Saudi eHealth Maturity Assessment (SeMA)

Executive Summary ​

The Kingdom of Saudi Arabia has embarked on an ambitious journey of digitization, set by the National Vision 2030. The Saudi Health Council as the regulator of both the public and private healthcare sectors is taking part of this national digital transformation journey and driving the digitization of healthcare facilities, including medical cities, hospitals and primary care centers.

The Digital Maturity Assessment project aims to establish a framework to measure the level of digitization across the various facility types in the Kingdom and gauge their adoption of digital health technologies that support the operations at the points of care.

The framework should address all related dimensions to have a successful assessment to identify the right digital maturity levels for the required facilities.

One of the NHIC's key initiatives under “Change and enablement" section of the roadmap includes the rollout of the Saudi e-health Maturity Assessment which can be illustrated in the figure below:​​

​This green paper released by the National Health Information Center is considered to be a discussion document intended to stimulate debate and launch a process of consultation, on the topic “National Digital Health Maturity Assessment". This green paper will present a range of ideas that are related directly to the implementation of this project and is meant to invite interested individuals or organizations to contribute views and information with regards to the matter mentioned above. ​​

Saudi e-Health Maturity Assessment is one of the key initiatives of NHIC that is designed to achieve the center's mandate in which they require the maturity of the different facilities to be able to fully achieve the mandate items and they are as follows:

1. Health Information Exchange: Act as a communication center to regulate and electronically exchange health information among health sectors and other related bodies.
2. Health Data Governance: Identify data and health information necessary to be provided by the concerned authorities in health services. Develop rules and mechanisms for the exchange of these information between relevant authorities as per technical systems that enable information sharing and connectivity
3. Standardization of Health Data: Standardization of terminology, names and definitions used in all health information systems and methods of collection.
4. Unified Electronic Health File: Coordinate with relevant entities to consolidate a unified electronic health file per patient, that can be electronically shared through an integrated system linking electronic medical records in hospitals and medical centers, so that the national ID or “iqama" act as a national reference
5. Medical Coding Standards Adoption: Adopt international coding system for diseases, set its by-laws and supervise its implementation in all health authorities in coordination with relevant authorities
6. Medical Networks and Telemedicine: Connect medical networks in the kingdom to create a national network of tele-medicine and supervise the network.

National Health Statistics: Prepare and publish national and health statistics, submit periodical statistical reports on health service activity to the Board​

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The Saudi e-Health Maturity Assessment (SeMA) model's objectives are described as the following:

• Set baseline for KSA's healthcare sector digital maturity and readiness
• Support national level decision making in the healthcare sector and guide the sector to achieve the 2030 vision and the digital transformation journey
• Enable comparisons between actual status and forecast, periodical analytical reports and trend analysis to support informed strategy alignment for the healthcare sector
• Support in onboarding new entities unto the HIE system, and other key national systems
• Support in identifying key initiatives/ targeted points of service…etc. to be able to achieve its strategy
• Act as a guide for the facility by identifying key pain points and priority areas to enable the implementation of digital health initiatives and accordingly, the facility's quality of care ​
  

Prior to ​the start of the project, a cuticle step to overcome was to build the basis of the model based on the current and latest best practices which resulted in performing a detailed research to identify the right models to be leveraged.

Moreover, the modes to be analysed were being assessed based on the following aspects to deduce key findings and lessons learnt:

• Entity - Background on the entity (credibility, stakeholders, etc.) & model ownership
  
• Assessment objectives & categories - categories & subcategories covered by the assessment and the cascading of the assessment categories from the objectives
• Process - The steps of the assessment and key activities with the average time for the assessment
• Incentives - The rewards that were offered to the facilities to encourage participation
• Coverage - The depth of the assessment's coverage in terms of questions when compared to the other selected models
• Applications & Case studies - General information about the usage of the assessment model and a deep dive case study
  Furthermore, certain amount of procedures needed to be done in order for to identify current challenges that were facing in which challenges on a high level were identified as the following:

