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Electronic Register of Cancer Patients of the Republic of Kazakhstan

The Challenge

The Ministry of Health of the Republic of Kazakhstan decided to switch to targeted funding of cancer treatment, whereby funds are allocated for each patient individually. This called for an accurate and up-to-date record of the total number of cancer patients. However, there was no consolidated database of cancer patients at that time, and information was often outdated and frequently duplicated. To resolve this problem, the government staged a competitive bidding process to select a developer of a centralized electronic register of cancer patients (commonly known by its Russian abbreviation "EROB"). The company Kaysat (Kaysat LLP) was the winning bidder.

For the bidding process, a system prototype was built using ASP.NET technology. However, the actual experience of developing the prototype revealed that up to 80% of the time was spent on low-level tasks, such as developing screens, components, and filters and loading data, instead of developing the business logic. In the commercial version of the system, this would have caused significant budget overruns and possible violations of the bidding terms and conditions, which limited the time of project development and data refinement to one year.

Upon further analysis of available technologies, the initial decision to use ASP.NET was withdrawn; instead, development of the commercial system would be based on Haulmont’s CUBA platform. The key factors behind this choice included the expansive selection of ready-to-use components required for the project, fast development, and reliable architecture, tested through a series of successful projects.

Solution

Project work commenced in March 2012, and, thanks to CUBA platform, the first project stage was put into productive operation within a month, enabling users to enter and verify data. Other system functions were subsequently implemented: keeping a patient history, documenting the diagnostics and treatment etc., and one of the key project requirements – synchronization with the database of all individuals in the Republic of Kazakhstan. The next stage involved building an expert module based on available data to help medical workers diagnose patients by checking the patient history data. This project phase took five months, and the module was put into productive operation in August 2012.

Platform functionality was used widely over the course of the project, including visual components and data filters, user access control, entity modification tracking, the report generation module, server clustering tools, and tools for integration with external systems.

Currently, 18 cancer treatment centers in the Republic of Kazakhstan and the Kazakh Research Institute for Oncology and Radiology are connected to the EROB system. During the quarterly reporting period, up to 450 users can log into the system at a time. In other periods, the system handles up to 100 user sessions simultaneously. The system is hosted by several virtual servers within a single physical server and uses relatively modest computing resources.

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Result

The project was delivered on time and enabled mapping targeted funding to specific individuals. Data refinement reduced the number of database records for cancer patients from 330,000 to 140,000. The new model offered incentives to diagnose cancer at early stages, promoting patient screening (initial examination of patients without cancer symptoms) on a large scale. As a result, in the first year since the launch of the system, the number of registered patients increased by more than 10%. In practice, this significantly increases the patients' chances of recovery and reduces the cost of treatment more than tenfold, making it possible to allocate more funding to other patients.

Following an internal competition staged by the Ministry of Health, the project was declared the best IT project in healthcare. The system actively continues to evolve, with all outpatient departments in the Republic of Kazakhstan (more than 3,000 users) to be connected in the near future.