Integrated Medical Information and Analytical System
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Annual savings (USD)
City Government Funded
Region : Europe
National GDP Per Capita (USD) : $10,950 (IMF, 2018)
City Population: 12.5 million
Year Implemented : 2011
National Gini Index : 37.7 (World Bank, 2015)
Tags : GOVERNANCE ECONOMY HEALTH
Technologies Utilized : end users interface verification system for medical personnel, centralized databases, an analytical platform for clinics’ performance real-time monitoring and retrospective analysis, cloud-budgeting system.
Funding Source : 100% regional government
Project Cost : NA
Project Savings : $48.6 million annually
Planned Project Duration : Indefinite
KPIs : daily notes added to health cards, number of unique patients processed, number of appointments processed annually, waiting time, visit duration
Project Context and Overview
As the most populous city in the Russian Federation and the most populated urban agglomeration in Europe, Moscow also accounts for a very significant portion of its nation’s GDP. Consequently, its GDP per capita is far higher than the national average. With its population of 12.5 million, its urban infrastructure must be equipped to serve citizens effectively and efficiently across sectors. In particular, the healthcare system is especially important. Following the dissolution of the Soviet Union, bureaucratic inefficiencies strained the system to the point of near-failure. Redundant and burdensome documentation and procedures burdened doctors, health staff, and patients alike. This led to inflated costs, chronically long wait times, and a decreased access to doctors and facilities.
While numerous reforms have been made which have contributed to the improvement of these conditions, a huge factor has been the use of ICT, which allowed for the Integrated Medical Information and Analytical System (IMIAS). IMIAS is a comprehensive, one-stop system which incorporates a number of solutions in order to streamline Moscow healthcare.
To be able to convert a pre-existing system of its size to be managed electronically was an immense challenge and numerous obstacles needed to be addressed. No laws were in place for such a system; no suitable software existed for the type of project at that time; and legacy systems were entrenched in the bureaucratic culture which hindered adoption. These difficulties required a number of significant measures to be taken. This included passing new legislation, developing software internally, and instituting education programs to retrain existing employees. Six years since the implementation of IMIAS, the Moscow government is satisfied with its results. This includes the number of patients being processed by the system, the decrease in wait times, the length of visits, and estimated budget savings. Additionally, the system is able to collect and analyze data from patients in real-time to continuously update and improve healthcare policy in the city.
Project Planning and Implementation
As IMIAS was a massive undertaking in scale, numerous stakeholders were involved in its development and implementation. The project was initiated by Moscow Deputy CTO, Vladimir Makarov, and was a collaboration between two major departments: the Moscow Department of Information Technology and the Moscow Healthcare Department. Employees throughout the Department of Information Technology participated in the project as well as approximately 4,500 specialists from over 30 Russian IT companies.
As it is a comprehensive, one-stop system, IMIAS is not a single solution. It is comprised of several technology solutions, which were created through a multi stakeholder collaboration. Perhaps the most important aspect of the project is the centralized data center for managing the large amounts of data collected and shared daily, such as the e-records and e-referrals. All servers are maintained at this central location. End user interface for patients, doctors and management was developed. This allows bookings and rescheduling to be made online or via mobile apps, and reduces the administrative burden on medical staff. Physicians also make referrals online. To ensure the safety of sensitive data, a verification system for medical personnel was developed. Data analytics are employed to evaluate the performance of clinics both in real time monitoring and in retrospect. Another aspect of the system is the cloud-budgeting platform for monitoring and making informed budget decisions.
Changes in regulations were made in order to allow for this form of digital healthcare as well as electronic document flow. Continuing education of healthcare staff to train them in using the system was necessary. Additionally, campaigns to inform the public of the system and ensure optimal usage was necessary.
At implementation, Moscow considered a number of indicators by which to assess the success of the project. These included the number of patients being processed by the system, wait times and visit durations, and estimated budget savings. Over 20,000 healthcare professionals are using the system. Currently, from the moment of applying for an appointment online, 85% of patients are able to schedule a doctor’s appointment on the same or following day, and 98% are able to do so within three days. Visit durations were also streamlined. As of 2016, some 91% of patients were able to see a doctor within 20 minutes of arriving at their appointment. The following diagram shows progress over time in other metrics by which Moscow monitors the performance of IMIAS.
Amount of Notes Added to Health Cards Daily
2011 – 70,000
2016 – 500,000
Number of Unique Patients Annually
2013 – 2.5 million
2014 – 5.2 million
2015 – 7 million
2016 – 9 million
Number of Appointments Per year
2011-2012 – 2.3 million
2013 – 33.5 million
2014 – 56.9 million
2015 – 63 million
2016 – 63.4 million
Finally, while budget savings is not the primary intended output of IMIAS, the program has saved budget in a variety of ways, from paper waste reduction to labor hours saved. Moscow estimates that 41 million Euros ($48.6 million USD) are saved annually by the program.
Recommendations for Transfer
While Moscow is a mega city, in principle, a similar project with adaptations could benefit cities of varying sizes. Some recommendations and insights from Moscow’s experience offer guidance for transfer.
Delegating too much of the project to any one external contractor is not advisable as too much knowledge will become concentrated with that contractor. In the future, this will make independence from that contractor less possible and negotiations on contract renewals more difficult. Also, should the contractor be unable to deliver the services for some reason, the entire program could be in jeopardy. Depending on the size of the project, a single contractor may not have the capacity to implement it alone. In the case of Moscow, some software was developed in-house which offers a great number of advantages such as proprietary rights to the product. However, in other contexts, such as smaller cities, contractor-developed solutions may be more suitable.
The scope and capacity of each subsystem should be well-planned and defined prior to beginning development of the project. Post-hoc add-ons and additional functions can strain the capacity of the system. Budgeting and planning should account for extensive training of employees to use the program as well as aggressive advertising to make citizens aware of the changes and amenable to changing their habits under the new healthcare system.
Figures and Images