standards and systems implementaon: challenges in implemenng … 1 workshop files/aehin-day...
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Standards and Systems Implementa/on: Challenges in implemen/ng HIS and ICD 10
in Cambodia By: Dr. Mean Reatanak Sambath M&E and Health Informa/cs Program Leader USAID BHS Project implemented by URC Cambodia Email: msambath@urc‐chs.com 7‐10 August 2012, Bangkok Thailand
Standards and Systems Implementa/on
• Standard repor+ng forms – HC1 form is for health centers – HO2 form is for hospitals
• Processing in HMIS on monthly basis • Accessibility at all level
Integra/on and interoperability
HMIS Launched 2011
– Greatly increased repor+ng (quan+ty, quality, and +meliness)
– Increased use of HMIS for informa+on
– Integra+on and interoperability
Timely Repor/ng
0% 20% 40% 60% 80% 100%
2010 2011 2012
Percentage of MoH health facili/es with /mely repor/ng of HMIS data to MoH
Percen
tage
Daily HMIS Page Visits
2852
7950
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
Num
ber o
f Page Visits
Implemen/ng Pa/ent Medical Record System‐PMRS
PMRS
• Started in Siem Reap
Provincial Hospital on
November 2011
• Hospital-based patient
database
• Integrated database system
Method
Medical school graduate students
• Review diagnosis from patient files
• Select diagnosis from ICD 10 codes
(21242 diagnosis codes in 2011)
• Type diagnosis if not in ICD10 list
Tes/ng ICD 10 at health facili/es
Results-Tes/ng ICD 10 at health facili/es
With 21242 ICD 10 codes
Admission Diagnosis
Discharge Diagnosis
Total
# (%) # (%) # (%)
Selected from ICD10
2361 44% 2724 50% 5085 47%
Typing 3042 56% 2729 50% 5771 53%
Total 5403 100% 5453 100% 10856 100%
Code in Pa/ent Record System
Patient ID Ward Admission Discharge
Date Diagnosis ICD Date Diagnosis ICD AG-000447 Med 7/9/2012 Diarrhea and
gastroenteritis A09 7/11/2012 Diarrhea and
gastroenteritis A09
AV-000268 Med 5/14/2012 Respiratory tuberculosis
A15 7/23/2012 Respiratory tuberculosis
A15
AB-002673 Med 7/16/2012 Rabies A82 7/19/2012 Rabies A82
AG-000998 Med 7/18/2012 Dengue hemorrhagic fever
A91 7/20/2012 Dengue hemorrhagic fever
A91
AH-000691 Med 7/22/2012 Plasmodium falciparum malaria
B50 7/26/2012 Plasmodium falciparum malaria
B50
Challenges in Implemen/ng HMIS
• Limited Accessibility of HMIS at remote health facili+es
• New technology and skills on PMRS • Maintenance cost for PMRS at hospitals • More equipment and infrastructure for PMRS
Challenges in Using ICD 10 Code
• Code changes within a year (2011 vs 2012) • Many terms for one code • One diagnosis with mul+ple codes • Limited codes for combined diagnoses • Some codes do not fit into regional needs
Many terms for a single code
O80 is for • Normal deliveries • Encounter for full‐term uncomplicated delivery
• Completely normal delivery case • Completely normal onset of labor • Spontaneous delivery Z38 is for outcome of delivery, unspecified
One diagnosis with mul/ple codes
O82 is for • Cesarean delivery, unspecified • Encounter for cesarean delivery, unspecified Z38.1 is for • Single liveborn infant, delivered by cesarean (outcome of delivery)
One diagnosis with mul/ple codes
Maternal hypertension • O13: Gesta+onal [pregnancy‐induced] hypertension without significant proteinuria
• O16: Unspecified maternal hypertension • O10.1:Pre‐exis+ng hypertension complica+ng pregnancy
One diagnosis with mul/ple codes
S/llbirth • P95‐S+llbirth • Z37.1‐Single s+llbirth • O36.1‐Maternal care for intrauterine death
One Code for mul/ple diagnoses
A09 code • Diarrhea • Acute gastroenteri+s • Enteri+s • Coli+s • etc..
Limited codes for combined diagnoses
• K29.9: Gastroduodeni+s, unspecified • E10.10: Type 1 diabetes mellitus with ketoacidosis without coma
Challenging in Using ICD 10 Codes
• Physicians are not familiar with the codes • Incorrect coding causes incorrect diagnosis classifica+on
• Varia+ons in local language • The accuracy of the code depends on the quality of the diagnosis term
Recommenda/ons
Code • Can not use ICD‐10 instead of diagnos+c term • Doctors must write all the diagnosis words first (with good quality)
• Then assign ICD‐10, but must follow coding rules and guidelines
Recommenda/ons
AeHIN strategic plan could be included • Pa+ent Medical Record System • Use of disease code
– Standard – Integrated in health informa+on system – Integrated medical record system
• Apply web based applica+on for rou+ne repor+ng system and data use
Recommenda/ons
Donors and governments could: • Increase financial resource for
– HIS and eHIN – Pa+ent Medical Record System
• Increase human resources at the country level – Capacity building both na+onally and regionally – Share knowledge and experience
HMIS Collabora/on Peer To Peer Assistance
26
Dr. Sambath (URC) presented HIMS at 6th Na+onal Conference on Informa+on
Technology in Health in Vietnam
May 16‐2012
27
MoH Vietnamese delegates met with the MoH and URC team, 28 May 2012
MoH Vietnamese Delegates visited HMIS in Cambodia
• Create HMIS in Vietnam
• See and experience HMIS in Cambodia