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HEALTH DATAINTEGRATION/INTEROPERABILITY
Health Informatics CentrePlanning and Development Division
Ministry of Health
INTERPRETATION
Systems Integration….The progressive linking and testing of system components to merge their functional and technical characteristics into a comprehensive, interoperable system. Note: Integration of data systems allows data existing on disparate systems to be shared or accessed across functional or system boundaries.
Federal Standards (FED-STD-1037 C 1996: Glossary of Telecommunication Terms
Interoperability……The ability of two or more systems to exchange information and to mutually use the information that has been exchanged
IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990
Vision : Plug and play (PnP)
HEALTHCARE DELIVERY IN MALAYSIA –SCOPE OF INTEGRATION
Healthcare Delivery in
Malaysia
Government
Ministry of Health
Non Ministry of Health
Ministry of Higher Education
Ministry of Defense
Ministry of Rural & Regional
DevelopmentNon Government
Private Sector
Non-Governmental Organisations
SUBSYSTEMS
Medical Management Information
System (SMRP)
Rural Environmental and Sanitation
(BAKAS)
International Entry Point
(PMA)
Family Health Family Planning
Blood Transfusion
Oral HealthFood Safety Information
System (FoSIM)Private
hospitals
Health Facilities
Non-MOH Hospitals
Health Human Resource
DIFFERENT TYPES OF DATA
Term Meaning ExampleRaw Data Collection of numbers, characters,
images or other outputs from devices to convert physical quantities into symbols, that are unprocessed.
1) Individual’s Sex•Male
2) ACE Inhibitor
Aggregated Data
Data combined from several measuresCan also refer to high-level data that is composed of a multitude or combination of other more individual data
Number of Male patients attending Klinik KesihatanSungai Dua in February
Number of different brands of ACE Inhibitors available on the Ministry of Health’s Drug List
EVOLUTION OF HEALTH INFORMATICS CENTRE• Collection and collation of health
information for routine statistics by Medical Services
• Collection and collation of health information for routine statistics by Medical Services
1874 - 1941
• No data collected (Japanese Occupation)
• No data collected (Japanese Occupation)1942 - 1947
• Medical services continue collection with increase in data quality & variety
• Medical services continue collection with increase in data quality & variety
1948 - 1962• Medical Records and Health Statistics Unit
• Data coordination unit for the Ministry of Health (MOH)
• Medical Records and Health Statistics Unit• Data coordination unit for the Ministry of
Health (MOH)1962
• Operations Research Unit• Monitor the development of the National Health
Management Information System (NHMIS)
• Operations Research Unit• Monitor the development of the National Health
Management Information System (NHMIS)1972
EVOLUTION OF HEALTH INFORMATICSCENTRE
•WHO Study recommends establishment of a comprehensive information system through a Health Management Information System Development Project (NHMIDSP)1975
•Information and Documentation Systems (IDS) Unit• Replaced Medical Records and Health Statistics Unit and Operation Research Unit1981
•Health Informatics Centre – custodian of all health and health related information in the country
•HMIS is now HIMS•Publication of Hational Health Data Dictionary2006•Quality initiatives in Data Management and Development of KPIs2010•Reactivation of Malaysia Health Data Warehouse (MyHDW)2011
HEALTH INFORMATION DATA WAREHOUSE
Clinical Data Warehouse (CDW) is synonymous with Health Information Data Warehouse
Formal definition (ISO) 'grouping of data accessible by a single data
management system, possibly of diverse sources, pertaining to a health system or sub-system and enabling secondary data analysis for questions relevant to understanding the functioning of that health system, and hence supporting proper maintenance and improvement of that health system'
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HEALTH INFORMATION DATAWAREHOUSE – PRINCIPLESA working definition for the Malaysian Health Data
Warehouse (MyHDW) is:
A trusted source of truth of comprehensive healthcare data structured for query and analysis purposes. This has the following characteristics: Data is integrated, interoperable and comprehensive A dedicated system that is optimized for analysis and reporting Build based on (national) informatics standards Information available in 'right time' Employs the notion of 'build once use many' with the objective of
reducing the burden of data collection and processing – This implies where possible aligning primary and secondary usage considerations
Can support many reporting and analysis tools and interfaces Implements secure and privacy sensitive access
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BENEFITS High quality, trusted sources of information to allow the
effective management of the health system. Good access to data in a secure and privacy sensitive
manner. Data is linkable and comprehensive allowing questions
across the continuum of care. Is integral to key health system management initiatives
e.g. KPI’s, 1Care, HIMS etc. Can support research and surveillance requirements Output can be provisioned at a variety of levels and
through different tools and interfaces. Increased analytical productivity and efficiency.
