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Qatar National E-Health & Data Program (QNeDP)

​​​​​​​​​​​Qatar National E-Health & Data Program (QNeDP)

PART I: THE E-​HEALTH JOURNEY



BACKGROUND

In the past decade, the Information Technology (IT) industry has witnessed the emergence of several new concepts on the health domain, among them: E- Health (or eHealth), Health 2.0, digital or electronic health, electronic health record, digital hospital and many others.
Today’s technologies makes it is now possible to envision and deliver on new solutions that address previous limitations. In addition, there are many opportunities to leverage best implementation practices and
modern public policies from several E-Health experiences from around the world.
This journey starts with a simple understanding of what E-Health is trying to achieve and its scope of influence.

E-Health Definition
“Transformative and continuous improvement of healthcare through the use of information and technologies that support the delivery of healthcare and clinical research.”


Under this definition, E-Health includes most of the information systems, digital devices, and data analytics solutions that at some point in time process health data.
This definition also highlights the fact that E-Health is not just about the technologies themselves, but rather positions technology as an enabler for positive changes in the healthcare system. In summary, E-Health brings together people, processes and health services in a collaborative union with a common goal of improving patient care.


QATAR E-HEALTH VISION
 


After consultation with key health stakeholders, the vision statement for E-Health in the State of Qatar has been defined as:
A world-class, sustainable, integrated and secure national E-Health ecosystem for the State of Qatar.

This vision describes desired characteristics of the E-Health destination. It brings to light Qatar’s desire to become a world leader in the adoption, use and development of innovative solutions.   It also highlights that the entire ecosystem be sustainable, allowing organizations to plan effectively and with confidence, knowing that a national E-Health capability will be supported for generations.



BENEFITS OF E-HEALTH
 

Change to existing methods and practice comes at a price, but also comes with expected benefits that will help increase patient safety, reduce overall system costs and provide better accountability to health system participants. More succinctly, benefits are expected in five key areas as outlined below.
​​
GUIDING PRINCIPLES
The implementation of the E-Health Strategy will involve dozens of decisions and compromises. In order to ensure that these are consistently aligned with the essential goals of this Strategy, it is necessary to define key guiding principles, for both E-Health and Data Management future project as described below.


GUIDING PRINCIPLES

The implementation of the E-Health Strategy will involve dozens of decisions and compromises. In order to ensure that these are consistently aligned with the essential goals of this Strategy, it is necessary to define key guiding principles, for both E-Health and Data Management future project as described below.






Seven key guiding principles that guide and frame the National E-Health Program:
  1. It is important to demonstrate benefits to individuals, showing how E-Health can help them to be healthy, how to access the healthcare system, and how to be informed about things that are important to their overall wellness.
  2. Generating positive value to healthcare practitioners and provider organizations recognizes the vital role these professionals play in delivering quality health care. Providing visible benefits to these stakeholders is an important pre-requisite to promote interest, adoption and change.
  3. Promoting solutions that are right for Qatar’s need, recognizing the size and capabilities of the country, leveraging existing organizations and solutions and respecting the unique cultural characteristics of its population.
  4. Enabling strong collaboration across all members of the health community will help promote and accelerate the adoption of standards and solutions
  5. The Qatar National Vision 2030 includes a significant focus on developing local knowledge and expertise through research and innovation. E-Health can play a significant role in this goal if the right incentives are made available to entrepreneurs and health researchers.
  6. In order to ensure sustainability of the E-Health program, the Strategy needs to develop the required E-Health skills among healthcare practitioners and for attracting qualified professionals.
  7. Finally, E-Health is not an end in itself, rather it is a supportive technological fabric that will help and accelerate the achievement of national health goals established by the NHS (National Health Strategy).

Similarly, in addition to these seven E-Health principles, five additional principles provide the direction to be followed in all data management activities and plans.
 


