In Which Phase Are We in Health Transition Program ?

The applications such as General Health Insurance, Family Practice Application, Unifying Social Security Institutions (SSI, State Retirement Fund, Social Security Organization for Artisans and the Self-Employed, Green Card /Health Card for Uninsured People in Turkey/ ), Passing to contracted status as working model, transforming administratively and financially hospitals to a autonomous structure with “Public Hospital Associations” Health-Net, Central Resource Management System, Electronic Receipt, Square Code Application, Public-Private Sector Partnership Project by State Partnership Administration of Ministry of Health, Central Hospital Appointment System, etc. concern everybody in Turkey within the scope of Health Transition Program. We interviewed with Deputy Undersecretary of Ministry of Health; Dr. Ekrem Atbakan in order to draw information about the transition of health care system.

Where we stand in order to extend countrywide Central Hospital Appointment System? What are the important acquisitions that we had during pilot application?

After an intensive planning period; we launched our pilot scheme from Dial Line 182 in Kayseri and Erzurum. We obtained important deductions from pilot scheme after analyzing. For example; our patients had realized their operations by getting an appointment without waiting in any precised day and hour. A structure has been created like patients go to related polyclinics without waiting by means of hospital information system. This situation (not waiting) minimized the risk such as infection at the hospitals. So cleanup costs and crowd costs are brought down. Thus physicians are able to deal with their patients. They are also able to work and provide service more efficiently.  

In the view of such practices, our plans has been verified. We stated that there are two important steps at our hospitals. The first one is a technological structure that is configured well technically and the second one is presentation of health care service. By this time we have been come a long way. We have achieved a great success for the integration of hardwares, call center or service and hospitals. Now, we are focusing on service presentation. In other words, changing of routines and physicians' and hospitals' the way of work.

We promise our patients with appointment system; as the name implies we are trysting. We need to develop service process peculiarly all together as security, register desk staff, nurse, physician, hospital administration and Ministry. We will definitely have some problems even if everybody works and struggles all together. For instance; patient comes to his/her appointment in time but physician could arrive late for 15 min. because of a traffic accident. We are mentioning about operations of 300 millions of patient with emergency patients in a year and we are talking about disciplining and organizing appointments of that high number of patient.

How will be the Stages of Functionality of Call Center Axial Central Hospital Appointment System?

            The patients dial line 182 with their home or mobile telephone number. If he/she desires to choose a physician or department, he/she does that by her/himself if not our operator lends assistance and makes suggestion. The operator takes provision via National Identity Number of patient. The operator assigns an appointment date and time according to patient request. Patient reads his/her informations and then operator confirms. Thus call center sends appointment info to the hospital.  

How does the system function if patient doesn't have any social insurance?

Even if patient doesn't have any social insurance, he/she can get appointment. We don't say that you can't get an appointment because you don't have any social insurance. We never treat our patients like that as Ministry. Since Health Transition Program has been launched for 7,5 years, we never turned back our patients by reason of their not having any social insurance. We generally request identity and address information of patient. The hospitals were like a prison. The patients were if well-meaning enslaved by reason of not paying treatment fees or not having a social insurance. There was an expression on press like “patient escaped”. Now there is no longer.

            We configured profoundly the system in order to overcome patient problems. We assigned a deputy head physician who is responsible for appointment systems and a technical staff in our hospitals. We have overcome nearly all the problems so far but we are aware of workload increase.

            Do you have any systematic solutions so as to facilitate becoming widespread of Central Hospital Appointment System? How resistance spots can be removed for service offer disciplining?

            Subsidiary payment system will be put into use. We are working in order to create performance improving individually and institutionally for our physicians, institutions that are compatible with our system. Dear Minister consider the project also important. 
 

            What is the educational level of operator staff who work in call center which is considered as a critical point?

            Well trained operators are working in call center. They are all certified from Health care Call Center Operator Certificate Program. By the way our trainings will be continued while the system becomes widespread countrywide. We know that call center operators will become more of an issue. This is for not only assigning an appointment and also directing the patient. Thus we are planning to train our operators abut hospitals' functionality and patients' situations. Perhaps we can think about providing a consultant physician in call center. Because it is not possible for everybody to know the appointment department.

