suitable out of 297 publications initially identified in the field. The results indicated that human and computerized systems are the most common challenges associated with data integrity and factors such as policy, environment, health workforce, and lack of awareness attribute to these challenges but if measures are taken the data integrity challenges can be managed.

Keywords: Data integrity, data integrity challenges, hospital information systems, South Africa.

Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 1219


[1] NDOH, "National Digital Health Strategy for South Africa 2019 - 2024", in Better health for all South Africans enabled by person-centered Digital Health. 2019, Department of National Health: South Africa.
[2] W. T. Maphumulo and B. R. Bhengu, "Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review". Curationis, 42(1): p. 1-9, 2019.
[3] F. M. Najem, "The Impact of Hospital Information System Quality on the Health Care Quality: A Case Study on European Gaza Hospital", in Department of Business Administration. 2016, The Islamic University-Gaza. p. 190.
[4] P. Vimalachandran, H. Wang, Y. Zhang, B. Heyward, and F. Whittaker. "Ensuring data integrity in electronic health records: a quality health care implication". in 2016 International Conference on Orange Technologies (ICOT). IEEE, 2016. 20-27.
[5] M. C. Katurura and L. Cilliers, "Electronic health record system in the public health care sector of South Africa: A systematic literature review". African journal of primary health care & family medicine, 10(1): p. 1-8, 2018.
[6] O. Shisana, "Presidential Health Summit 2018", in Strengthening the South African health system towards an integrated and unified health system. 2018, Department of Health: Johannesburg.
[7] P. Mathebeni-Bokwe, "Management of medical records for healthcare service delivery at the Victoria Public Hospital in the Eastern Cape Province: South Africa", in Department of Library and Information Science. 2015, University of Fort Hare.
[8] B. Malakoane, J. C. Heunis, P. Chikobvu, N. G. Kigozi, and W. H. Kruger, "Public health system challenges in the Free State, South Africa: a situation appraisal to inform health system strengthening". BMC Health Services Research, 20(1): p. 58, 2020.
[9] A. Karrim. "Covid-19 data: SA still in 'first industrial revolution', reporting infections via old 'paper system'". 2020 02 August 2020]; Available from:
[10] A. Pandey, A. Khan, Y. Abushark, M. M. Alam, A. Agrawal, R. Kumar, and P. R. Khan, "Key Issues in Healthcare Data Integrity: Analysis and Recommendations". IEEE Access, 8: p. 40612-40628, 2020.
[11] J. Pollard, J. Blankenship, and T. Lyness, "Beware The Coming Data Integrity Crisis", in Data Tampering Will Threaten Your Digital Transformation. 2018.
[12] B. Liu, X. L. Yu, S. Chen, X. Xu, and L. Zhu. "Blockchain Based Data Integrity Service Framework for IoT Data". in 2017 IEEE International Conference on Web Services (ICWS). 2017. 468-475.
[13] S. Pearlman. "What is Data Integrity and Why Is It Important?". What data integrity isn't 2019 8 August 2019
[cited 2019 20 September]; Available from:
[14] P. Ranade-Kharkar, S. E. Pollock, D. K. Mann, and S. N. Thornton, "Improving Clinical Data Integrity by using Data Adjudication Techniques for Data Received through a Health Information Exchange (HIE)". AMIA ... Annual Symposium proceedings. AMIA Symposium, 2014: p. 1894-1901, 2014.
[15] UN, "E-Government Survey 2020", in Digital Government in the Decade of Action for Sustainable Development. 2020, Department of Economic and Social Affairs: United Nations, New York.
[16] M. S. Bhadrashette, "Overview of Data Integrity issues in the Pharmaceutical industry". International Journal of Pharmaceutical Sciences Review and Research, 14: p. 95-101, 2018.
[17] S. Soares, Data Governance in a Box: An End-to-End Approach to Operationalize Data Governance. USA: Information Assets LLC^, 2016.
[18] R. Ganiga, R. M. Pai, M. M. Pai, and R. K. Sinha, "Security Framework for cloud based Electronic Health Record (EHR) system". International Journal of Electrical and Computer Engineering (IJECE), 10(1): p. 455-466, 2020.