  1. A focus on data quality is paramount to the success of an E-Health ecosystem. Making informed decisions on patient safety through confidence in the underlying data from multiple organizations will help ensure maximum benefit to the health system while at the same time minimizing errors made with incomplete or unreliable data. Good data is a fundamental pre-requisite for supporting new advanced data analytics services that will be providing reporting and insights about the health system.
  2. Data governance ensures that there is accountability and focus on data usage across the full health ecosystem. It includes oversight on data sharing policies as they relate to sensitive patient date.
  3. A system of policies, regulations and legislation will cover the protection of sensitive patient data for multiple purposes including primary, secondary and tertiary care and health analytics. In addition, the securing of this information from external parties will help build confidence in the E-Health system in order to maximize health system benefits.
  4. Terminologies provide the basis to derive meaning and knowledge from health data, especially to transform textual data into codified terms. Active management of terms and the establishment of a terminology authority (or National Product Center) will help ensure that terminologies are maintained appropriately.
  5. As with the E-Health Guiding Principles, a sustainable E-Health ecosystem needs to define, attract and build the necessary data management skills and capabilities in a local workforce.
 


E-HEALTH CONCEPTUAL MODEL
 

To achieve the E-Health vision that has been agreed, it is necessary that all components of the E-Health ecosystem be designed and implemented to work collaboratively towards a common goal: better health for all people in Qatar.

Each conceptual component represents the various resources, processes and technologies that will be impacted, at some form or another, by this Strategy.


Component Description Strategy Implication
E-Health and Data Management Governance Defines the organizations, roles and responsibilities, policies and processes of the E-Health Program. Implementation of E-Health policies and organizations is imperative for the launch and success of the National Program.

 

 

Health Information Infrastructure

Collection of E-Health resources, including people, technologies and national services, required to support the collection and sharing of health information. Establishment of the national E-Health services needs to be prioritized in order. Foundational services, repositories and systems need to be procured and implemented early in the program timeline.

 

Electronic Medical Record (EMR)

All application systems that digitize health data at the care delivery points of services (e.g. hospital systems, pharmacy systems, lab systems, etc.). The Strategy needs to promote the use and adoption of EMR systems in all healthcare delivery locations, both private and public services.

 Personal Health Account (PHA)

Collection of consumer health applications that include a unified personal health record and support health self-management services for individuals in Qatar. The PHA is the centerpiece of the Strategy, as it is the primary door to the E-Health services for all individuals. Many of the envisioned benefits require active participation of patients and caretakers.​

Component

Description

Strategy Implication

 

 

 

 

 

Population Health Systems

Collectionofsystems that monitor population-levelhealthmatters suchas, but not limitedto,non-contagious and contagious diseasemanagement, outbreakdetection,immunization management, etc.).

PublicHealthsystems focus onhealthy lifestylepromotionandpatient empowerment, diseasepreventionand populationhealthprotection. In orderto do this effectively,thesesystems will depend on reliableinformationfrom healthcare facilities aswell as a secure channel for direct communicationwithall providers and otheremergencyresponse agencies.

 

 

HealthData Services

Consistsofthecollection,quality review, aggregationand reporting of health-relateddatafor clinical and system-wide use.

Withtheincreasing availabilityofcoded clinical data,supportedbystandardized terminologies,it willbepossibleto create advanceddataanalytics services,forboth clinical and operationalhealth data.

 

 

 

Health Research Network

Collectionof organizations that perform health-specific research (e.g. evidence- basedprotocols,populationhealth management,genetics,disease prevention,healthsystem performance, etc.).

Thehealthresearch communitywillbea key beneficiary ofthe E-HealthStrategy onceinitialservicesareoperationaland morehigh-qualityclinicaldatabecomes available. However,newpoliciesforthe useofthis datawillrequire patient consent.

 

 

HealthInsurance Funding

Collectionoforganizations, policiesand processesassociatedwiththepayment forhealthcareservices inQatar.

Significant transformationis under way on howhealthcareservicesare funded. NHIC is thefirst organizationto collect detailed system-widedata,and willbenefit from theextendedcapabilities to beprovided bythenationalhealthdataservices.

 Population Health Systems

Collection of systems that monitor population-level health matters such as, but not limited to, non-contagious and contagious disease management, outbreak detection, immunization management, etc.). Public Health systems focus on healthy lifestyle ​promotion and patient empowerment, disease prevention and population health protection. In order to do this effectively, these systems will depend on reliable information from healthcare facilities as well as a secure channel for direct communication with all providers and other emergency response agencies.

