Guardian Y. Sanjaya
gysanjaya.blog.ugm.ac.id
Kenapa standar dan interoperabilitas
Standar dalam informatika kesehatan dan permasalahannya
Model maturitas interoperabilitas, inisiatif dan contoh pelaksanaanya
Konsep pertukaran data kesehatan (HIE)
Strategi untuk mendorong interoperabilitas
Tatakelola untuk mencapai interoperabilitas informatika kesehatan
Outline
www.healthinformaticsforum.com
Berapa banyak sistem informasi kesehatan di tempat kita?
Berapa banyak vendor dan organisasi kesehatan bekerja pada sisteminformasi kesehatan?
Apakah fasilitas kesehatan telah mengadopsi rekam kesehatanelektronik?
Berapa banyak biaya yang terbuang akibat duplikasi pengumpulandata?
Dapatkah interoperabilitas meningkatkan kualitas pelayanan dankeselamatan pasien?
Mengapa interoperabilitas?
MoH
SIHASITT
KARTINI
DHIS2
SIP
HISE-LOGISTIK
INA-CBGs
KOMDAT
SI GIZI
HRIS
SI STBM
FaskesPRIMARYCARE
HIS
CLINIC
INDIVIDUALPRACTICE
FaskesFaskesHealthcare Facility
Lainnya REGISTRY
SURVEILANCE
VITAL STATISTIC
REPORTLainnyaLainnyaOthers
BPJS Kes
HEALTH FACILITY REGISTRY
MEMBERSHIP
SEP
P-CARE
Social Health
Insurance
Individual Data
Aggregate Data
Data Source
Sistem Informasi digunakan di semua level organisasi
kesehatan
Essential Public Health management function
Sistem Informasi di Fasilitas Kesehatan An EMR is a computerized medical record used to capture, store and
share information between health-care providers in an organization, supporting the delivery of health services to patients.
An EHR is a computerized health record used to capture, store, access and share summary information for a patient between health-care organizations and providers.
WHO-ITU. 2012. National eHealth Strategy Toolkit
patient’s problem list, medication record, history and physical, progress notes, consultation reports, physicians’ orders, nurses’ notes and interventions, rehab and other clinical documentation, imaging and x-ray results, lab results, immunization record, operative report, pathology report, and discharge summary
Data Klinis
demographic information about the patient,
consents for treatment and surgery,
authorizations,
pre-authorization,
scheduling,
insurance eligibility,
billing, and
diagnosis and procedure codes (klaim)
Data Administratif
Tipe data yang dikumpulkan
Brooks. 2010. Standards and Interoperability in Healthcare Information Systems: Current Status, Problems, and Research Issue
Data standards
Resistensi
Regulasi dan tatakelola
Privasi dan kerahasiaan data
Mekanisme insentif
Investasi
………
Permasalahan interoperabilitas
An essential building block of interoperability is the adoption and use of:
Terminology, and
Messaging standards
Terminology standards will provide an unambiguous, machine-readable meaning of specific terms and messaging standards permitting the electronic exchange of information in a consistent manner
Kebutuhan interoperabilitas
ICD 10
ICD 9CM
ICD-O
UMDNS
LOINC
NANDA, NOC, NIC
…….
Standar Internasional
Sosio-demografi
Obat
Billing
Unit layanan
Panamaan tempat tidur
…….
