Suplemented version of IHIS specifications.pdf

7/29/2019 Suplemented version of IHIS specifications.pdf

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Ministry of Health of the Republic of Macedonia

Health Sector Management Project

Project Coordination Unit

TECHNICAL AND FUNCTIONAL REQUIREMENTS

FOR

INTEGRATED HEALTH INFORMATION SYSTEM

OFTHEREPUBLIC OF MACEDONIA (IHIS)

ICT REPORT (Contract activity C)

Final 1.2

November 2007


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IHIS Specification Version 1.2

2007 Ministry of health 2

Document status

Document purpose: To present technical specifications for Integrated Health Information System

in the Republic of Macedonia

Content: See table of Contents

Document sign.: Report No.2 and No.3 (joint specifications of contract activity b and c)

Status: Final

Version: 1.2

Version Date: 13.11.2007

Client / User: MOH, PCU

Authors / Prepared by: IPMIT d.o.o.

Date of Delivery: 14.11.2007 WG, MoH

Version History:

Version Last Change Comments

0.1 Draft 12.09.2007 First draft on document structure

0.2 Draft 14.09.2007 First draft (structure & basic content)

0.3 Draft 25.09.2007 Second draft

0.4 Draft 01.10.2007 Harmonizing specifications with WG

05.10.2007 Sent to WG and MoH

1.0 Final 15.10.2007 Final version for WG and WB verification

19.10.2007 Sent to WG for final verification

1.1 Final 27.10.2007Accepted comments from WG FINAL

VERSION

1.2 Final 14.11.2007 Accepted comments from WB

Confidentiality: According to PCU and project procedures

Document copyright

2007 Ministry of Health, Republic of Macedonia, Skopje;

All Rights Reserved. Reproduction of this document in part or in full in any manner and in anymedium without the written consent of the author is unlawful. Limitations shall not apply to stateauthorities of the Republic of Macedonia. Violators will be prosecuted pursuant to the Copyrightand Related Rights Act and the Penal Code of the Republic of Macedonia.


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Table of contents

1 PROJECT BACKGROUND ..........................................................................................61.1 Background information ......................................................................................61.2 Document purpose...............................................................................................6

2 PROJECT DESCRIPTION............................................................................................72.1 Subject of the project ...........................................................................................72.2 Project scope........................................................................................................82.3 Project objectives.................................................................................................82.4 Organization..........................................................................................................9 2.5 Processes............................................................................................................11

3 CURRENT STATE OF HEALTH IS IN THE REPUBLIC OF MACEDONIA ...............123.1 Introduction.........................................................................................................12 3.2 Key findings ........................................................................................................123.3 Current state in Health related institutions in Macedonia...............................133.4 Starting point for future IHIS..............................................................................14

4 FUTURE IHIS SPECIFICATIONS...............................................................................154.1 Future IHIS architecture.....................................................................................154.2 General IHIS use case and process description..............................................164.3 Health Data & Application Center HDAC .......................................................17

4.3.1 Introduction of HDAC .....................................................................................174.3.2 Hardware........................................................................................................17 4.3.3 System Software, servers software and licenses...........................................184.3.4 Central IHIS software, database and interfaces.............................................194.3.5 Common Health and other registers, coding tables .......................................204.3.6 Standards.......................................................................................................21 4.3.7 Security and User rights management...........................................................224.3.8 User activity tracking User & activity LOG files ...........................................224.3.9 Telecommunications ......................................................................................234.3.10 System backup & Disaster recovery ...........................................................234.3.11 Data Migration.............................................................................................234.3.12 HDAC organization .....................................................................................24


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4.4 Patient Health ID & Insurance card, Professional ID Health Card ..................244.4.1 Health insurance card and patient identification.............................................244.4.2 Professional staff identification.......................................................................25

4.5 HCI subsystem....................................................................................................254.5.1 Introduction of HCIs subsystem .....................................................................254.5.2 Hardware, System software and telecommunication for HCIs .......................264.5.3 Special medical/hospital software ..................................................................294.5.4 Financial, accountancy and administrative solution FAAS..........................324.5.5 Database........................................................................................................34 4.5.6 User interface requirements...........................................................................35

4.6 Pharmacy subsystem.........................................................................................364.6.1 Introduction of Pharmacy requirements .........................................................364.6.2 Hardware, System Software and licenses, Telecommunication.....................364.6.3 Software solution for Pharmacies & Interfaces...............................................36

4.7 HIF subsystem....................................................................................................374.7.1 Introduction of HIF requirements....................................................................374.7.2 Hardware, System Software and licenses, Telecommunication.....................374.7.3 Interfaces for HDAC HIF communication ....................................................37

4.8 (N)IHP subsystem...............................................................................................404.8.1 Introduction of (N)IHP requirements...............................................................404.8.2 Hardware, System Software and licenses, Telecommunication.....................414.8.3 Software solution for (N)IHP...........................................................................42

4.9 Management subsystem....................................................................................434.10 eHealth portal ..................................................................................................44

4.10.1 eHealth portal introduction ..........................................................................444.10.2 Portal functionality.......................................................................................44

5 TESTING, TRAINING, PRODUCTION, MAINTENANCE, Documentation, USERSUPPORT .........................................................................................................................45

5.1 Testing requirements .........................................................................................455.2 Training requirements........................................................................................465.3 Maintenance requirements and user support ..................................................46


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5.4 Documentation....................................................................................................49 6 IHIS & HDAC COMPLEXITY MEASURES.................................................................507 SCALABILITY, FUTURE IHIS UPGRADES...............................................................518 PROJECT IMPLEMENTATION PLAN .......................................................................51

8.1 Implementation phases, deliverables and time schedule (delivery plan)......519 SELECTION CRITERIA - QUALIFICATIONS, MEASURES......................................5410 Documents and sources .......................................................................................57

Acronyms

IHIS Integrated Health Information System

RMK Republic of Macedonia

MoH Ministry of Health

HDAC Health Data and Application Center

HIF Health Insurance Fund

HCI HealthCare Institution(s) Hospital, Health Centre(Home)

WG Working Group

NIHP National Institute for Health Protection

IHP Institute for Health Protection (regional units)

WHO World Health Organization

EHR Electronic Health Record

EPR Electronic Patient Record

UCCSUniversity Clinical Centre in Skopje


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1 PROJECT BACKGROUND

1.1 Background information

The Republic of Macedonia has received a Specific Investment Loan from the International Bank

for Reconstruction and Development in amount of US $ 10 million toward the cost of a Health

Sector Management Project. The project comprises of four components [1]:

Component 1: Policy Formulation and Implementation

Component 2: Strengthening HIF Governance and Management

Component 3: Improving Service Delivery

Component 4: Project Management, Monitoring and Evaluation

The Macedonian health care system faces multiple challenges of improving access, quality andefficiency. The Government of Macedonias objectives are to obtain a healthcare system based on

long term stability, sound governance and an appropriate institutional capacity in the key players in

the health care system. It wants to see MOH, HIF and the health care providers operating in a

reformed health care environment, all focused on the patient as the most important element in the

health care system [1].

Within the Health Sector Management Project, there has been also developed Integrated

Information System Strategy. Its primary aim is to recommend the necessary actions to rectify

present deficiencies in health information systems and to put in place the frameworks to ensure the

optimal development and utilization of health information [2].