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BENEFITS (CONT.)
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Secondary use data can be broadly categorized as:
Category Description Information Use
Health System Management
Improve the efficiency and effectiveness of the health system
• Cost management• Strategy, planning and policy
development• Resource allocation, priority-setting and
funding• Resource utilization• System performance reporting
Research Insights in regards to improved medical treatments and programs of care, and better understand the performance of the system and health of the population
• Clinical research studies• Comparative effectiveness and
evaluation• Retrospective analysis of
policies,initiatives, and interventions• Population research• Modeling and simulation
Surveillance
Manage the health of the public
• Public health surveillance• Public health education• Public health reporting
Clinical Program Management
Improvedelivery of clinicalcare and evidence-based best-practice
• Quality control and improvement• Disease management• Patient safety initiatives• Monitoring access to care
Malaysia Health Data Warehouse (My HDW)
HIS & SPP TPC OHCIS
LHR
eNotice Casemix HIMS ePengamal
Quest3 Fomema Facility
SPAMedPCs
APC
KZM FOSIM FEXOC
FEXCISGlobinmedAset
CMIS
MyHDWConsumer
MyHDW Data Sources
Disease Registrie
s
QAP
OPPORTUNITY
Health System
Managers
Health
s
Health System
Researchers
SurveillanceClinical Program
Managers
BENCHMARKING CRITERIA
Certification The system comply with ISO TC 215 Standards on Health
Informatics or other relevant standard by other Standards Development Organisations (List of Standards to be provided including HL7) – the committee agrees but requires further deliberation on the details
The system comply with international quality certification - the committee agrees but requires further deliberation on the details (refer to example provided by JCI for pathology)
The system should have participated and successfully certified by MSC Malaysia Connectathon (to produce certificate)
The company has attained MSC status (to produce certificate) The system developed for the purpose of revenue collection and
billing must be approved by the Accountant General
BENCHMARKING CRITERIA
Integration and Interoperability The application should be able to interoperate with
Government ICT initiatives, to include MyKad and other 3rd party systems like SMRP, NIA and MyHIX
The system must interoperate with the existing systems The system must be integrated with all medical devices The system should have ALL Health Informatics Standards
in place, comprising of HL7, NHDD, SNOMed CT, CDA, DDSA, and ICD-10 (or any latest version)
DATA INTEGRATION
Involves combining data residing in different sources and providing users with a unified view of these data.
Fragmented data assets are aligned to support business goals
A good data integration system would let the user view all the required information from all the relevant sources in a unified way, leaving out any information that did not apply to the search
DATA INTEGRATION
The goal of data integration is to gather data from different sources, combine it and present it in such a way that it appears to be a unified whole
In order to achieve good data integration, the proper use of Health Informatics Standards is crucial
STANDARDS
ISO Definition for Standards
Document, established by consensus and approved by a recognized body, that provides, for common and repeated use, rules, guidelines or characteristics for activities or their results, aimed at the achievement of the optimum degree of order in a given context.
