Guardian Y. Sanjaya

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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