Please briefly describe the initiative, what issue or challenge it aims to address and specify its objectives (300 words maximum)
The Virtual Consultation project is a telehealth solution that was launched nationally in Qatar in 2020 in order to improve timely access to medical attention, assist in the navigation of the health system, and reduce the spread of infections and diseases (e.g. COVID-19). Background research found that many Qatari and non-Qatari patients miss necessary and timely treatment in Qatar because they are unable to attend in-person consultations or do not know the appropriate site to receive care, resulting in an influx of patients coming to hospitals.
Virtual Consultation is based on establishing the information and communications technology (ICT) infrastructure to enable remote patient care, thus allowing patients to conduct a secure audio or video consultation with their physician without being in the same room. Due to the COVID-19 pandemic, the rollout of this solution was expedited in 2020 covering over 30 specialties (including Mental Health, Dental, Cardiology).
This project applies Qatar’s vision of using innovative, digital solutions to improve standards of living for all residents irrespective of age, sex, disability, race, ethnicity, etc. by providing them an equal opportunity to access timely medical care
Please explain how the initiative is linked to the selected category (100 words maximum)
Inability to access medical care and confusion with navigating the governmental healthcare system became aggravated challenges and pain points to Qatar’s population due to the restrictions driven by the COVID-19 pandemic as the main providers of health-related services were restricting access to only urgent physical visits. The virtual consultation project addressed these issues using ICTs to provide virtual medical care. The healthcare sector relied on multiple access points and utilized different technologies such as cloud and chatbot services to directly link patients to doctors as well as allow nurses to triage patients to the right site of care.
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)
GOAL 3: The project uses ICTs to improve population access to medical care, improve continuum of medical care, and improve quality of medical care for all people in society, especially those at risk of not being able to attend in-person consultations
GOAL 9: The project uses ICTs to re-think how the health system can use existing resources to meet the needs of society: shift from expanding physical infrastructure to empowering individuals which improves continuum and quality of care
GOAL 10: This project facilitated access to healthcare and services for all irrespective of age, sex, disability, race, ethnicity, origin, religion, economic or other status especially the most vulnerable groups including elderly, children, women, migrants, and refugees. Access to video consultations for urgent medical care was utilized by females more than males (58% compared to 42%), by elderly aged 60+ years (11% of total users), by children aged 0-17 years (27% of total users) and by migrant workers (more than 70% of total users).
GOAL 11: The project allowed Qatar’s healthcare system to face the pandemic more efficiently by reducing unnecessary footprint to facilities, allowing for efficient triage, and relieving healthcare workers thus showing resilience in the face of an unexpected challenge
b. Please describe what makes the initiative sustainable in social, economic and environmental terms (100 words maximum)
Traditional healthcare is expensive for patients considering the cost for transportation to and from care sites, childcare expenses, and lost time from work leading to an increased likelihood of no-shows. Chronic disease patients and patients with mobility limitations suffer recurrently from these additional costs which could be tackled this initiative. Similarly, medical facilities incur high cost with patients reporting to emergency rooms and utilizing unnecessary resources. With this project, patients, from all segments of the society, can access on-demand care and be directed to the right site of care.
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)
Improving the continuum of care and navigation of the health system is a key challenge that Qatar's health sector needed to address. Many patients still miss necessary and timely medical treatment because they are unable to attend in-person consultations or do not know the appropriate site to receive care. This results in an influx of patients coming to hospitals for simple medical care, contributing to longer wait times. For population health to thrive, it is important that patients can access care on-demand, without barriers.
b. Please describe how your initiative addresses gender inequality in the country context. (100 words maximum)
Virtual consultations enabled virtual care services to patients irrespective of sex and catered especially the most vulnerable groups including elderly, children, women, migrants, and refugees. 300+ clinics offering an array of services were onboarded to the solution which allowed women to access clinics offering specialized services such as women mental health services, postnatal midwifery homecare services, and women physiotherapy services thus ensuring equal access to medical services across 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 solution is targeted at patients residing in Qatar who need medical consultations or advice to address feeling unwell, require new medications, or need routine appointments. The project plays a pivotal role in providing care to patients with conditions that might jeopardize their visit (e.g., pregnant women, patients with mobility problems) and patients with chronic conditions who typically require recurrent visits for check-ups
a. Please describe how the initiative was implemented including key developments and steps, monitoring and evaluation activities, and the chronology. (300 words)
The virtual consultation project was awarded in December 2019 and kicked off in January 2020 while engaging stakeholders across the governmental healthcare ecosystem. Multiple workshop sessions were conducted to gather feedback from the stakeholders and address clarifications needed prior to implementation. With requirements sessions planned in March 2020, the vendor began the feature prioritization exercise but had to swiftly adjust into full roll out mode with the disruption of the sector by the Covid-19 pandemic. By end of March 2020, the first clinic was onboard at the Primary Healthcare Corporation and followed by clinics from Hamad Medical Corporation and Sidra Medicine. The solution rollout continued with limited features mimicking a pilot phase to enable population wide access to medical service without delaying implementation. By June 2021, 300+ clinics across Primary Healthcare Corporation, Hamad Medical Corporation, Ministry of Public Health and Sidra Medicine were continuously using the service. Physicians were onboarded on the solution and trained using a “train the trainer” approach to ensure proper use of the solution without exposing the physicians and doctors to risk of infection during the pandemic.
