Healthcare Online Services
Information & eGovernment Authority

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
The situation before launching the health care online services was not convenience, tedious, time and efforts consuming for both the service provider and the social groups - especially the imitative – in the community. Some years ago, if a person were looking to find doctors in their area, they would turn to the phone book and browse until they found the right doctor name. Perhaps they would simply call and make an appointment with the doctor who had the biggest and most attractive looking advertisement. After that, to attend the appointment, they have to go early to find a park first, then standing in the que and waiting in the corridors until the time of the treatment. People who don’t owns transportation, women who take care of babies, disables with difficult movement all are suffering from the waiting and the efforts consumed. In addition, if the case happened that the user should take appointment for more than one specialty, imagine the sufferings. Moreover, if the case happened to revert to pick up a document or pick up the monthly medications, the sufferings will be double and it is extremely frustrated when having to contact a place multiple times for the same reason. The relationship with the hospitals was one to one relationship; people cannot act on behalf of others to complete the formalities, for example, the mother act instead of her babies, the father act instead of his children or his old parents and so on. From security wise, the manual papers or blood, X-ray results may lost if they are not archive in proper place. No backup system available and if you would transfer to another hospital, you should carry your paper and hand them to other hospital manually. Thus, all may expose the documents for risk. From availability wise, the traditional health care services are not available around the clock, which limits the people to certain time only to utilize the service. Furthermore, there was not any notification if any changes happened to the appointment time or changing in the drugs prices or the authorized health products. Moreover, some people were not familiar with the location of the health care facilities, including hospitals, clinics, pharmacies and other health products shops, which needs from them extra efforts to ask about the location. In addition to the previous, the employers were consuming lots of time to authorize their employee formalities, they need to take all the employees to the health center to book appointments for their health checkup and then wait until the consultation and the needed results. In summary, achieving the 3rd SDG “Ensure healthy lives and promote well-being for all at all ages” was not possible since there were various obstacles in the ease of access to healthcare services.

B. Strategic Approach

 2. What was the solution?
The initiative was to deliver a broad array of healthcare services to all the citizens, residents, immigrants and other businesses in Bahrain using secure and diverse communications channels to resolve issues mentioned previously and to support all social groups. The healthcare strategy created in alignment to the strategic vision of kingdom of Bahrain 2030 and it aims to provide a bundle of services according to the human life cycle phases from birth to death and commensurate with all the social groups in the community e.g., poor, illiterate, disabled, elderly, immigrants, women, youth and ethnic minorities. The strategy developed with an emphasis on linking different types of healthcare organizations together to provide the best services that satisfy the user’s needs.

 3. How did the initiative solve the problem and improve people’s lives?
The existence of the healthcare services electronically profound changes in the nature and structure of the health care industry and, ultimately, the delivery of health care services. The health care industry is—and will continue to be—diverse, with individual organizations facing different environmental pressures, pursuing different missions, and cultivating different cultures, but the Internet appears capable of supporting at least a handful of common strategic interests. The objectives of the initiate and the strategy as follow: • Deliver high quality new services directly to all customers to eliminate any kind of intermediaries (disintermediation) and to achieve the gender equality. This objective came in line with the UN SDG 5 ‘Achieve gender equality and empower all women and girls”. For example, there are special services only provided for the women linked with her children (immunization service). • Deliver different services accommodate with the human life cycle from birth to death. This objective came in line with the UN SDG 3 “Ensure healthy lives and promote well-being for all at all ages”. • Applying the concept of whole-of-government, by providing access to healthcare electronic services from all providers, with the collaboration of other relevant stakeholders and government entities, using eGovernment channels, as a one-stop-shop for government services. • Enhance the quality of healthcare services using technological innovation. For example, in the Birth certificate service, the certificate is delivered by mail to the doorsteps of the parents’ home for those who want to receive a hard copy, in addition to being sent by email. For doctors’ appointments, adequate notifications and reminders are used to confirm appointments and remind users of upcoming appointments. In addition, GPS technology in the users’ phones is used to locate the nearest healthcare provider. • Diverse the ways of providing the services, through different channels, e.g., Ministry of Health website, through the Bahrain National Portal, Mobile Apps, kiosks etc... This objective came in line with Bahrain vision 2030 to “shared goal of building a better life for every Bahraini”. • Improve the organizational decision-making, increase the long-term revenue, reduce the costs, and achieves the national and international standards and KPIs. • Develop partnerships with other related organizations in an effort to leverage strengths, such as First Deputy Prime Minister Office, as an essential party providing regulations, directions, policies and procedures for Bahrain vision 2030. Moreover, Information & eGovernment Authority is playing the role of the main party providing electronic services for all citizens, residents, visitors, businesses and governments in Bahrain. Additionally, other private hospitals and other health organizations in Bahrain are taking part in providing the necessary healthcare services. • Achieve high-level standard of living for the audience in kingdom of Bahrain and the public welfare. Again, this objective came in line with the UN SDG 3 “Ensure healthy lives and promote well-being for all at all ages”