[19] H. I. Colquhoun, D. Levac, K. K. O’Brien, S. Straus, A. C. Tricco, L. Perrier, M. Kastner, and D. Moher, "Scoping reviews: time for clarity in definition, methods and reporting". Journal of Clinical Epidemiology, 67: p. 1291-1294, 2014.
[20] J. Peterson, P. F. Pearce, L. A. Ferguson, and C. A. Langford, "Understanding scoping reviews: Definition, purposes, and process". Journal of the American Association of Nurse Practitioners, 29(2017): p. 12-16, 2016.
[21] A. Agrawal and N. R. Alharbe, "Need and Importance of Healthcare Data Integrity". International Journal of Engineering and Technology (IJET), 11(4): p. 854-859, 2019.
[22] IBM, "The Cost of a Data Breach". 2019, Ponemon Institute.
[23] WHO, "Guideline on Data Integrity". 2019, World Health Organization.
[24] W. Yadow. "3 Key Data Integrity Testing Strategies for DW/ BI Systems". 2019
[cited 2020 3 July 2020]; Available from:
[25] M. Masrom and A. Rahimly, "Overview of Data Security Issues in Hospital Information Systems". Pacific Asia Journal of the Association for Information Systems, 7(4): p. 51-66, 2015.
[26] C. Curz, "Data Integrity, Data Analysis and Monitoring". 2018, PDA.
[27] H. Balfour "Exploring data integrity guideline changes moving into 2020". 2020.
[28] G. Wright, D. O'Mahony, and L. Cilliers, "Electronic health information systems for public health care in South Africa: a review of current operational systems". Journal of Health Informatics in Africa, 4(1), 2017.
[29] T. E. Mutshatshi, T. M. Mothiba, P. M. Mamogobo, and M. O. Mbombi, "Record-keeping: Challenges experienced by nurses in selected public hospitals". Curationis, 41(1): p. e1-e6, 2018.
[30] S. A. Bantom, "Accessibility to Patients' own Health Information: A Case in Rural Eastern Cape, South Africa", in Faculty of Informatics and Design. 2016, Cape Peninsula University of Technology: Cape Town.
[K. A. Wager, F. W. Lee, and J. P. Glaser, "Laws, Regulations, and Standards That Affect Health Care Information Systems", in Health Care Information Systems: A Practical Approach for Health Care Management 2017, San Francisco: John Wiley & Sons, 2017, 285 - 322.
[32] T. B. Mahlaola and B. Van Dyk, "Reasons for Picture Archiving and Communication System (PACS) data security breaches: Intentional versus non-intentional breaches". Health SA Gesondheid, 21(1): p. 271-279, 2016.
[33] J. R. N. Barrett. "Achieving Data Integrity and Accuracy in the Electronic Health Record". Clinical Analytics 2020
[cited 2020 23 June 2020]; Available from:
[34] S. Bowman, "Impact of electronic health record systems on information integrity: quality and safety implications". Perspectives in health information management, 10(Fall): p. 1c-1c, 2013.
[35] M. O. Kim, E. Coiera, and F. Magrabi, "Problems with health information technology and their effects on care delivery and patient outcomes: a systematic review". Journal of the American Medical Informatics Association, 24(2): p. 246-250, 2017.
[36] E. Coiera, J. Ash, and M. Berg, "The Unintended Consequences of Health Information Technology Revisited". Yearbook of Medical Informatics, 25(01): p. 163-169, 2016.
[37] L. Salahuddin, Z. Ismail, U. R. Hashim, R. R. Raja Ikram, N. H. Ismail, and M. H. Naim @ Mohayat, "Sociotechnical factors influencing unsafe use of hospital information systems: A qualitative study in Malaysian government hospitals". Health Informatics Journal, 25(4): p. 1358-1372, 2018.
[38] M. G. Amato, A. Salazar, T.-T. T. Hickman, A. J. L. Quist, L. A. Volk, A. Wright, D. McEvoy, W. Galanter, R. Koppel, B. Loudin, J. Adelman, J. D. McGreevey, D. H. Smith, D. W. Bates, and G. D. Schiff, "Computerized prescriber order entry-related patient safety reports: analysis of 2522 medication errors". Journal of the American Medical Informatics Association, 24(2): p. 316-322, 2017.