 

 Health Data Services

Consists of the collection, quality review, aggregation and reporting of health-related data for clinical ​and system-w ide use. With the increasing availability of coded clinical data, supported by standardized terminologies, it will be possible to create advanced data analytics services, for both clinical and operational health data.

 

 Health Research

Network

. The health research community will be a key beneficiary of the E-Health Strategy once initial services are operational and more high-quality clinical data becomes available. However, new policies for the use of this data will require patient consent.

 

 Health Insurance Funding

Collection of organizations, policies and processes associated with the payment for healthcare services in Qatar.
Significant transformation is under way on how healthcare services are funded. NHIC is the first organization to collect detailed system-wide data, and will benefit from the extended capabilities to be provided by the national health data services.​


PART II: REALIZING THE VISION

 


TECHNOLOGY ADOPTION

The availability of quality health information in digital form is an essential pre- requisite for achieving the E-Health Vision and benefits. Most health data is still processed using paper today and significant effort and investments need to occur in order to change this scenario. The adoption of modern, standards based IT solutions must take place across everywhere, including government, semi-government and public sector organizations.
The E-Health Program will need to collaborate with the various stakeholders to find pragmatic and creative solutions to resolve this issue and accelerate the use of digital solutions while implementing the national E-Health services.


Personal Health Account (PHA)
The National Health Strategy has as one of its main goals enhancing the wellness of the people of Qatar so that a vibrant, healthy, and productive society can be established for today, and for the future. To achieve this goal, individuals need to be engaged and empowered to manage their own health status and that of other people they may be responsible for.
This is the principal purpose of the Personal Health Account (PHA), which forms the primary focus of this strategy. The PHA will not only provide the desired single point of interaction between individuals and their health data and services, it will also act as the primary guide to decisions and priorities to be made by the national E-Health Program.




Electronic Medical Record Systems

Several governmental and semi-governmental healthcare providers have embarked or are planning to embark on various programs to implement EMR systems with a defined roadmap. The current implementation of a single, EMR system across all HMC hospitals and PHCC sites is the best example of the financial and organizational commitment of these entities to automate their clinical processes and digitize their health data.
However, many other providers, mainly within the private sector, do not have such systems in place and some don’t even have immediate plans to implement them. This situation cannot be allowed to continue, both for the quality and safety of healthcare services, but also if the E-Health Vision is to be achieved.
One of the key priorities of the E-Health Program will be to find ways, through a combination of incentives and penalties, to accelerate the adoption of electronic systems in all organizations that deliver health care in the country. A robust understanding of program benefits is required for designing incentives and penalties that promote value generation by stakeholders. It will also need to establish the minimum requirements, standards and capabilities that these new systems will need to meet in order to become participants of the national E-Health services.
 

Population Health Systems
Population Health Systems is a category of applications that perform continuous, systematic collection, analysis and interpretation of health-related data at a population level. This data can be used for the planning, implementation, and evaluation of communicable disease outbreaks. If an outbreak is detected, contact tracing, outbreak management and case management functions are used to monitor the outbreak and help ensure the outbreak is contained. As recent outbreaks as MERS, Ebola and SARS have demonstrated, disease outbreak can move swiftly and across borders.
Therefore, it is critical to have systems in place to help detect, monitor and contain communicable disease in Qatar, and indeed, the GCC region.
Population Health Systems also include preventive measures such as managing immunizations provided to a patient group (cohort) as part of a vaccination program. Many diseases can be prevented and / or mitigated through a demonstrated program of vaccination; knowing which patients have received specific vaccines can assist in their treatment.
Population health systems will leverage Health Data Services (see E-Health Conceptual Model), aggregating and summarizing data at a population level. This can be used for identifying outbreaks, cohorts for immunization campaigns and for identifying population groups for education and preventative planning measures. Population health systems could also leverage social media in some situations to better predict trends in the population.
 


