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Ireland 'perfect' for e-booking system that solved Macedonia's waiting list crisis

Since July 2013, doctors in Macedonia can book patients an appointment with a consultant online.

Macedonia ebooking map Source: Source: Moj Termin

Ireland is grappling with a series of challenges that are impacting our citizens’ quality of life. TheJournal.ie is examining solutions to these issues which have worked or are currently being trialled in other states and asking: Would It Work Here?

HOSPITAL WAITING LISTS are causing serious problems: with over 80,000 people on the inpatient list by the 30 December last year, we have the longest waiting times in Europe for Emergency Department appointments, and are among the worst in other categories.

Recently, an RTÉ Investigates programme showed that this huge figure was only a fraction of the real figure, as there are at least two other waiting lists not published by the National Treatment Purchase Fund, which monitors the figures.

In an episode of RTÉ Primetime where waiting lists were discussed, Dr Arne Björnberg, Chairman of the Health Consumer Powerhouse said that if he were to do one thing overnight that would change things, he would send someone to Macedonia to look at its solution to eradicating hospital waiting times.

And it’s not a complicated system – it just involves booking specialist appointments online.

In 2013, Macedonia dealt with their long waiting lists for hospital referrals by introducing an e-booking system, which meant that a GP can book an appointment with any specialist or heavy diagnostic equipment in the country in real-time while the patient sits in the room with them.

This did away with waiting times in less than six months after start-up, giving people quick access to appointments, provided that patients were willing to travel a short distance (the entire country measures approximately 200km by 130km, with the capital Skopje located fairly centrally).

The policy was implemented by the then-Health Minister Nikola Todorov; a 31-year-old with a degree in law who gave 1 July as the date the new policy should be implemented by.

shutterstock_529627504 The total number of people waiting on the inpatient waiting list as published by the NTPF on December 30th last year was 81,015. Source: Shutterstock/Mark Alan Howard

In the 2014 Euro Health Report, Macedonia’s overall ratings jumped from 27th place to 16th, as waiting lists got shorter and patients’ attitudes towards their healthcare system improved dramatically.

Since then, Serbia has adopted the system, and although there is a settling down period where patients and GPs adjust, it’s already shortened waiting lists.

So… could Ireland do something similar?

How does it work?

You book an appointment with your GP, who after assessing you, decides whether you need to be referred to a specialist, or if you need special assessment, like an X-ray.

If you do, the doctor can view a map of Macedonia, where all the country’s specialists, medical equipment, and medical centres are listed.

You can select ‘radiotherapy’, for example, to view all specialists across the country in this area, then select an area that is closest to the patient. You can then view that particular specialists’ timetable in real time, and book an appointment that suits the patient.

It’s a very simple system: the green times are the available slots, the red mean they’re booked.

Macedonia ebooking Source: Moj Termin

The map is also available to view by members of the public – but only doctors can book appointments after assessing a patient. But could it work for Ireland?

‘Ireland is perfect for this’

Dr Björnberg, author of the Health Consumer Powerhouse’s health report told TheJournal.ie that Ireland is a “perfect” candidate to try this new system.

“You have a small population and a centralised healthcare system (HSE) which makes Ireland perfect for this (Serbia has a population of 7 million, and it’s already working for them). The system can be licensed from the Australian-Macedonian company which made it, at a very reasonable price.”

It also shows you where the country’s resources actually are.

The project management team is extremely firm, they go around each university hospital and ask for a complete list of every specialist that is supposed to receive patients. The list had to be submitted within two weeks, and nobody was asked if they wanted to participate.

The completed lists would then be added to the appointment scheduler, while patients who want a more immediate appointment and don’t mind travelling can do so.

shutterstock_563166598 Source: Shutterstock/cha cha cha studio

He says that it’s surprising no country other than Macedonia (and now Serbia) has done this as the technology has existed for at least 20 years.

“Serbia hired an implementation team from Australia and Macedonia, implemented the new system in less than six months, and is now on the track to beating waiting times. There’s absolutely no excuse for anybody else.”

Macedonia also has an e-prescriptions website, which tracks the prescriptions being given by doctors and what conditions they’re being diagnosed for in real time, which has two main benefits.

The first, is for patients who need repeat prescriptions. They can simply apply for prescriptions from home and download the form. This means patients don’t have to keep booking appointments purely for prescriptions.

The second is for monitoring doctors: the real-time information lets healthcare management track the prescriptions that doctors are handing out: meaning if some doctors are too quick to prescribe over a long period of time, they’ll be easily identified.

MojT Source: MojT

What could get in the way?

So when every GP has access to an appointment scheduler and can book patient in real time, how exactly does that cut down on waiting lists? Is the current process, where GPs effectively ‘send a request’ for an appointment, completely ineffective?

“Scheduling of appointments…” Björnberg says. “…is not always primarily directed by patient needs. I remember in Ireland a couple of years ago, 75% of specialist neurologists were located in Dublin, which isn’t great for the west of the country, is it?”

He says he hopes that that situation has changed. It hasn’t.

Strong political leadership and firm hospital management are also needed to get the system implemented; he’s hopeful when he hears Health Minister Simon Harris’ promise to ‘take politics out of healthcare’ and to clamp down on hospital management.

So has Harris or HSE management considered implementing an appointment scheduler system for consultant referrals?

TheJournal.ie is waiting for their response.

Read: Want to end homelessness? How about converting every emergency hostel in Ireland into a home

Read: Simon Harris wants to remove HSE managers ‘who don’t measure up’ from their roles

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