1. Strategy Alignment - There are too many digital health strategies on the national level, which makes it hard for the different entities in the sector to align with a single strategy
2. Budget - Implementation of new technologies/ digital initiatives requires a budget which causes resistance from the provider's side
3. Digital Competencies - Not all healthcare employees have the required digital acumen to support in the digital transformation journey. HIM & EMR need to be taught in medical schools
4. Resistance to Change - New digital projects/ initiatives are usually faced with resistance unless it is mandated or benefits are communicated to provider. There is also resistance to change on the user level
5. Leadership & Organization - Decision making processes are long, especially in larger entities If Digital health is not on top management agenda, the facility's buy in is slower
   

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​​The Saudi e-Health Maturity Assessment (SeMA) Framework was developed and customized to be implemented for 4 healthcare Segments which are the medical cities, hospitals, primary care centers & specialized/ standalone centers. Moreover, the SeMA framework model has also been built based on 4 different pillars that considers multiple important factors to help in creating a relevant maturity assessment framework and model and they are as follows

• Digital Fitness Assessment Framework: Digital Fitness Assessment model considers: People, Processes, Technologies… etc. and multiple other factors to assess an organization's readiness to uptake technologies
• International Digital Assessment Benchmarking: Other Assessment models such as HIMSS, EMRAM that considers inpatient and outpatient models, Global Digital Health Index that encompasses a set of KPIs to measure maturity, and NHS
• KSA Current State: Current State Assessment covers samples from Regulators, Providers and Similar Assessment Programs
• Emerging Technologies: The team will consider the top emerging technologies that NHIC will be adopting in KSA in the upcoming period and account for the prerequisites for these technologies to be considered in the model 
  
• In establishing the SeMA Framework, 6 Design Guiding principles have been identified and they are as follows
  
• 1. The Framework needs to be flexible to include the needs of various stakeholders such as regulators and private/public health entities
  2. The Framework must be scalable and future proof to accommodate the digital health emerging technologies
  3. The Framework needs to be tailored to KSA local needs in terms of demographics and the current and future healthcare delivery model
  4. The Framework should measure the baseline and define the interim or target state
  5. The Framework needs to be simple and not complex

  The Framework needs to compliment and guide the Model, the Questions and Roadmap

• Also, eight core dimensions have been identified to decide on the KSA's SeMA framework outline which cover the main components that were concluded in the benchmarking stage and target are as follows:

  1. Strategy & Governance
  2. Patient Experience & Population Health
  3. Organization & Workforce Competencies
  4. Applications & Infrastructure
  5. Privacy & Security
  6. Interoperability & Integration
  7. Business Intelligence & Analytics
  8. Emerging Technology
  Moreover, each of these dimensions had also areas of focus that were identified for the purpose of having a comprehensive and an inclusive model
  
  
  

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The facility assessment process for healthcare entities covers the same steps within the KSA's SeMA model

1. Orientation
• The facility would start with a brief on the model's objectives, topics overview, pathway, and benefits (alignment with national strategies, umbrella of the other available models like CBAHI and Qiyas)
• Training on the self-assessment portal will be provided at this stage as well.

2. Registration
• The facility would create its organizational structure and list the services they offer
• The self-assessment portal will dynamically create audience targeted assessments based on the available services
  
   

3. Mock Assessment
• To be completed within 2-4 weeks with follow-up phone calls/emails throughout the process
• The team in charge of filing in the correct details must comprise of a nominated member of each department and one facility head representative
• To ensure the margin of error is very low, the assessment process has to be simple and straightforward, which can be done through Multiple Choice Questions style with minimal need for extra writing
  
   

4. Actual Assessment and Internal Validation
• Templates and relevant examples should be provided to ease evidence collection and to avoid collecting unstructured data
• Entities would be allowed to edit their answers based on a clearer understanding before final scoring and publishing to avoid any misunderstanding and inaccurate reporting
• Internal validation can be done through providing evidence by certificate attachments, photos/videos, and any relevant document and/or through random sampling (audit)
  
   

5. Verification
• Online verification steps will be conducted by the NHIC team to make sure that the questions were answered accurately and the attached evidences are relevant and up to date.
• Onsite verification steps will be conducted based on a selection criterion (random and based on the maturity score level) An interview with predetermined members of the governing bodies and heads of departments will also be conducted. Visits and interviews can be done virtually as long as proper requirements are met as an additional form of validation
• Appeal option at the end of the verification step will be available for the facility where an additional verification step will be conducted.
• Alternatively, facilities that cannot share data for security reasons can opt for an on-site visit
  
