Intinsive Care Automation - Emerginces
Ministry of State for Administrative Development

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
The idea of the initiative started in 2011 and it was based on improving the services provided to patients. The situation was as follow before this initiative : 84 Hospitals in Cairo, Giza, and Kaliobia send a fax twice daily to the Call Center of the Central Administration of Intensive Care that follows the Ministry of Health. The fax indicates the number of the occupied and unoccupied beds in the care units (intensive care – burns – incubators) which leads to several problems including : - Receiving the fax only twice daily leads to the inability to update data related to beds which in its turn leads to directing the patient to a wrong hospital which may cause risk to the patient's life. - If the fax is not working for any reason, the hospital will not be able to send the report to the Call Center and hence the status of beds in that hospital will not be known. - The Call Center does not have a mechanism to monitor the conditions of the patients who are directed to the hospitals and to check the services they are provided with. - Cases are not diagnosed by using a consolidated code in hospitals which leads to the inability to calculate the number of patients who suffer from a certain disease. - The Call Center in Cairo, Kaliobia and Giza receives about 2000 average calls daily. Accordingly, employees of the Call Center exert great efforts to inspect the received faxes in order to find the unoccupied beds which leads to delaying the service that should be provide to the patient who needs immediate care.

B. Strategic Approach

 2. What was the solution?
According to the instructions of the decision makers in the different Ministries of the Egyptian Government, Ministry of Health and Ministry of State for Administrative Development have agreed on a plan for solving some problems including the problem of intensive care units. This initiative is carried out by the Ministry of State for Administrative Development in collaboration with the Central Administration of Intensive Care as they have analyzed the applied work systems in care units of hospitals. Hence, the Ministry of State for Administrative Development could create and test an appropriate system and could also help the Central Administration of Intensive Care to train the intensive care units employees in different hospitals on that system. The Central Administration of Intensive Care monitors the hospitals in order to check the ability of intensive care units staff to apply the system and to provide them with support whenever necessary. The initiative has helped in solving the aforementioned problems as follows: - The system depends on entering the patient's date immediately on reserving the bed and making a summarized report on each case immediately after leaving the hospital which leads to a continuous update of beds data. Hence, the technical and personal implications of sending faxes by hospitals will be avoided as hospitals will not be in a need for sending faxes. - The reports related to the system will enable the Central Administration of Intensive Care to follow up the conditions of patients including the dates of reserving beds for them and the dates of their leaving the units in order to recognize any failure from the part of the hospital in providing the patient with any service. - Usage of the international ICD 10 codes in diagnosing the disease will help the decision makers in the Ministry of Health to recognize the numbers and categories related to a certain disease in a stated period. - There should be updated reports every minute in the Call Center on the unoccupied beds and their places in order to direct the caller immediately to the nearest hospital which in its turn helps in saving the patients' life. - The existence of a database containing the data of all the patient's staying periods in the hospitals that are included in the system will enable to inspect certain data such as the dates related to the stays and the previous diagnoses in each hospital.