Standar Lokal/Nasional
Terminologi dan klasifikasi
Struktur informasi/ messegeuntuk setiap aktivitas
Pasien baru
Admisi pasien
Pemeriksaan fisik
Hasil pemeriksaan penunjang
Diagnosis
Tindakan medis
Obat
<observationEvent>
<id root="2.16.840.1.113883.19.1122.4" extension="1045813"
assigningAuthorityName="GHH LAB Filler Orders"/>
<code code="1554-5" codeSystemName="LN"
codeSystem="2.16.840.1.113883.6.1"
displayName="GLUCOSE^POST 12H CFST:MCNC:PT:SER/PLAS:QN"/>
<statusCode code="completed"/>
<effectiveTime value="200202150730"/>
<priorityCode code="R"/>
<confidentialityCode code="N"
codeSystem="2.16.840.1.113883.5.25"/>
<value xsi:type="PQ" value="182" unit="mg/dL"/>
<interpretationCode code="H"/>
<referenceRange>
<interpretationRange>
<value xsi:type="IVL_PQ">
<low value="70" unit="mg/dL"/>
<high value="105" unit="mg/dL"/>
</value>
<interpretationCode code="N"/>
</interpretationRange>
</referenceRange>
Message Protocol (HL7 V3)
Classification, vocabulary, and terminology standards;
Data interchange standards; and
Health record content standards
Kategori standard
1. Ad hoc – when a group of interested people or organizations agree on a certain specification;
2. Defacto – when a vendor or other commercial enterprise controls such a large segment of the market that its product becomes the recognized norm;
3. Government mandate – when the government mandates a standard;
4. Consensus – when representatives from interested parties work together and reach a consensus.
Pengembangan standard
Brooks. 2010. Standards and Interoperability in Healthcare Information Systems: Current Status, Problems, and Research Issue
IHTSDO SNOMED-CT
Regenstrief Institute LOINC
WHO WHO International Family of Classification
HL7
DICOM
NLM RxNorm
Standard Development Organization
(SDOs)
Need for multi-purpose standards and terminologies
Lack of content in terminology standards
Gaps in data standards
Overlapping standards
Different requirements from different agencies when exchanging data
Changes in standards
Isu yang berkaitan dengan standar
Brooks. 2010. Standards and Interoperability in Healthcare Information Systems: Current Status, Problems, and Research Issue
Interoperabilitas Kemampuan antar sistem yang berbeda untuk komunikasi dan
pertukaran informasi secara akurat, efektif dan konsisten sertamenggunakan informasi tersebut.
Antar sistem di dalam organisasi kesehatan (EMR)
Antar sistem lintas organisasi kesehatan (EHR)
Kebutuhan interoperabilitas
Arsitektur interoparabilitas (OpenHIE)
Penggunaan standar data kesehatan (terminologi dan klasifikasi)
Protokol komunikasi/standar message (HL7)
Maturitas model interoperabilitas
http://caristix.com/blog/2012/11/hl7-survival-guide-chapter-1-how-to-integrate-and-exchange-data/
EHR evolutionCollector
Phase 1Documenter
Phase 2Create data/information, Unidirectional
Goal: intention Point-of-care data capture,Simple Alert system,Result managementGoal: Efficiency
Longitudinal record
DSS in acute care and ambulatory
Goal: efficiency, patient safety
Helper
Phase 3
Evidence-based practiceCombine with PHRGoal: Consumer empowerment
Health Information exchangeGoal: Integrated health service
Partner
Phase 4 Mentor
Phase 5
GartnerGroup generation of EHR (Amatayakul, 2009)
Waktu
Point-to-point interface
Keuangan
Pendaftaran
Laboratorium
Radiologi
Inte
rfa
ce
1
Interface 3
Interface Engine
Interface Engine
Pendaftaran
Laboratorium
Radiologi
Keuangan
Interoperabilitas
Technical
Interoperability
Semantic
Interoperability
Pro
cess In
tero
pera
bility
TB MCH
Vaccine
IDSR
Malaria
AIDS
Others
TB
Vaccine
AIDS
Others
MCH
Malaria
IDSR
PUSKESMAS:
Programs use DHIS2,
both data use and
reporting
DISTRICT:
Integrated data
warehouse &