   

6. Scoring
• Scoring criteria has to be clearly stated and communicated to the superusers or representatives of the facilities
• There should be a clear reference for each point in the scale (a description for each score)
• Scoring should be clear enough to act as a guide for the facilities. (The highest score description is what the facility should aim to do)
• Weights can be allocated to the different dimensions or different questions within the dimension to ensure fair rating
  
   

7. Certification & Renewal
• To be repeated every 3 years
• Assessment can be repeated based on the facility request
  
   
  
  Moreover, definitions of Facility Maturity Levels and Scoring Criteria, weighting are as follows;
  
   
  
   

The assessment framework that was created has been translated to an assessment model with a list of questions for each sub-dimension. Moreover, reference to support the facilities in scoring themselves in the self-assessment is provided as well as guide them to ​

By July 2021, the selected facilities for undergoing the pilot execution will undergo a physical onsite verification on their submitted self-assessment, those facilities will be provided with an improvement roadmap for them to target better scores in the next assessment iteration.​

Upon the compilation of this pilot phase, outcomes will be analysed and the assessment model will be updated to reflect the lessons learned as preparation for undergoing the second cycle of the national digital health maturity assessment exercise.

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Dimnsion Definition: Strategy and Governance dimension is related to a clear understanding of the digital health strategy across leadership and governance across the organisation, alignment with national eHealth strategies and initiatives, and eHealth partnerships

Scope:

• This dimension is related to a clear understanding of the digital health definition, vision and purpose, in addition the national, regional and local digital health strategic direction for the healthcare entities.
  
   
• It also means that there is willingness to invest and funding available to support the strategy.
  
   
• Also, the related governance bodies/committees to manage and implement the key initiatives from the strategies.
  
   
  
  Relevance to SeMA:

• Identify the Digital health baseline within the healthcare provider facilities within the strategy and governance dimension
• Identify the Digital Health maturity levels/scores and any gaps in the baseline within the strategy and governance dimension
• Propose Digital Health areas of improvements and suggestions in the baseline within the strategy and governance dimension
  
   
  
  Key Criteria:
• Alignment with KSA national Digital Health strategies
• Defined facility level Digital Health initiatives aligned with national strategies and initiatives
• Defined and well-planned facility level digital health roadmap with clear timelines, dependencies and relevant funding planning
  
   
  
  Sub-Dimensions:

5.1.1 Clear Vision and Leadership Alignment

5.1.2 Defined Strategy

5.1.3 Alignment with National Strategies

5.1.4 Governance Bodies/Organization Structures

5.1.5 Partnerships

5.1.6 Financial Efficiency & Digital Operations in Supply Chain 

Assessment Questions

Defined Strategy

Alignment with National Strategies

Clear Vision

Leadership Alignment

Governance Bodies/Organization Structures

Partnerships

Financial Efficiency & Digital Operations in Supply Chain

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Dimension Definition: Patient experience and population health dimension is related to patient digital engagement with the healthcare institutions and providers, as well as population health enhancement through digital channels

Scope:

• This dimension is related to patient experience which focuses on finding new ways to engage patients to strengthen their experiences in health systems.
  
   
• Consumers are the primary decision-makers and use digital tools to self-manage their health and wellness.
  
   
• It also means population health that enables mobilization of data to track health outcomes to enable prevention and wellness.
  
   
• This is enabled via digital tools, dashboards, and public reporting strategies to engage and enable population health outcomes.
  