E-HEALTH AND DATA MANAGEMENT GOVERNANCE
 

The E-Health and Data Management Steering Committee has provided the leadership and guidance needed during the development of the E-Health and Data Management Strategy.
To ensure the successful implementation of this Strategy over the coming years, a permanent governance structure and respective operational business functions needs to be formally established.
The proposed governance model is composed of the following levels:

Strategic: Where overall direction to the E- Health program will be established and confirmed;
Functional: Where committees and groups will entertain specific topics such as lab exchange standards, national E-Health blueprint management, and clinical coding standards, for example;
Operational: Leveraging staff and resources from an E-Health program office to support the Strategic and Functional committees; and
Analytical: Responsible for the strategic and functional processing of health data for the purpose of reporting, analysis, policy development, system management, regulation and research.

LEGISLATIVE AND REGULATORY CHANGES
 

Qatar has a comprehensive and fine grained State Legal System. The MOPH is the highest authority for the supervision of medical care in the State of Qatar. The MOPH has wide authorities to achieve its role and purpose. Alongside the MOPH, in matters of importance to the E-Health Program, is the Ministry of Information and Communication Technology (MICT), which is the legal regulatory authority
in the Information and Tele-Communication sector in the country.
The national E-Health Program will have to be created and governed within this complex legal framework. New laws, policies and regulations will likely need to be created to provide the support to establish the organizations, rules and requirements, incentives and remedies required to fully execute the E-Health Strategy.
Data Privacy Laws
A Data Privacy Law is currently being developed and will provide for the first time a comprehensive set of safeguards that defines the rights of individuals to decide what can be done with and who may access their personal information that has been collected by other parties.
A key cornerstone in both draft laws is the individual’s right to grant or deny consent for data sharing and uses beyond the original purpose for which the data was collected. Under the principle of express, informed consent, the
individual must be first educated on the required use of their health data for the purpose of healthcare services, and also be advised if that information may be used for different purposes in the future (e.g. research, etc.) in the future. An explicit consent must be obtained or confirmed before personal health information can be collected and processed.
E-Health and Data Management Regulations
The Ministry of Public Health is the preferred vehicle to regulate E-Health in the State of Qatar and house a new entity which will oversee the governance of the national E-Health Program. Based on its enabling legislation, the MOPH has the powers to issue policies, adopt new organizational structures, supervise technical systems for health data, and set out policies for systems of control within the health care industry.
These policies will need to address the following areas:
Patient Consent Policies: Defining when and how consent to process health data should obtained from an individual;
E-Health Governance: Defining the new organization that will be responsible for executing the E-Health Strategy;
Data Security Policies: Defining security requirements for protecting health data (e.g. Business Continuity Management, Risk Management, Identification, Authentication and Authorization, etc.);
Data Management Policies: Defining data lifecycle responsibilities and requirements (e.g. Data Ownership / Stewardship, Audit, Creation and Collection, Retention and Disposal, Data Quality, etc.);
Right to Use Policies: Defining the purposes for which health data can be used by providers in the direct delivery of care to the patient
(e.g. “Need to Know” rules); and
Data Sharing Agreements: Defining the purposes for which health data may be shared between organizations and terms of responsibilities that must be observed by all custodians of that data.


 
LEGISLATIVE AND REGULATORY CHANGES
 

Qatar has a comprehensive and fine grained State Legal System. The MOPH is the highest authority for the supervision of medical care in the State of Qatar. The MOPH has wide authorities to achieve its role and purpose. Alongside the MOPH, in matters of importance to the E-Health Program, is the Ministry of Information and Communication Technology (MICT), which is the legal regulatory authority
in the Information and Tele-Communication sector in the country.
The national E-Health Program will have to be created and governed within this complex legal framework. New laws, policies and regulations will likely need to be created to provide the support to establish the organizations, rules and requirements, incentives and remedies required to fully execute the E-Health Strategy.

Data Privacy Laws
A Data Privacy Law is currently being developed and will provide for the first time a comprehensive set of safeguards that defines the rights of individuals to decide what can be done with and who may access their personal information that has been collected by other parties.
A key cornerstone in both draft laws is the individual’s right to grant or deny consent for data sharing and uses beyond the original purpose for which the data was collected. Under the principle of express, informed consent, the
individual must be first educated on the required use of their health data for the purpose of healthcare services, and also be advised if that information may be used for different purposes in the future (e.g. research, etc.) in the future. An explicit consent must be obtained or confirmed before personal health information can be collected and processed.

