Questions/Answers
Question 1
Please briefly describe the initiative, what issue or challenge it aims to address and specify its objectives (300 words maximum)
The aim of the Paperless Exams project is to act on the circuit of requisition, provision, availability of results, and billing of Complementary Means of Diagnosis and Therapeutics (MCDT), introducing deep and systemic changes in it, leading to a paradigm change, from a model whose main vector of information transmission is paper, to the detriment of a dematerialized model, where information follows the user and the professional digitally and is made available at any point of the National Health Service (SNS), regardless of its location.
It is within this framework that the Ministry of Health decided to favour the use of electronic means to support the processes of prescription, provision, sharing of results and billing of MCDT carried out in the NHS, regardless of whether the providers are from the public sector or holders of agreements or conventions with the NHS, thus completing the creation of the Paperless Exams project, which aims to dematerialize the entire process associated with the realization of these MCDTs, advocating a change in paradigm regarding the management of NHS resources.
The purpose of the Paperless Exams project is to actively manage the installed capacity of the NHS regarding the realization of the various types of MCDT, promoting articulation with agreed entities and removing the patient as the main responsible for the transmission of information between NHS units and others health care providers. It is intended that the information relating to the MCDT carried out can accompany the patient anywhere in the NHS, without the need for the patient to have the results and requests for them on paper.
Question 2
Please explain how the initiative is linked to the selected category (100 words maximum)
By enabling the reduction of bureaucracy of processes and the improvement of the relationship between patients and the NHS, the Paperless Exams project contributes decisively to reduce the waste associated with carrying out MCDT, allowing direct and indirect savings to be obtained for everyone involved in this process, ranging from the elimination of unnecessary repetition or duplication to the reduction of associated administrative, human and environmental costs.
Question 3
a. Please specify which SDGs and target(s) the initiative supports and describe concretely how the initiative has contributed to their implementation (200 words maximum)
The Paperless Exams project supports «Quality Health», by providing, with security, the clinical information of patients to health professionals, insofar as greater security and speed of access to information, allows for greater quality in the provision of health care.
With the dematerialization of the entire circuit of prescription, provision, sharing of results and invoicing of MCDT, the Paperless Exams project supports «Sustainable Production and Consumption», by drastically reducing the use of paper (transcription, digitization, archiving and reduction of administrative tasks), and consequently, the associated costs, as well as the reduction of waste, avoiding the repetition of exams and the duplication of clinical records.
b. Please describe what makes the initiative sustainable in social, economic and environmental terms (100 words maximum)
The Paperless Exams project allows to increase information retrieval, with greater security, within the process of prescribing, providing and sharing MCDT results, improve information sharing among health professionals, facilitate citizens' access to relevant information for the management of one’s health, as well as contributing to the sustainability of the NHS, avoiding the realization of duplicate MCDT or not totally necessary or effective in view of the clinical history.
Question 4
a. Please explain how the initiative has addressed a significant shortfall in governance, public administration or public service within the context of a given country or region. (200 words maximum)
The Paperless Exams project is based on the National Database of Requisitions (BDNR), which constitutes the cornerstone for dematerialization, and translates into a central infrastructure that allows controlling and auditing the entire process and all its different states. BDNR ensures, through a set of webservices, that the rules for prescribing, providing and sharing results are respected, regardless of the source of the information: Primary Health Care (CSP) or Contracted Providers. In this way, there is a central control since the MCDT are prescribed, until its realization, and consequent billing, considerably reducing the risk of error and fraud.
b. Please describe how your initiative addresses gender inequality in the country context. (100 words maximum)
The initiative is transversal and does not implement any differentiation in terms of gender inequality in the context of the country.
c. Please describe who the target group(s) were, and explain how the initiative improved outcomes for these target groups. (200 words maximum)
The Paperless Exams project has as target groups: patients and health professionals. The dematerialization and centralization of information related to the entire circuit of prescribing, providing and sharing MCDT results, allows patients to have access to requisitions and respective results, without the need to travel to health institutions/ contracted service providers, giving the user a greater convenience in accessing one’s health information, as well as allowing health units and their professionals to centralize their availability in effective health care. In turn, access to patients' clinical information allows health professionals to reduce the number of requests issued, avoiding unnecessary duplication, and greater security and ease in the issuance of requests, allowing for more effective follow-up of patients.
Question 5
a. Please describe how the initiative was implemented including key developments and steps, monitoring and evaluation activities, and the chronology. (300 words)
The implementation plan of the Paperless Exams project includes three distinct stages, whose final objective is the complete dematerialization of the circuit of requisition, provision, sharing of results and invoicing of MCDT.
In the first stage, in 2017, the project focused on the following developments:
• Availability of results, in .pdf format, in the Professional Area of the SNS 24 – This portal allows health professionals to access citizen information, namely to the results of the MCDT, at various points in the NHS;
• Availability of results, in .pdf format, in the Personal Area of the SNS 24 – Access to patient health information, which also includes the results of their MCDT, can now be carried out, audited and managed by the patient himself through his Personal Area;
• Collection of informed consent from the user – In order to share the results, each patient shall give their informed, free and express consent. As a result, all MCDT prescription software shall obtain this consent and register it centrally.
In 2018, the second stage of the project focused on the following developments:
• Electronic registration of requests – The MCDT prescription software installed in prescribing entities shall validate and register the requisition centrally at the BDNR;
• Dematerialization of the requests – Prescription accessible and interpretable by computer means and issued electronically, with information being made available to the patient through the Delivery Guide, SMS and/or e-mail;
• Electronic consultation of requests by providers – At the time of provision, the provider accesses the patient's MCDT request, exclusively, by presenting the prescription number and the access code.