1.2 Document purpose

This document represents functional and technical specifications for Integrated Health Information

System of the Republic of Macedonia (also IHIS). Specifications are aligned with: Integrated

Information System Strategy, current state of the health information system in Macedonia, concrete

functional and information needs in the health sector recognized through several analyses in the

past, modern trends in information technology field.

The purpose of the document (specifications) is to present functional and technicalrequirements of IHIS to bidders and is therefore the basis for preparing their bids.

Specifications include:

1. Project information

2. Current state of health information system in the Republic of Macedonia

3. Future IHIS architecture

4. Functional requirements

5. Technical requirements (system software, hardware, telecommunications, interfaces)

6. Other conditions regarding implementation, operating and maintenance of future IHIS


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7. Project plan and implementation phases

8. Other information important about the project and IHIS implementation for bidders

2 PROJECT DESCRIPTION

2.1 Subject of the project

Implementation, maintenance and user support of central Integrated Health information

system (also IHIS) of the Republic of Macedonia, which will have to integrate all relevant health

related institutions, public and private, including: Ministry of health, Health care institutions (Health

homes, Hospitals), Pharmacies, Health insurance Fund, National Institute of Health Protection and

regional units. It is decided that IHIS will be centralized information system with central EHR

database and central software installed for all health care institutions. The majority of users will use

the software solution through web browsers. No local servers or databases are planned except forHealth insurance fund and Pharmacies which already have their own solution and therefore only

integration is needed with IHIS. It is planned to establish one powerful Health Data & Application

Center (also HDAC) for IHIS in Macedonia. Selected provider will have to offer software solution

and also hardware and telecommunication equipment for Health Data & Application Center. It is

also planned to provide bar code cards for patients and professionals for identification and

authorization within health care related processes.

The ministry is looking for provider to implement most adequate solution according to

current situation and actual requirements. The solution should be modern, corresponding

to standards and proven by other customers. Therefore MoH is looking for ready made

solution which must be localized on Macedonian language Cyrillic alphabet, customized

and upgraded if needed to satisfy all requirements.

Required subsystems of IHIS:

1. Health Data & Application Center HDAC (Central software, HW, Telecommunication equipment)

2. Patient Health ID & Insurance card, Professional ID Health card

3. HCI subsystem with special software for Health centers and Hospitals hosted in HDAC, including

EPR/EHR data, modules for financial, accountancy, administration processes and data analysis

4. Pharmacy subsystem (integration with existing Pharmacy software)

5. HIF subsystem (integration with existing HIF software)

6. Subsystem for National institute for health protection and regional units (Datawarehouse, OLAP, Decision

support)

7. Management subsystem

8. eHealth portal

Project will be implemented through several phases according to the implementation plan. Each

phase includes detailed analysis and design, development, testing, trainings, putting in production.

After each implementation phase maintenance and user support is required.


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2.2 Project scope

IHIS implementation is complex project concerning all aspects of the information system starting

with hardware and system software for database center, hardware and system software for users

(Health Care Institutions also HCIs), telecommunication equipment and services for database

center and for users, special software for HCIs and other health related institutions, interfaces for

data interchange with other existing systems and institutions, special IHIS equipment (e.g. health

insurance card/identification and/or devices), implementing world standards related to health and

ICT, several levels of users training, system maintenance and upgrading, other aspects described

in this document.

Because of this complexity project is divided in to logical implementation phases and subsystems

which are described at the end of the document, after all functional and technical requirements are

explained.

2.3 Project objectives

Project objectives are divided into short term objectives (concerning functional and technical

requirements presented in this document) which should be achieved after implementing IHIS, and

long term objectives which should be achieved afterwards.

Short term objectives:

1. Establish Health Data and Application Center (also HDAC) in Ministry of Health (hardware,

system software, telecommunications, training) central part of IHIS.

2. Integrate Health Care Institutions within IHIS: MoH, HCIs, NIHP, IHP, HIF, Pharmacies

3. Implement central medical/hospital software for HCIs running centrally in HDAC and used

through web browsers by HCIs (n-tier architecture, web based)

4. Implement central database and software for NIHP and IHPs

5. Implement interfaces and solutions for integrating with HIF and Pharmacies

6. Establish Central registers and Coding tables for IHIS

7. Provide health insurance card or other identification for insured citizens

8. Implement Electronic Health Record (also EHR) and/or Electronic Patient Record (also

EPR) in HDAC according to European standards and best practice

9. Implement e-prescription solution

10. Implement Health Care and ICT related standards and best practice in Europe

11. Provide professional ID card or other identification for professional staff

12. Train IHIS users and professional staff for managing IHIS

13. Provide reliable and scalable IHIS infrastructure and solutions

Long term objectives:


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1. DRG Implementation for Hospitals

2. Personalized eHealth portal for patients

3. Telemedicine

2.4 Organization

Contracting authority, other stakeholders and users will set up special project organization for IHIS

projects. Next organization chart is showing roles and groups of this project organization. MoH is

expecting to run more than one project for IHIS implementation. Also requirements in this

document could be divided into more than one project (e.g. Each IHIS subsystem is one project,

each IHIS implementation phase is one project to be decided by MoH).

Steering CommitteeSteering committee has the highest position in project hierarchy. Steering committee consists of

key stakeholders members and decision makers. Its role is to fully support program, to supervise

program implementation, to provide key business decisions and to ensure budgeting of the

program and projects. Steering committee is acquainted with program progress through reports

sent and presented by program manager.

Program Manager and Technical Program Manager

Program managers main tasks are: planning, project management, reporting to the Program

Steering Committee, progress and quality control. Technical program manager is responsible for

taking over Program managers tasks in case of his absence.

Technical program manager has the same tasks as Program manager. Within these tasks he

provides support to Program manager and is responsible for forming technical-technological

guidelines, their implementation and for resolving technical-technological issues within projects.

Program manager is obligated to report periodically to the Program Steering Committee.

Advisory board

Advisory board is Program managers consultation body and it evaluates suggestions and

solutions regarding projects. Composition of Advisory board usually stays the same through whole

duration of the program and assures verified and uniform solutions.

Tasks of Advisory board: handling suggestions for processes and solutions implementation,

preparing guidelines for implementation of various solutions.

Advisory board has regular meetings with program manager where advisory board is discussing

and proposing technical and other solutions for projects.

User representatives group


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User representatives group usually consist of representatives of key users of new solution to be

implemented through projects. Program manager will regularly discuss project requirements and

project results with users.

Project Office

Project office provides main expert services for program planning, controlling, reporting and

documenting. It performs methodological and administrative tasks in the field of program

management.

(Contracting authority) Project Manager and Technical Project Manager

Project manager tasks are project planning, project management (delegating tasks, coordination,

risk management), reporting and controlling project progress and quality. Project manager is

regularly reporting to the Program manager. In the time of his absence Project manager issubstituted by Technical project manager. This refers to all tasks and responsibilities of Project

manager.

Technical project manager also provides support to Project manager and is responsible for forming

technical-technological solutions, their implementation and for resolving technical-technological

questions, which arise within individual projects.

Providers Project Manager

Providers project manager has similar tasks like project manager, but limited to managing projecttask required from provider. Providers project manager is regularly reporting to Project manager.

Project Group

Project group operates directly under project managers leadership. Project group members are

defined in the Project initiation document prepared by contracting authority Project manager and

confirmed by Program manager. Project group constitutes of contracting authoritys members and

external providers members. The main task of Project group is to produce project results.


