Understanding NPHIES, KSA’s health information exchange

In the GCC, Saudi Arabia stands out as one of the leading areas spearheading the transformation of the region’s healthcare landscape. The country’s ambitious Vision 2030 goals include a range of objectives, including improving healthcare services, digitizing healthcare records and increasing the overall efficiency of the national healthcare system.

Given the Kingdom’s resolute commitment to these healthcare advances, it is not surprising that Saudi Arabia is poised to introduce a comprehensive Health Information Exchange (HIE) system that has the potential to surpass its global counterparts.

As medical director of the Council of Health Insurance (CHI) in Saudi Arabia, Dr. Wail Yar is one of the key figures driving the program. The CHI plays an integral role in establishing 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 consists of two parts: NPHIES Taameen (Insurance) and NPHIES Sehey (Health),” explains Dr. Yar out. “This division is necessary because of the way healthcare in Saudi Arabia functions and includes both the public and private sectors.”

The Kingdom’s public sector consists of four entities: the Ministry of Health (MoH), the Saudi Arabian National Guard, the Ministry of the Interior and the Ministry of Education’s health services.

“NPHIES Taameen acts as an infrastructure for interaction between insurance companies and the private sector,” he said.

Dr. Yar – who is also an assistant professor of preventive medicine at King AbdulAziz University – is expected to appear at the 6th GCC eHealth Workforce Development Conference (eHWDC 2023), will take place between October 31 and November 2, 2023 at Jumeirah Emirates Towers. The event will feature a special panel where further details about NPHIES will be revealed.

But what exactly do we know about it?

NPHIES TAAMEEN

According to public data, the first phase of NPHIES implementation began in 2020 and has been steadily progressing since then. The project consists of two parts: one for the insurance segment, known as Taameen, and is managed by the CHI; and one for healthcare, called Sehey, which is overseen by the Saudi Ministry of Health.

As of now, NPHIES Taameen has achieved wider public accessibility, with approximately 75% of healthcare providers currently integrated into the system.

“The role of the CHI, which was founded twenty years ago, was to mediate between insurance companies and healthcare providers. Before NPHIES Taameen was launched, hospitals would send requests directly to insurance companies, following the pre-authorization process,” says Dr. Yar. “Today, the NPHIES platform acts as an intermediary. Hospitals and insurance companies link their systems to NPHIES. Requests for hospital services 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 such as fraud, abuse or delays in patient care.”

He continues: “Currently, 75% of private providers are already connected to NPHIES and we aim for a connection rate of 91% by the end of October 2023.”

NPHIES SEHEY

Like other HIEs, NPHIES Sehey will store extensive patient data such as medication history, allergies, vaccination records and outpatient visits. It is currently in the testing phase.

More is expected to be revealed about NPHIES Sehey in the coming weeks.

As NPHIES Taameen approaches 90% adoption by the end of October, the same percentage target is set for NPHIES Sehey, but with a different time frame.

“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, expansion to NPHIES Sehey will undoubtedly take more time; probably three to five years to reach a comparable level of integration. The process for hospitals is quite expensive and complex; it’s not that easy to do. It requires a lot of manpower, equipment, education, technical implementation and adoption. It is a significant undertaking.”

Learn more about NPHIES at eHWDC 2023. Register to attend by visiting gccehealth.org.