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