Electronic Health Records / I-Seha
Ministry of Health/King Hamad University Hospital

The Problem

Many health oeganization using paper based Medical records , in their hospitals and health centers , but facing difficulty to share patients information between Health care provider, experiance dealyed in retrieve data, X-ray and diagnostic pictures cannot be transfer, the growing size of the records create storage problem, it required huge human resources for maintenance and transfer even within the same medical care institution. And by using handwritten notes and prescriptions which is known to be associated with medical errors , they are threaten their patients safety. Several improvement introduce to medical records but recent evidence prove that electronic medical records can reduce medical errors and improve patient' safety.

Solution and Key Benefits

 What is the initiative about? (the solution)
The project named I-Seha is The National Health Information system for Bahrain.
The Electronic Health Records (e-HR) in this project named (I-Seha) as Seha in arabic means health, provides individual lifetime health information from Birth to Death, providing curative and preventive health services (Mother and Child care, student immunization, pre-employment examination) to all Bahraini residents. I-Seha has unique features due to the national scope of the project and Bahrain’s health infrastructure. The incorporation of primary and secondary care, together with electronic medical records comprising the whole life span preventive and curative information makes I-Seha a very unique project, never yet done on a national and regional level.

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
The initiative started as upgrade of the existing IT system in the Ministry of Health, through a ministerial order a formal committee represent all the stakeholders was created, to ccordinate and supervise all the project activities, as their involvement in the planning for the change will strengthen the ownership for the project.

The stakeholders include in addition to Ministry of Health, Ministry of Finance (as financial funder ) , Central Statistic organization (as the national organizer for the country information), Civil Service Bureau (as the body responsible for organizing the government recruitment) and E-Government organization .

(a) Strategies

 Describe how and when the initiative was implemented by answering these questions
 a.      What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
The project named I-Seha is The National Health Information for Bahrain, directly extracted from the Bahrain Health Care mission statement,
Bahrain Health Care Mission Statement is as follows:
“The aim is to ensure the provision of accessible preventive, curative and palliative health services to the community of Bahrain. We will encourage personal responsibility for health and will use available resources as efficiently and effectively as possible to provide a high standard of care based on research, evidence and relevant international best practice.”
[Bahrain Health Strategy – Framework for Action 2002 – 2010]

The I-Seha project aim is dual:
􀂃 Get the health data from birth to death updated and available to any medical staff that needs it, for all citizen in the Kingdom of Bahrain.

􀂃 Get the best usage possible out of the resources, enhancing Quality, safety and efficiency.

(b) Implementation

 b.      What were the key development and implementation steps and the chronology? No more than 500 words
The proposed way for implementation is that the Ministry of Health will be purchasing a service - owned by the vendor as such, the vendor will be responsible to build and provide a working system.

This will entail the development, installation and customization of any module, and also the provision of the necessary hardware.

The outsourcing model chosen by the Ministry of Health for the HealthIT project entails four main areas: Software, Hardware, Operation and Implementation includes the important topics of Budgeting and Payment structures. The BOOT (Build, Own, Operate and Transfer) model is selected as the base model for the HealthIT .

On 2007, the request for proposal (RFP) were developed, followed by evaluation and selection started on the last quarter of the year and continue during the following year,were the negotiation among the selected bidder taken place. The mobilisation and customisation continue from 2009 and 2010 followed by operational stage in 2011.

(c) Overcoming Obstacles

 c.      What were the main obstacles encountered? How were they overcome? No more than 500 words
The main challenge rather than obstacles is to convince Ministry of Finance for the best options available to update the IT, so they can secure the required budget within the cost that affordable and within the allocated budget.
The choice for doing the project through outsourcing model with payment in installments, as the project outsource for 10 years with a total cost of 25 million Bahraini Dinars, thus the yearly payment is 2,5 millions, and if the project will create a one million electronic medical record, the cost of each record is costing 2,5 Dinar /year ( an average of 12 US$ for each file/year)
This argument was persuasive to emphasize the cost effectiveness of the project and the ministry of finance able to finance it without major burden on the yearly budget.
Other attractive factors related to the expected saving when avoiding duplication of investigation and saving the cost of chemical and developing x-ray films as this will not be needed when using the digital pictures ( as the existing budget for x-ray films is 300,000 Dinars).

Other challenges related to integrated and migrating the data was not complicated, as it was implemented in pilot processes and gradually integrated with new system, intensive training and creating tutors from different medical field play an important role in making the user accept the new change in the system, as learning from frindes who share with the staff the same concern and inquires.

(d) Use of Resources

 d.      What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
The representation in the supreme committee for different related governmental agency, make all resources of expert and local available consultant made available for the project , this was ccordinated with ministry of health staff in general and the staff of the Health Information Directorate was the most contributing resources , to developed the Request for Proposal (RFP) and play an important role in the selection and evaluation of vender.
Local consultancy firm were also utilize to support the decision making process.

The major benefits are:
• Transparency - general online access for management & staff to administrative and medical data.
• Safety – the use of Electronic Medical records has the evidence for reducing medical errors.
• Efficiency – central repository of electronic Health records with e-prescription and e-result from different medical units.
• Quality and accreditation - the implementation of the Electronic Health Records enhance the quality and support the accreditation.
• Cost & Resources management – best possible usage of all resources: staff, drugs, biomedical equipment, beds, theaters …etc.

Sustainability and Transferability

  Is the initiative sustainable and transferable?
The BOOT model of outsourcing include the transferability of the project to Ministry of Health after 10 years, meanwhile the national nature of the project make it quite possible to be joined by other health organization , other than Ministry of Health and King Hamad University Hospital and Military Hospital. This will include private medical organization, and even in future other organization in the region . The data base for the whole population can be shared by all members who will be willing to affiliated to the project, and it can pave the way for a universal Health Insurance system with a common billing system.

The project will generate a wealth of database of information that would benefit the whole future generation, many familial and genetic disease can be prdicted, risk factors and health projection and trend can be generated and preventive strategies can be implemented to change the public health status, having the base line data for all citizen will enhance the monitoring process and detect the chnages which could occur after implementing thoses preventive stratgies. This more likely to inspire many other countries to replicate or transferee this any suucessful exeriance or apply it to their own people.

Lessons Learned

 What are the impact of your initiative and the lessons learned?
1-Coordination between different stakeholders is quite challenging but it would be possible if involvement start from planning and not only during the implementation.

2- Exploring the best cost effective options for the project might take some times but it is an essential element for convincing the funder to support the project budget.

3- The tangible and non-tangible benefits when implementing the project could exceed the existing cost and budget ,if the organization continue without it.

4- Patient Safety improvement associated with the project has great value that would be fully demonstrated when the project put in wider scale and action.

Contact Information

Institution Name:   Ministry of Health/King Hamad University Hospital
Institution Type:   Government Agency  
Contact Person:   Fawzi Ameen
Title:   Director  
Telephone/ Fax:   +973-17-17444004
Institution's / Project's Website:   www.khuh.org.bh
E-mail:   fawzi.ameen@khuh.org.bh  
Address:   P.O. Box 22118
Postal Code:  
City:   Muharreq
Country:   Bahrain

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