How to Develop National Digital Health Service like Ukrainian HELSI?

Digital technology is inevitably becoming an integral part of the healthcare industry. They help significantly to improve the quality and speed of patient care, optimize the doctors' and healthcare organizations' work, and reduce the cost of medical care. One of the brightest examples of this digitalization of the medical industry is the Ukrainian platform HELSI. It is the largest medical information system in Ukraine, which has managed to gain the trust of 23 million patients, 50,000 doctors and more than 1,300 different public and private clinics for five years on the market.

In this article we will tell you how to create your own clone service service following the example of the Ukrainian service HELSI, and what you need for this, how such development takes place and how much it costs to launch such a project.

Step 1: Choose a business model

HELSI is a medical platform that provides digital health services in Ukraine for ordinary patients and medical institutions. Patients can create their electronic medical records, make an appointment with a doctor, get an online consultation (text chat, audio and video chat), find out test results and much more. Medical institutions can use HELSI to simplify and automate processes related to document management and patient care. Moreover, HELSI provides analytics and marketing services for clinics, allowing them to optimize their business.

The project is one of the largest in Ukraine in terms of attendance and the number of registered users in the field of medical services.

Due to this, the service can use several monetization tools:

• Licensing. When the project was launched, state and municipal institutions received free access to HELSI, but as the demand grew and the platform improved, the situation changed. Now, every user who performs any activity in the system that could lead to commercial gain and money from the National Health Service of Ukraine pays HELSI a certain amount of money for a license every month.
• Transaction Earnings. For each patient's appointment with a commercial clinic, HELSI receives a percentage of the services provided, such as fees for online consultations, tests ordered, or medications purchased from pharmacies (they may also connect to HELSI for e-prescriptions).
• Advertising and marketing. HELSI provides healthcare providers with data and analytics to help them better understand their patients' needs and improve the quality of care. HELSI also provides the ability to conduct marketing campaigns and promote its services through a web platform and mobile app.

Step 2: Hire a development team

Choosing a developer to create a digital medical platform such as HELSI is key to ensuring the success of the project. As the competence, skills and professionalism of designers and programmers determine the attractiveness, reliability and security of the future product. Therefore, it is important to conduct a thorough analysis and hire a development company that best fits the needs and goals of your future project.

Merehead is a great example of a company that can definitely cope with such a task. Our team specializes in developing and launching high-quality digital products in various fields, including medicine. Our employees are highly qualified and have an in-depth knowledge of modern technology and development techniques, which allows us to develop innovative products that meet the highest standards.

When you choose developer Merehead to build a digital medical platform like HELSI, you can count on:

• In-depth programming and development expertise.
• Individual approach to each client and flexibility in solving problems.
• Excellent communication skills that allow them to interact effectively with clients, understand their needs, and strive for common goals.
• Extensive experience in developing complex and scalable projects, including building healthcare platforms.
• High level of security and confidentiality in all projects.
• Transparency in working with clients and strict adherence to deadlines.
• Using advanced technologies and development methodologies.

Step 3: Identify HELSI functions

The HELSI health information system consists of two components:

• The healthcare facility platform;
• The patient portal.

Platform for health care institutions

The platform automates many processes of a medical institution, doctor, laboratory, hospital, maintaining electronic medical records, and also helps to generate reports. The platform has a simple and convenient built-in designer of blanks and forms of medical documents and functionality to work under the program of medical guarantees with NHSI. A regular physician cannot register with HELSI on his or her own. The platform cooperates only with medical institutions and physicians-entrepreneurs (individual-entrepreneurs).

In order to connect to HELSI, the clinic, pharmacy or doctor-entrepreneur should leave an application on the site of the service. It will be reviewed by Technical Support. They get in touch with the applicant and receive data on medical license, types of medical services, availability of contracts with NHSU. Data is checked thoroughly in several databases, and if everything is normal, the institution or doctor-foreigner will be connected to HELSI.

Then the HELSI information system is installed in this medical institution or at the workplace of a doctor-therapist-FLP.