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
a. Matching the profiles of a patient's health status with existing network-based health information resources among the medical centers in Bahrain. This eliminate the problem of transferring all the papers manually in case of going to another medical center for any reason. b. Support e-mail exchanges between patients and physicians for any inquiry. This help in improve the customer perceptions. c. Delivering the documents directly to customer house by Bahrain post. This will save the time and the effort of customers instead of vising the hospital again to collect the documents. d. Utilizing the smart devices features, so the services will be more creative, e.g., using the location service to route a specific hospital or pharmacy, receive notifications if a medical result is ready, reminder for an appointment and the other health tools imbedded on the smart devices. This all will save the customer time and effort and will create patients that are more informed. e. The backend integration between the ministries will create a comprehensive service that will save the time and the efforts on the customers. E.g., the birth system integrated with IGA to create the CPR automatically and integrated with Bahrain post so the birth certificate will be deliver directly to the customer.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The solution was implemented by various parties working collaboratively to progress in implementing the strategic objectives. These entities include the Information & eGovernment Authority and the Ministry of Health. The First deputy prime minister office played a role in formalizing the strategic vision and supervise its implementation. The target audience of the initiative were all citizens and residents of the kingdom, which are around 1.4 million people.
 6. How was the strategy implemented and what resources were mobilized?
The key component of the health care strategy is to set the long-term objectives of the kingdom and the organization. The Strategy includes both the solidification of the objectives as well as establishing the medium to be used to realize those objectives. Thus, the strategy is focusing in the manner of deployment of the resources to achieve the objectives. The strategy established since 2010, gradually developed, maintained and updated. The implementation followed the traditional method with various phases: initiation, planning, execution, monitoring and controlling; and closing. a. The initiating phase: The strategy started first by analyzing and evaluating the organizational surrounding environment, then by analyzing the conditions and the environment within the health organizations. b. The planning phase: all the business and functional requirements related to the health care services were collected in this phase. The project plan and the stakeholder register were created. Several meetings were conducted with different stakeholders to collect the details requirements for all the services and their business rules. c. Executing phase: in this phase, all the business requirements and business rules were converted to codes and real implementation. The process workflow is finalized; the design and the prototype of the services were created and finalized. The backend is updated based on the requirements from the health organization side, the frontend (screens) designed by iGA team was integrated with the backend system. d. Monitor and control phase: in this phase, the quality team and control initiate the services testing for all the services (migrated and developed) to insure that all the standards and ground rules are applied on the services. Furthermore, the performance analysis is performed in this phase to discover and analyze the gap between the planned and actual performance and do the needed action. e. The closing phase: in this phase, the implemented services are moved to production for the public. A proper training is given to the support team who will be mainly responsible to support users of the service and register the cases and a proper training for the user of the service and concerned stakeholders. Finally, the lesson learned document must be created that will include preventative point for future projects. f. After implementation phase: in this phase, a checkup is done for the services on regular bases. This to insure the availability and reliability to the services. The feedback collected from the users are listed and converted to enhancement action plan, which will again go through the previous phases. As for the resources, the strategic health services were funded by the FDPM office. Shared resources from HID and iGA are collaborate in the entire cycle of the project to share the knowledge and to save cost. Sometimes, the need of third party solution is effective. The variable costs have varied between migrated a service already exist and services developed from the scratch. At its cheapest, for the migrated services that already exist and just need to link them with the National portal, needs the cost of inspecting the services by using quality Assurance software and the cost of the resources who work on the inspection and adhering to the applied governance, follow up of fixing the defects, and the technical migration development. On the other hand, developing services from the scratch have more costs; more human resources are involved during the project life cycle. At least, the individual project need a project manager, project coordinator, an analyst, three developers, business process reengineer person and a tester. In general, the cost can be reduce by optimization of the resources and the cost saving the variables and direct cost when possible.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
a. First Deputy Prime Minister Office as an essential party providing regulations, directions, policies and procedures for Bahrain vision 2030. b. Health information directorate (HID) as main part owning the customers medical data and accountable for the services backend development and services business rules c. Information &eGovernment authority (iGa) as a main party providing services for all citizens, residents, visitors, businesses and governments in Bahrain. HID and iGa are collaborate to integrate the services to provide them in different channels. d. Private hospitals as minor party providing services that may need some integration with other health system. E.g., birth system. e. Other entities as minor party providing services that may need some integration with other health system. E.g., pre-employment services. f. Information technology workers who are skilled in new technical areas. g. Business process reengineer team responsible for capturing the while picture and processes of the service. h. Project manager or leader that insure the proper development of the services within schedule and budget with strong institutional leadership skills and a shared vision of what the organization is trying to accomplish. i. Project coordinator working in correlation with project manager, helping in administrative tasks, arrange for meeting, writings minutes, helping in drafting the projects documentations and other tasks. j. Project analyst responsible for creating the design of the service based on the given requirements, business rules with adhering to any ISO and Quality Assurance standards. k. Developers that are responsible to develop the service and integrate with other systems l. Testers that are responsible for inspecting the services and increase the quality and the security m. Public relation team that are responsible for marketing for the service in different social media and trying to reach the customer directly by sending emails and SMSs about the services