Provide specifications which are necessary for systems to communicate meaningfully with one another
FUNCTIONS OF STANDARDS
enable the electronic exchange of data between two or more computer systems by establishing the format and sequence of data during transmission to more efficiently accomplish interoperability between computer systems
reflect the existing clinical and administrative data contained in both paper and electronic data systems to maintain patient data consistently in growing electronic health record systems
transfer health data using predictable business processes and accommodate necessary ethical and regulatory demands
foster electronic transmission as a business strategy promote efficient information sharing among
individual computer systems and institutions
DATA INTEGRATION
Request for Integrated Data
Web server sends requests for individual datasets from individual databases
Sends data requested back to master server
Master server combines data into unified view
Master Server sends unified view to user
CASE SCENARIO
SISTEM MAKLUMAT RAWATANPERUBATAN (SMRP) Development of web-based application Based on existing manual reports with a focus at
a granular (raw) level Intended to enable effective data mining and
analysis Proper use of Health Informatics Standards was
monitored in the development of 3 HIS Hospitals
SMRP DATA DEFINITIONS
File Name : SMRP_YYYYMMDD.TXT
RECORD ATTRIBUTES
FIELD NAME DATA TYPE DATA SIZE
DATA FORMAT DESCRIPTIONS KEY
Maklumat Pesakit
no_kadpengenalanbaru varchar 12 No Kad Pengenalan Baru Y
no_lainpengenalan varchar 20 No Pengenalan selain no kad pengenalan baru
nama varchar 80 Nama pesakit Y
namaLain varchar 80
alamat1 varchar 60 Alamat pesakit Y
alamat2 varchar 60
bandar varchar 4 Kod bandar Y
poskod varchar 5 Poskod Y
negeri char 2 Kod Negeri Y
negara char 3 Kod Negara Y
METHODOLOGY
PlanningEngagement of Relevant
Stakeholders
Development of Application•Proper use of Data Definitions
Testing of Application
Monitoring of Integration
with Hospital Information
System
Testing of Integration
between HIS and SMRP Web-based
INTENDED OUTCOME
Accessing Information on database
QueryQuery
Dengue cases in
February?
Special computer languagee.g. Structured Query Language (SQL) REPLY
ACCESSING INFORMATIONDate of Admission
Date of Discharge
Name Sex Age Diagnosis
30 January 2 February Siti SalwaSalmi bt. Ali
Female 46 Dengue Fever
4 February 7 February Cheok GimChuan
Male 34 Dengue Fever
5 February 8 February Tan Song Sang Female 62 Dengue Fever
9 February 11 February Kuldip Singh Sidhu
Male 23 Dengue Shock Syndrome
10 February 15 February Mohd Ariff b. Ismail
Male 12 Dengue HaemorrhagicFever
15 February 18 February Cheah Pei Lean
Female 3 SuspectedDengue fever
27 February 28 February Zainal HajiSabri
Male 17 Unlikelydengue fever
WAY FORWARD - DEMONSTRATION OFINTEGRATION AND INTEROPERABILITY
Between Radiology Information System (RIS) and Teleconsultation (TC). This is the first such interoperability between HIS (Hospital Bintulu) and TC demonstrated in a HIS hospital within the Ministry of Health, confirmed by representative from World Care.
Between The Pharmacy Information System (PhIS) and Pharmaniaga. This is the first such interoperability demonstrated between them.
Between HIS with the web-based Sistem Maklumat RawatanPerubatan (SMRP).
Between HIS and HIMS (daily census), at the moment undergoing confirmation of data flow.
WAY FORWARD - DEMONSTRATION OFINTEGRATION AND INTEROPERABILITY
Between HIS and the NIA/QAP, at the moment undergoing confirmation of data flow.
Between the ultrasound machine to Radiology Information System (RIS) through a DICOM converter, and the old CT-Scan with RIS.
Between HIS and e-GL. Integration between HIS and eTerimaan, currently in
further developmental phase to cater for latest enhancements at the other side.
Demonstration and implementation of Health Informatics Standards (HL7 and SNOMED CT) as recommended by HIC. However, implementation of SNOMED CT would require further deliberation with HIC.
WAY FORWARD - DEMONSTRATION OFINTEGRATION AND INTEROPERABILITY
ASIA MEDICAL 2011 – Health Information System Interoperability Summit
5 – 7th OctoberPWTC
Khadzir@moh.gov.myDrilias@moh.gov.my