E-Health and Data Management Regulations
The Ministry of Public Health is the preferred vehicle to regulate E-Health in the State of Qatar and house a new entity which will oversee the governance of the national E-Health Program. Based on its enabling legislation, the MOPH has the powers to issue policies, adopt new organizational structures, supervise technical systems for health data, and set out policies for systems of control within the health care industry.
These policies will need to address the following areas:
  • Patient Consent Policies: Defining when and how consent to process health data should obtained from an individual;
  • E-Health Governance: Defining the new organization that will be responsible for executing the E-Health Strategy;
  • Data Security Policies: Defining security requirements for protecting health data (e.g. Business Continuity Management, Risk Management, Identification, Authentication and Authorization, etc.);
  • Data Management Policies: Defining data lifecycle responsibilities and requirements (e.g. Data Ownership / Stewardship, Audit, Creation and Collection, Retention and Disposal, Data Quality, etc.);
  • Right to Use Policies: Defining the purposes for which health data can be used by providers in the direct delivery of care to the patient
  • (e.g. “Need to Know” rules); and
  • Data Sharing Agreements: Defining the purposes for which health data may be shared between organizations and terms of responsibilities that must be observed by all custodians of that data.

LEGISLATIVE AND REGULATORY CHANGES
 

Qatar has a comprehensive and fine grained State Legal System. The MOPH is the highest authority for the supervision of medical care in the State of Qatar. The MOPH has wide authorities to achieve its role and purpose. Alongside the MOPH, in matters of importance to the E-Health Program, is the Ministry of Information and Communication Technology (MICT), which is the legal regulatory authority
in the Information and Tele-Communication sector in the country.
The national E-Health Program will have to be created and governed within this complex legal framework. New laws, policies and regulations will likely need to be created to provide the support to establish the organizations, rules and requirements, incentives and remedies required to fully execute the E-Health Strategy.
Data Privacy Laws
A Data Privacy Law is currently being developed and will provide for the first time a comprehensive set of safeguards that defines the rights of individuals to decide what can be done with and who may access their personal information that has been collected by other parties.
A key cornerstone in both draft laws is the individual’s right to grant or deny consent for data sharing and uses beyond the original purpose for which the data was collected. Under the principle of express, informed consent, the
individual must be first educated on the required use of their health data for the purpose of healthcare services, and also be advised if that information may be used for different purposes in the future (e.g. research, etc.) in the future. An explicit consent must be obtained or confirmed before personal health information can be collected and processed.
E-Health and Data Management Regulations
The Ministry of Public Health is the preferred vehicle to regulate E-Health in the State of Qatar and house a new entity which will oversee the governance of the national E-Health Program. Based on its enabling legislation, the MOPH has the powers to issue policies, adopt new organizational structures, supervise technical systems for health data, and set out policies for systems of control within the health care industry.
These policies will need to address the following areas:
Patient Consent Policies: Defining when and how consent to process health data should obtained from an individual;
E-Health Governance: Defining the new organization that will be responsible for executing the E-Health Strategy;
Data Security Policies: Defining security requirements for protecting health data (e.g. Business Continuity Management, Risk Management, Identification, Authentication and Authorization, etc.);
Data Management Policies: Defining data lifecycle responsibilities and requirements (e.g. Data Ownership / Stewardship, Audit, Creation and Collection, Retention and Disposal, Data Quality, etc.);
Right to Use Policies: Defining the purposes for which health data can be used by providers in the direct delivery of care to the patient
(e.g. “Need to Know” rules); and
Data Sharing Agreements: Defining the purposes for which health data may be shared between organizations and terms of responsibilities that must be observed by all custodians of that data.

