| 4. In which ways is the initiative creative and innovative?
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CDAS project is begun to be argued in 2005. In 2007, software analysis studies were completed. In the midst of 2008, CDAS software began its phase of being improved and it was made ready to use while gaining its all functionality in August, 2009.
In September 2009, CDAS Call Center service protocol was signed between the Ministry of Health and Türk Telekom. Pursuant to the protocol, a Call Center was established in which 144 operators would serve by detecting two pilot provinces and for the purpose of forming appointments to the hospitals in these provinces.
In October 2009, the first CDAS Integration Workshop was held with Hospital Data Administration System (HDAS) soft wares and CDAS software. Our hospitals in Kayseri and Erzurum that were chosen as pilot provinces were included in CDAS.
By year of January 7, 2009 call center began to serve. CDAS ranked among the preferential 11 e-State projects that were published by the Prime Ministry in 2010.
By depending on the pilot studies’ processing successfully, the process of dissemination of the project gradually through the country has been started by ending the pilot practice with a decision which was taken by the Ministry of Health in June 1, 2010. For recovering the processes of CDAS during the transition period, in certain terms technical and administration educations were given to HDAS developers and CDAS managers in the Provincial Directorates of Health.
CDAS that enabled service to the citizens with just 182 Call Center Line until July 2011, became to be able to give appointments also with CDAS web application (https://mhrs.gov.tr) after that date.
The pilot practice that contained 2 provinces in 2010 was put into practice in all provinces except Istanbul in two years. Istanbul was included in the extent in March 26, 2012 and the system became a public service that was presented to whole country.
In January 1, 2013, another alternative way that would ease to get appointments was presented to the citizens by presenting CDAS Mobile Application.
In June 1, 2013, CDAS expanded its scope and not only the doctors in the hospitals but also the family doctors in the Family Health Centers were included in the appointment system.
As of today, the CDAS project presents an appointment service to people live in the country via 182 Call Center Line and to people who are somewhere in the world and want to be treated in Turkey via web and mobile applications. System gives service with 3.250 Call Center workers in 5 different call centers, 32.621 specialist physicians in 822 hospitals in 81 provinces and 21.062 family doctors in 947 Family Health Centers.
In the “2011 Top Ranking Performance” contest that was held by Contact Center World in 2011, AssisTT Çağrı Merkezi ve Rehberlik A.Ş. owned a silver medal came in second with the CDAS Project in the category of “Best Outsourcing Partnership”.
It is aimed to perform 100% appointed examinations in all health facilities in 2023 which is the 100th anniversary of establishment of the State of the Republic of Turkey.
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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CDAS project is a project that is put into practice by the Ministry of Health. Consequently, its greatest and most important shareholders are individuals who take health service and its employees who give health service.
With the experience they get, 182 Call Center Line workers regularly and continuously contribute to the development of the system.
The most important contribution is the support of Honorable Minister, counselor and other senior executives in the development and maintenance of the system.
System’s project management leader and team have been the same people from the beginning of the project and are still working with the same job enthusiasm and sense of responsibility.
When job rules are being formed in CDAS, opinions and suggestions from hospital head doctors, specialist physcians, family doctors, provincial directorates of health and advisor doctors who are attached to the Ministry of Health are taken into considreation. With respect to the opinions and suggestions, CDAS applications processes are continuously being recovered.
To provide the data unity throughout the country, various integration studies are being made with the other units within the Ministry of Health.
With the HDAS and Family Practice Data System (FPDS) company employees who play an active role in developing the software, workshops are being held periodically.
Also, the individuals who use the CDAS state their opinions and suggestions about the system via mail address of mhrs@saglik.gov.tr and the appropriate ones are actualized by being evaluated.
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| 6. How was the strategy implemented and what resources were mobilized?
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All products and services are financed by Ministry of Health’s own sources of circulating capital except the call receiving service that was presented by Türk Telekom with one year duration and 144 call center employees in the beginning of the project. From the beginning of the project, tenders have been lodged 6 times. Total tender price is 500 million Turkish Liras. Payment that is made until now is 200 million Turkish Liras. 85% of this payment has been used for personnel expenses.
Call centers have been established in provinces that are privileged in progress and with high rate of unemployment. 97% of the over 3.500 personnel who work in the operational side of the system are giving service in these provinces.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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It is provided for patients and doctors to manage the time they spare for the examination more efficiently and planned.
It has presented the opportunity to plan the doctor workforce to hospital managers. It has provided a decision support intended to improve health policies to ministry managers.
It has brought dynamism in the software industry.