 3. How did the initiative solve the problem and improve people’s lives?
- Web application is created in order to hospitals can register the number of occupied and unoccupied beds instead of sending it by fax. - The number of beds is calculated through deducting the bed from the number of the unoccupied beds once the patient enters the hospital. The bed will be available once more after the patient's leaving the hospital. - The system will be applied in hospitals through 3G techniques by using USB Modems. Service provides in the Call Center can review the reports that indicate the data of beds in hospitals. Besides, reports will be developed in the coming period in order to appear on the maps system GIS in the ambulances that can be directed by the GPS to the suitable place. - Using the national ID number of the patient in recognizing his/her medical history will help to provide the patient with suitable medical service. Besides, the medical history of patients can be associated in the future with other systems such as insurance and pension system.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Implementation strategy focuses on the following points : - Preparing an integrated plan for the automation system that will be created, and make sure operated on phases in order to avoid its being rejected by users. New properities will be added gradually to that system as a part of administrating changes. - The system will be implemented by the Egyptian government in collaboration with the private sector through using information and communication technology as well as certified programs as the Egyptian government always encourages the private sector. - Providing the owning entities, namely, the Central Administration of Intensive Care that follows the Ministry of Health with the required skills and efficiencies and making sure that the administration has already adopted the project and is capable to operate it. - Carrying out some initial trials in order to create confidence in the system and to assess its ability to meet the required needs before its application in all hospitals. - Providing the staff of intensive care units in the different governmental hospitals that participate in the project with the required training and support on the system. - Forming a central team in the Central Administration of Intensive Care for providing the needed support on telephone in order to solve the implementation problems that may face the users of the system in the governmental hospitals.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
- Automation of intensive care units in hospitals and Call Centers is a project implemented by the Ministry of State for Administrative Development in collaboration with the Central Administration for Intensive Care that follow the Ministry of Health as the Administration is responsible for supervising and organizing the intensive care units of the different governmental hospitals, monitoring their operation and directing the critical cases to the nearest hospitals that have available beds. - The Ministry of State for Administrative Development has created an electronic system for the automation of all intensive care units in the different hospitals and for the development of the Call Center in a manner enabling hospitals to receive patients easily through the Call Center. The private sector will provide the required communication services through using 3G technique as well as GPS and GIS techniques in reviewing reports and directing the ambulances to speed up providing patients with the required services. - The Information Center of the Ministry of Health supports the Central Administration of Intensive Care through hosting the web application technically and administrating the database in collaboration with the Ministry of State for Administrative Development. The Information Center also helps the Central Administration of Intensive Care in training hospital staff.
 6. How was the strategy implemented and what resources were mobilized?
Financial Resources : - The Egyptian government finances the project with the value about of 1,000,000 Egyptian pounds (155,000 US $) including the price of hosting hardware, computers, communications devices and training devices as well as the costs of the operating team of the project. Technical Resources - The system is implemented on the devices of the Ministry of State for Administrative Development (1 main server). - Server is hosted and operation is supervised by a specialized data center supervised by the Information Center of the Ministry of Health in order to ensure providing the service for 24 hours/7 days. - Each hospital is provided with a number of two PCs and two USB Modems. - The system is secured by securing devices and networks that are supervised by the Information System of the Ministry of Health. Human Resources : - The team of the Ministry of State for Administrative Development: The program director / The project manager/ Team leader / Technical members. - The team of the Central Administration of Intensive Care: Emergencies' administration manager / Call Center's manager / Call center's members. - The team of the Information Center of the Ministry of Health: Information center manager / Technical support manager/ Technical members.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
- Immediately direct the patient by the Call Center to the nearest hospital. - The database containing of patients' national ID leading to the speed and accuracy of access to their data. - Diagnoses codes using ICD 10 leads to the unification of all diagnoses in hospitals. - 55 hospitals in Cairo, Giza and Kaliobia are participating in the system. - Increased awareness of service providers in hospitals to the citizens' right to receive excellent service.

 8. What were the most successful outputs and why was the initiative effective?
- Through the employees of the Call Center, the Central Administration of Intensive Care can follow up work in hospitals, can make sure of delivering the equipment and USB Modems to the hospital employees and can include hospitals on phases in the system in accordance with the prepared plan. - The Central Administration of Intensive Care will make sure that the hospitals are included in the system. It will also inspect the number of hospitals and make sure that all the units and beds in the intensive care units are included in the system in accordance with plan prepared by the Ministry of State for Administrative Development and the Central Administration of Intensive Care. - The Ministry of State for Administrative Development will inspect the operation of the Central Administration of Intensive Care in order to make sure that work is being carried out in accordance with the prepared plan and to interfere and provide support whenever necessary. - The Central Administration of Intensive Care will inspect operation through the reports that are related to following up the numbers of patients on beds and comparing them to the numbers of the patients who are still in the hospital.