LEGISLATIVE AND REGULATORY CHANGES
 

Qatar has a comprehensive and fine grained State Legal System. The MOPH is the highest authority for the supervision of medical care in the State of Qatar. The MOPH has wide authorities to achieve its role and purpose. Alongside the MOPH, in matters of importance to the E-Health Program, is the Ministry of Information and Communication Technology (MICT), which is the legal regulatory authority
in the Information and Tele-Communication sector in the country.
The national E-Health Program will have to be created and governed within this complex legal framework. New laws, policies and regulations will likely need to be created to provide the support to establish the organizations, rules and requirements, incentives and remedies required to fully execute the E-Health Strategy.
Data Privacy Laws
A Data Privacy Law is currently being developed and will provide for the first time a comprehensive set of safeguards that defines the rights of individuals to decide what can be done with and who may access their personal information that has been collected by other parties.
A key cornerstone in both draft laws is the individual’s right to grant or deny consent for data sharing and uses beyond the original purpose for which the data was collected. Under the principle of express, informed consent, the
individual must be first educated on the required use of their health data for the purpose of healthcare services, and also be advised if that information may be used for different purposes in the future (e.g. research, etc.) in the future. An explicit consent must be obtained or confirmed before personal health information can be collected and processed.
E-Health and Data Management Regulations
The Ministry of Public Health is the preferred vehicle to regulate E-Health in the State of Qatar and house a new entity which will oversee the governance of the national E-Health Program. Based on its enabling legislation, the MOPH has the powers to issue policies, adopt new organizational structures, supervise technical systems for health data, and set out policies for systems of control within the health care industry.
These policies will need to address the following areas:
Patient Consent Policies: Defining when and how consent to process health data should obtained from an individual;
E-Health Governance: Defining the new organization that will be responsible for executing the E-Health Strategy;
Data Security Policies: Defining security requirements for protecting health data (e.g. Business Continuity Management, Risk Management, Identification, Authentication and Authorization, etc.);
Data Management Policies: Defining data lifecycle responsibilities and requirements (e.g. Data Ownership / Stewardship, Audit, Creation and Collection, Retention and Disposal, Data Quality, etc.);
Right to Use Policies: Defining the purposes for which health data can be used by providers in the direct delivery of care to the patient
(e.g. “Need to Know” rules); and
Data Sharing Agreements: Defining the purposes for which health data may be shared between organizations and terms of responsibilities that must be observed by all custodians of that data.

PART

II


PART II: REALIZING THE VISION: REALIZING THE VIR​T II: R

NATIONAL STANDARDS
 

A strong foundation in E-Health Standards will reap significant benefits to the health system in Qatar. The establishment and management of numerous E- Health Standards will form a strong underpinning of the E-Health Program.
Specifically, this element of the Strategy will focus on:
  • Core & Fundamental E-Health Standards;
  • Standards Selection;
  • Standards Change Management;
  • Standards Certification;
  • Supporting Policies, Procedures and Standards Governance;
  • Operational Support; and
  • Initial Standards Recommendations.

Core & Fundamental E-Health Standards
There are numerous E-Health Standards available today, implemented in various parts of the world. These range from HL7, X12, ICD-9 & ICD-10, SNOMED CT and ISO, to name a few.
Health Data Set Standards: These describe data elements for a particular clinical or administrative domain such as claims, patient, encounter or E- Dispense. Health Data Sets (HDS) form the necessary building blocks for a comprehensive view of data across the continuum of care.

Data Standards: For coded data elements, the series of valid values for data elements such as Route of Administration,  Gender and Diagnosis.


Terminologies are defined against these coded data elements and are
drawn from international code sets, such as ICD, SNOMED, LOINC, wherever possible.
Interoperability Profile Standards: An interoperability profile standard describes the data elements that are necessary to support an exchange of information from one organization or system to another. Examples include a prescription, lab result, diagnostic image or diMOPHarge summary.
Privacy and Security Standards: Protecting a patient’s sensitive data is critical to ensuring there is faith and trust from patients in the E-Health system. This includes managing consent agreements, audit and ensuring appropriate controls are in place to monitor access.