[39] S. J. Champagin, "Medicare Loses Billions to Billing Errors", in Proceedings of the Ninth International Conference on Engaged Management Scholarship. 2019, SSRN eLibrary.
[40] OIG. "Security Gaps May Threaten Electronic Health Records". 2011 06 July 2020; Available from:
[41] F. Xhafa, F. Y. Leu, and L. L. Hung, Smart Sensors Networks: Communication Technologies and Intelligent Applications. Intelligent data-centric systems, ed. F. Xhafa. Amsterdam: Academic Press^, 2017.
[42] Y. Zhang, D. S. Myers, A. C. Arpaci-Dusseau, and R. H. Arpaci-Dusseau. "Zettabyte reliability with flexible end-to-end data integrity". in 2013 IEEE 29th Symposium on Mass Storage Systems and Technologies (MSST). IEEE, 2013. 1-14.
[43] D. F. Sittig, A. Wright, E. Coiera, F. Magrabi, R. Ratwani, D. W. Bates, and H. Singh, "Current challenges in health information technology–related patient safety". Health Informatics Journal, 26(1): p. 181-189, 2018.
[44] HPCSA, "Ethical guidelines for good practice in the health professions". 2019, Health Professions Council for South Africa.
[45] S. Stevenson, "The National Health Act Guide", J. Berger, et al., Editors. 2019: Cape Town, South Africa. p. 207.
[46] B. Zenda, R. Voster, and A. Da Viega, "Protection of personal information: An experiment involving data value chains and the use of personal information for marketing purposes in South Africa". South African Computer Journal, 32(1): p. 113-132, 2020.
[47] S. Anthony, "Medical Records in South Africa", in Medical Protection Society Guide. 2014, Medical Protection Society: South Africa. p. 36.
[48] L. P. Luthuli and T. Kalusopa, "The management of medical records in the context of service delivery in the public sector in KwaZulu-Natal, South Africa: the case of Ngwelezana hospital". South African Journal of Libraries and Information Science, 83(2): p. 1-11, 2017.
[49] N. N. Mchunu, "Adequacy of healthcare information systems to support data quality in the public healthcare sector, in the Western Cape, South Africa". 2012, Cape Peninsula University of technology.
[50] M. Ahola, "The Role of Human Errors in Successful Cyber Security Breaches". 2019, usecure: Manchester.
[51] Z. M. Manyisa and E. J. Aswegen, "Factors affecting working conditions in public hosptials: A literature review". International Journal of Africa Nursing Sciences, 6(2017): p. 28-38, 2017.
[52] M. J. Mokoena, "Perceptions of professional nurses on the impact of shortage of resources for quality patient care in a public hospital: Limpopo Province". 2017, University of South Africa: South Africa.
[53] J. C. Lubbe and L. Roets, "Nurses’ scope of practice and the implication for quality nursing care". Journal of Nursing Scholarship, 46(1): p. 58-64, 2014.
[54] P. Barron and A. Padarath, "Twenty years of the South African Health Review". South African Health Review, 2017(1): p. 1-10, 2017.
[55] H. K. Nevhutalu, "Patient's rights in South Africa's public health system: Moral-critical perspectives". 2016, Stellenbosch: Stellenbosch University.
[56] J. C. J. Garvey, "Data Integrity: A Structural Approach for Sustainable Outcomes". 2017, FDAnews. p. 46.
[57] M. Botha, A. Botha, and M. Herselman. "Data quality challenges: A content analysis in the e-health domain". in 2014 4th World Congress on Information and Communication Technologies (WICT 2014). 2014. 107-112.
[58] Y. Vawda and A. Gray, "South African health review 2018". 2018, Health Systems Trust.
[59] GPW, "Protection of Personal Information ACT, 2013". 2013, Government Printing Works: Pretoria.
[60] HPCSA, "Guidelines on the Keeping of Patient Records", in Ethical guidelines for good practice in the health care professions. 2016, Health Professions Council of South Africa: Pretoria.
[61] NDOH, "District Health Management Information System (DHMIS) Policy", N.D.o. Health, Editor. 2011, National Department of Health: South Africa.
[62] B. Babati, "What is data integrity". 2018, Youredi Ltd.
[63] APIC, "Practical risk-based guide for managing data integrity". 2019, Active Pharmaceutical Ingredients Committee. p. 54.