This is a comprehensive software for the management of medical institutions, which includes several modules:

• Patient management. Allows you to keep records of patients, create electronic medical records, record the results of examinations, prescribe treatment and monitor its effectiveness.
• Medical facility personnel management. Allows you to keep records of employees, their qualifications, form a work schedule, make payroll, prepare reports on employment and performance.
• Admission scheduling and management. Allows the medical facility to schedule appointments with doctors, determine appointment times (set and change) and distribute the workload among doctors.
• Management of emails and SMS messages. Allows the institution to automate the sending of appointment reminders, as well as messages about examination results and other important events for patients and staff.
• Medical equipment management. It allows the clinic to control the stock and usage of medical equipment, perform its maintenance and repair, and write it off.
• Medical Inventory Management. Allows the medical institution, pharmacy or doctor-physician to control stock of medicines, their consumption, make purchases and control expiration dates.
• Analytics Management. Allows you to analyze the data of a medical institution and generate statistical reports on the work of the institution, patient health indicators and staff performance.
• Financial accounting. Allows you to keep records of expenses and revenues of the medical institution, generate reports for tax authorities and manage the financial resources of the institution.

Access to the service is available around the clock. The platform has the ability to create new user groups with the configuration of access and rights to work in the system. Each user signs an obligation to keep the identifiers of access to the system confidential and not to disclose them to third parties.

Typically, their users are:

• chief physicians;
• primary, secondary, and tertiary care physicians;
• various health care workers;
• technical support staff;
• system administrators;
• registrars;
• laboratories;
• patients.

Patient Portal

The patient portal in the HELSI Medical Information System gives patients an access to their electronic medical records (viewing diagnoses, appointments, referrals, prescriptions, test results and tests), appointment schedules and other information.

Listed below are some of the features available to patients through the portal:

• Authorization. It is done by a cell phone number. When a new device (laptop, tablet, phone) logs in for the first time, the HELSI system will send an SMS with a confirmation code to your phone. Afterwards, you will only need to enter your phone number and password to log in from this device.
• Patient's Personal Profile. The patient can view his or her diagnoses, doctor's recommendations, prescriptions and referrals, test results and examinations in his or her personal account.
• Medical data storage. Patient medical records are stored in a secure database. The patient and his/her family physician have an access to the medical data. Other doctors at any medical facility can request the patient to access them through a password sent to the patient's phone - a simple and secure way to maintain confidentiality.
• Online doctor appointment. You can make an appointment to see a doctor through the Web site (using a computer or smartphone). On the website, you need to select your city, find the right doctor, choose a convenient day and time for a visit and confirm the appointment. Then the patient can come to the (offline) clinic at the appointed time and get a consultation with a doctor without waiting in line.
• Reminders and notifications. Patients can receive reminders about appointments, examination results and other important events via SMS, e-mail, popular messengers and/or mobile application.
• Fees. For each patient's appointment with a commercial clinic, the founders of HELSI receive a percentage of the amount of services provided. The site also sells health insurance.

Step 4: Design the platform architecture

To create a medical digital system like HELSI, you need to design an architecture that provides scalability, security, high availability and the flexibility to change requirements or add new features. One of the most appropriate types of architecture for this purpose is a microservice architecture. It involves dividing the system into small services, each of which is responsible for performing specific tasks and has its own code base, independent of the other services.

Examples of services that can be implemented in the architecture of a medical information system such as the Ukrainian HELSI:

• Service of authorization and authentication of users.
• Service for management of patients and their medical records.
• Service for management of appointments and treatment sessions.
• Medical equipment and medication management service.
• Service of analytics and reporting.

In addition, the microservice architecture will allow the use of different technologies and programming languages for each service depending on its functionality and performance requirements. This will not only make it more flexible, but will also reduce the risks of possible security threats such as hacks and data leaks. Protection should be used at all levels of the system, including authorization, authentication, encryption and auditing.

Thus, a microservice architecture is appropriate for developing a medical information system such as HELSI because it provides scalability, flexibility, security and high availability of the system.

Step 5: Develop the UX/UI design of the platform

Good UX/UI design of a platform plays an important role in its success, so design development for a national digital health service must be particularly thorough. The reason for this is that the quality of the design directly affects the usability and effectiveness of the future service for users. Also, the design should be adaptive and support operation on different devices and operating systems. This will ensure the maximum accessibility of the service for users with different preferences and technical capabilities.

The process of design development can be divided into several stages:

1. Research. At this stage there is a study of the target audience of the future platform, its needs, expectations and habits. It is also important to study existing solutions on the market and identify their pros and cons.
2. Design projection. Next, a general design concept is created, and the key elements of the interface and their interaction are defined. It is recommended to create several options of design in the form of sketches (warframes) and choose the most suitable (effective).
3. Prototyping the design. At this stage you have to create a working prototype of the design, where the buttons, animations, icons, etc. are working, but the functions and services are not. You can use this prototype to test it on real users and further improve the design.
4. Design testing. At the end there is design testing on real users, who can give feedback and identify possible problems in the use of the interface.