Standards Selection
One of the major challenges facing organizations is selecting the most appropriate E-Health Standard to adopt. There are numerous standards focusing on terminology, exchange, clinical concepts or privacy and security. There is no perfect E-Health Standard that will meet all needs across the spectrum of health use cases.  Therefore, a pragmatic and systematic approach to selecting standards is crucial. This includes:
Selecting international standards where there is an exact fit (Adopt);
Adjusting international standards to meet Qatari needs (Adapt); or
Developing Qatari standards where no international standard exists (Develop).
In almost every case, an existing international standard should be adopted or adapted. The good news is there are few situations where new standards are necessary. Regardless of adopting, adapting or developing, a structured peer review with stakeholders across Qatar is necessary to ensure that all affected



groups and organizations have their input into selecting the appropriate E- Health Standards for the country.

Standards Change Management
E-Health Standards are not static and change to reflect new methods, new clinical procedures and new disease. When SARS struck, new ICD codes were required in order to track the outbreak of the disease. Recognizing change to E-Health Standards requires implementing structured change management processes based on ITIL (Information Technology Infrastructure Library) methods. Along with Standards Selection, this forms a Standards Management approach that not only organizes changes into Releases, but ensures that these Releases are structured and published so that they can be properly implemented into solutions in a timely fashion.




Standards Certification
An important consideration in the deployment of E-Health Standards is certification of solutions to these standards. An information system that cannot properly communicate to a national repository will compromise data quality and integrity and call into question any interpretation of that data, whether for patient care purposes or health analytics. It is therefore critical that a program of conformance testing be put in place to certify solutions against critical E-Health Standards. Going further, tying incentives and purchase decisions to select only those compliant solutions will help motivate software vendors and organizations to pursue certification of their products.

Operation Support
The establishment of a Standards Division with the E-Health Program will help support the Standards Governance committees and the E-Health Standards Selection and Standards Change Management functions. Critical roles that are required include:
Standards Manager, with oversight and responsibility for the Standards Division;
Release Manager, to orchestrate new Releases of E-Health Standards;
Privacy & Security Analyst(s), to manage privacy & security standards;
Interoperability Analyst(s), to manage Exchange Standards and interoperability profiles;

Data / Terminology Analyst(s), to manage Data Standards; and
Help Desk Analyst(s), to respond to standards queries and triage requests for change.

Initial Standards Recommendations
An initial set of E-Health Standards are recommended, subject to further peer review and approval by the Standards Governance committees. These include:
Health Data Sets: Data elements, definitions and data types are drawn from:
  • HL7 (Health Level 7) FHIR (Fast Healthcare Interoperability Resource);
  • Claim MDS (Minimum Data Set); and
  • MHMDS (Mental Health Minimum Data Set).
Data Standards: Coded values for the Patient and E-Dispense Health Data Sets:
  • ICD-10 AM;
  • SNOMED CT; and
  • HL7.
Exchange Standards/Interoperability Profiles: Profiles, message and document standards:
  • CDA (Clinical Document Architecture);
  • IHE-XDS (Cross Enterprise Document Sharing);
  • IHE-XDR (Cross Enterprise Reliable Document Sharing)
  • IHE-PIX / PDQ (Patient Identity Cross-reference / Demographic Query)
  • HL7 FHIR (Fast Healthcare Interoperability Profile).

PART III: STRATEGIC PLAN (2016 – 2020)


MISSION AND GOALS
 

The mission statements are grouped according to the 4 pillars of E-Health. The mission objectives listed below describe the key activities and deliverables to be produced by the E-Health program during its initial 5-year period.



 

PART III: STRATEGIC PLAN (2016 – 2020)





In order to evaluate the progress of the E-Health program and adjust as needed, several specific goals or targets will be defined and monitored according to the implementation roadmap. These targets will be established according to a framework structured around three main themes: Digitize, Standardize and Integrate. These themes and the specific dimensions to be measured for each goal are shown below.



IMPLEMENTATION ROADMAP
 

The E-Health Vision represents the long term destination, but reaching it requires a pragmatic and systematic approach that can ensure the success of the journey.
Realizing the E-Health Vision to its fullest extent and across all organizations is a long term journey that will require dedicated planning, commitment and execution. Complicating matters is the fact that new technologies are created in an ever changing, very dynamic market, where innovation and obsolescence cycles are shortening at an incredible rate.