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Technical

Project Manager

Technical

Project Manager

Technical

Program Manager

Program Manager

Program Steering

Committee

Advisory Board

IT, Medical, Legal,

Project Manager

Project 1

Project Group

Contracting

authority project

group

Provider Project

Manager

Provider ProjectGroup

Project Manager

Project N

Contracting

authority project

group

Provider Project

Manager

Provider ProjectGroup

Project Group

Project Office

&Technical

support

Person

Legend

Group User

Representatives

Group

2.5 Processes

Processes for managing the project will be defined by contracting authority. Most important

processes, which will be defined and aligned with above organizational structure, are: project

reporting, change management, risk management and quality assurance/management. If

needed, presented project organization will be reorganized at the beginning of the project to fullyaddress all important processes for managing the project.

Relevant processes, concerning awarded provider, will be presented at the beginning of the

project.


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3 CURRENT STATE OF HEALTH IS IN THE REPUBLIC OF MACEDONIA

3.1 Introduction

In the health sector in the Republic of Macedonia there is no unified integrated information system.The number of IT staff in the health sector is very little, not enough to create conditions for faster

development. There is no central body responsible for ICT implementation and monitoring the

development of integrated health information system, and also there is no central health database.

[3]

Computer education of the health care providers is not on a satisfactory level. There is no mass

internet use, there are certain exceptions, but mainly dial-up mode is used, and in some institutions

there is ADSL connection. Application of information-communication technology (ICT) in the health

sector in Macedonia is very much below the European Standards.

Health Information system shows significant variables regarding the technical equipment andcomputer education of the employed. Thus there are health care institutions that fulfill the

European standards for ICT development and institutions that completely lack any ICT.

The crucial deficiency of HCIs and also others health related information systems in Macedonia is

the fact that they are not connected electronically, they do not use unified coding standards, health

record standards, ICT standards and central registers, they also use different standard and formats

for patient records. Therefore each institution represents a kind of isolated information island which

is not capable to communicate with others electronically [7].

3.2 Key findings

Key findings about current information systems are:

1. There is no electronic communication trough the internet between HCIs, HIF, NIHP and

MOH and consequently no Integrated Health Information system (IHIS).

2. Reporting on provided services from HCIs to HIF is paper based or in some cases with

magnetic media.

3. Weak local area network in HCIs, especially in health centers and some hospitals.

4. The data about HCI services is entered in different information systems up to 4 times nosingle data entry point.

5. Rare internet access points in HCIs (dial-up or in some cases ADSL).

6. Relatively well established local area network in NIHP and local/regional IHPs and also well

equipped with hardware and software.

7. There are few relatively well equipped hospitals and centers with hardware, software and

local area network (e.g. , The Institute of Radiotherapy and Oncology Former University

Clinical Center of Skopje, Hospital of Orthopedics and Traumatology Ohrid).

8. Lack of IT professional staff in HCIs for further information system development andimplementation.


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9. IT staff in HCIs are mostly working with older IT technologies and are not well educated for

implementing new technologies, new IT processes and e.g. security threats on the internet.

10. No strategy, plan or clear vision in HCIs for their information system.

11. Lack of knowledge about health record standards, coding and ICT standards.

12. Different standards or no standards used in local information systems in HCIs.

13. No central institution or body responsible for coordinating, planning, implementing and

standardizing health information system in Macedonia.

14. Information systems in HCIs are mostly based on older and non-internet information

technologies and environments (e.g. DOS environment) established from 1993 to 2001.

15. No electronic patient card or professional card for patient identification, authentication and

checking patient insurance status (still using blue cards/tickets).

16. No central database or integrated system for electronic patient records or electronic health

records.

3.3 Current state in Health related institutions in Macedonia

Former University Clinical Centre in Skopje (also UCCS), as the largest educational, research-

scientific, health care institution in the country, for many past years has been the first in Macedonia

to develop information system. There was several software solutions developed that are still

operational. However, in the past years there was not enough maintenance and care taken for

further development of the information system in UCCS, thus making it old now, disintegrated and

brought in a situation of being not operational. Thus, what is needed is fast and quality interventionaimed to build new Hospital Information System that will further be integrated with the health

information systems from the other health care institutions [3].

The Institute of Radiotherapy and Oncology (within former UCCS), as well as the Special Hospital

of Orthopedics and Traumatology in Ohrid, there are advanced solutions for the hospital system

functioning in both hospitals. They have relatively new medical equipment, functional network and

completely operational hospital information system that cover electronically all most important

routine procedures for the patients.

Current information system of HIF is relatively well integrated and operational. This system is

actually hierarchically divided in two levels: central level and branch offices. The data is kept in thecentral database, and the branch offices use only those data that are of interest to their area of

coverage. The establishment of treasury system made possible to establish electronic

communication, and exchange of data with the Drug Bureau and State Statistical Office is realized

through magnetic or optical media. Currently, under procedure is the procurement of computer

hardware, which would make HIF IT system complete and fully operational.

National Institute for Health Protection is a referent centre for health statistics and official

partner in the national and international organizations (WHO). NIHP has functional ICT equipment,

but as in many health care institutions it is necessary to renew and complete it with new ICT

equipment. Ten regional Institutes of Health Protection have satisfactory level of ICT equipment;there is partial unification of software applications, almost all of them have ADSL or cable internet


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access. With the Medical Map Project it was planned to establish communication of NIHP with the

other IHPs, and at the same time unified software application.

Ministry of Health and Drug Bureau have implemented ICT on a satisfactory level, there is fast

internet access, there are developed and upgraded several software applications. Large

disadvantage that influenced a lot on the delays in the development of ICT was the inexistence ofICT sector and IT experts in the Ministry of Health, which disadvantage started continuously to be

overcome and is now in the phase of forming a team that would work on IHIS implementation. Very

soon, also RIHP will have the opportunity to connect to this network that would enable exchange of

data with MOH and Drug Bureau.

General conclusion is that the least investments were made in the Health Homes. In some of the

special hospitals the situation is good, but in many of them the ICT is missing.

Situation in the larger hospitals is relatively satisfactory, but there is a need of additional

investment in equipment and infrastructure. Most complete system is found in the Institutes of

Health Protection and almost all of them are operational, information structure is brought to anoperational level and is functional, also with small exceptions, the computer equipment is brought

to a level necessary for continuous functioning.

Pharmacies are using their own software and hardware to support their business processes for

selling drugs, issuing drugs, stock tracking, reporting and others. Information system is running

locally for each Pharmacy or in some cases central information system is established for a group of

pharmacies belonging to one company (e.g. Zegin). There is no electronic communication between

pharmacies and HIF or MoH communication is based on paper and floppy disks according to

predefined data structure for reporting.

3.4 Starting point for future IHIS

Current situation analysis of Health IS in Macedonia is showing us that there are many

weaknesses but in the other hand also many opportunities to improve situation and also many

issues to solve in the future. The lack of integrated health information system could be understood

as great opportunity to develop modern and unified system from with solid foundations: there will

be less integration with existing systems because they dont exist, unified solutions could be

implemented and maintained centrally, central registers and coding tables could be used from the

beginning of IS implementation, common standards could be used in all relevant institutions and

solutions.