dashboard
Puskesmas – Health facility
PROVINCE:
Integrated data warehouse
& dashboard used by all
DHIS2
Data access
& use
DHIS2
Integrasi Data Level
Kabupaten/Kota
Output
Sistem Informasi Logistik
Data Bank E-Logsitik
Pharmacy Warehouse
MoH
Internet
Internet
Internet
Primary Care
Information
Systems
Pharmacy
Warehouse PHO
Web Services/
txt File
Web Services
MoH
202.70.136.60:8181/e-logistics Pharmacy
Warehouse DHO
Monthly report
Medical Product
Distribution
Promoting Drug Standard
DistributionReporting
.txt based information sharing
INA-CBGs (DRG)
HOSPITAL SYSTEMS
SEP SYSTEM
WEB SERVICE
CLIENT REGISTRY
P-CARE
WEB SERVICE
WEB SERVICE
PRIVATE
CARD ID
REFERRAL ID
SEP ID
PU
BL
IC
CARD IDREFERRAL ID
CL
AIM
SIM BPJS dan SIM Faskes (SIMRS, SIMPUS)
Membershipverification
Admission registry
SUPPLY DATA
PHC SYSTEMS
SIKDA
e-Puskesmas OTHERS
SIMPUSHOSPITAL SYSTEMSHOSPITAL SYSTEMS
Informationexchange
Arsitektur Pertukaran Data Kesehatan
https://ohie.org/
Health Information Exchange
Healthcare Providers Payors Supply ChainPersonal Health
PortalOthers
Community health
workers Systems Hospital
Systems
Lab. Systems
Pharmacy Systems
Primary Care Systems
Private InsuranceProviders
Public Insurance Providers
Pharmaceutical company
Distribution channel
Medical Suppliers
Personal Health Records
Public Health
Research
Government
Community/NGOs
Client Registry
Health ProviderRegistry
Health FacilityRegistry
Terminology Standard
Shared Health
Records
Emergency Medical Services
Health Managament Information
Systems
TelemedicineFinance/Bank
Indicators and Data Elements
Goal of EHR: Health Information exchange
Model Consolidated: Central Repository System
Central DatabasePraktek Pribadi
Puskesmas
Rumah Sakit
Dinas Kesehatan Klinik/RS Swasta
Localrepository
Localrepository
Localrepository
Localrepository
Localrepository
Goal of EHR: Health Information exchange
Federated: independence repository system
Praktek Pribadi PuskesmasRumah SakitDinas Kesehatan Klinik/RS Swasta
Cloud ComputingElectronic Exchange
Goal of EHR: Health Information exchange
Patient Manage model
Praktek Pribadi Puskesmas
Rumah Sakit
Dinas Kesehatan
Klinik/RS Swasta
• Laws and regulationRegulatory frameworks
• Standard (terminology, registry) Information Structure
• Communication networks, Electronic directory, Identification, Authentication, information structure
Technical Infrastructure
• Electronic Health records, administrative support systems, national patient’s summary, decision support, prescription support
Supportive and interoperable ICT Systems
• Access across organization and boundaries
• Accessibility for citizenAccess information
Bagaimana mencapai interoperabilitas?
Mansoor, Majeed. 2010. Achieving Interoperability among Healthcare Organizations
Standar terminologi kesehatan mulai dikembangkan (idn-hdd.depkes.go.id)
Tersedia standar internasional
Adanya dukungan kebijakan (Peraturan pemerintah)
Keragaman sistem informasi
Inisiasi integrasi sistem dan interoperabilitas
Peluang interoperabilitas
Organization Structure
Recognize
Acknowledge
Endorse by stakeholder
Physical Infrastructure
Application and Demo
ICT equipment
Human Resources
Management competence
Technical Competence
Health competence
Finance
Infrastructure
Human resource
Activity/Research
Maintenance
Activities
Proposed standards
Interoperability Testing
Advocacy
Knowledge management
Tatakelola interoperabiltias
Standar mendukung komunikasi data antar organisasi kesehatan, pelayanan kesehatan yang efisien (interoperabilitas)
Beberapa inisiatif yang mengarah pada isu interoperabilitas
Banyak model interoperabilitas yang sudah terjadi
Perlu tatakelola yang jelas terhadap pencapaian interoperabilitas
Kesimpulan