 Step 6: Write the backend and frontend code

Backend. In services such as HELSI's Ukrainian service, the backend is responsible for handling requests from the frontend, processing and storing medical data, authorizing and authenticating users, controlling access and ensuring data security, etc. The backend also provides connectivity to other systems, such as payment systems, insurance companies and healthcare providers, which allows for data sharing and improves system efficiency.

Here is the technology stack for backend development of a service like HELSI:

• Programming language: Java, Python, JavaScript, (Node.js), Ruby, PHP.
• Database management system: MySQL, PostgreSQL, MongoDB, Oracle.
• Framework (a set of tools and libraries): Spring Framework (Java), Django (Python), Express.js (Node.js), Ruby on Rails (Ruby), Laravel (PHP).
• Cloud services: Amazon Web Services (AWS), Microsoft Azure, Google Cloud Platform (GCP) and others.
• Testing tools: JUnit (Java), Pytest (Python), Mocha (Node.js), RSpec (Ruby), PHPUnit (PHP).
• Integration with other services: REST API, GraphQL.
• Web server: Apache, Nginx
• Version control system: Git, SVN.
• Operating system: Linux, Ubuntu.
• Message queue: RabbitMQ.
• Caching: Redis.
• Search: Elasticsearch.

Frontend. The main task of the frontend is to make the web application user-friendly and intuitive for users, as well as to provide a fast and responsive interface. In the context of a national digital health service such as HELSI, the frontend provides the user with information about health services, doctor's appointments, the ability to view medical results and more.

Here's the technology stack for developing a frontend analog to HELSI:

Step 7: Test the created product

Testing is an important step in the development process of any project because it allows you to identify bugs and eliminate them before the software goes into production. This helps to ensure the quality of the product, increase user satisfaction, and reduce the risk of future problems.

The testing phase of the HELSI analog development process includes:

1. Unit Testing. Testing system components, such as individual modules or functions. Tools such as JUnit or NUnit are used for this.
2. Integration Testing. Testing how the system works as a whole, how components interact with each other and with third-party systems and services. The Selenium WebDriver or TestComplete tools are used for this.
3. System Testing. Testing the entire system in its integrity. For this purpose such tools as Apache JMeter or HP LoadRunner are used.
4. Automated Testing. Testing using automated scripts. Such tools as Appium or Robot Framework are used for this purpose.
5. Manual Testing. This is testing which is carried out manually. Methods like Exploratory Testing or Acceptance Testing are used for this.
6. Performance Testing. This is checking the system's performance at high loads. Apache JMeter or HP LoadRunner are used for this.
7. Security Testing. Testing of the system for possible vulnerabilities. Such tools as Burp Suite or OWASP ZAP are used for this.

Step 8: Launch the helpdesk

The Help Desk in Medical Digital Services is responsible for providing technical and advisory support to system users. The main tasks of the Help Desk are to solve problems that arise from the use of the service and to educate users about the platform, as well as to collect feedback to improve the functionality and products of the medical platform.

To organize a support service, such as in HELSI, it is necessary to develop procedures and rules for providing support to users, define support levels (basic, standard, premium), describe the criteria for request escalation, provide a system for monitoring service quality and regular feedback from users. It is also necessary to define the composition and qualification requirements for support specialists and create procedures and tools for their training and maintenance of knowledge.

In addition, for a more effective Help Desk it is necessary to use specialized CRM-systems, ticketing systems, systems of monitoring and analytics of requests.

The cost of HELSI creation

The cost of developing a service like HELSI can vary depending on many factors, such as the amount of functionality and level of complexity, as well as the size of the development team. In addition, the cost is also highly dependent on the location of the developers, for example in the United States according to Research 2 Guidance, who conducted a survey among 2,400 developers, the cost of creating a medical app from scratch is approximately $425,000.

Certainly, the cost of developing a HELSI analogue in Europe and even more so in Ukraine will be much lower due to lower labor costs and low cost of living. Whereas the level of developers' qualification in Ukraine remains high, because Ukrainian IT-specialists have the access to quality education and also have experience of working with international companies through freelancing.

Final thoughts

Developing a national digital health system like Ukraine's HELSI project can improve the availability and quality of medical services in the country, but many factors must be considered for the project to succeed, such as the financing model, attracting qualified specialists and creating a reliable infrastructure, as well as developing effective methods of interaction between medical institutions, patients and partners.

This may seem too complicated a task, but the experience of Ukraine shows that the implementation of digital innovations in medicine can be successful and justified in the long run and that the national projects in this area can become an important tool of modern medical practice, contributing to improving the quality of life and health of the country's population.