The ministry is looking for provider to implement most adequate solution according to

current situation and actual requirements presented in this document. The solution should

be modern, corresponding to standards and proven by other customers. Therefore MoH is

looking for ready made solution which must be customized and upgraded if needed to

satisfy all requirements. Ministry and other stakeholders are aware of the IHIS

implementation complexity, therefore project will be accomplished through several logical

phases defined at the end of specifications.


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4 FUTURE IHIS SPECIFICATIONS

4.1 Future IHIS architecture

IHIS is central oriented information system with strong networking capacities connecting allrelevant institutions and information systems in health sector in Macedonia. Institutions taking part

in the system are: MoH, HCIs, HIF (and regional HIF units), Pharmacies, NIHP, IHPs. Institutions

will be connected through IP VPN to the central IHIS location, called Health Data & Application

Center (also HDAC) which will be placed in MoH. Also backup ADSL connection is planned for

critical institutions and applications. Application and modules should be web based with central

database located in HDAC. Health related data standards, ICT standards and best practice should

be used.

IHIS subsystems that should be provided and implemented by selected providers/partners are:

1. Health Data & Application Center HDAC

2. Patient Health ID & Insurance card, Professional IDHealth card

3. HCI subsystem, including EPR/EHR data, modules for financial, accountancy,

administration processes and data analysis

4. Pharmacy subsystem

5. HIF subsystem

6. (N)IHP subsystem

7. Management subsystem8. eHealth portal

All subsystems of IHIS will be basically implemented and running in HDAC. Subsystems will be

used by end users or other existent systems through IP VPN connections. Next schema is showing

institutions included in the system and some basic functionality for each institution (see arrows).

Beside IHIS subsystems implementation, it is expected from provider to provides other important

services during IHIS implementation and production like user training, maintenance, software

adjustments (e.g. Integration with existent software solutions in HCIs).

Detailed IHIS functional, technical and other requirements, that must be considered by potential

providers and implemented if selected according to the procedures, are described further in the

document.


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4.2 General IHIS use case and process description

The usual IHIS process starts with patient who wants to visit general practitionerwhile having

some health problems or needs. Patient should first appoint himself for a visit and after that he

visits general practitioner on scheduled term (scheduling patient visits). On arrival patient

identifies him self with unique identification (Patient Health ID & Insurance card). General

practitioner (GP) uses his professional identification and patient identification to start process within

the Health information system. Information system first automatically checks patient ID and

insurance. According to GP rights and policies, information system offers to the general

practitioner new data stored in EHR central database if any.GP can check new data in EHR or

request more detailed data from third health care provider. After medical examination and checking

data in the information system, GP can decide on diagnosis and further process. Data aboutdiagnosis, further procedures for diagnosis (e.g. laboratory), doctors note for hospital, treatments

or prescribed drugs are all stored in the Electronic patient data (EPR) or EHR central database.

After that patient leaves GP and visits other HCIs or accomplishes other examinations if

necessary. During next examinations or during staying in the hospital, patient always uses his

unique identification document to identify him self, to check insurance electronically and to enable

doctors to gain access to his EPR or EHR and after that supplement EPR or central EHR with new

medical or other data according to the procedure (e.g. discharge letter, disease). The most

important gain of the new integrated information system is unique identification, electronic

insurance checking, and access to central EHR database for patient medical data wherever patient

uses some medical services.


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After finished treatments or examinations in several HCIs patient can return to his GP. GP can

check all data about treatments or examinations in the central EHR or EPR database, check

discharge letter or some other treatment/therapy conclusions. GP can also decide to prescribe

drugs to the patient in this case doctor uses information system to select drugs from the register

and to confirm (prescribe) drugs to the patient. Data about prescription is stored in the central

database and can be used either for Pharmacies when issuing drugs or for statistics on prescribing

drugs.

When patient gets prescription for drug according to the treatment, he goes to the pharmacy

having no paper document or paper prescriptions. Only thing he is carrying is his identification

card. Pharmacy information system uses patient identification card to access central database

and to gain data on prescribed drugs by the doctor. Pharmacist issues prescribed drugs to the

patient and the action is stored in the central database.

The central information system, physically located in MoH, will enable HCIs to automatically

report to other institutions according to the regulation. All data will be stored in central database

and reports could be prepared automatically or semiautomatic and send periodically to other

institutions using common interfaces.

4.3 Health Data & Application Center HDAC

4.3.1 Introduction of HDAC

Health Data & Application Center is the heart of IHIS. HDAC will provide software solutions and

services for institutions connected to the system. All solutions/subsystems will be hosted by HDAC

and used by users through internet via web browsers or in some cases through special interfacesto existent systems (e.g. HIF). HDAC must also host central database with EHR/EPR and other

relevant personal, medical, analytical, statistical, financial and administrative data. In later phases it

should support also DataWarehouse.

To ensure full functionality of HDAC, providers will have to implement all subsystems described in

this document and set up efficient Hardware, System Software and Telecomunication equipment to

support subsystems.

MoH will assure proper location, telecommunication services and people (2 4 people) to help

establish HDAC and later managing IHIS implementation and production activities. During first

phase of IHIS implementation, selected provider should prepare requirements for location andtelecommunication services according to offered solution.

4.3.2 Hardware

HDAC will be a heavy duty data and application center and therefore sufficient processing

resources and storage capacity must be ensured. Provider must offer necessary hardware

equipment to support all IHIS subsystems in testing phase and production phase:

Production phase (Heavy duty, reliable equipment with sufficient redundancy):

- applications servers (clustering, load balancing)- internet servers (clustering, load balancing)


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- database servers & storage (clustering, SAN)

- caching servers

- business Intelligence / Reporting server

- backup/Management server

- other if needed according to offered solution requirements

Testing phase (less powerful):

- applications servers

- internet servers

- database servers

- other if needed according to offered solution requirements

Other equipment:

- Rack(s) for hardware and telecommunication equipment

- Hardware for backups, Backup subsystems (in later phases backup location will be

established)

- UPS (sufficient for 15 minutes operating without power), electricity generator for backup

power will be ensured by MoH in chosen location.

4.3.3 System Software, servers software and licenses

System software, server software and licenses must be included in offer:

- Network operating system + licenses

- Operating systems for servers + licenses

- Software for database server + licenses

- Software for application and internet server + licenses

- Software for tracking/controlling the usage of system resources

- Software for tracking/controlling the usage of network resources

- Special firewall software if needed (depending on solution)

- Antivirus software for servers (central automatic update for servers)

- Backup software + licenses

- SAN software + licenses

- other if needed according to offered solution requirements + licenses


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4.3.4 Central IHIS1 software, database and interfaces

Provider must offer and implement software for all subsystems described in this document.

Software will be placed in HDAC and accessed by users through IP VPN connections using only

web browsers; in case of interfaces to other systems (e.g. HIF), XML exchange format or direct

connection to central database will be used. All software subsystems are described further in thedocument:

- Patient Health ID & Insurance card, Professional ID Health card

- HCI subsystem, including EPR/EHR data, modules for financial, accountancy,

administration processes and data analysis

- Pharmacy subsystem

- HIF subsystem

- (N)IHP subsystem

- Management IS

- eHealth portal

Offered Solutions (subsystems), designed and implemented on the basis of Service Oriented

Architecture (SOA), will be preferred. Subsystems must satisfy requirements for mission critical

operations (high availability and high reliability), wide range scalability (national level roll-out), high

security and data protection standards compliance and to support efficient system management for

performance stability and accountability. For maximizing adjustability and scalability of offered

solution it is desired to use BPMN (for modeling processes), BPEL and Enterprise Service Bus(ESB), Service Oriented Architecture (SOA) and J2EE5.

