| 4. In which ways is the initiative creative and innovative?
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The digital paper forms were designed based on the old ordinary legacy papers, but the new designs took in consideration the requirements of the digital pen technology, in the new e-forms the change was approximately 10-20 % when compared to the legacy paper forms.
Initial proof of concept was conducted on five Medical Centers on the first year (2012), followed by expanding the process to incorporate two major hospitals in addition to the first five medical centers (2013), aiming at reaching twenty five medical centers and twelve hospitals involved in Hajj Mass Healthcare services on (2014).
Initially regular PCs was used for transferring date from USB cradle of the digital pens, later on PCs were replaced by USB Servers, cutting down significantly on the cost and making it very simple and cost effective to implement.
As receptionist, doctors, nurses, and pharmacists interact with patients, they reflect their patient encounters on the e paper forms, upon docking the digital pen to a USB server, data is spontaneously synched to a virtual PC on a remote server. Data gathered from two field hospitals and five primary care centers, was processed in our business intelligence software server. After which collected data was converted into meaningful graphs that summarizes Key Performance Indicators and presented to healthcare leaders and decision makers through an interactive dashboard on a 150-inch interactive multi-touch screen in the health command center. Similar dashboard would also be available on mobile web-based multi-touch tablet devices for those top healthcare leaders.
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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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Interdisciplinary focus groups were conducted at each site to evaluate user’s utilization including physicians, nurses, pharmacists, and receptionists. Business Process maps were generated using Visagi reflecting different roles and all actors involved. Feedback from all stakeholders was elicited. And based on such analysis and feedback modification of implementation strategy was applied to enhance the functionality. For example, User feedback was employed to identify the best location for the pens and for the docking stations; in reception area, doctor’s rooms, nurses’ observation rooms, dressing rooms, pharmacy booths, & wherever a service provider exists. The proposed pen location was consistent across sites. Similar user feedback was used to modify paper forms structure for future use.
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| 6. How was the strategy implemented and what resources were mobilized?
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Human Resources:
- Ministry of Health Planners
- Ministry of Health IT Teams
- Digital Pen Domain Experts IT Personnel
- Ministry of Health Service Providers including Doctors, Nurses, Pharmacists & Receptionists
Technical Resources:
• Creating a Special Datacenter that guarantee availability and security
• Hardware: Digital Pens, Docking Stations, USB Servers.
• Specialized Software Solution: Applications that collect data from e-Papers & eventually presented as KPIs for Health Leaders.
• Specialized Dashboard Applications that allow healthcare leaders to monitor the data collected from multiple healthcare centers.
Supplies Resources:
- Digital Papers
Financial Resources:
The Project was financed by the Ministry of Health; Finance was utilized to cover research and development, hardware requirements, consumable supplies, and Human Resources mentioned above.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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1. Simple User Friendly data capture requiring no training and no users’ change management: The digital pen and paper technology provided a feasible user friendly solution for capturing patient-doctor encounter data in Mass-health care situation.
2. High Service Providers’ Satisfaction Rate: The technology was associated with improved satisfaction of end- users performing data collection (Doctors, Nurses, Receptionists, and Pharmacists).
3. Complete Patient Service Cycle: Usability of the digital pen was significantly improved through pre-implementation workflow process evaluation and mapping (e.g. linking digital pen forms to cover the whole cycle, starting from the reception of the patient, the doctor patient encounter, the nursing observation and dressing, the pharmacist delivery of prescribed medications, till discharge).
4. High Healthcare Leaders Satisfaction Rate: The technology was associated with improved satisfaction of healthcare decision makers, since it had allowed them to make right-on- time decisions based on real accurate statistical data.
5. Immediate Response of Healthcare Leaders to Potential Threats:
(this is the most valuable outcome of this initiative): This innovative approach provided a real-time monitoring facility that allows healthcare decision makers to act immediately on any intervention needed for assuring prevention of disasters and combating infectious out-breaks spreading .
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| 8. What were the most successful outputs and why was the initiative effective?
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In such masses gatherings of people from all around the world, the chances of bringing infectious illnesses and spreading it or even emerging new strains of viruses and illnesses is always a potential nightmare. For healthcare leaders in charge of monitoring such masses wellbeing the responsibility is humongous and the mistakes are devastating. Early detection is necessary, and having the right tool is essential. With an interactive dashboard on a 150-inch interactive multi-touch screen in the command center, coupled with mobile web-based multi-touch tablet devices, the health care leaders were able to monitor the Key Performance Indicators generated from our business intelligence software server gathered from two field hospitals and five primary care centers on a real-time basis. Drill down functionality allowed them to zoom on any area of suspected concern, and enquire more and send field teams for further actions.
Examples of KPIs presented on command control dashboards
Guarding against out-breaks:
- Census of Patients given care
- Diagnosis of Patients serviced
- Body systems affected by diseases diagnosed.
- Geographical Distribution of patients seen across medical centers
Measuring Quality of Service
- Patient Queue Time from Reception to Doctor
- Patient Queue Time from Doctor to Pharmacist
- Patient Queue Time from Doctor to Dressing / Observation.
- Patient Discharge Status
Measuring Productivity Rate
- Service provider availability
- Service Center Census compare to other centers
- Service center census over 24 hours
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| 9. What were the main obstacles encountered and how were they overcome?
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1. No Major obstacles apart from working at a time constraints:
Although the planning had been given excellent attention, the only obstacle was related to routine logistic processes that had delayed the award of project budget.
In order to avoid any delays, extraordinary cooperative efforts from Ministry of Health personnel and other parties had to be activated in order to overcome the high pressure of importing certain equipment and printing the digital forms in a relatively short period.
1. highly stressful, highly demanding situation of Mass Health services.
2. Almost no learning curve is needed for a
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