| 4. In which ways is the initiative creative and innovative?
Phase 1: Multi-stakeholder consultations to inform initiative strategy and implementation
-Health Service Advisory Board is formed by HIRA to respond to public demand for better information to healthcare services.
-Board convenes consultations with consumer advocacy groups, relevant government agencies, major Korean telecommunication companies, healthcare providers, and academic experts.
-Consultations lead to agreement that improved public service is needed to empower citizens to make better healthcare decisions.
-HIRA leadership decides to launch “HIRA application” initiative on a fast-track timeline.
Phase 2: Development of HIRA Application
July 2010 – HIRA recruits university IT students to bring creative and consumer-oriented ideas for the development of the application.
July 2010 – “HIRA application” Development Committee is formed. This working group is comprised of approximately 70 members including HIRA personnel, the university students, SK telecom, consumer advocacy groups, and target application users (e.g. elderly women). Committee meets on weekly basis to assess progress of HIRA application development and provide feedback.
March 2011 – HIRA forms a public-private partnership with SK Telecom to receive technical, financial, and human resource support in HIRA application development.
Late 2010-2011 – Strategy: Building information base for HIRA application. HIRA application development committee begins review, collection, and selection of key health information and features for first version of application and lays out strategy to include further information in subsequent versions. This also entails a transfer of available web services to the mobile device format as well as future enhancements.
Phase 3: Launch of HIRA Application version 1
October 2010 – HIRA application version 1 is launched with two features:
1) The HIRA Healthcare Facility Application: This first version includes comprehensive information on 85,000 hospitals and pharmacies in Korea and GPS-location services and emergency call button that alerts responders of emergency and provides basic health information of citizen.
2) “Health” webzine: This application is the electronic version of the previously paper-based health information magazine for the lay audience. It provides a visually appealing and easy-to-understand information on popular and important health topics.
December 2010 – “Health” webzine receives first place award for 2010 Web Award Korea competition. First time public sector wins award in this competition.
-Consumer Monitoring Group meets every month to discuss customer satisfaction, provide feedback, and suggest improvements to application,
- HIRA application development committee receives feedback from Monitoring group, customer satisfaction ratings, and its own member experiences to continue to improve application.
-HIRA launches annual competition to solicit innovative ideas from general public for improvements and new features to HIRA application.
Phase 4: Upgrades and Additional Features for HIRA applications
- Strategic Plan for Integration of Comprehensive Health Information is completed. This plan lays out strategy for the stepwise integration of the vast amount of information and resources at HIRA.
March 2011: Version 2.0 is launched. New features include:
oPatients can check personal drug history
oImproved GPS-location services to more accurately pinpoint distance to hospitals.
oAndroid version introduced in December thereby expanding user base as more consumers shift to Samsung phones.
-SKT telecom provides investment in HIRA Hospital information project by fully supporting version 2.0 upgrade
-October 2012 – HIRA application wins 1st prize for Korean Mobile Award for public sector app category.
-November 2012 – HIRA application wins 1st prize Korean Mobile App Award for public sector app category.
January 2013: Version 3.0 is launched. New features include:
- Application now incorporates comprehensive HIRA information as detailed in Strategic Plan.
- Version 3.0 focuses on reflecting citizen feedback.
- Includes Medical Fee Review service for personalized hospital bill assessment.
- Important security updates to protect patient information
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
There were several committees involved in the design and implementation of this initiative. The main groups were the 1) Health Advisory Board which provided initial recommendations, 2) the HIRA app task force which ensured that key HIRA services were reflected in the application 3) the HIRA application development committee that guided the development of the application at the working level, 4) the Consumer Monitoring Group that provided customer satisfaction feedback and suggestions for enhancements, and 5) the Patient Advocacy group composed of consumer groups and healthcare associations.
The specific stakeholders were:
HIRA – convened the stakeholders, led the consultations, design and implementation of the HIRA application initiative, and is responsible for the ongoing maintenance and upgrades to the applications.
Ministry of Health, Family and Welfare – provided high-level monitoring of progress. HIRA provided monthly briefings and solicited feedback from Ministry.
SK Telecom – provided pro-bono technical knowledge for development of application, the server on which the application is based, training sessions for HIRA staff for maintenance and upgrade of application, and financial investment in the application.
Other Korean telecommunication and internet companies: Naver and Daum provided feedback during initial consultations. Naver and Daum are the number 1 and 2 web search engines, respectively, in Korea. They have partnered with HIRA to provide comprehensive hospital information.
Consumer Research Advocacy Alliance, National Center for Korean Consumers, the YMCA, the YWCA were involved in consultations and participated as members in the Consumer Monitoring group and Patient Advocacy Groups.
Korean Association of Hospitals, Korean Doctors Association, academic experts participated in patient advocacy groups and consultations.
-Senior citizens as target users who provided feedback on the application
-University students who provided pro-bono services to assist in the development of the application.
| 6. How was the strategy implemented and what resources were mobilized?
The success of the HIRA application initiative was greatly dependent on the formation of a public-private partnership between HIRA, the Ministry of Health and Family Welfare, and SK Telecom as well as the volunteer services of university students, consumer groups, and private citizens to provide knowledge and feedback to the development of the application.
The Funding for this initiative is as follows:
2010: $70,000 USD: Initial HIRA application
–Cost for initial version of HIRA application
–Fully financed by HIRA
2011: $200,000 USD: Version 2 upgrade
–Cost for version upgrade to include GPS-technology and other features.
–Fully financed by SK Telecom
2013: $200,000 USD: Version 3 upgrade
-Cost for additional upgrades and enhancements including security features
-Fully financed by HIRA
Ongoing maintenance costs without major upgrades are estimated to be $800/month, which is financed through the HIRA budget.