IHIS central database requirements

- HDAC must host central database for all IHIS subsystems. Therefore database content

should be: medical data, personal data, EHR/EPR data, analytical and statistical data,

financial and administrative data and other

- Database must be relational or object-relational

- Detailed description of data, relevant to each subsystem, is described further in thedocument where subsystems are described.

- Central database should be physically implemented with storage system or other heavy

duty data management solution offered by the awarded provider.

- Central database should be logically divided into four logical databases: medical and

personal data, reporting and statistical data, other data (financial, accountancy), log files.

In later phases also Data warehouse will be implemented.

1Integrated Health Information System


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- Central database will include central registers and central coding tables needed by

subsystems. Registers and coding tables are described further in the document.

- Central database must enable log files for tracking each user activity (user, activity,

date&time, application, data)

- Provider will have to provide detailed documentation on database including minimum:database schema, described entities & attributes, keys, integrated restrictions, user rights

and triggers.

- Awarded provider will have to implement backup system (backup system, backup unit,

backup media) and describe backup/restore procedures. In later phases full disaster

recovery policy should be implemented and also physical backup location (hot location).

- Backup location with fully redundancy servers and other equipment, fully replicated

database, hot location totally ready and capable for operation in case of primary location

failure. MoH will ensure phisicall location with proper other equipment (air conditioning,

electricity, electricity generator, telecommunication lines to primary location, physicalsecurity)

Central interfaces:

- Central interfaces will be implemented for data interchange between existing software

solutions (e.g. HIF) and new IHIS/HDAC solutions.

- Interfaces could use synchronous or asynchronous communication

- Preferred format for communication is XML based

- For medical data exchange HL7 v.3 standard must be used Health data communication

standard

- Possible interfaces: interface with HIF, interface with Pharmacies, Interface with existing

hospital information systems, interface with Statistical Office, interfaces with relevant

national register (e.g. Residents register)

- Interfaces are described further in document where describing IHIS subsystems.

4.3.5 Common Health and other registers, coding tables

IHIS subsystems must include unified registers and coding tables related to the health care area.

Provider will have to implement unified registers and coding tables in four layers:

1. implement registers and coding tables in central database in MoH/HDAC

2. interfaces for managing registers and coding tables

3. integration of registers and coding tables in IHIS subsystems/solutions

4. presentation of registers and coding tables in public eHealth portal (functionalities: preview

form for each register or coding list, search form, download option)


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All registers and coding lists will be maintained centrally in HDAC. Content for registers and coding

lists will be provided, verified and maintained by MoH and other competent health care

organizations defined in the first phase of the project. Each record in register or coding list must

have unique identification corresponding to EU standards and best practice. Provider will have to

execute data migration from existent registers to new registers in central database regardless of

current form of registers (paper, Excel, database). Verification of data, to be migrated in central

database, will be verified by MoH and other competent authorities in Macedonia. Most important

registers and coding lists to be included:

- Register of drugs (data will be provided by MoH, Drug Bureau)

- Register of herbal medicines (data will be provided by MoH, Drug Bureau)

- Register of Doctors (data will be provided by Macedonian Medical Chamber)

- Register of Dentists (data will be provided by Chamber of Dentists)

- Register of insured citizens (data will be provided by HIF, automatic synchronization must

be implemented between HIF register of insured citizens and IHIS/HDAC register)

- Register of all Health care institutions in Macedonia (data will be provided by MoH)

- ICD-10 International Classification of Diseases (international standard diagnostic

classification)

- Register of nurses and other medical staff working in HCIs

- Other registers and coding tables according to offered solution

4.3.6 Standards

The adoption of standards is an essential requirement for improving the quality and usefulness of

information for all stakeholder groups, and is of crucial importance in the use of the electronic

healthcare record. Most important standards to be implemented:

- application protocol for electronic data exchange in healthcare environments HL7, version

3 RIM

- EHR/EPR standards have to be based on HL7 v.3 RIM and combined with the best EU

practice and other standards if necessary (oSIST prEN 13606, EHRcom, CDA, IHE XDS,

MML, SR, XDS). Standard should define: structure and contents, using, sharing, and

exchanging electronic health records. Final decision on standards and some adjustmentsmust be a part of first implementation phase, according to offered solution and actual local

needs.

- ICD-10 International Classification of Diseases (international standard diagnostic

classification)

- CEN _ENV 12967: Healthcare Information System Architecture (HISA)

- Identification standards for patient should be used (described further in the document)

- DICOM Digital Imaging and Communications in Medicine (offered system should be

prepared to include DICOM if decided to implement it in later phases)- Other standards according to offered solution


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4.3.7 Security and User rights management

Due to the extremely sensitive and confidential data related to the inner workings of the Health

care institutions, which is usually classified up to the highest level, a special attention should be

paid to the design and the implementation of security and privacy mechanisms.

IHIS/HDAC must assure physical and system/software security. Physical security for HDAC will beensured by MoH. System or software security must be implemented in IHIS subsystems by

awarded provider.

Principles of system security and system components that should be implemented:

- physical security (to be ensured by MoH)

- firewall

- antivirus programs

- solution for detecting and preventing attacks from the network, e.g DoS (Denial of Service)

- to access any subsystem (or part of any subsystem) of IHIS minimum username and

password should be required (except for the public non-personalized portal), for

professional staff also in combination with PID professional identification card

- each active IHIS user must have unique ID and his own username and password

- user activity must be recorded in log files in HDAC

User rights management and system monitoring will be performed by local staff in HDAC center.

During the first phase of implementation, provider will have to perform training for local staff in

HDAC center to gain optimal knowledge for managing security issues and user rights

management.

It is demanded that user rights management system is opened for changes in legislation and user

right policy. Currently the health related legislation in Macedonia is in the process of adjustments

and modernizing and therefore some new access rights to medical and personal data will be

introduced shortly.

4.3.8 User activity tracking User & activity LOG files

Each user activity must be tracked and stored in log file, starting from user login until log out.Minimum data to be stored for each user activity: Professional user ID (e.g. doctor),

subsystem/application, activity (read, write, change, delete), patient ID, data changed or accessed,

date&time.

Interface for user activity tracking and log file controlling must be implemented by provider.

The monitoring and record keeping concerning any use of the system by anyone should be on the

24/7 basis, generating a security trail for analysis, review, evaluation, and system checking. The

automatic processing of the logs should be subject to searches for access and usage behavior

patterns and consequently semantic reports. Once a particular transaction has been saved, it

should not be possible to delete it (i.e., a new transaction must be initiated to change the data, butthe original transaction should still be accessible).


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4.3.9 Telecommunications

Telecommunication lines for HDAC and contracts with telecommunication providers in Macedonia

will be performed, financed and agreed by MoH. Awarded provider for IHIS solution will have to

ensure and install adequate telecommunication equipment in HDAC center. Beside HDAC

telecommunication equipment it is required from the provider to set up or verify local area networksin HCIs according to the implementation plan (described in more detail further in the document

where describing HCI subsystems and implementation plan).

