Several years ago, IT projects manager Artem Mykhailyuk and his colleagues worked on an order for an outsourcing company, doing medical ERP with CRM elements. Back then the project instructions didn’t seem quite logical to the team, however, they didn’t argue with the customer. Since then they didn’t forget about the problem of how to create an effective medical system for the hospital. In 2016, they founded a startup specifically to develop their version of the medical system, where patients could make an appointment with the doctor through the website, where doctors could keep medical records and track a database of patients online Hospital managers could monitor these processes and collect statistics. Back then there were only three of them in the team: two analysts and one programmer. Now 21 people work in a startup.
Photo: Co-founder and CEO of start-up Artem Mykhailyuk
“We understood that it is right to isolate for a year, develop the correct system architecture and data structure, and immediately come out with a full-fledged product. However, we took the path of a startup, made the minimum working version and started by the end of 2016,” says Artem.
Working with public hospitals
The team launched the pilot project in the Podolsk district of Kyiv. Back then it was MVP with the simplest functions: an electronic registry (so that the patient could make an appointment on the website) and an electronic patient card, where the doctor could record the diagnosis from the medical classifier and make notes. We started by talking with officials from the Department of Health of the KSCA, we said that we were ready to give free of charge service to Kyiv polyclinics and hospitals, and that we are ready to help to implement it, and we got the green light. The team was introduced to the heads of hospitals.
Convincing hospitals was harder than expected.
“I remember us talking to the head of one of the Podolsk hospitals and he answered us: “You are already the sixth who offers such service to us. Of course, I don’t mind talking, but I don’t believe that you will succeed in implementing something like that,” remembers Artem.
However, the team still managed to convince four governmental medical facilities to participate in the pilot. These were the Center of Primary Health Care No. 1 of the Podolsk District, the Center of Primary Health Care No. 2 of the Podolsk District, the Consultative and Diagnostic Center of the Podolsk District, and the Children’s Clinical Hospital No. 9.
The fact that the service was free of charge helped to convince the hospitals to participate in the project (nominal price was 1 UAH). The district authorities also liked the fact that the system was patient-oriented. After all, the patient had never seen such portals, only doctors worked with them before. “There have already been some good decisions on the market. There is no point of making the same one again. We made a patient portal and thus changed the market,” says the startup co-founder.
How are user data protected?
Data transfer between the end user (patient, doctor, registrar) and the server occurs via the HTTPS protocol using the TLS transport layer encryption protocol (RFC 5246). The Helsi system is located in the Tier III “DeNovo” data center, with a certificate of compliance of the CSIS from the State Special Communication Service.
The introduction of the system in the first hospitals did not go without difficulties. The team had to solve some problems not directly related to the service. For example, a startup promised the heads of hospitals to train computer literacy doctors for free. The medical staff was tested and divided into groups according to the level of their PC skills. To do this, they compiled a list of questions, for example, “Do you know how to copy a file from a flash drive?”, because a doctor will need an electronic digital signature to use the system. Or “Do you know how to work with Google Calendar?”, because the doctor will have to work with the schedule in the system. Some of the doctors and nurses turned out to be advanced users, and some of them literally did not know how to open a laptop.
Photo: Training of doctors, photo – Helsi.me
As a result, a startup trained 2,000 medical staff. But that was not the end. Out of the 10 locations of medical institutions that participated in the pilot, only two were connected to the Internet. According to Artem, that is a typical situation for Ukrainian hospitals: they bought computers, but there was no Internet, and even local networks were missing. The startup has agreed with the provider “Kyivnet”, which provided gigabit optics in all 10 locations free of charge, with free Internet access for a year.
The implementation of the system itself was also not without difficulties. In many hospitals, according to the experience of the team, there was complexity at the management level.
“We agree on something with the head physician, he transmits the information to the head doctor, who talks about it with medical supervisor, supervisor tells it to the doctors and in this process the percentage of correct information that has reached doctors is less than 10%. You need to walk with your own feet and negotiate with everyone to make it work,” says the co-founder of the project.
During the pilot launch, the team personally went around several hundred doctors’ offices in the Podolsk district, and took pictures of schedules on the doctors’ office doors. Then they compared them with the one they added to the system, and it turned out that 30 doctors (out of 300) did not have working hours table on their door at all, and 60 of them had a timetable different from Helsi. It is clear that this leads to cases when the patient has signed up for a doctor, came to an appointment, but there is no doctor. I had to correct the schedule.
“There were a lot of difficulties. For example, the doctor got sick, his appointment is at 8:00 AM, he calls the reception at 10:00 AM, the registry hangs a note on the doctor’s office doors. In case the hospital is connected to Helsi, the information should immediately get into the system. After all, if the patient enrolled to an appointment through the site at 10:15 AM, came at the exact time, but there is no doctor, he starts worrying at 10:16 AM. There was a doctor who refused to accept patients signed via e-service, and the head physician refused to force him, because he would not find another specialist like him. We personally went to talk with the doctors, showed them how it works and trained them,” says Mykhailyuk.
Photo: The startup has become one of the winners of the MBioS medical startups competition.