The human resources involved in the initial launch of the initiative included the technical expertise and representative voices of 26 members from consumer groups, healthcare groups, and private citizens, 70 HIRA staff members, 5 SK telecom personnel, and 2 university IT students.
Currently, there are 2 fully dedicated HIRA staff members who maintain the application and the ongoing efforts of the various committees.
Public-Private Partnership (PPP):
The partnership with SK telecom was critical from technological, financial, and human resource perspectives.
•Technology: GPS-location services is very expensive technology to include in application. SK Telecom provided this service for free to HIRA, which was very important for the functionality of the application and a huge cost saving for the government. They also provided the server on which the application is based for free as well.
•Financial: In 2012, SK telecom provided full financial support for the version 2.0 upgrade.
•Human Resources: SK telecom staff worked closely with HIRA staff and the university IT students to provide technical expertise for the development of the HIRA application. Their work was critical for ensuring a high-quality product. They also provided training workshops for HIRA staff on how to maintain and upgrade the application thereby increasing in-house technical capacity.
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
1.Comprehensive up-to-date information on over 85,000 healthcare facilities.
These include over 3000 hospitals, 28,000 clinics, 20,000 pharmacies, 16,000 dental clinics, and 15,000 oriental medicine facilities. Within each it details which departments, services, and medical devices and tests are available. This information is regularly updated by healthcare facilities and subsequently reflected in the HIRA application. The comprehensive and reliable source of information on healthcare facilities assures that citizens can know where to go for a particular health concern wherever and whenever they are located.
2.Location-based service with GPS technology
The GPS-enabled location service is available for about 10 features, including GPS-location for hospitals, clinics, pharmacies, and emergency room. It reports the closest health facilities in meters within user radius at any location within the country. Users can also click on a map to view where all the closest facilities are located. This service would also show urban planners where gaps in health care services may exist.
3.Quality ratings and evaluation of hospitals
HIRA quality ratings are available for approximately 32,000 hospitals and clinics. Citizens can further access information on how often or experienced a healthcare facility is in providing a certain healthcare service. This gives citizens an objective quality assessment that is more comprehensive and informed than “word-of-mouth” approaches and can also attract patients to lesser-known high-quality health facilities.
4.Estimate of hospital fees and price comparisons
The application provides information on estimated hospital fees. This allows citizens to get a sense of the fair range of cost for a given procedure and can allow them to compare prices between healthcare facilities. User surveys have shown this to be one of the most popular features of the application.
5. High quality, user-friendly, and presents data for meaningful use
The application is visually appealing, easy-to-use, and presents data in a comprehensible fashion. The application has been continuously tested and enhanced with citizen feedback. The focus on high quality of the HIRA application led to two awards for best smartphone application in 2010.
| 8. What were the most successful outputs and why was the initiative effective?
The implementation of the initiative had robust monitoring and evaluation mechanisms through regular reports and meetings by the HIRA application development committee with two principal groups:
1)The HIRA application task force – an interdepartmental committee of senior staff at HIRA that received regular reports from the HIRA application development committee regarding the budget, timeline for completion, and key features of the HIRA applications.
2)Consumer Monitoring Committee – this group is composed of approximately 30 members of civil society groups. They met on a monthly basis during which they received briefings and updates from the HIRA application development committee. The consumer groups provided user satisfaction feedback that they surveyed amongst their constituencies and from their own experience. The recommendations from this group led to over 20 enhancements to the HIRA series of applications.
The reports to these two groups included a description of key activities, timeline, and indicators such as:
-The development of a strategic plan for comprehensive integration of information
-Progress on migration of website information to mobile format
-Progress on data migration of each HIRA app feature (e.g. hospital localization, medical diagnostics, specialty services) and how it will be accessed
-Demonstration of each HIRA app function and service.
-# of healthcare facilities covered, # of services covered, # of informational videos.
Feedback from the task force and consumer monitoring committee was used to adjust and enhance the development of the HIRA applications. The HIRA Application task force provided overall oversight and final approval.
| 9. What were the main obstacles encountered and how were they overcome?
1.Opposition from major hospitals and healthcare facilities
Major hospitals and healthcare facilities expressed concern and initial opposition to certain features of the application, particularly regarding the quality rating. In particular, low-ranking facilities feared that patients would be driven away to other facilities. Large hospitals that had good ratings were also concerned that patients would go to other lesser-known but highly ranked healthcare facilities with this new information.
Ongoing discussions and consultations with healthcare facilities helped to allay these concerns. Moreover, the appeal from consumer groups and citizens for access to comprehensive information about healthcare service facilities and their quality ratings was too strong to prevent this information from becoming more accessible.
2.GPS technology and real-time information
GPS location services and real-time information were considered to be essential features of the HIRA application. However, the technology for both of these features was costly and sophisticated. The partnership with SK telecom was critical to overcome the technical and financial barriers as they provided the expertise and full financial support for these features.
3.Creating a quality public-sector smart phone application and attracting user interest
One of the key challenges was overcoming the negative stereotype of public sector web services and mobile technology. A consumer survey found low user satisfaction amongst government websites and smartphone applications. HIRA was challenged to create an application that was high quality and could attract enough attention to convince users to download it. The intense and ongoing consultations with consumer groups and users, various mechanisms for monitoring and evaluation, and user feedback, as well as the technical expertise provided by HIRA staff, university students, and SK telecom were critical in providing and maintaining a high-quality smartphone application. As the HIRA application started to receive awards and media attention, the user base has continued to expand.