Separate appointment applications have been singularized and a more economic appointment service has been provided.
Contributions have been made to the economies of the provinces where call centers are established and to the development of human resources.
Everyone has been presented with a 100% right to choose the doctor and reach.
It has contributed to the uplifting of the time that doctors spare for their patients from approximately 2.5 minutes to 12 minutes.
This data is the sign of getting closer to the examination duration standards that are determined by the World Health Organization in a short time.
The satisfaction level of the citizens who use the CDAS is positively in the 92% rating. While in 2004, the average of the number of applying to doctor per person was around 3.5 in a year, according to the results of 2014’s first ten months, this number is around 10. CDAS’s contribution to this increasement is great in terms of providing an ease to reach the doctor.
One of the proofs of CDAS’s success is the increasing graphic of call day after day. First 9 months of 2014, the number of calls received by 182 Call Center Line have been 64.092.295. Though in the first 9 months of 2011,this number was only 6.399.209. According to these numbers, it is seen that in three years the number of received calls has shown an increase at the rate of 901,57%. This increase is one of the most important signs of the righteousness of the investment that was made.
While the CDAS project enters into its 5th year, average of 350.000 appointments are formed in daily basis. According to this number, every 40 patient from 100 are still get examined by getting appointment. The aim of 2023 is 100% examination with appointment.
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| 8. What were the most successful outputs and why was the initiative effective?
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The process needs to be controlled, evaluated and improved continuously because CDAS project always needs to be up and running to serve properly.
CDAS Help Desk team is established in February 22 2011 and consists of 20 people. Help desk gives 7/ 24 support both to hospitals and software firms and to citizens. Complaints and requests about the system coming from various channels are resulted in the very same day and a come-back is made.
At the same time, there are 25 engineers in the contractor company for the CDAS project’s software, system maintenance and support works. Relevant contractor company analyzes the system 7/24 thanks to the monitoring programme and interferes in the situation immediately for not to suspend the receiving of appointments in a potential alarm situation. Besides this, while the intensity control on the servers are made manually, the intensity on the network is managed automatically via the Layer7 Firewall device. For the control of active users (session) in the database, various programmes are being used. Virtual robots established in call centers can generate alarms against the problems that can occur by simulating all of the operations that a call operator makes immediately.
CDAS Call Centers Tracking Desk Team that serves with its team of 11 people, can watch the sudden and retroactive activities via the tracking programme.
Also, CDAS Call Center Quality Team with its team of 21, measures the service quality of every call center worker. With the aim of supporting the quality team, systemic speech analysis programme’s pilot application studies have been started.
CDAS Hospital Tracking Team with a team of 5 also provides the regular tracking of the coordination between hospitals and CDAS, doctors’ transferring the appointment plans to the system regularly and the tracking of the hospitals’ operations.
Lastly, The Communication and Social Media Unit that will provide to control of the high capacity public project on all stations, has been established. This unit has been charged to analyze all kinds of content that citizens indicate in social media environment about CDAS. Project management are given briefings by comparing the problems and claims that reflect to social media and results from reporting units.
Information about the operation is accessed by evaluating the daily, weekly and monthly reports that are regulated by our CDAS reporting teams and CDAS’s conduct is decided by looking at these feedbacks.
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| 9. What were the main obstacles encountered and how were they overcome?
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We can gather the problems that we encountered in CDAS application under three main headlines;
Technical substructure:
The main source of the problems occur in technical substructure is that of it has to improve and grow continuously. There is a need for new features and new modules depending upon the proliferation of CDAS usage. Technical conditions are being organized convenient to the rising demand and thus problems can be held in minimum level.
Hospital Operation:
HDAS-CDAS integration problems and doctor working scales’ recording deficitly are the main two problems. First problem as the project’s technical step is tried to be overcome in constant meetings held with HDAS developers. For the other problem to be lowered to a minimum level, there published a CDAS legislation by the Ministry of Health and in this legislation doctors’ juridical responsibilities about the system has been determined.
Call Center Operation:
The main source of the burdens that are encountered in the operation of Call Center results from having a big scaled call center organization. To minimize the problems occur during the processes of over 3200 employees’ routine recruitment, excitation, education, planning etc. Call Center Tracking Desk and Quality Team have been established.
On the other hand, another problem at the Call Centers is about the information security and sharing information. Previously, sharing patient history information by the operators is forbidden due to ensure the confidentiality of personal health data and to make standard information security. CDAS Project Management has harmonized the system software to remove the hassles that happened by the people, that is managing ISO 27001 right now. Employee trainings are put in order in this way too.
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