Case Study: MALFFI Program In SEHA

Introduction

SEHA is the corporate marketing name of Abu Dhabi Health Services Company, an independent public joint stock company that owns and operates all public hospitals and clinics across Abu Dhabi. SEHA Operating 12 hospitals, 62 ambulatory and primary healthcare centers, and 2 blood banks, with a combined of more than 18, 000 professional staff, SEHA’s operations expand across the entire Emirate of Abu Dhabi, from the Western Region to the Eastern Region through the Middle and Island Regions. SEHA is the largest healthcare network providing a continuum of care to Abu Dhabi’s residents and utilizing leading-edge medical technologies.

All services provided focused on patient-centered care so SEHA supporting all innovation strategy not only in clinical sector but also in admin working environment. This case study will focus on admin innovation strategy that SEHA applied to enhance patient experience and improve patient access to healthcare services. In order to develop the performance of the health system in the Abu Dhabi with the best achievements in the field of information and communication technology, SEHA initiate the idea of unifying all health information related to patients such as medical records, pharmaceutical prescriptions, diagnostic information and others by digitalize all the patients records. The purpose is to make the process more effective and efficient for the patient that they can use any hospital under the umbrella of SEHA and transfer all the needed medical information through the system without referring to the previous hospital. In addition, this will facilitate the process of electronic exchange between the various hospitals, while maintaining the integrity and security of these data and information and privacy protection, in accordance with international standards adopted in UAE, such as the rules on the conditions of entry on the system, Ensuring the reliability and availability of data and information. This unified central system will play an effective role in enhancing the efforts of the government to collect and study data and statistics from various hospitals and thus draw up and develop national health policies. This program is called ‘’Malaffi’’ which means my file in English. Leaving each hospital operating independently will adversely affect the performance and reputation of government hospitals and this is against of UAE e-Government vision, which is "one patient / one record". The case study will illustrate the Background of SEHA Company and identify its business model. Then it will show the beginnings of innovation in the company and the process followed to achieve its innovation goals. In addition, it will cover the business issues and the challenges that SEHA was facing before centralizing patient information. "Malaffi" program will be study as an example of the innovation solution that applied in SEHA. Finally, it will show the result of applying this technology and the future of it.

About SEHA

Seha was established by the government of Abu Dhabi by Emiri Decree No 10 of 2007. All public healthcare system in Abu Dhabi is operate and own by SEHA. It continuously improving and developing public healthcare delivery system and comparing it at the highest international levels. Seha follows its values as a socially responsible, reliable, quality oriented, and innovative organization.

According to the e-government strategy that UAE is adopting, SEHA Company continuously identifying the best global strategies and explore competitive ideas. SEHA entered into a number of partnerships with international healthcare institutions. Their world-class capabilities have contributed much to SEHA’s growth and development in knowledge transfer, education, promoting healthcare excellence, and achieving goals with competitive advantage. Partners include Johns Hopkins Medicine International, Cleveland Clinic Foundation, and Fresenius Medical Care.

Nowadays, SEHA Health System consists of 12 hospitals with 2, 644 beds, 64 Primary Healthcare Clinic, 10 Disease Prevention and Screening Center, 3 Mobile Clinics, 1 School Clinic, 2 Blood banks, 4 Dental Center, 2 Employee Healthcare Center, and 1 Vaccination Center. It is the largest healthcare network in the UAE. SEHA’s facilities accommodate 100, 000 inpatients annually and conduct 41, 000 surgeries, as well as treating more than five million outpatients.

Innovation History in SEHA

In 2011, SEHA started to introduce the innovation in her system by defining the innovation strategy, which is Promoting the value of innovation for SEHA by adopting drivers and bases to reinforce innovation as high organization value that cover Sciences, Business and Technology. Its strategic objective is raising potentials and enablers to create an environment that encourages global innovations, in pursuit to providing innovative services to facilitate for easy access and healthy happy community. It stands on four dimensions:

• Creating stimulating business environment
• Empowering creative talents
• Provide more innovative services and tools that exceed expectations
• Enable partnership with innovative.