            We carry on collecting data for Health-Net. We were having some problems on transition period. What is the current situation? Is there any study about using collected data for decision support systems. What are these data?

            We have struggled with critical turnout so far for the project. But now; the final situation gives hope to us. By means of Health-NET, we are collecting all personal health care data in a common format.

          This data is collected for two main goal. The first one; effective using method personal health care data. In other words, when a patient goes to a health care institution, all his/her informations can be displayed by any physicians. The second one; operating scientifically and statistically the data. We have serious expectations about the acquisitions from analyzes and reports by physicians. In order to have a better decision and a better planning, we also have serious expectations for budgeting. 

          We would like to advance slow and sure though we are in a certain extent for the target. As you know; one of the main subsection of Health-NET is Family Practice Information System. Now we are offering service with more than 7000 family physicians in our country. The whole health care data can be displayed retrospectively for each patient. If the patient change his/her family physician, all of these data is to his/her new physician.

          But we are walking on thin ice about operating data from second and third step. Because they have some connections about privacy and security. We need a complete regulation about that subject. Prime Ministry have realized a study about law amendment for e-State applications within this framework. As a part of our ministry, Health-NET have participated in this study. A draft law is prepared by Prime Ministry and approved by Ministerial Cabinet and finally sent to Grand National Assembly of Turkey. We hope that it will be also approved by Grand National Assembly of Turkey. After the law is introduced, we will issue how and which data will be used. For the second one; we are more lucky about evaluating, and considering the privacy of personal information and the data for administrative decision processes by various academicians. Considering the privacy of personal information, we will create a statistical analyze data repository. We will be adequate so as to analyze Health-NET data as Executive Directors and Ministry at the end of the year.

            Do you have any other studies in order to circulate health care data and create electronic health records?

            We started our studies about the subject 4 or 5 years ago. We published Domestic Health Care Data Dictionary in 2007. In 2008, we published 1.1 version. The next year we are going to publish 2011 version. We defined explicitly how health care records were been formed and stored. In other words; we published a Turkish Dictionary and spelling book of electronic health care. Now the main object is to enable hospital directors, software companies, central directors of ministries and physicians to use carefully this dictionary and spelling book. In fact; it is the main axle but we always discover new innovations. We should keep up with all these new innovations. There will be surely new innovations to add to main axle.

            It is very important to extend the usage of dictionary and spelling book. Indeed, Health-NET made it popular. And also Electronic Identity Card Application still exists. We are operating pilot scheme in Bolu. More than 100.000 cards are delivered to locals. These cards will be used instead of identity card. They will be used via PIN Code and fingerprinting verification.

   How will be electronic receipt functionality and security set up?

   Each individual will confirm by verifying electronic identity card via fingerprint or password. The records will be stored in a central structure and after confirmation, it will be easy to access patient receipt.

            e-receipt application is very useful but we need to build it rightly and also to observe and to query the processes well in order to develop the optimal system. As Ministry, we are open to dialog and to operate with all parts of work. We are not at desired level though we proceeded a lot about electronic receipt. We are working now on various projects. The notion of e-receipt is used in different ways. We need to know the response of question “What is e-receipt”? Writing out a prescription by using Word program on computer is an e-receipt. Or printing an e-receipt through receipt module from a computer in order to give a patient is an e-receipt as well. All of these are e-receipt application. There are lots of various method for that. For instance, a patient may go directly to a pharmacy after the physician prescribe the medication. The whole pharmacies are able to access to e-receipt application. By connecting to the system via electronic identity cards, they can realize the necessary transactions and we call all these steps “e-receipt”.

            We organized several e-receipt workshops and discoursed. The pilot scheme is resuming. It will show us if it will function or not... We will wait and see...

            What are the facilities of electronic receipt application to providers and vendors?

            Pharmacists won't be have to enter receipt informations to a computer by means of e-receipt application. They will be able to see all patient receipt information. Unnecessary medication usage will be prevented by means of this application. The misreading mistakes will be also prevented.

            All the patients will be able to have their medications prescribed in an electronic environment by the physicians without having any document. The physicians will be able to realize diagnosis and treatments via smart cards by accessing patient health informations.

            Electronic Identity Cards that we delivered to locals will facilitate various daily transactions. Irregularity of traditional methods while offering service will be prevented. Human mistakes will be minimized and saving of time will be enabled.