The pilot was successful, and soon all the heads of the district health departments of the Kyiv city knew about it. In one of the districts, the startup was “lucky”: the pilot was started by another company there, however, they could not finish it within the deadlines. Helsi.me threw the efforts of the whole team into that area and implemented the system in a short time. The second pilot was implemented in Obolonskyi district. “We fell into the trap many times in Podolskyi, so in Obolonskyi district work was already going faster,” says the co-founder of the project. According to Bohdan Lehyn, the head of the Podolsk district administration, the Helsi.me system “works successfully and has proven its effectiveness.”
Along the way, the team made adjustments to the work of the service, dictated by the way people used it. For example, the hypothesis was that people with smartphones will be making appointments via the Internet, and the elderly people would do it through the regular phones. Mobile lines were added to the call center just in case. But as a result, at the beginning, a lot of people made appointments on the mobile, the mobile lines were constantly overloaded, so we had to increase their number. Only few people called the city number, operators often simply don’t give batch minutes to make city calls.
In order to eliminate possible conflicts between a live queue and those who signed up through the site, they were smashed out in time: the doctor has appointments from the live queue at one time, and there is different hours for those signed up through the electronic service. Over time, the number of hours by previous appointments increased, and the live queue decreased. Two months after the launch, the team noticed the occupancy of the schedule slots of doctors of 75% by electronic services appointment.
“We observed in the corridors how patients react to the system. For me, the following scene became a positive signal: an elder lady and an elder man were waiting in the queue, and they understood that people who signed via enrollment system were coming to appointments, so they came to the door, read the announcement about the appointment enrollment system, took out a notebook, copied our number there, and communicated with each other saying that this it convenient,” says Artem.
The turning point for the service came when a critical mass of users appeared. On the first day of launch, at the beginning of December 2016, the system had 7 entries per day, in December 2017 it was 7,000 entries on a weekday. Data for October 2018 is 23,000 records per day.
Currently, 7,000 doctors are registered in the system, it was used by 2 million patients who make almost 500,000 appointments per month since the first day of the launch. The system employs hundreds of hospitals, not only from Kyiv, there are hospitals from Dnipro, Odessa, and Mykolaiv. In Dnipro, the first hospital which refused live queue at all, was launched.
Photo: Dynamics of the number of patients and appointments per day
Business model
Until the middle of 2019, medical systems have an agreement with the Ministry of Health: modules of mandatory interaction with the central component of e-health will be free for public hospitals. The team is going to make money on the other thing. 25% of patients are making appointments using their smartphones, that is, after leaving the office, the patient will not peer at the appointment paper, but read the doctor’s prescription on the smartphone. At this point, it will show the user a button “Nearest pharmacy”, “The cheapest pharmacy” and “Order medicines home.” They are planning to earn 2-3% of the cost of drugs, pharmacies will pay for leads.
Presentation of the project at the startup competition:
The system is free only for governmental hospitals, private clinics must pay $10 from one account per month. The site also sells medical insurance, now the startup is working with two insurance companies: patients are offered up to 100,000 UAH to cover expenses for medicines.
“Website attendance is 1.6 million visits per month, and we are going to convert this flow into earnings, selling insurance, recommending medicines and private doctors. For example, the patient urgently needs ENT doctor, and in public hospitals the queue is scheduled for a week and there are no free urgent appointments available, so we’ll offer private hospitals and private doctors,” says Artem.
So far, the project is operating at a loss, it is planned to be self-sufficient in 2019. The team estimates the cost of creating such a system with a minimum of functions at $100,000, with a maximum of more than $1 million.
Plans
Now the system is not limited to an electronic queue and an electronic medical card. For a doctor, this is a full-fledged workplace, for managers of hospitals it is an access to statistics, on the basis of which management decisions can be made. For example, they can keep track of how long the doctor’s appointment is for one patient, why does the average number of appointments last 15 minutes for some doctors, and for some it’s 20 minutes, why does this doctor have specific diagnosis more often than others? Before the medical system started rising in Ukraine, medical statistics were collected using old-school methods: the so-called outpatient tickets were filled in by hand, they were manually laid out on piles according to one criterion, the numbers were entered to Excel tables, then another criterion was considered, and again the table was filled manually. Data was collected with a delay and it was not always accurate. Medical systems like Helsi.me give a more accurate picture. But, of course, they cannot replace the head physician.
In the future, we are talking about few months, we plan to run reviews about doctors. The average rating of all the doctor’s assessments will be shown to all patients, but the reviews themselves will be seen only to the doctor and the head physician. “Of course, I would like the top doctors to use the rating of doctors as a gingerbread, and not as a whip, we will think how to implement it,” notes Artem.
In the perspective of several years we plan to launch interoperability between various systems operating in Ukraine, so that the patient can go to any hospital and he or she would have access to his/her electronic card, regardless of the medical system within which it works.
Also, a startup might be spread on other countries, we are studying markets for now. However, the legislation regulating the protection of health and the protection of personal data is different everywhere, so the service will be different for each country.
“Today, most doctors are happy with us. They say it has become easier to work. The chief physicians like the system as well, they say that the doctors are less late,” says Mykhailyuk.