SEHA launched it innovation strategy through a program called Musharaka that means participation in English. H. E. Saif Bader Al Qubaisi, Chairman of SEHA said. “The intent of the program is to engage our employees in our mission of continuous quality improvement and solicit their participation in achievement of our vision. In return, they not only share in the credit for improvements, the can share in the benefits derived in the form of a financial incentive. These ideas can be about any quality issue that directly increases the efficiency or effectiveness of SEHA performance. Some examples are how to reduce waiting times for patients, improvements to procedures, how to increase customer satisfaction, enrich the patient journey, improve patient safety, improve clinical outcomes and the like. Ideas that eliminate waste and overhead costs or permit us to redirect savings to patient needs are also welcome. ” The program was launch on 15th May 2011. All SEHA employees could participate and submit suggestions. Information on the program are available to all SEHA employees.

SEHA introduce several innovative ideas that improves healthcare services. All ideas that shared through musharaka program have to pass several stages. Starting from an approving the idea then convert the idea into project through two phases. Phases one which is Concept Case Request and it includes defining the project objectives, main deliverables, and main activities to accomplish the project. Also, it define the desired results of completing the project. In addition, it Define the services that the project will enhance and the level of the advantage that the project will add to these services. Phase two, which is Project Management Plan process. It covers Project Numbering that issued by Project Management Office (PMO) then provide an executive summary of the approved business case. Also, describe the project scope and constraints that are expect to occur during the project life cycle.

There are many implemented projects. For example:

1. Mas'ool Program which enable officials from SEHA to communicate with members of the public, identifying their problems and solving them quickly and effectively. This initiative has made significant achievements during the past years and has found solutions for many of the issues that are of concern to the public. It was launch in 2013.
2. Customer Happiness Map, which is an indicator of happiness and positivity for employees and customers at all SEHA facilities. It measures their satisfaction and experience with healthcare services provided by SEHA through electronic surveys. The main goals for this indicator is achieving transparency and creating a competitive spirit among SEHA employees to achieve the best and the highest outputs in the healthcare system. The map is automatically update every 2 minutes and it is available in SEHA website under Customer Care Services.

Paper-based records

Long-time back, hospitals in the UAE used non-computerized medical files (paper-based system) which contained consultation and information about a patient health treatment created and produced in paper format. This approach has many issues related to productivity, cost, accessibility and quality. Each problem is discussed in below:

Productivity

Lack of productivity affects many departments in SEHA. Staff members’ time is required to deliver paper medical files to a specific area. If the paper file is not readily accessible, office staff responsible for filing documentation may need to make several attempts before the task is completed. In addition, medical errors may be happen if the staff makes judgment on inadequate information. Furthermore, there is no ability to sort data fields in a paper record. The staff in SEHA must perform a manual review for reporting mandated data elements to the appropriate organizations so the probabilities of inaccuracies can occur.

Cost

Losing or missing patient's paper record or file has negative impact on cost by repeating patient testing required replacing lost or missing test results. In addition, repeating procedures may threaten the patient’s health and waste of time, materials & staff's efforts that can be used for other patients. Of course, this lead to delay the treatment and create a potentially harmful situation for the patient.

Accessibility

Lack of access to the paper record affects negatively to the flexibility of treatment procedure in SEHA because the medical staff must wait until the file is available for their use and this also contributes to the difficulty of editing or updating the paper record, forcing them to make new copies to update old records. In addition, loss of direct accessibility leads to misplace the records through delivering documentation by hand to the patient’s temporary location as well as delaying coding, billing, and payment processes. Access time is one of the primary problems of paper records in SEHA due to the consumed time for locating a few files in a large paper filing system, searching for a file may take minutes if not hours especially during peak time and congestion during morning period.

Quality

The matter of quality includes the physical record, documentation, and patient care. The paper records naturally deteriorate over time in storage, regardless of how well their environment is controlled, and they tend to spoil upon excessive handling. The paper records also can be threaten by water and fire.

