Understanding NPHIES, KSA’s health information exchange
In the GCC, Saudi Arabia stands out as one of the leading territories spearheading the transformation of the healthcare landscape in the region. The country’s ambitious Vision 2030 goals encompass a range of objectives, which include enhancing healthcare services, digitising healthcare records, and elevating the overall efficiency of the nation’s healthcare system.
Given the Kingdom’s resolute commitment to these healthcare advancements, it is unsurprising that Saudi Arabia is poised to introduce a comprehensive Health Information Exchange (HIE) system that has the potential to outshine its global counterparts.
As the Medical Director of the Council of Health Insurance (CHI) in Saudi Arabia, Dr. Wail Yar is one of the key figures driving the programme. The CHI plays an integral role in the establishment of the country’s HIE known as NPHIES, which stands for the National Platform for Health and Insurance Exchange Services.
“What makes NPHIES unique is that it has two parts: NPHIES Taameen [Insurance] and NPHIES Sehey [Health],” explains Dr. Yar. “This division is necessary due to how healthcare functions in Saudi Arabia, encompassing both public and private sectors.”
The Kingdom’s public sector comprises four entities: the Ministry of Health (MoH), Saudi Arabian National Guard, Ministry of Interior, and Ministry of Education health offerings.
“NPHIES Taameen serves as the infrastructure for the interaction between insurance companies and the private sector,” he states.
Dr. Yar – who is also Assistant Professor of Preventive Medicine at King AbdulAziz University – is scheduled to appear at the 6th GCC eHealth Workforce Development Conference (eHWDC 2023), taking place between 31 October and 2 November 2023 at Jumeirah Emirates Towers. The event will feature a dedicated panel where further details about NPHIES will be revealed.
But just what do we know about it as of now?
NPHIES TAAMEEN
According to public records, the initial phase of NPHIES’ implementation commenced in 2020 and has steadily advanced since. The project comprises two parts: one for the insurance segment, known as Taameen, and is under the management of the CHI; and one for healthcare, referred to as Sehey, which is overseen by the Saudi MoH.
As of now, NPHIES Taameen has achieved broader public accessibility, with approximately 75% of healthcare providers currently integrated into the system.
“The CHI’s role, established two decades ago, was to mediate between insurance companies and healthcare providers. Before NPHIES Taameen was launched, hospitals sent requests directly to insurance companies, following the prior authorisation process,” says Dr. Yar. “Today, the NPHIES platform acts as the intermediary. Hospitals and insurance companies connect their systems to NPHIES. Hospital service requests now go through NPHIES, and insurance companies respond through the platform. The CHI can monitor and regulate these transactions, ensuring transparency and addressing any issues like fraud, misuse, or patient care delays.”
He continues: “At present, 75% of private providers are already connected to NPHIES, and by the end of October 2023, we aim to achieve a 91% connection rate.”
NPHIES SEHEY
Similar to other HIEs, NPHIES Sehey will house comprehensive patient data, such as medication history, allergies, vaccination records, and outpatient visits. Currently, it is in the testing phase.
It is anticipated that more will be revealed about NPHIES Sehey in the coming weeks.
With NPHIES Taameen approaching 90% adoption by the end of October, the same percentage target is set for NPHIES Sehey but with a different timeframe.
“Our goal is to reach 90% of the market,” reveals Dr. Yar. “From an insurance perspective, 90% of the market will already be linked to NPHIES Taameen by the end of October.
“However, expanding to NPHIES Sehey will no doubt take more time; likely 3 to 5 years to achieve a similar level of integration. The process for hospitals is quite costly and complex; it’s not that easy to do. It requires a lot of manpower, equipment, education, technical implementation, and adoption. It’s a significant undertaking.”
Find out more about NPHIES during eHWDC 2023. Register to attend by visiting gccehealth.org.
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