Required equipment for HDAC to be provided:

- High performance gigabit switch(es) (incl.: quality of service SW, web based access, virtual

LANs)

- Router(s) (enabling static IP, DHCP, IP VPN connections)

- Patch panel(s) CAT6

- Patch cords CAT6

- Other equipment according to offered solution needs

4.3.10 System backup & Disaster recovery

Provider must offer and implement hardware equipment and software for periodical data and

system backups. Backups will be managed in HDAC by local staff. Backup media will be stored in

other location outside HDAC. During the first phase of implementation, provider will have to

perform training for local staff in HDAC center to gain optimal knowledge for managing

backup/recovery processes. During first phase of implementation, provider will have to prepare

document describing procedures for backup/recovery.

In later phases, according to the implementation plan, provider will have to establish fully functional

backup location (hot location) with all hardware, software, solutions and other equipment.

Communication lines will be ensured by MoH, backup location (geographical location in

Macedonia) will be agreed between MoH and provider. Parallel to backup location set up provider

should prepare complete document describing all processes for disaster recovery, business

continuity and contingency planning.

4.3.11 Data Migration

Provider will have to migrate data from existent systems and databases if needed to new IHIS

database. Existent sources of data which should be considered carefully, filtered if necessary,

normalized if necessary and then migrated into new database:

- Register of drugs (Drug Bureau)

- Register of herbal medicines (Drug Bureau)

- Register of Doctors (Macedonian Medical Chamber)

- Register of Dentists (Chamber of Dentists)

- Register of insured citizens (HIF)- Register of all Health care institutions in Macedonia (data will be provided by MoH)


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- Register of outpatient and inpatient services

- Register of Nurses and other professional health care staff

- Others

MoH and other institutions will provide the latest existent data which is worth of migrating to new

platform. Migration (either with software interfaces or manually) should be implemented by

provider.

4.3.12 HDAC organization

MoH will dedicate 2 4 educated staff with minimum 5 years of experience in managing processes

in datacenters. They will be competent for strategic processes of IHIS implementation and strategic

development in the future as well as operation procedures in data center (e.g. backups, traffic

monitoring).

HDAC center will bi placed within MoH.

4.4 Patient Health ID & Insurance card, Professional ID Health Card

4.4.1 Health insurance card and patient identification

IMPORTANT NOTICE: Designing, printing and ID cards delivery IS NOT REQUESTED with

this tendering procedure and should not be included in to the offer. It is required from the

provider to assure software solution which will be capable of using bar code cards and

standard bar code readers. For ID cards and bar code readers there will be another

tendering procedure parallel to this tendering procedure.

Provider will have to establish subsystem for health insurance and patient ID card (also HIPID

card). HIPID Subsystem must be integrated with other IHIS subsystems (e.g. for patient input or

output, HIPID card should be used in combination with professional staff identification).

Subsystem will have to be designed and aligned with current information system on HIF, where the

register of all ensured citizens already exists and each patient has his/her own insurance number.

The most important functionality enabled by HIPID will be patient identification and checking

patient insurance status - patient identification number and patient insurance number have to be

linked.Patients will have to use HIPID card for each contact with health care institutions, pharmacies,

IHPs and HIF in needed. This card will be unique identification for single citizen of the Republic of

Macedonia.

It is decided that HIPID card will carry only basic personal and ID data with no chip on it. All other

personal and medical data will be stored in central database and could be accessed from each

institution connected to the IHIS. The final decision of MoH and other stakeholders is to

implement bar code card with basic written data on it.

Data, that will be printed on bar code card or coded in bar code, will be defined at the beginning of

the project by MoH and discussed with the provider.


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4.4.2 Professional staff identification

IMPORTANT NOTICE: Designing, printing and ID cards delivery IS NOT REQUESTED with

this tendering procedure and should not be included in to the offer. It is required from the

provider to assure software solution which will be capable of using bar code cards and

standard bar code readers. For ID cards and bar code readers there will be anothertendering procedure parallel to this tendering procedure.

Provider will have to assure software solution for professional staff identification card (PID card)

which will be similar to HIPID card with basic personal and professional data. PID cards must be

integrated with other IHIS subsystems (e.g. for patient input or output, HIPID card should be used

in combination with professional staff identification).

Professional staff will have to use PID cards for each contact with patient. This card will be unique

identification for professional of the Republic of Macedonia. IHIS must be implemented in a way

that professional staff will use their PID in combination with their username and password to

access HCI subsystem and functionalities.

Data, that will be printed on bar code card or coded in bar code, will be defined at the beginning of

the project by MoH and discussed with the provider.

Types of professional staff which will receive PID:

- general practitioner

- doctor specialist

- physiotherapist

- nursing staff

- laboratory assistant

- pharmacist

- other staff defined by MoH

4.5 HCI subsystem

4.5.1 Introduction of HCIs subsystem

Provider must offer and implement web based IHIS subsystem for HCIs. Web based applications

and modules will be hosted in HDAC using central database with decided EHR/EPR standards.

HCI subsystem must provide modern information services for HCIs. It will have to support all

relevant medical processes, administration processes and data records for Health homes

(centers) and also common medical processes and data records for Hospitals and other

HCIs with purpose to use all advantages of central EHR/EPR database. Functionalities are

described in more detail further in this chapter 4.5.


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4.5.2 Hardware, System software and telecommunication for HCIs

IMPORTANT NOTICE: Hardware, System software, telecommunication equipment and

installation services for equipment for HCIs are not requested with this tendering procedure

and should not be included in to the offers. The specification in this chapter should be used

only as information for bidders to have clearer picture of the whole project complexity.Another tendering procedure for HCIs Hardware, System software and telecommunication

equipment and installation will start parallel to this tendering procedure.

Most of Health homes (centers) do not possess adequate hardware, system software and

telecommunication equipment and capacities to join IHIS and start using HCIs subsystem through

web interfaces or any other complex system. Therefore provider will have to set up local area

networks for Health Homes (e.g. installing router, cables, end connectors), install hardware

equipment (personal computers, printers, bar code readers) and system software according to the

implementation plan within special tendering procedure not part of this tender.

Local area network should be at least CAT 5e standard, minimum 100Mbit/s. Communication lines

between HCIs and HDAC will be provided through IP VPN (static VPN) in the network provided by

MoH. Also backup ADSL line must be established in case of primary connection failure backup

lines will be also provided by MoH or HCIs and are not a part of the tender. Communication lines

and services will be coordinated and agreed between MoH, HCIs and telecommunication providers

in Macedonia in the first phase of implementation.

Some hospitals already possess adequate hardware, system software and LAN equipment and

others not. According to the implementation plan also Hospitals will be included and provider will

have to install missing hardware, LAN and system software in Hospitals if necessary not part ofthis tender. Hospitals, which will decide to use their own software and will connect to IHIS using

interface (described further in the document), will have to upgrade their software, servers and local

communication equipment by them selves. It this case only advanced communication lines

between Hospitals and HDAC (not part of this tender) will be provided by MoH and some

computers workstations with bar codes readers should be installed by the awarded provider

according to the implementation plan.