The quality of the actual documentation differs based on the medical staff’s documentation skills and knowledge level, not all staffs use the same abbreviations, terminology or format. This can result in incomplete or inaccurate healthcare data collection. Handwritten information may be unstructured or less-structured free text and illegible, creating the potential for errors in patient treatment or medication orders.

With paper records in SEHA data can get out of order that means if someone accidentally puts a file in the wrong place, or takes a file out of a cabinet and forgets to put it back, it can lead to lost data or the creation of additional copies of files.

By this traditional system, the staff spend around 12% of their work time in reading information but up to 45% looking for it. The average copied document in one office reached 14 times. About 8% of the paper records were incomplete and 30% of the records get lost or spoil. Stacked files!" I had an appointment at a government hospital in the kidney department", Mariam said. The appointment was at 8:00 am. I went to the hospital. When I arrived, I went to the medical records to take the appointment paper from the appointment officer and asked me to go to the file section to bring my file. " I waited a full hour until they found my file in the middle of the files stacked over the shelves and placed oddly. I do not blame the employee if I delayed sending the file to the bad organization in the file room and after a long waiting; the employee took out my file. The big surprise was that the doctor was not there because of his travel. To the employee, he gave me an appointment two weeks later. The results were lost! Reem confirmed that the nurse did not find her file, which contains the documents of the results of medical laboratory tests and X-rays, which called for the opening of a new file and new tests.

Malaffi

The problems of the paper-based records lead the Abu Dhabi Health Services Company (SEHA) to successfully implemented Electronic Medical Record called “Malaffi”, which allows SEHA physicians to view, share, and collaborate on a patients care regardless of the patient's location. This new feature supports SEHA's One Patient, One Record philosophy. The new software feature enables medical staff to easily access medical records from any location at any location. The physician used the unique SEHA patient identifier to view medical records, tests, recommendations and previous medical history. Commenting on this milestone achievement, Robert Pickton, Chief Information Officer Abu Dhabi Health Services (SEHA) said: "This advanced technology enables our medical staff to access unified electronic patient records throughout SEHA facilities through a simple, swift, and secure process. The “Malaffi” system is a key initiative of SEHA's strategy to adopt state-of-the-art technology that complements the Abu Dhabi government's drive to develop excellence in health care. " Basheer Al Mehairbi, Deputy Chief Information Officer at SEHA, said: "Deploying this feature has proved to be a tremendous milestone as it facilitates the process of physicians gaining access to the patients' comprehensive medical record.

SEHA had started to implement “Malaffi” system at Tawam Hospital, Al Ain in 2009. In addition to Tawam Hospital, 11 additional hospitals and 39 clinics throughout the Emirate of Abu Dhabi has been implemented this system in the 2008-2009 timeframe. “Malaffi” system makes a huge change in health care environment and solved many problems related to manual medical records. It solved many issues related to Information Confidentiality, quality, access to information, communication and reduce medical error. Safeguarding Information Confidentiality: “Malaffi” system provide records on clinical information including sensitive personal information, diagnostic process as well as plans of care and placement orders. Regulations for patient record privacy place stringent demands on healthcare providers to protect patient information while implementing electronic methods for sharing with other caregivers and patients.

By having sound security plan, it can help to meet legal requirements to protect sensitive and privacy of patients’ information. Therefore, access to patients’ information is highly restricted and it allows only authorized users to access all patient information available within organization. Simultaneously provides resilient security to protect patient record information across the entire wired and wireless environment. The information can be classified into few stages of security such as confidential, restricted and public. As example, with regards to client information, it should be private and confidential and those who are dealing with the patients are the one that allow creating, modifying and verifying. Whereby those who are not directly involved with shall be restricted and may allow for reviewing. For data information purpose, it can be disclose to researcher. As “Malaffi” system keeps sensitive personal information about patients, therefore, users are responsible and liable to ensure the information are not leaks to other parties and compliance with privacy regulations.

