To underpin the system, The Portuguese Government instigated a full procurement procedure to evaluate the different solutions available for call centre management and clinical decision support applications. Vendors evaluated included McKesson, Dshi Systems as well as Clinical Solutions. Clinical Solutions was chosen over its competitors to provide S24 with the required software. The company was selected due to its proven ability to deliver on a national scale, as demonstrated through the partnership with NHS Direct. LCS recognised the system's ability to meet national requirements while being customisable in a changing environment.
Luis Alves, COO of LCS explains, "The Public Health system was under great pressure to provide healthcare with limited resources. The national helpline provides a valuable means of support and reference for the Portuguese people and enables the Public Health System to allocate its resources more efficiently - making sure that the right level of care meets the right people. We saw Clinical Solutions as having experience and expertise demonstrated through their success with NHS Direct in England. They were the ideal partner for this project."
Clinical Solutions' Telephone Triage applications allow complete visibility of a patient encounter, from personal details through to final outcome, using tried and tested decision support algorithms, helping S24 nurses to assess callers' needs.
In addition, specialist or localised content can be adapted to suit the needs of the Portuguese Public Health System.
The implementation was a complex project with multi-dependency on different suppliers. This was overcome by close communication between all parties, resolving issues before they had a chance to escalate. LCS was formed to implement and operate the health helpline, responsible for ensuring that the development of the service met the requirements set out by the Portuguese Health Ministry. In order to maximise self dependence within S24, a Clinical Solutions 'train the trainer' cascade process was also put into operation - enabling staff to provide self-support to their teams.
The health helpline went live in April 2007 and was officially launched the following month by Portuguese Prime Minister Mr. José Sócrates and Minister of Health Mr. António Correia de Campos.
Richard Turner, the Director for Trade and Investment at the British Embassy in Lisbon attended the launch event. At the launch he explained, "The new service will provide a lifeline for the Portuguese people and an invaluable resource for the Portuguese Public Health system. The choice of Clinical Solutions' technology is a testament to the company's track record in the UK. Britain's ability to export this technology says very positive things about its healthcare infrastructure."
Over time, Clinical Solutions and LCS have worked together to improve and upgrade the technology behind S24, adding functionality to the benefit of LCS and its customers. These included updates to clinical content, options to list patient demographics and links to the telephony system.
Success and recognition
S24 can now offer direct access to a significant number of the population who previously had limited access to healthcare advice. Patients benefit from quick reassurance of their condition and advice on the best course of action to take. Being a user of S24 also guarantees immediate access to the level of care required in an emergency situation.
The top five most common ailments or symptoms registered by S24 are abdominal pain, nausea, coughing, a headache or a sore throat. The most frequent outcomes for a patient calling S24 are self care, which accounts for almost 32 per cent of all clinical dispositions, an immediate doctor's appointment (12 hours) with approximately 20 per cent and 16 per cent are referred to hospital.
Saúde 24 (S24) has consistently gained the trust of the population. This service set up in April 2007 reached almost 1,200 calls daily in their first eight months of operation. The figure rose to an average of nearly 1,400 per day in 2008, year of its first public recognition, winning the Deloitte, and National Institute of Administration prize for Best Practice in the Public Sector. In addition the service has obtained the Quality Certification ISO 9001. The year 2010 brought new public acknowledgment as Optimus and Accenture recognised with a prize the key role of S24 during the pandemic of 2009, in the Optimus Innovation Awards' 10.
Independent research reported 94 per cent of awareness in June 2010 (awareness index, Nielsen, July 2010).
Put to the test
The efficiency and value of S24 was put to the test during the influenza pandemic of 2009 - and the service rose to the challenge. During the year covering this period, more than 1,600,000 calls were handled by a significant 1,000 health professionals at call centres in Lisbon, Porto and Coimbra, which was exclusively dedicated to flu triage and referral. Research was conducted with users of the service to ask about their experience. According to the research 98 per cent of users were satisfied with the service, while a further 98 per cent would recommend it to others. Currently the services are provided by S24 both in Lisbon and Porto by more than 500 health professionals.
The year 2010 brought additional challenges as the Portuguese population demanded more from the service. In addition a new customer oriented strategy meant a new focus on efficiency and effectiveness. From January 1st to August 31st, S24 handled an average of almost 1,800 calls per day. Latest independent research reported 100 per cent user satisfaction in August 2010 (satisfaction index, Nielsen, September 2010).
LCS and Clinical Solutions are working together to support the expansion and development of the service. The current S24 service is viewed internally as a baseline for future growth in order to develop further ways to support the population of Portugal. The senior medical teams are collaborating on an ongoing basis in order to increase clinical content and help better manage the service and patient expectations.
About Clinical Solutions
Clinical Solutions is a trusted provider of decision support and clinical knowledge solutions to healthcare staff (clinicians, doctors, call centre staff and receptionists), providing high-value and low-risk encounters to patients and empowering patients to take a safe and active role in their own care.