Local area network in HCIs should be implemented or upgraded by the awarded provider in

special tendering procedure not part of this tender. Needed equipment for local area network(e.g. for one building):

- Router

- Switch(es)

- UPS

- Patch Panel

- Patch and link Cables

- Rack (sized for all equipment described above + minimum 10U free space)

- LAN Wiring: CAT.5E, STP


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- Office equipment (metal canals, RJ-45 jacks with anti dust cover, cables, grounding

according to standards, standard electrical jacks, standard electrical jacks for UPS, testing,

measuring)

Standard working place:

- element with two RJ-45 jacks with anti dust cover (left jack for data, right jack for telephone)

- one element with 3 standard 230V jacks

- one element with 3 UPS 230V jacks

- labels for data and telephone jack (numbers related to patch panel)

- for 10m2 2 standard working places are required, for each next 7m2 aditional 2 standard

working places are required (e.g. for 17m2 office, 4 standard working places must be

provided)

Important common characteristics to be included in designing and implementing LANs in HCIs:

- LAN will be used for two purposes:

q Web based IHIS applications hosted in HDAC center with high security demand

q General access to the internet (traffic splitting)

- Connection from HCIs to HDAC center will be based on IP VPN

- 10/100 Ports for end users, additional 10/100/1000 Ports on Switch

- Integrated security solution (Firewall, VPN SSL, Authentication, Encryption, MAC Based

Filtering, URL Filtering, Access Control, System Log, traffic and bandwidth limiting, Web

based monitoring software)

- Free VPN tunnel connections must be available

- Each floor must have its own data switch

- Equipment (Router) must be adjustable to enable different adapters (copper, optic fiber)

- Autonomy (UPS) minimal 15 minutes

- VoIP Ready (upgradable with VoIP modules and IEEE802.3af standard)

- VLAN Ready

- WLAN ready (upgradable with WLAN modules, 802.11b/g/n standard)

- All equipment rack mountable

- Respecting local (Republic of Macedonia) standards for wiring FTP and 230V.

Awarded provider for this equipment will have to prepare detailed LAN schemas, wiring schemas,

LAN components characteristics and cost calculation at the beginning of the project for each

building or location. After inspecting and approving plans and calculations by MoH, provider will

have to install required hardware.

Standard specification forworkstation that should be provided and installed by provider accordingto the implementation plan (not part of this tender) is:


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- The proposed PC configurations must have minimum score of 270 under the SYSmark

2004 SE Benchmark (Sysmark 2004 Rating) and 210 under the SYSmark 2004 SE

benchmark (Office Productivity (Overall)). Benchmarks and scores are available on

www.bapco.com. CPU should be 64 bit (emulated processors would not be acceptable)

and working at designated CPU frequency by the CPU vendor. CPU must have at least

three years warranty from the original CPU producer and this must be documented properly

by the original CPU producer.

- Memory: DDR, minimum 1Gb RAM, maximum 4Gb

- Disk: 200 Gb disk space or more; ATA or SATA or SATA II; minimum 7200 rpm; minimum

8MB cache

- Graphics: minimum 256 Mb (not shared), supporting native resolution for 15 and 17

monitors, DVI port

- CD/DVD: DVD ROM + CD R/W (combo drive)

- Network: 10/100/1000 Mbit/s Fast Ethernet Network Card

- Sound: Integrated sound card

- Ports and interfaces: minimum: 6xUSB 2.0, 1xSerial, 1xPS/2 Mouse, 1xPS/2 Keyboard,

1xParalel, 1xVGA, 1xDVI-Out, 1x MIC audio, 1xLine out Audio, 1xRJ45

- Mouse & Keyboard: 1xstandard mouse, 1xkeyboard

- Standard BarCode Reader: 1x (for reading bar codes printed in Health insurance card and

patient identification and Professional staff identification)

- Monitor: LCD 17 supporting native resolution for 17 monitors- Operating system: MS Windows XP Pro or other equivalent with similar functionalities;

Software for rescue and recovery

- Warranty: 3 years minimum

Standard specification forprinter that should be provided and installed by provider according to

the implementation plan is:

- Resolution: 600 x 600 dpi

- Pages per minute: minimum 16ppm, or better

- Memory: minimum 8 MB, or better

- Connection: USB 2.0

- Software: Drivers for Windows XP

- Toner: Toner cartridge included

- Warranty: 1 year minimum


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4.5.3 Special medical/hospital software

Special medical software for Health homes and Hospitals will be hosted in HDAC and used by

professional medical staff thorough web browsers (solution should be adapted for latest version of

Internet Explorer or Mozilla).

Software functionalities for Health Homes:

Software solution must support all relevant areas in the primary Healthcare. Minimal requirement is

to support next areas:

- Common functionalities (functionalities that are commonly used through different sectors,

outpatient clinics, doctors, specialist or nurses according to security schema):

q Patient scheduling

q Patient identification

q Assigning patients to chosen doctor as family/personal GP chosen physician

q Accessing patient records and archives in central EPR/EHR database

q Updating patient records in EPR/EHR database according to specific medical area

(for each appointment, visit or performed service for the patient)

q Updating specific and essential medical notes for patients in central database (e.g.

chronic disease, allergy, disability,..)

q Creating, updating and deleting personal patient data in central database according

to security schema (e.g. for general practitioners, family doctors). Once a particular

transaction has been saved, it should not be possible to delete it (i.e., a new

transaction must be initiated to change the data, but the original transaction shouldstill be accessible).

q Using central registers and coding lists (e.g. central drug register, central register of

HCIs, ICD-10, coding list of provided services required by HIF)

q Ordering patients (Order Entry) to in-house diagnostics and examinations.

q Connection with laboratory and other In-house diagnostic and examination units

(e.g. X-Ray Organizational unit) reporting test and examination results from

diagnostic and examination units to other units (results will be stored in central

database).

q Referring patients to other specialist or examinations to other HCIs

q Drug prescription

q General reporting (on provided services, scheduling, costs) and reporting for

specific areas in primary Healthcare

q Preparing and issuing invoices for patients which are paying for services fully or

partly by them selves.

q Preparing reports or entering data for NIHP, HIF or MoH only for data which could

not be generated automatically from existent records for patient or services incentral database.


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- Specific functionalities supporting processes and data records for:

q general practitioners (supporting processes and data records for general

practitioner)

q dental practitioners (supporting processes and data records for dental practitioners)

q gynecological practitioners

q laboratory

q physical therapy

q rescue services (transport)

q emergency services

q X-Ray services

q ultrasound services

q neurology

q dental technique

q psychiatry

q orthodontics

q pediatric

q preventive medicine for children and schools

q preventive occupational medicine

q home visits of general practitioners and nurses

q other areas and services commonly provided by health homes

Software solution must support basic functions for practitioners: professional staff registration and

identification, patient scheduling, patient identification with HIPID card, keep records on diagnosis

and provided services for patient, track data for each patient in EHR/EPR central database

according to user rights, drug prescription (e-prescription module), laboratory results preview, etc

(described above: common functionalities). Special solutions and added value for all special areas

of primary health care is desired.

E-prescription must enable doctor to prescribe drugs electronically without any paper. Data about

prescribed drug must be stored in central database.

Reporting to HIF and NIHP must be implemented electronically and automatically if data required

for reporting already exists in central IHIS database reports should be generated automatically

and stored in central IHIS database (later Data Warehouse). Reporting formats and forms will be

presented to the provider after award of the MoH contract.

Software must be adjustable in a way to implement DRG or to connect with DRG subsystem,

which is planned to be implemented in year 2008.


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Health homes will be connected to the IHIS regarding implementation plan presented in this

document.

Software functionalities for Hospitals:

Some hospitals already have their own applications or information system, also clinics in Clinical

Center in Skopje, other hospitals have weak software solution or they dont use it at all. It is

required from provider to provide basic software solution with common functionalities for

hospitals. Software should also be web based (users should access software through web

browser). Software must use central EHR/EPR database to store all relevant data according to

chosen EHR/EPR standard.