Reduce the Possibility of Lost Records: “Malaffi” system allow of saving data in the server and helps ensure that patient records, test results and other critical data are kept in electronic form. It can replace paper-base which can avoid tendency to be incomplete, fragmented (different parts in different locations), hard to read and sometimes hard to find. Therefore it will reduce risk of misplaced due to human error as compared to manual handling of medical records such as misplaced of the document apart from paperless supported environmental friendly initiatives.

Improve Quality and Originality of Documentation: Healthcare providers are striving to reduce reliance on handwritten records and implement better systems to efficient documentation of patient interactions. Traditionally, doctors’ handwriting is often undecipherable, thus unclear writing can lead to mistakes. Typed information is less likely to create misunderstandings and a poor typist may actually take a long time to input information. Maintain a data and information trail that can be readily analyzed for medical audit, research, quality assurance, epidemiological monitoring and disease surveillance. “Malaffi” system usage enables a more accurate service authorization and billing process, as well as an easier method for finding the information needed to correct errors

Improve Service Provided: “Malaffi” system can reduces patient waiting times with faster, easier workflow and enhances productivity and organizational workflow efficiency. Skilled caregivers spend most of their time completing paperwork instead of treating patients. When a doctor has instant access to all of a patient’s information, including things like x-rays, lab tests and information about prescriptions or allergies, he or she is empowered to act right away, thus saving time. This may be particularly helpful in emergencies where a patient cannot answer questions about medical history due to extreme illness or injury. In addition, “Malaffi” system have superior capabilities for storing, processing and retrieving information and computerized methods are significantly faster than paper-based methods. This system can facilitate workflow and improve the quality of patient care and patient safety.

Accessibility to the Information: Information is immediately accessible at any unit workstation whenever needed. It also helps caregivers obtain better information at the point of care, thus it will improve patient care through greater access to information by provider. The record can be continuously updated and is available concurrently for use everywhere. Electronic data allows easy data transaction making it accessible from remote sites to many people at the same time and retrieval of the information is almost immediate. “Malaffi” allow the patient portability where the files can be sent instantly via email, instead of waiting for the office to authorize the release and copy and mail old records. It enables more flexible access to information for mobile caregivers at point-of-care. Such communication of clinical data from individual system of “Malaffi” could later progresses through a number of distinct stages in HIS within an organization.

Improve Communication Between Providers: “Malaffi” system improves interdepartmental communication. It allows multiple accesses to document at one time thus integrate communications from different department within an organization. Adding to the complexity, most patients are not care by a single physician or one organization, but by a collective process, that includes nurses, consulting specialists, diagnostic technicians and administrative personnel. “Malaffi” system allows for customized views of relevant information according to the needs of various specialties. This enables clinical personnel to have a comprehensive picture of a patient’s status and allows more time to planning appropriate care for patient and continuity of care to patients is ensured. Restraint Medical Errors: “Malaffi” system can link the clinician to protocols, care plans, critical paths, literature databases, pharmaceutical information and other databases of healthcare knowledge. Patient might see several specialists particularly whom with complex health issues can easily become confused by overlapping advice. By using the “Malaffi” system, it allows everyone on the care team to be aware of the other team members’ actions and recommendations and understand the approaches taken to a condition. Patient sufferance due to medical errors and the inability of analysts to assess quality with paper-based system can be helped by implementation of “Malaffi” system.

Cost Savings: “Malaffi” system also represents a huge potential for cost savings and decreasing workplace inefficiencies. Simultaneously, it reduces paperwork, record filing and retrieval, reduction in paper and supply costs, decreased staffing for chart management, decreased staffing resulting from improvements in workflow. Implementation of “Malaffi” system in primary care can result in a positive financial return on investment to the healthcare organization.

Improve in Data Storage: Storing records in computers represents a small percentage of the space where physical storage space is replaced with digital records instead of keeping huge paper files on patients. The previous manual data can be stored by key in to new system or scanning. It can increase storage capabilities for longer periods.