Problem: Long waiting times for health services; weak communication channels between providers; lack of coordination and standardization in referral practices; dependence on paper-based referrals and inconsistent use of technology.
Solution highlights: The Ministry of Health designed and implemented a web-based appointment platform to streamline information flows and reduce artificially-inflated waiting times. Additional features, such as e-referral and e-prescription applications, have since been incorporated into the information system; a comprehensive investigation at the beginning of the initiative supported the development of an informed solution to directly address key challenges; alignment with previous investments in technological infrastructure enabled rapid uptake of the new information system by providers and more economical use of existing resources; an effective communication plan, including public campaigns and efforts to gain public trust, helped ensure widespread uptake of the new information system.
Description of practice
In the early 2000s, lack of coordination and standardization in patient registration contributed to long waiting times for health services. Due to a general public distrust in the referral system and concerns over long waiting times, patients often registered multiple times in different locations for the same service. Paper-based referrals contributed to inefficiencies, limiting coordination between providers and preventing duplicate registrations from being addressed. While government reforms had successfully generated extensive investment in information technology across the health system, these efforts were largely unsystematised, which limited their ability to optimize service delivery.
In 2006, the Government of the Former Yugoslav Republic of Macedonia launched an initiative to develop an integrated health information system. A comprehensive study of health system challenges and information exchanges informed the governmental Strategy for Development of an Integrated Health Information System, helping to establish the necessary framework to guide change. Within this Strategy, the Ministry of Health assumed a leadership role over the initiative and carried out a scoping investigation to further inform the specific design of the information system. As the Health Insurance Fund had existing electronic links with general practitioners, a partnership was formed between the Ministry of Health and the Health Insurance Fund to design a system compatible with the current infrastructure. Synergizing with the existing infrastructure is credited with accelerating the rollout of MyAppointment and minimizing investment costs. Shortly after the launch of MyAppointment, a reduction in waiting times was observed. Today, general practitioners continue to electronically register patients for services in MyAppointment, which helps to prevent duplicate service registrations, improve accuracy in measuring access and facilitate timely coordination of care. Patients also have access to the platform to monitor appointments and view waiting times. Additional features, such as e-referral and e-prescription applications, have since been incorporated and the information system continues to evolve under the guidance of the Ministry of Health’s new e-health department. Moving forward, focus is being placed on using the data collected by the information system to guide service delivery improvements at the stewardship level.
Implementation of practice
What stage is the practice currently in?
Fully implemented and scaled up
Who was/is responsible for the implementation of the practice?
Top-down leadership from the government, in partnership with the Health Insurance Fund and health providers, drove the initiative forward. The Ministry of Health formalized the overarching framework for the initiative and created an e-health department to support development, management and improvement of the new information system. The Ministry worked closely with the Health Insurance Fund to develop the information system and its associated applications. Additionally, the Health Insurance Fund played a key role in promoting providers’ use of the system through contractual agreements with general practitioners.
Improvements in waiting times were observed within just a few months of launching MyAppointment, with the effort to improve reporting and monitoring of patient flows generally regarded as being highly successful. Waiting list times dropped from as high as 17 months down to just a few days, with the longest waiting times down to around two weeks.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
Please click on the link below for more information about this practice.
- Neda Milevska-Kostova
- Studiorum, Centre for Regional Policy Research and Cooperation (CRPRC Studiorum)