Imagine contributing to an entire nation's capacity to improve healthcare outcomes for its citizens. Read through this chat where Alia Jundi, a senior organizational change consultant at Oracle Cerner, discusses with Dr Khalid Alodhaibi, chief information officer at Ministry of Defense Health Services (MODHS), and Eng Azzam Amro, chief information officer at the Prince Sultan Military Medical City (PSMMC) about their organizations’ electronic health record (EHR) project, RABET, and how it is enabling a digital transformation for healthier outcomes in the Kingdom of Saudi Arabia (KSA).

RABET – which means ‘connecting facilities’ in Arabic – was created in 2017 by MODHS to enable a massive digital transformation in healthcare in KSA. It is implemented in 26 hospitals and 160 primary healthcare centers (PHCCs) within MODHS.

“RABET is an exact representation of the healthcare delivery transformation envisioned for the KSA 2030 vision. One of the goals for this project is to have one unified record for every citizen in Saudi [Arabia], because we want to provide immediate access to critical information when needed for the project that we worked on,” says Dr Alodhaibi.

The main goals through RABET are to:

• Enforce clinical pathways and medical best practices
• Provide patients’ information when needed
• Streamline communication across all their healthcare facilities and between healthcare units, such as nursing, pharmacy, lab, and imaging, in each hospital

With one of the project’s main pillars being healthcare accessibility, their aim is to enhance the enablement of integrated healthcare in KSA by integrating with NPHIES, the nationwide EHR, and build an HIE-enabled solution that can be connected to other platforms when needed.

Q: How did you structure this project to have your clinicians involved in the design and development of RABET?

Eng Azzam Amro: End users’ real engagement in a project’s implementation phases plays the main role in its success.

As an example, the project was structured so that all EHR solutions would be led by clinicians and the implementation team to report to the steering committee. The committee governed the project implementation, solving project major issues and making sure that adoption of best practices.

From a staffing perspective, the clinical team makes up around 70% of the RABET implementation team. Their engagement is reflected clearly in all project phases right from data gathering, future set review, future state validation, testing, and data migration, to building of the relevant training materials. Moreover, they were engaged in assessing the project’s go-live readiness; their approval was mandatory in each phase. They were also engaged in writing the testing scenario to ensure system testing covers integrated workflow and is not limited to an individual solution.

Clinician engagement is not limited to the implementation team. Everyone in the organization can communicate their concern by attending clinicians’ dialog, visiting the RABET website, or calling the RABET hotline. Real engagement with all project stakeholders in each phase of EHR implementation is crucial for a successful go-live and better outcomes.

Q: How did you ensure that the decisions taken during the design phase of RABET supported your vision to provide integrated care across KSA?

Eng Azzam Amro: MODHS’s objective was to have a centralized electronic health record that provides integrated care across our hospitals. The first rollout will be in Riyadh with three hospitals and more than 34 PHCCs. The challenge here is to make sure the designed clinical workflow and pathways are adaptable in all other hospitals and that it covers their needs.

Right from the initial stage of the project, specifically during the management alignment session, we ensured that we engaged the clinical subject matter experts from different hospitals in all targeted solutions and considered them as RABET’s team members.

No workflow is accepted if it is not reflected in the headquarters’ policy and procedures, and doesn’t comply to the JCI standards. Lastly, the workflow change committee process is governed by the steering committee’s approval to study the impact of all changes and to ensure it is aligned with our goals and objectives.

Q: How would you define success for MODHS?

Dr Alodhaibi: You know it is successful when people appreciate using the system and rely on it. The benefits the practitioners and healthcare providers are seeing from this project are tremendous. Any issues they see in the system are a strong indicator that this is becoming a major part of their daily activity and functionality.

We have created a data governance team: an independent team that defines the KPIs and captures its results by interacting directly with all clinical departments for their feedback on the system. Based on the quantitative and qualitative feedback we get, we create KPIs at the organizational, hospital, departmental and individual levels, which suggests that the system is being widely used and accepted.

This is, however, just the beginning. There is a lot more work to do, especially when we start expanding to other facilities. While we have accomplished the goals we created for this project, as of today, there is way more to accomplish down the road to conclude it as a definite success.

Q: What factors do you believe have contributed to or led to the frontline staff adopting RABET and drive the value from it?

Eng Azzam Amro: Many factors helped collaboratively in achieving this. First of all, sharing our beliefs, vision, and main objectives of RABET with everyone in the organization by using different communication channels played a big role in this.

In addition, system localization and validation were done by the clinicians with the participation of SMEs from the frontline and different departments. We can't forget the role of users, who provided immediate support to frontline staff, when needed, during the go-live. After the go-live, they immediately recognized the benefits of our EHR. For example, the documentation time for nursing reduced, while the EHR now gives better tracking and more standardized communication as well. Therefore, it's very clear that the value of using RABET is recognized by the frontline staff.

Oracle Cerner thanks Dr Khalid Alodhaibi and Eng Azzam Amro for sharing their insights on RABET and we look forward to continuing this journey with MODHS to realize their vision to transform healthcare outcomes in KSA.