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With the support of EHTEL member, Sorsix

Sorsix, a new EHTEL member, is an enterprise health tech company with 10 years of history in assisting health systems to enable more care through technology. Sorsix’s focus is on system-level improvements to provide interfaces and integration throughout the healthcare sector.

Reducing waiting lists and costs

Long waiting times for care continue to be a significant problem in health systems throughout the whole of Europe.

Ten years ago, one country unexpectedly bucked this trend through introducing two key reforms. The reforms enabled:

  • All clinicians to access an integrated resource directory with a live calendar of availability.
  • Access to electronic referrals and scheduling of care via this directory.

The country with the reform was North Macedonia: it implemented a national process and technology reform based on Sorsix’s technology called Pinga.

The reform started in 2012. It began to deliver immediate results on reductions in waiting time. Doctors using the system were able to make a booking for a patient by using an e-referrals process. As a result of implementing the system, 100% of all referrals in the public system are now electronic, enabling an improved workflow.

As part of a commitment to transparency with the public, and to aid in the outcome of this reform, the government provides a public interface to show live availability of care and waiting times for different specialist doctors and diagnostic machines. The interface also serves as a public directory of all services provided by North Macedonia’s public health and care system, and integrated private entities.


A live availability map of publicly funded care in North Macedonia, viewable at this website. 

Enabling impact

The impact of this reform was startling, especially for public services.

Before the reform, patient waiting lists were as long as many months for all medical specialties and diagnostics. Instead, the reform enabled doctors to connect patients with their colleagues in other clinics and municipalities directly; previously, this would have required numerous phone calls and have uncertain outcomes. After the reform, despite still having a low volume of doctors per capita, North Macedonia was now able to eliminate entirely outpatient waiting lists for publicly funded specialists and diagnostic imaging.

The delivery of care in North Macedonia changed substantially after the system was fully implemented across all public facilities, from the end of 2013 to the end of 2017. During this four-year period, there was a marked increase in net care delivered per doctor while waiting time decreased (to around one day on average across the system).


Care delivered per day (blue dots, aggregated weekly) and

average waiting time (orange line) between December 2013 – December 2017

Despite no significant new investment in resource capacity, this startling result came about as a direct result of the process reform.


Showing the role of technology

This 2013-2017 reform was made possible by the rapid implementation of the Sorsix Pinga system throughout North Macedonia, aided by a firm commitment from the country’s health ministry and its newly formed e-health directorate. The directorate continues to build up and improve the system in tandem with the company today.

Several obstacles exist in healthcare systems to the technical implementation of such a reform, however. Chiefly, they involve standards, performance, and availability that can inhibit the spread of reforms:

  • Standards: There are (still) conflicting healthcare messaging and integration standards.
  • Performance: The system must provide lightning-fast responses to a doctor (or otherwise time is wasted and there are lags in usage and compliance).
  • Availability: On-premise systems that require specific hardware and continual maintenance.


Sorsix's Pinga resolves these three challenges by being natively cloud-based and accessible to any user with an account and a modern browser, including on a phone or tablet. This leap to the cloud simplified the rollout of Pinga rather than complicating it. It provided a central infrastructure that ensured that the system was not dependent on any messaging tools or secure delivery systems. All users were able to securely access the common availability archive and make bookings via the system without requiring a separate messaging utility being.


Achieving success and even more success

The success of this reform in North Macedonia led to recognition of this progress by the World Health Organization and the annual Health Consumer Powerhouse reports (from 2012 on).

Sorsix is proud to assist the North Macedonian government in the delivery of this remarkable development. Today, Sorsix continues to work closely with the health ministry in adding new modules and functionality to the platform, which remains in common usage across the public health and care system.

It is Sorsix’s hope that the promise of technological improvement and the cloud can be achieved throughout the European healthcare landscape. This is especially vital, given the increase in pressures on Europe’s health systems, combined with the needs to improve accessibility and reduce waiting times for care.


For more info on Sorsix

To see:

- The live public view of availability described in this article.

- Publications from the Health Consumer Powerhouse here.

- WHO information on North Macedonia.

For more information, contact Sorsix at info@sorsix.com



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