 9. What were the main obstacles encountered and how were they overcome?
The initiative has face some difficulties in several aspects : The Technological Aspect : • Electronic and technological preparations are not available in several hospitals. As a temporary solution to this problem, USB Modems operating by 3G technique are delivered to hospitals in order to be used till completing the information network in all the governmental hospitals. Personnel Development Aspect • Data entry personnel in hospitals are not aware of the basics of using the computer. To overcome this problem, computers are delivered to hospitals and short training courses for a day or two are held in hospitals in order to provide the needed help. • Some hospitals do not enter the patients' data due to problems in connecting to the server or similar problems. To overcome this problem, a specific property is created for the Call Center employees in order to enable them from entering the patients' data on behalf of the hospital till restoring the operation of the system in the hospital.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
- Because of the aforementioned problems, it is necessary to think of a system enabling the service providers in the Call Center to be acquainted with the updates related to the number of beds immediately after reserving a bed for a patient or after the patient's leaving the hospital as the intensive care units are necessary for saving the lives of patients who are in the need of urgent care. - The Ministry of State for Administrative Development, which is responsible for the electronic government program in the Egyptian government, has started the project in 2012 with the aim of creating a system that connect all the intensive care units in the governmental hospitals. - It is easy to connect the system with other systems as the purpose of the project is to connect all the governmental, universities and private hospitals with the ambulance system in the future in order to provide patients with the best and the fastest service. - The trial version of the system is implemented in 2013 and it was tested technically and administratively. The first phase of the system was launched at the beginning of 2013. That phase include providing automatic connection between 84 hospitals in Cairo, Giza and Kaliobia and the Call Center. - The system achieves in this phase several benefits for those who deal with it directly through the Call Center or indirectly through the researches that depend on the data base. - As for the employees of the Call Center, they are provided with the mechanism that enables them to recognize the numbers of patients in intensive care units in all the hospitals that are included in this phase. - Including the patient's data on the national ID enables to recognize the diagnosis and the times on which the patient was staying in the hospitals that are included to the system in this phase. - The patient has become able to contact the Call Center in order to ask for the nearest hospital that provides the service needed to save his/her life on the basis of accurate and updated data. - As for scientific research students and decision makers, they can use data from the system such as data related to: type of patients, the area where they live, their occupations, their ages, numbers of their staying in the intensive care units and their diagnoses. They can use ICD 10 Codes that will help them in collecting semi-aggregated and semi- accurate data that they can depend on.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Continuity of the project depends on efficiency of its performance, easiness of dealing with it and ability to depend on it in directing patients. Continuity factors can be categorized as follows: Financing : - The project is financed from the budget of the government and its revenues will be in the form of improving the medical service provided to patients. Social Benefits - The whole country will benefit in general from the project as it will provide the citizen with distinguished medical service and it will also help students in their scientific researches which in its turn will lead to the development of the health system in general. Usage - The project is greatly fostered by the decision makers which increases the chances of its implementation success in all the governmental hospitals. - As it is easy for the staff of care units to use the system and as it is easy to deal with the system in general, it is encouraged to apply the system on the long term in other departments of the hospitals that are included in the system. As for the possibility to transfer the project: Procedures and data that are implemented in the project can be used easily in other departments in hospitals with simple modifications. They can be also transfer outside Egypt to Arab countries.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
- Trial operation of the system enables to avoid and solve several problems before operating the system which will help to improve dealing with the system in an easy manner. - The central implantation will help greatly in saving time and efforts required to provide the patient with service. - Implementation of the system on phases permits developments and better usage of the new systems. - Finding methods for providing the employees of the governmental hospitals with training as well as holding training courses on preparing easy electronic files related to utilization and delivering them to the employees or loading them on the system. - Using the patient's national ID will make it easy to connect the patient with all the provided services and to know the numbers of his/her staying in the hospital as well as his/her medical condition in each stay.

Contact Information

Institution Name:   Ministry of State for Administrative Development
Institution Type:   Government Department  
Contact Person:   Tarek El-Shafiee
Title:   Projects Manager  
Telephone/ Fax:   24000100 / 24000140
Institution's / Project's Website:  
E-mail:   tshafie@ad.gov.eg  
Address:   13 Salah Salem Street
Postal Code:  
City:   Cairo
State/Province:   Cairo
Country:  

          Go Back

Print friendly Page