The E-Health Strategy should be implemented via a “benefits-led” methodology, which reflects current best practices of large scale health IT transformation programs. This enables the project to focus on those components of the project that aim to deliver the greatest benefits to all stakeholders, including patients, providers and the government. The main aspects of such an approach are illustrated below.



The E-Health Strategy should be implemented via a “benefits-led” methodology, which reflects current best practices of large scale health IT transformation programs. This enables the project to focus on those components of the project that aim to deliver the greatest benefits to all stakeholders, including patients, providers and the government. The main aspects of such an approach are illustrated below.
First E-Health Generation (Gen-1)
The first E-Health generation will introduce the foundational services that need to be implemented first at a national level as they are pre-requisites for all future capabilities. These include:
  • Non-clinical registries;
  • Key clinical repositories and integrated health workflow management services; and
  • National Health Information Exchange (HIE).
The figure below shows the proposed collection of systems and services to be implemented as part of the first generation (Gen-1) of E-Health services.



In addition to the HIE and non-clinical registries, a minimum set of clinical repositories and process management systems should be delivered in conjunction, as these are the services that will effectively deliver tangible benefits to the healthcare delivery:
  • Event Repository and Document Repository: These two services, when combined, provide a simple but very effective timeline of each time the patient has been in contact with the health system and a summary document with the key clinical findings, diagnosis and medical advice resulting from these encounters.
  •  Record Index: A general index for any type of clinical data about the patient that has been created and published to the HIE. These may be records or documents that will remain at each EMR system, and may include patient family history, clinical assessments, lab results and many others.
  • Diagnostic Imaging Repository: A national archive that will contain all diagnostic imaging reports, manifests and images that have been created in hospitals or imaging clinics across the country. This repository may also provide a vendor-neutral image viewer that can be used from any EMR system.  Finally, Gen-1 will also include two very important workflow management systems to be provided as a centralized service to all applicable healthcare sites:
E-Referral Management: A system that will receive and coordinate all requests for referrals between healthcare providers, including those from primary care to specialists, between specialists, from hospitals back to general practitioners, long term care and/or home care services.
Medication Management: A system that will be used across community pharmacies, public and private sectors, to manage the medication profile for patients. It will provide the combined functions of several systems:
  • Drug repository (profiles);
  • E-Prescribing and E-Dispensing processing;
  • Drug interaction checking;
  • Pharmacy practice management; and
  • Drugs benefit management (claims).

This system is proposed as a single national E-Health solution to be provided as a cloud-service and used by all community pharmacies.

Finally, the E-Health Program team will work with the various stakeholders to promote and measure the adoption of local and national E-Health systems, focusing on the digitization and standardization of clinical data.

 




The chart below shows the various activities that will be required to complete the implementation of Gen-1, the first E-Health generation.




Second E-Health Generation (Gen-2)

The second generation (Gen-2) of E-Health services will significantly enhance the capabilities provided by the national services. Its main focus will be to fully explore and use information already collected and shared through the Gen-1 services.
Additionally, Gen-2 will begin to deliver on the goals linked to consumer involvement and empowerment. It is here that the full extent of the Personal Health Account (PHA) will be provided to everyone in Qatar.
The figure below shows the proposed collection of systems and services to be implemented as part of the second generation (Gen-2) of E-Health services.

 

New clinical repositories are also planned for the Gen-2 scope, and complement those already in delivered during Gen-1. These include:
  • Disease Registries: The first of possibly many disease-specific repositories, it will hold a record of all diabetic (and possibly pre-diabetic) individuals in Qatar, along with key diabetes management information that has been collected and/or presented to the patient.
  • Personal Health Record: A national archive that will contain all clinical data provided by the individual and not by providers or healthcare  professionals. This repository will be directly associated with one or more of the Personal Health Account applications.

Finally, Gen-2 will add two new workflow management services to the national E-Health services: Personal Health Account and Virtual Medicine Applications.
Gen-2 will overlap with the end of Gen-1, and will extend for the last three years of the implementation plan. First in the activities for Gen-2 is to evaluate the results obtained with the rollout of the first group of E-Health services.





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Email : GHCC@MOPH.GOV.QA
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