The operation of the project started after June 2020 with continuous monitoring of usage and implementation of adoption initiatives. Another phase for the project is currently being considered to migrate the solution and host it in Qatar to enable integration with electronic medical records and active directories of the healthcare organizations. The second phase is planned to take place in 2022 and last for approximately 8 months paving the way for a smooth workflow and seamless data collection and management process.
b. Please clearly explain the obstacles encountered and how they were overcome. (100 words)
As an expedited rollout was driven by the pandemic, the project encountered difficulties in securing resources needed to enable proper use of the solution. With supply chains suffering around the world, healthcare providers faced difficulties in arranging for the proper hardware that would enable clear audio and video conferencing with patients. Not only hardware resources were in shortage, but also non-clinical support human resources were exhaustively overworked during the pandemic thus impacting the swift implementation of the project. Additional obstacles such as policies to regulate the use within the healthcare institutions were not drafted yet causing lack of clarity on usage for physicians
a. Please explain in what ways the initiative is innovative in the context of your country or region. (100 words maximum)
The virtual consultation project was designed to facilitate remote consultation and diagnostic services from Qatar’s healthcare practitioners, across more than 30 specialties allowing for on-demand support and intervention when needed. The project was the governmental sector first step into telehealth services and instrumentally changed care delivery during the covid-19 pandemic
b. Please describe, if relevant, how the initiative drew inspiration from successful initiatives in other regions, countries and localities. (100 words maximum)
Virtual consultation solutions are popular telehealth initiatives that have been successfully rolled out in many countries, including Canada, USA, UK, Singapore, and Switzerland. Similar solutions became more popular during covid-19 with a 175% increase in patients’ adoption and 264% increase in physicians’ adoption between 2019 and 2020 in the United States according to AMWell Physician and Consumer Survey 2020. The market covers a wide range of solutions covering features beyond video calls such as ordering home lab tests, rating physicians, etc
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)
The solution leverages cloud hosting and chatbot which allowed direct access to urgent care clinics from the Primary Healthcare Corporation website thus removing the obstacle of accessing on demand medical care through digital channels. In the upcoming phase of the project, the hosting of the solution on Qatar’s TASMU platform will enable access to governmental services such as unified authentication services as well as cloud computing capabilities ensuring a smoother user experience and allowing the solution to integrate with the medical systems within the organizations such as electronic medical records and active directory
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)
The solution has been utilized across different cities in Qatar including Doha, Al Wakra, Al Rayyan, Al Dafna, Al Khor, Leabaib covering more than 18 health centres which offer primary care and 25 facilities that offer secondary care
b. If not yet transferred/adapted to other contexts, please describe the potential for transferability. (200 words maximum)
a. What specific resources (i.e. financial, human or others) were used to implement the initiative? (100 words maximum)
A team with representatives from Primary Healthcare Corporation, Hamad Medical Corporation, Ministry of Public Health, and Ministry of Communication and Information Technology was put together to work collaboratively with a team selected by the vendor to ensure the successful implementation of the project. Additionally, a budget made available through the TASMU program was dedicated for the implementation of the project with a subsequent yearly budget dedicated by Ministry of Public Health, Primary Healthcare Corporation, and Hamad Medical Corporation was secured for the operation of the solution including licenses & support
b. Please explain what makes the initiative sustainable over time, in financial and institutional terms. (100 words maximum)
As the solution implementation was implemented successfully at 300+ clinics across governmental medical services which account for more than 80% of medical visits within the sector, minimal expansion to new clinics is required. Additionally, the project leverages a stable technology thus requires minimal resources for support and maintenance.
Once phase two is implemented, solution hosting will be on Qatar’s TASMU platform allowing the vendor to effortlessly leverage additional services and reduce potential duplication activities.