The third stage of the project is currently underway:
• Sharing structured results;
• Registration and provision of In-hospital MCDT.
b. Please clearly explain the obstacles encountered and how they were overcome. (100 words)
The main obstacles found are the resistance to change on the part of health professionals, on the management of providers of prescription and delivery/sharing systems, and on the great diversity of internal and external stakeholders. These obstacles were dissipated with the publication of legal documents that reinforce the need to use the solutions made available within the scope of the project, and through clarification sessions with suppliers and follow-up meetings with the different stakeholders.
Question 6
a. Please explain in what ways the initiative is innovative in the context of your country or region. (100 words maximum)
The Paperless Exams project, which aims to dematerialize the entire process associated with the realization of MCDT, calls for a change in the paradigm of the NHS in this context, since the dematerialized electronic requisition gathers numerous advantages, namely in terms of user convenience and in terms process transparency, and has been gradually replacing paper requisitions, as well as materialized electronic requisitions, continuing to gain large scale in Portugal.
b. Please describe, if relevant, how the initiative drew inspiration from successful initiatives in other regions, countries and localities. (100 words maximum)
The Paperless Exams project was inspired by the Paperless Prescription project, through which the citizen receives the prescription by email or SMS, being able to obtain medicine dispensation at any pharmacy in the country and consult their treatment guide on a tablet or mobile phone, through the Personal Area of the SNS 24. Following the success inherent in the Paperless Prescription project, in 2018, the process of internationalization of the project began.
c. If emerging and frontier technologies were used, please state how those were integrated into the initiative and/or how the initiative embraced digital government. (100 words maximum)
N/A
Question 7
a. Has the initiative been transferred and/or adapted to other contexts (e.g. other cities, countries or regions) to your organization’s knowledge? If yes, please explain where and how. (200 words maximum)
No.
b. If not yet transferred/adapted to other contexts, please describe the potential for transferability. (200 words maximum)
The main objective of the Paperless Exams project is the total dematerialization of the MCDT circuit, from the request to the availability of the results of these same exams, currently starting in CSP units. However, work has already started to increase the scope of the project, and extend it to Hospital Care, allowing the dematerialization of the entire circuit of prescription, delivery and sharing of MCDT results, also in a hospital environment.
Question 8
a. What specific resources (i.e. financial, human or others) were used to implement the initiative? (100 words maximum)
The project had the involvement of the Ministry of Health and associated institutions, which together ensured the implementation of the project.
b. Please explain what makes the initiative sustainable over time, in financial and institutional terms. (100 words maximum)
By enabling the reduction of bureaucracy of processes and the improvement of the relationship between patients and the NHS, the Paperless Exams project contributes decisively to reduce the waste associated with carrying out MCDT, allowing direct and indirect savings to be obtained for everyone involved in this process, ranging from the elimination of unnecessary repetition or duplication to the reduction of associated administrative, human and environmental costs.
Question 9
a. Was the initiative formally evaluated either internally or externally?
Yes
b. Please describe how it was evaluated and by whom? (100 words maximum)
Yes, internally.
c. Please describe the indicators and tools used (100 words maximum)
d. What were the main findings of the evaluation (e.g. adequacy of resources mobilized for the initiative, quality of implementation and challenges faced, main outcomes, sustainability of the initiative, impacts) and how this information is being used to inform the initiative’s implementation. (200 words maximum)
Question 10
Please describe how the initiative is inscribed in the relevant institutional landscape (for example, how it was situated with respect to relevant government agencies, and how the institutional relationships with those have been operating). (200 words maximum)
Being a national project in health, which emerged as part of an important initiative of the Ministry of Health, it had the involvement of various government entities, such as the Central Administration of Health Systems, the General Directorate of Health, the Regional Health Associations, as well as other associations representing the contracted service providers. SPMS, in the pursuit of its competences and as responsible for the digital transformation in health, has promoted, together with these entities, meetings to align the strategy and objectives, which took place at regular intervals, via digital platforms, to provide a better response to the needs of patients and health professionals.
Question 11
The 2030 Agenda for Sustainable Development puts emphasis on collaboration, engagement, partnerships, and inclusion. Please describe which stakeholders were engaged in designing, implementing and evaluating the initiative and how this engagement took place. (200 words maximum)
Due to the dimension of the impact that the project has on NHS agents, the Central Administration of Health Systems, the General Directorate of Health, SPMS, the Regional Health Associations, with the respective CSP Units, Hospital Units, contracted service providers, and even providers of prescriptions and delivery/sharing systems, health professionals and patients.
Since the beginning of the project, it has been crucial to involve, inform and alert stakeholders to all developments, to prevent resistance to change, especially on the part of professionals. To keep all interested parties involved and in constant cooperation, working groups were created to listen to needs, strategies for implementing the project in the field and suggestions for improvement, several team and alignment meetings were held, as well as creating periodic reports on the status of work carried out under the project.
Question 12
Please describe the key lessons learned, and how your organization plans to improve the initiative. (200 words maximum)
In order to minimize resistance to change, both by the providers of MCDT prescription and delivery/sharing systems, and by the health professionals themselves, the involvement of stakeholders throughout the process was considered extremely important, from the moment of defining objectives and strategies, to gathering requirements, as well as monitoring the implementation schedule, combining knowledge, skills and competences in a transversal project that involves the day-to-day of the patient and health professionals at National level.
The publication of legal documents that reinforce the necessary changes and the rules associated with the project was also considered extremely pertinent, as it clarifies, establishes limits, rules and reinforces the legitimacy of the necessary developments, demanding their compliance and establishing legal deadlines.