The NPHIES health information exchange platform, designed to unify patient care records for healthcare providers and optimize insurance services, is central to the digital transformation of healthcare in Saudi Arabia.
As onboarding director for the Cooperative Health Insurance Council (CCHI), which recently launched NPHIES in collaboration with the National Health Information Center and the Ministry of Health, Nesreen Elofi plays a key role in the evolution of the platform.
CCHI awards accreditation for health service providers and sets medical service standards for claim settlement between service providers and insurance companies. Elofi leads the Onboarding Department, which is a part of CCHI’s Technology and Digital Transformation arm, managing project implementation and certifying vendors for integration into the NPHIES system.
The evolution of NPHIES is in line with the Kingdom’s Vision 2030 plan to diversify the country’s economy and develop sectors such as technology, as well as enhance public services including healthcare. The NPHIES platform allows CCHI to analyze the services provided to the patients and implement a value based healthcare (VBHC) strategy, which aligns payments to the quality of services provided and their cost.
In this Q&A Elofi elaborates on her role, how the NPHIES project is progressing, and what can be done to bring more women into technology roles.
CIO Middle East: You joined CCHI amidst the pandemic, what were your main challenges? How did your experience in IT help you as director of onboarding?
Nesreen Elofi: The challenge of the pandemic is overwhelming for many — adding to that, I recently joined a new employer. There were many challenges: Catch up on a project already started, leading a [remote] group, dealing with change resistance, and so on. However, I managed, engaged, and formed a team to collaborate with stakeholders to implement change.
I believe that my experience in IT helped me as onboarding director because I am working on one of the most impactful digital transformations in the healthcare sector. It requires the integration of the NPHIES platform project with the HIS/RIS (health information system/radiology information system) and RCM (revenue cycle management) system for IT vendors, healthcare providers and payers to be able to use NPHIES platform. My technical background gave me a better understanding of the raised issues, to propose alternative solutions.
CIO Middle East: Can you share some of the initiatives you have implemented recently?
Nesreen Elofi: [One] great initiative is to develop SLAs (service-level agreements) between the contract companies and CCHI following international standards. My role as an onboarding director in the transformation and digital technology department is to implement the changes in any project. The initiatives focus on developing an onboarding (implementation) plan, measuring performance indicators, process automation, and continuously monitoring progress towards the realization of project objectives.
CIO Middle East: One of the biggest projects will be to implement NPHIES platform connections to all healthcare insurers and healthcare providers. Could you give us more details about this?
Nesreen Elofi: NPHIES is an abbreviation taken from the National Platform for Health and Insurance Exchange Services, which is the unified electronic services platform launched by the Cooperative Health Insurance Council (CCHI) and the National Center for Health Information (NHIC) to transform the health care sector in the Kingdom of Saudi Arabia, to enhance the level and quality of health services. It includes two main components: the insurance services and the clinical services (including unified health records).
Of course, because NPHIES is impacting the healthcare system in Saudi Arabia, CCHI took extra measures to work with IT providers operating on our platform.
This platform consists of multiple layers. The first layer is API management and this is connected directly to the healthcare entities; the second one is the core solution that is responsible for validation and saving the data; the last layer is the database — it serves the businesses that will eventually serve the consumer (G2B2C) and it’s an Oracle database.
CIO Middle East: You mention the different solutions you have been implementing recently — how did those tools help you during the COVID-19 pandemic?
Nesreen Elofi: One of the solutions we implemented was onboarding IT companies — certifying their solutions for smooth integration, which will save costs and expedite the integration with our projects. Also, we created a ‘community portal’ which includes all the inquiries (administration, training, user manual, Q&A, implementations plan, etc.) that can be used, either for self-onboarding or as a support during the company onboarding journey.
CIO Middle East: If you could implement any innovation within the hospital that could make a difference what would it be?
Nesreen Elofi: The world is changing and having an AI system in healthcare facilities is a must. Therefore, I would recommend having a central healthcare system to digitize, automate and optimize the services. Also, preventive intervention can ensure the sustainability of our health services in the future.
CIO Middle East: On another note, how would you encourage women to study a technology career? What do you think companies should do in order to empower women in IT?
Nesreen Elofi: A career in technology in the market nowadays is no longer applicable to programming only. It now encompasses both operational and managerial positions ranging from cybersecurity to user-centered design. Therefore, women will have so many opportunities to find a job when they are done studying and job hunting.
Companies can empower women in IT by supporting their professional development with mentorship, coaching, and sponsoring them into external activities and workshops that will help promote them into diverse positions of leadership within several sections of the company’s IT department. Moreover, they can offer flexible work environments to help women balance navigating their professional and personal lives.