The mining industry provides employment to hundreds of thousands of workers from across the region, but this employment comes with significant socio-economic challenges to keep this burgeoning workforce safe from occupational diseases.
As it has done throughout its history, the South African mining industry is a fundamental driver of economic growth. For example, in 2013 the industry contributed 16.7% to the annual GDP of South Africa. Moreover, South Africa’s mineral wealth remains some of the world’s most valuable, with a worth of approximately R20.3-trillion ($2.5-trillion).
Naturally, a major industry such as this will attract a vast labour force with an estimated direct and indirect employment in the sector in 2012 totalling over 1.36 million people.
The rate of TB infection in South African mines is the highest in the world with estimates that between 3000 and 7000 new infections per 100 000 of the population are recorded per year. This is between 4 and 7 times higher than the general population of South Africa, which in itself has the second highest TB rate in the world. Tuberculosis directly affects 500 000 workers, 230 000 partners and 700 000 children.
On an annual basis, thousands of migrant workers from across the Southern African region travel to work in South Africa’s mines, where they are exposed to the risk of contracting tuberculosis (TB) and other occupational diseases. The miners’ vulnerability to TB is exacerbated by the multiple risk factors associated with their jobs, such as prolonged exposure to silica, their densely populated living conditions and their associated lifestyles.
In addition to health implications, TB is adding to the increased operating costs of the mines as the profits of mining houses are squeezed due to increasing medical costs and lost productivity. The disease costs the mining industry an estimated $570 million in lost productivity and miners themselves lose an estimated $320 million per year in wages.
With increased pressure from the South African Government to root out the disease in the mining sector, many mining houses are increasingly focusing more time and attention on the disease. They are becoming more conversant with their obligations in terms of medical surveillance of their employees, the treatment of TB and the compensation thereof as an occupational disease.
The South African Mine Health and Safety Act (29 of 1996), stipulates that each company has an obligation to provide medical surveillance for all of its employees, and furthermore must keep an accurate and complete record of the surveillance for a period of 40 years from the last date of the medical surveillance of that employee.
Historically, the mining houses produced and kept paper-based records of each employee’s medical file. X-ray chest examinations were exposed onto film and stored along with the record and these were kept in filing rooms at the mines and at external document storage companies. Many of the old records are still kept in this manner.
With the advent of digital systems of patient records, however, a number of the mining houses now store their medical records in a digital format keeping track of the employee’s occupational health records and test results. The challenge faced in modern times is how to store the inordinate amount of digital data to comply with the legislated retention period and in particular, the storage of digital x-ray images.
The first such challenge facing mines’ IT and/or Occupational Health departments, is how to adequately store this data for the required period. The x-ray image data can run into many terabytes of space, severely using up much of the annual storage budget of the departments. Furthermore, as new data is generated on a daily basis, the total amount of storage capacity required to accommodate all the data will grow exponentially.
The second challenge is that of technology obsolescence. As information technology rapidly changes, many of the systems that are in use today will be obsolete and unsupported in the near future. Hardware only has a limited useful lifespan and x-ray image data that is stored on these legacy servers and storage arrays will need to be migrated to newer equipment a number of times during the retention requirement of the data. With technology obsolescence, it is not unlikely that the x-ray images of an employee who works at a mine for 25 years will go through 13 complete hardware refreshes in its lifespan, with a significant cost each time.
A further consideration for the mining houses is how to ensure continuous availability of the patient record, from the initial baseline image recorded during the employee’s on-boarding, right up to the latest x-ray image produced during the last patient visit. The mine occupational health practitioners are very often frustrated at not having the full patient record available and having to request historical data to be retrieved from disparate backup solutions, which may take up to a week to be done. Besides the obvious frustration experienced by the doctors, the impact on patient care can be affected as they wait for diagnosis to be completed.
IntriHEALTH has been assisting a number of companies in the mining industry in alleviating these challenges for the past number of years. IntriHEALTH’s core focus, and in fact the backbone of the organisation, has been the archiving of digital medical x-ray data for the mining sector.
IntriHEALTH offers its clients a solution whereby they provide up to 5 years of local on-site archive capacity, coupled with a permanent cloud based archive solution of the full patient image record in the IntriHEALTH data centres. All data is stored in a Vendor Neutral Format allowing for the data to be accepted from any vendor modality or PACS and in turn viewed on any preferred vendor DICOM viewing software. Strengthened with a “Zero Deletion” policy in its data centre, which means that all data, once received, is permanently archived and redundant data centres in geographically disparate locations, IntriHEALTH assures that all patient data archived is secure, effectively taking the concern of how to manage the image data away from their clients.
Not only is patient security at the heart of the whole IntriHEALTH solution, and remains a key focus in everything they do, all the data that is handled, is immediately compressed into a 100% guaranteed lossless format, and is then encrypted using a 256bit compression algorithm.
Furthermore, the transmission of the data from the local site to the data centre is processed along a secure encrypted channel, further adding to the patient security. The only time the data is ever unencrypted is when it is requested by an authorised DICOM request from a known DICOM Storage Class User (Viewing station).
Once the image data is securely archived, adding value to clients becomes realistic because of the speed with which the company is able to move data around. Many of the Occupational Health Practitioners employed by the mining houses would prefer for the chest x-rays to be read by a radiologist, particularly the baseline examinations and the studies that present with an occupational disease detected or some other anomaly.
IntriVIEW, one of the products supplied by IntriHEALTH, is a secure web based diagnostic x-ray viewer. Through secure login, the company is able to share patient information to an approved user in any location, providing they have internet access. This zero footprint viewer never downloads patient data onto the device, further ensuring patient confidentiality and can be accessed by any web-enabled device including smart phones, tablets and computers. The IntriVIEW viewer boasts a full suite of diagnostic tools as well as a unique timeline that displays the existence of all prior patient examinations. These historical studies are instantly available for image comparison.
IntriHEALTH is able to facilitate with the secure sharing of the patient image data with the selected preferred radiologist of the mining company’s choice or alternatively by utilising one of the doctors in the IntriHEALTH tele-radiology stable. As always, IntriHEALTH ensures that the access to the data is granted in a secure manner with user authentication privilege being granted to the doctors. The mine can choose whether to anonymise the patient data with the radiologist or to share that information should they deem it medically relevant. Of great interest to many of IntriHEALTH’s mining clients has been the ability to get a random percentage of all studies performed peer reviewed by an external radiologist. IntriHEALTH’s tele-radiology solution has been of immense benefit in such cases.
There are many interested parties in the health and wellness of mine workers, including the Department of Mineral Resources, the Department of Health and the Mining Board of Disease. Through the ability of IntriHEALTH to archive the digital diagnostic quality images, the company is well placed to provide consented access to the data.
As the focus on eliminating occupational diseases in the mining sector gathers momentum, the onus and focus really is on the players in the mining sector. They need to be seen to be proactively addressing the debilitating effects of these diseases in their staff populations. They need to have a targeted focus on identifying those who are afflicted and assisting them in recovery. IntriHEALTH’s suite of products can go a long way in helping the mining sector to effectively meet the challenge head on.