Implementing an electronic medical leave system for beneficiaries of the National Health Fund (FONASA) is one of the challenges that the Ministry of Health of Chile has taken on as part of the National eHealth Strategy and “one of the country’s greatest efforts to automate and modernize the public health system,” stated René Prieto, Director of the ICT Department of the Ministry of Health.
This initiative earned the distinction of being named “Best project of the year” in the client service category, an award bestowed annually by the Center for Information Technologies at the Pontifical Catholic University of Chile. “This award recognizes the tremendous effort, dedication, resolve, and professionalism demonstrated by the team, which managed to implement this project in 13 months. This team included the participation of FONASA proffessionals and was led by Mr. Gino Olave, Chief of Information Technologies of that institution,” added Prieto.
Implementation of the FONASA electronic medical leave system began in November 2011 with a pilot project to which adjustments and improvements were made, followed by a five-month testing phase.
During the testing phase, a total of 8,892 leaves were granted. At its conclusion, the adoption stage began, first in the Santiago Metropolitan Region and then in the other regions. To date, over 100,000 electronic medical leaves have been processed, with a high level of implementation among providers in the Santiago Metropolitan Region. “The plan for this year is to continue implementing the solution in the other regions,” explained Prieto.
Processing a medical leave on paper takes up to 90 days from the time the physician grants a patient leave to when the patient receives payment, if appropriate. In the FONASA electronic medical leave pilot project, substantial improvements were made, enabling the process to be completed in 15 days. This is already happening in the Health Insurance Institutions (private insurers known by the Spanish acronym ISAPRES).
This initiative is scaled for use in all health establishments in public and private networks throughout Chile, directly benefitting nearly 6 million FONASA subscribers, with nearly 3.5 million medical leaves per year.
Each year, medical leaves cost the government some US$ 650 million, with fraud and abuse estimated to account for about 25% of that figure. Indispensable for reducing that percentage are FONASA’s electronic medical leave system, together with process analysis and fraud detection.
Considering the significant reduction in processing time for FONASA subscribers and the expected impact on fraud reduction, “it is essential that the system be adopted nationwide, as the project will ultimately be highly profitable both economically and in terms of social justice, which cannot be ignored,” Prieto emphasized.
With the broad adoption of this initiative, users of the public health system will have timely, safe, quality services that save time and money for patients, providers, insurers, and employers.
Benefits of the FONASA Electronic Medical Leave System:
Chile’s National eHealth Strategy is aligned with the Ministry of Health’s strategic objectives, which are also aligned with PAHO’s eHealth strategy. Strategic Area 2 of the latter seeks to improve public health through the use of tools and methodologies based on innovative information and communication technologies.
Documenting Experiences and Best Practices is part of PAHO/WHO's commitment to the member states, through the Strategy and Plan of Action on eHealth for the Americas, to make the eHealth Regional Laboratory a space of research, promotion and discussion of the objectives and strategies on the implementation of ICTs in public health, and to promote intersectoral cooperation between countries through an electronic mechanism for sharing best practices, lessons learned and regional resources.
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