The project relies on a licensing model which dictates the budget based on usage of the solution optimizing the yearly budget needed
a. Was the initiative formally evaluated either internally or externally?
b. Please describe how it was evaluated and by whom? (100 words maximum)
The project was evaluated by the Ministry of Communication and Information Technology and the Ministry of Public Health.
The Ministry of Communication and Information Technology prepares a biweekly report which analyses the use of the solution within each healthcare organization at a service and clinic level.
The Ministry of Public Health prepared a case study report analysing the deployment across clinics, the challenges faced during implementation, improvement initiatives to be implemented based on success stories and benchmarking.
c. Please describe the indicators and tools used (100 words maximum)
The Ministry of Communication and Information Technology measures the number of video consultations on a monthly, weekly, and biweekly basis segmented by service and clinic. Other reported indicators include number of clinics onboarded (live, deployed, deactivated), percent of video consultations of total virtual consultations (video and telephone), and demographical use of the solution (by gender, age, and nationality).
The Ministry of Public Health used benchmarking techniques and analyzed the implementation in comparison to other countries as well as other similar solutions. The report assessed challenges faced and concluded recommendations for improving adoption of the solution.
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)
The report identified four distinct groups of challenges:
1. Complex and time-consuming workflow which would be improved by integration with electronic medical records and minimizing the steps to access through integration with active directory
2. Initial low physician engagement as physicians are reluctant to use new technology and change existing workflow considering no clear guidelines or policies were issued to regulate the service
3. Low organizational readiness due to expedited roll out not allowing the institutions to properly advocate for the solution or devise a plan for the deployment of the solution within suitable services
4. Additional awareness on availability and benefits of the solution to better engage patients
This detailed analysis allowed the team to devise initiatives to improve the services:
1. Integrate with electronic medical records and active directory through a second phase of the project
2. Incentivize physicians with competitive performance tracking, setting recurrent feedback loops, and introducing new capabilities for the solution
3. Identify suitable services for the solution to enhance providers’ implementation
4. Launch awareness campaigns to engage the public
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)
The solution is currently implemented within the public healthcare sector covering Primary Healthcare Corporation, Hamad Medical Corporation, and the Ministry of Public Health and is yet to expand to the private healthcare sector. Once phase two is completed and the solution is hosted on Qatar’s TASMU platform, e-payment capabilities could be enabled through access to payment gateways thus allowing further expansion to private sector.
Throughout the implementation of phase 1, public healthcare organizations have shared implementation learning given they employ similar systems and aim to unify services across primary and secondary care. In addition, they aligned on the transition of patient for this specific service from primary to secondary care based on previously agreed workflow for physical visits
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)
The virtual consultation project was implemented following an agile approach which included a discovery phase during which different entities from the healthcare sector collaboratively designed the solution. Journeys of end-users are considered to define the solution’s workflow and select the features to be developed and tested through a pilot leading to a solution which tackles the market’s needs. Hamad Medical Corporation (HMC), Primary Health Care Corporation (PHCC), Ministry of Communications and Information Technology (MCIT), and Ministry of Public Health (MOPH) worked hand-in-hand to ensure an expedited roll out of the solution and allow Qatar’s population access to medical services during the Covid-19 pandemic. Once the solution was rolled out, cross-organizational efforts to monitor the adoption of the solution, share learnings from one another, and plan adoption improvement initiatives
Please describe the key lessons learned, and how your organization plans to improve the initiative. (200 words maximum)
Key lessons learned based on initiatives driven by select clinics, organizational environment of high video adoption clinics, and international benchmarks and success stories:
• An active and engaged leadership, preferably with experience in implementing new technologies, can significantly affect the project’s success. The project team has held multiple workshops with senior management of Ministries and healthcare providers to secure buy-in and map out adoption initiatives to be steered by them (e.g. policies and guidelines).
• Dedicated resources assigned to the project allow for a timely completion of project activities, phases, and initiatives. The ministry requested assigned focal points from the healthcare providers to monitor use and operation of the project and allow for continuous reporting.
• Open communication channels and feedback loops from physicians and patients are critical to detect gaps and improvement areas. Recurrent surveys, one-on-one meetings, and workshops were implemented and will be needed recurrently to ensure honest and clear feedback is captured.
• Effective and nation-wide awareness campaigns instrumentally impact the ability to reach a wider audience and create the impact intended by the project. Cross-organizations efforts can augment reach and allow for the utilization of multiple channels to promote availability and benefits of the solution