 8. What were the most successful outputs and why was the initiative effective?
- Delivering health services of high value and quality directly to the community. We were keen to provide services that have reach content and great benefits to the society. Our services enable the people to complete different kinds of transactions online in the most flexible, efficient and effective way and with less time, effort and cost. This output came in line with the UN SDG 3 “Ensure healthy lives and promote well-being for all at all ages” - All our health services are aligned with the set of global standards. All standards required and related to the quality of service, security of data, stability of infrastructure were implemented and enforced. Clear enhancement and maintenance strategy was established. Plans have been created to make sure that an enough attention is given to the services after going live. Maintaining the service is a key success factor. A dedicated support team is established to make sure that the services are running at the best performance level and without any issues. Also, a change management team has been created a consists of number of specialists whose their main focus is to look into how service provider manage the work and the processes of the workflow and reengineer and change the deficiencies toward the smoothness of the work and the dependent services. - Facilitated processes and comprehensive studies for all of the implemented health services. Detailed study took place to measure the benefits of each service and how it can be provided online to the public in the most proper and effective way. As a conclusion for this effort, a clear process was drawn for each individual service that takes care of all the service aspects and to ensure the perfect utilization of resources (service duration / ease of use / accessibility / transparency). - Pursuing the public benefit principle by achieving the cooperation between the parties. Successful Integration between the systems of all the involved parties, all the needed systems were integrated together and the databased and legacy systems were maintained. - creating solid partnerships with other related organizations in an effort to leverage strengths (e.g., FDPM office, MOH, private hospitals, NHRA, LMRA, third party companies and other health organizations

 9. What were the main obstacles encountered and how were they overcome?
The main obstacle encountered during implementing the services the resistance to change from people, they do not want to do their transactions online since they trust the manual process. But since we have a clear plan in mind and through a proper change management we were able to change the mindset of people gradually. Many marketing campaigns took place to introduce the services to people and tell them about the great benefits that these services are bringing to them. It is important to make sure that your services are reachable and close to the hands of the intended users. One of the difficulties that we faced when implementing some of the services is the limitation of channels through which a service can be accessed. For example, Request for Birth certificate service was available online only through Bahrain.bh portal, but the same service is currently available on the eGovernment Kiosks that are distributed in the different areas of the kingdom. Also, many services are currently available through the mobile app like Check Outpatient Clinics Appointments and Radiology Result Status. Non-availability of the required infrastructure was a main problem that we gave priority. We have provided all the needed system and infrastructure required in order to deliver services that are stable, secure, and compliant to the standards.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
Many benefits resulted from implementing the health services and all - It facilitated the communication between the public and Ministry of Health (management / Doctors). For example, through "Ask a doctor" service, the user is able to ask any health related question online and a doctor will reply to the question in a short time period. - Less effort is needed to complete health related transactions and services. For example, Issuance of Birth Certificate is much easier than before. It will generate the Child Personal number and the parents will be able to request the birth certificate online. This eliminated the need to visit the health center repeatedly. - Less time is needed to complete the services. - Easy access to personal and family information and records. For example, the immunization service is enabling a mother to check the history of all vaccinations given to her Childs through a small number of clicks and basic authentication information. Also, a person can check his blood type through check your blood record service if he/she has a previous blood record in Salmaniya Medical Complex (SMC).

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
This initiative helped restrict possible corruption by ensuring that there is no human intervention in some functions. For example, appointments availability were more clearly visible to any healthcare seeker, which prevented administration staff from saving early appointments for their friends and relatives. Moreover, it improved the utilization of the healthcare services by representing appointments allocation in a visual manner to the patients and allowing them to book an available slot, even if it was for appointments within minutes. It also gave clarity to the availability of doctors and their timings, which gave more credibility to the scheduling system in such health centers. All of this was measured by reviewing the number of patients treated by doctors through regular appointment systems as opposed to those who are treated through electronic appointment system.

 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)
Though there is a great emphasis on the importance of improving the situation of the poorest and most vulnerable, as well as benefit women and girls, the healthcare system does not discriminate between any groups. No healthcare services, whether provided online or via traditional means, have any eligibility criteria related to gender, nationality nor social status.

Contact Information

Institution Name:   Information & eGovernment Authority
Institution Type:   Public Authority  
Contact Person:   Khalid Almutawah
Title:   EA & IT Services  
Telephone/ Fax:   0097317388298 - 0097339291021 - 0097317387500
Institution's / Project's Website:  
E-mail:   aaljowder@iga.gov.bh  
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