  
  Relevance to SeMA:

• Identify the Digital health baseline within the healthcare provider facilities within the patient experience & population health dimension
• Identify the Digital Health maturity levels/scores and any gaps in the baseline within the patient experience & population health dimension
• Propose Digital Health areas of improvements and suggestions in the baseline within the patient experience & population health dimension
  
   
  
  Key Criteria:
• Streamlined and lean patient experience processes and workflows
• Defined facility level patient experience(consumer-enabled) and population health strategy
• Defined facility level patient experience(consumer-enabled) and population health initiatives
• Planned or implemented patient engagement tools
• Planned or implemented population health tools
  
   
  
  Sub-Dimensions:

5.2.1 Patient Engagement and Information Services and Tools

5.2.2 Population Health delivery and information Services and Tools

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Assessment Questions

Patient Engagement

Information Tool

Information Service

Patient Tool

Population health delivery

Dimension Definition: Organization and Workforce competencies dimension is related to workflows, processes and policies automation, eHealth adoption change management, clinical safety digital procedures, workforce digital health competency and training

Scope:

• This dimension is related to the advances in the digital health technology and consumer-enabled care delivery and its impact on the knowledge, skills and abilities across the workforce to support and enable adoption of digital health technologies.
  
  
• The healthcare workforce requires expertise and guidance to evaluate new technologies, using processes grounded in real-world evidence.
   
  Relevance to SeMA:

• Identify the Digital health baseline within the healthcare provider facilities within the organization & workforce competencies dimension
• Identify the Digital Health maturity levels/scores and any gaps in the baseline within the organization & workforce competencies dimension
• Propose Digital Health areas of improvements and suggestions in the baseline within the organization & workforce competencies dimension
  
  Key Criteria:
• Streamlined and lean workflows and processes
• Change management framework and plan in place and implemented
• Digital Health workforce education and training plan and program planned or in place
• Digital Health workforce tools planned or in place
  
  Sub-Dimensions:
  
   

5.3.1 Workflows, Processes and Policies

5.3.2 Change Management

5.3.3 Clinical Safety

5.3.4 Healthcare Workforce Competencies and Training

5.3.5 Healthcare Workforce and eHealth Training Delivery Tools

Assessment Questions

Workflows, Processes and Policies

Healthcare Workforce Competencies and Training

Healthcare Workforce and eHealth Training Delivery Tools

Change Management

Clinical Safety

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Dimension Definition: Application and infrastructure dimension is related to applications providing to users' services such as data sharing, decision making, reporting, information access, and systems providing services such as medical information processing and storage, data analytics, and more.

Scope:

• This dimension is related to applications for enabling services and systems, access, and exchanging and management of information.
  
   
• This includes different applications in healthcare, from Enterprise Resource Planning (ERP) data to patient care data in EHR systems.
  
   
• Also includes the infrastructure which is the foundation for information exchange across all the applications and services. Including networking, computing, applications infrastructure, and operations/support.
  
   
  
  Relevance to SeMA:

• Identify the Digital health baseline within the healthcare provider facilities within the applications & infrastructure dimension
• Identify the Digital Health maturity levels/scores and any gaps in the baseline within the applications & infrastructure dimension
• Propose Digital Health areas of improvements and suggestions in the baseline within the applications & infrastructure dimension
  
   
  
  Key Criteria:
• EMR/EHR system readiness or planned
• ERP system readiness or planned
• PACS system readiness or planned
• Infrastructure readiness or planned
• Connectivity readiness or planned
  

Dimension Definition: Privacy and Security dimension is related to patient electronic health information consent management and cybersecurity measures to protect against unwanted access, manipulation or sharing of medical records 

Scope:

• This dimension is related to the importance of privacy and security with the increased usage of digital health technologies and consumer-enabled care especially with the introduction of new digital workflows and processes.
• As data becomes more plentiful and complex, there is a need for improved understanding of its use while ensuring security and privacy measures are robust and access to data is appropriately managed.
  
   
  
   
  
  Relevance to SeMA:

• Identify the Digital health baseline within the healthcare provider facilities within the privacy & security dimension
• Identify the Digital Health maturity levels/scores and any gaps in the baseline within the privacy & security dimension
• Propose Digital Health areas of improvements and suggestions in the baseline within the privacy & security dimension
  
   
  
  Key Criteria:
  
   
• Privacy framework in place or planned
• Compliance readiness with the MoH/NHIC Saudi eHealth Security and Privacy Interoperability Specification
  
   
  
  Sub-Dimensions:
  
   

5.5.1 Consent Management & Patient Health Information Sharing and Confidentiality

5.5.2 Cybersecurity

Assessment Questions

Consent Management & Patient Health Information Sharing and Confidentiality

Cyber Security

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Dimension Definition: Interoperability and integration dimension is related to seamless flow of data through safely interconnected and integrated internal and external systems.