Reporting to HIF and NIHP must be implemented electronically and automatically if data required

for reporting already exists in central IHIS database reports should be generated automatically

and stored in central IHIS database (later also Data Warehouse). Reporting formats and forms will

be presented to the provider after award of the MoH contract.

For hospitals and clinics which already use their own systems and are capable to communicate

with other systems, it is required from the provider to prepare one unified interface for all existent

solutions. Interface must be implemented according to EHR/EPR and HL7 v.3 standard and

according to reports that hospitals have to send to other institutions (e.g. HIF). XML format is

preferred for communication. Existent hospital system upgrade will be carried out by hospitals

themselves, regarding to specifications of software interface prepared by the provider therefore

existent hospital software adjustment is not required from provider. Hospitals, which will decide to

use their own software and will connect to IHIS using interface, will have to upgrade their software,

servers and local communication equipment by them selves. It this case only advancedcommunication lines between Hospitals and HDAC (not part of this tender) will be provided by

MoH and some computers workstations with bar codes readers should be installed by the awarded

provider according to the implementation plan (hardware installation for HCIs in not a part of this

tender).

Basic Software solution for hospitals:

Software solution must support relevant areas in Hospitals. It is required to provide basic and

common functionalities for Hospitals (e.g. ADT (Patient Admissions/Discharge/Transfer) data and

functionalities). Its is important for Hospitals to use central EPR/EHR database and all benefitsoffered. Minimal requirement is to support next areas:

- Common functionalities (functionalities that are commonly used through different sectors

in Hospitals according to security schema):

q Patient scheduling, scheduling appointments

q Patient identification and registration (identifying patient, registering at reception

desk, selecting doctor)

q Internal patient management In-Patient management

q Recording provided services for patient, medicines, materials at individual patient

level


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q Referring patients to examinations and other outpatient clinics, recording and

tracking results Transfers

q Ordering other services, medicines, materials for patient

q Out-patient administration and management, recording and tracking results

q Accessing patient records and archives in central EPR/EHR database

q Updating patient records in EPR/EHR database according to specific medical area

(for each appointment, visit or performed service for the patient)

q Updating specific and essential medical notes for patients in central database (e.g.

chronic disease, allergy, disability,..)

q Preparing discharge letters and notifications

q Basic functionalities and processes for financial and inventory calculations

q

Using central registers and coding lists (e.g. central drug register, central register ofHCIs, ICD-10, coding list of provided services required by HIF)

q Connection with laboratory and other In-house diagnostic and examination units

(e.g. X-Ray)

q General reporting (on provided services, scheduling, costs) and reporting for

specific areas in primary Healthcare

q Preparing and issuing invoices for patients which are paying for services fully or

partly by them selves.

q Preparing reports or entering data for NIHP, HIF or MoH only for data which could

not be generated automatically from existent records for patient or services in

central database.

Hospitals will be connected to the IHIS regarding implementation plan presented in this document.

4.5.4 Financial, accountancy and administrative solution FAAS

It is required from provider to provide basic software solution with common financial,

accountancy and administrative solution for health centers and hospitals. Software should

be web based (users should access software through web browser). Software must use centralIHIS database in HDAC to store all relevant data for administrative and accountancy processes

and to use central registers and coding tables. Software must be adjustable in a way to implement

DRG in later phases.

Financial, accountancy and administrative solution (FAAS) must be tightly integrated with special

medical and hospital information software described above. FAAS must use same registers,

coding tables and other relevant data wherever possible to avoid double manual data entry and to

process data more efficient.

Reporting to HIF must be implemented electronically and automatically if data required for

reporting already exists in central IHIS database reports should be generated automatically and


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stored in central IHIS database. Reporting formats and forms will be presented to the provider after

award of the MoH contract.

Some health centers and hospitals already have their own applications or information system for

administrative and accountancy processes. For HCIs which already use their own system and its

capable to communicate with other systems, it is required from the provider to prepare one unifiedcommon interface. Provider will have to develop only one unified interface according to data

interchange standards. All existent systems will have to adjust their logic to communicate with this

standard Interface. Interface must enable HCIs to report required administrative and accountancy

data to the central IHIS database. Basically this interface should be developed on the basis of

reports required by HIF. Interface should use XML format for data exchange. Reporting formats

and forms will be presented to the provider after award of the MoH contract. Existent HCIs system

upgrade will be carried out by HCIs themselves regarding to specifications of software interface

prepared by provider therefore existent software adjustment is not required from provider. HCIs,

which will decide to use their own software and will connect to IHIS using interface, will have to

upgrade their software, servers and communication equipment by them selves.

Required modules and functionalities of FAAS:

- General ledger

q Standard functionalities with standard reports

- Managing payments and invoices (accounts payable, account receivable)


- Managing partner contacts and partner basic data used for payments and invoices

- Material ledger with small inventory support


- Asset Management


- Inventory management including stock management


- Hospital pharmacy inventory management

q Standard functionalities (e.g. ordering, stock, costs,) with standard reports

q Integrated with described software solution for hospitals and health centers

q Sending material and drug orders to HIF (interface with HIF solution is required)

q Reporting to HIF according to the HIF rules and the list of positive drugs

- Human resource management including module for managing salaries/payrolls


- Procurement, purchasing, ordering module


- Basic tools for analyzing (report), planning and forecasting


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- Software solution must be fully integrated with software for hospitals and health homes.

- It is required to record and track all expenses for provided medical services, material and

other costs foreach patient. The solution must enable functionality to prepare invoices for

patients. Costs for invoices must be calculated automatically from recorded costs per

patient and according to the patient health insurance status and rules for refunds.- Recorded services per patient, materials, invoices and all costs per patient will be stored in

central database and must be accessible to HIF for further processing in HIF information

system (interface to HIF is required).

- Software must be implemented and adjustable in a way to implement DRG or to connect

with DRG subsystem, which is planned to be implemented in year 2008.

- Supporting other basic financial, accountancy and administration operation needed to run

business in hospitals and health centers.

- Solution must support standard reports for all information areas and dimensions covered in

the solution. Solution must also support custom reports defined by users through several

parameters (e.g. period, cost center, material, partner)

- Solution must use central registers and coding tables in HDAC (e.g. register of all HCIs,

register of HCI staff,)

- Solution must be integrated with medical/hospital information system offered by the

awarded provider.

- Solution must use central database in HDAC.

- No manual data entry/transfer from medical/hospital information system to financial and

accountancy system is allowed or vice versa. If data already exists in central database it

should be used or linked automatically for further processing.

4.5.5 Database

All personal data, medical data, accountancy data, administrative data, reports and other relevant

data for this subsystem (HCI subsystem including EPR/EHR) must be stored in central database in

HDAC. Local databases physically placed in HCIs are not planned.

Database requirements for Special medical/hospital software and Financial, accountancy and

administrative software:

- Database will be placed in HDAC central database center, therefore requirement for central

HDAC database, described in 4.3.4, must be fulfilled,

- Database for Special medical/hospital software and Financial, accountancy and

administrative software must:

q use central registers and coding tab in HDAC

q store medical data, personal, data, EHR/EPR data, transactional data, financial

data, accountancy data other administrative data

q store all relevant data produced by Special medical/hospital software and Financial,accountancy and administrative software


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q implement EHR/EPR record according to chosen standar