Scope:

• This dimension defines interoperability and integration as the flow of data which requires connected, integrated, safe and secure coordination and oversight to ensure information systems are interoperable and data access is easily accessible to consumers.
• The capture and mobilization of data across multiple sources, from clinician teams and health services to consumers, must be connected, accessible, and seamlessly interoperable
  
   
  
   
  
  Relevance to SeMA:

• Identify the Digital health baseline within the healthcare provider facilities within the interoperability & integration dimension
• Identify the Digital Health maturity levels/scores and any gaps in the baseline within the interoperability & integration dimension
• Propose Digital Health areas of improvements and suggestions in the baseline within the interoperability & integration dimension
  
   
  
  Key Criteria:
  
   
• Compliance with MoH/NHIC Interoperability Standards and it being used
• Facility level localizations or proprietary additions/changes in the standards/versions
  
   
  
  Sub-Dimensions:

5.6.1 Interoperability Standards

5.6.2 External System Integrations

5.6.3 Devices Integrations

5.6.4 National External Interfaces

Assessment Questions

Interoperability Standards

Devices Integrations

External System Integrations

National External Interfaces

Dimension Definition: BI and analytics dimension is related to the reliance on analytics to transform data into insights that drive better decision making and ultimately better healthcare outcomes

Scope:

• This dimension defines the importance of data & analytics in the consumerism era, this gives the ability to transform data into knowledge, insights and eventually better healthcare outcomes.
• Health systems generate massive amounts of data. However, unless and until — data is mobilized, exchanged and analysed to reveal insights, information and knowledge, then it cannot adequately inform stakeholder Decisions.
  
   
  
  Relevance to SeMA:
  
   

• Identify the Digital health baseline within the healthcare provider facilities within the data & analytics dimension
• Identify the Digital Health maturity levels/scores and any gaps in the baseline within the data & analytics dimension
• Propose Digital Health areas of improvements and suggestions in the baseline within the data & analytics dimension
  
   
  
  Key Criteria:
  
   
• Master Data Management (MDM)/ processes and policies
• Single source of truth
• Predictive data analytics capabilities and tools
• Data storage and retention policies
  
   
  
  Sub-Dimensions:

5.7.1 Data Standards

5.7.2 Common Terminologies

5.7.3 BI Reporting/Dashboards

5.7.4 Data Analytics

5.7.5 Data Storage and Retention

Assessment Questions

BI Reporting/Dashboards

Data Analytics

Common Terminologies

Data Standards

Data Storage and Retention

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Dimension Definition: Emerging technology dimension is related to near term and long-term technological advancements in the healthcare sector, such as Artificial Intelligence (AI) and Internet of Things (IoT), that could be leveraged for improved healthcare education, training, and services provision

Scope:

1. This dimension defines the near- and long-term emerging technology especially with the rise of genomics, digital medicine, AI and precision medicine which are all changing the landscape of healthcare.
   
    
   
   Relevance to SeMA:
   
    

• Identify the Digital health baseline within the healthcare provider facilities within the emerging technology dimension
• Identify the Digital Health maturity levels/scores and any gaps in the baseline within the emerging technology dimension
• Propose Digital Health areas of improvements and suggestions in the baseline within the emerging technology dimension
  
   
  
  Key Criteria:
  
   
• Leverage any of the following emerging technologies as a POC/prototype or live with what use cases:
• Artificial intelligence/Machine learning/ voice recognition / chat bots
• AR/VR
• Integration with wearable devices / IOT
• Personalized Medicine System
• Blockchain
  
   
  
  Sub-Dimensions:

5.8.1 AI /Machine learning/ voice recognition / chat bots

5.8.2 Integration with Wearables, IoT devices

5.8.3 AR/VR

5.8.4 Personalized Medicine System

5.8.5 Blockchain

5.8.6 Robotic Process Automation (RPA)

5.8.7 Digital Building Management Related Systems

Assessment Questions

Artificial intelligence/Machine learning/ voice recognition / chat bots 

AR/VR

Integration with wearable devices / IOT

Personalized Medicine System 

Blockchain

Robotic Process Automation (RPA)

Digital Building Management Related Systems

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