Standard Integrasi dan Interoperabilitas dalam Informatika Kesehatan Guardian

Standard, Integrasi dan Interoperabilitas dalam Informatika Kesehatan Guardian Y. Sanjaya gysanjaya. blog. ugm. ac. id

Outline 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 sistem informasi kesehatan

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Mengapa interoperabilitas? Berapa banyak sistem informasi kesehatan di tempat kita? Berapa banyak vendor dan organisasi kesehatan bekerja pada sistem informasi kesehatan? Apakah fasilitas kesehatan telah mengadopsi rekam kesehatan elektronik? Berapa banyak biaya yang terbuang akibat duplikasi pengumpulan data? Dapatkah interoperabilitas meningkatkan kualitas pelayanan dan keselamatan pasien?

MEMBERSHIP HEALTH FACILITY REGISTRY HIS PRIMARY CARE CLINIC Faskes Healthcare Faskes Social BPJS Health Kes SEP Insurance Individual Data P-CARE Facility INDIVIDUAL PRACTICE HRIS SIHA KARTINI SI STBM INA-CBGs KOMDAT SURVEILANCE REPORT Lainnya Others SITT Mo. H DHIS 2 Data Source SIP E-LOGISTIK HIS SI GIZI REGISTRY VITAL STATISTIC Aggregate Data

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 e. Health Strategy Toolkit

Tipe data yang dikumpulkan Data Administratif 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) 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 Brooks. 2010. Standards and Interoperability in Healthcare Information Systems: Current Status, Problems, and Research Issue

Permasalahan interoperabilitas Data standards Resistensi Regulasi dan tatakelola Privasi dan kerahasiaan data Mekanisme insentif

Kebutuhan interoperabilitas An essential building block of interoperability is the adoption and use of: Terminology, and Messaging standards Terminology standards will provide an unambiguous, machinereadable meaning of specific terms and messaging standards permitting the electronic exchange of information in a consistent manner

Terminologi dan klasifikasi Standar Lokal/Nasional Sosio-demografi Obat Billing Unit layanan Panamaan tempat tidur ……. Standar Internasional ICD 10 ICD 9 CM ICD-O UMDNS LOINC NANDA, NOC, NIC …….

Message Protocol (HL 7 V 3) <observation. Event> <id root="2. 16. 840. 1. 113883. 19. 1122. 4" extension="1045813" assigning. Authority. Name="GHH LAB Filler Orders"/> <code="1554 -5" code. System. Name="LN" code. System="2. 16. 840. 1. 113883. 6. 1" display. Name="GLUCOSE^POST 12 H CFST: MCNC: PT: SER/PLAS: QN"/> <status. Code code="completed"/> <effective. Time value="200202150730"/> <priority. Code code="R"/> <confidentiality. Code code="N" code. System="2. 16. 840. 1. 113883. 5. 25"/> <value xsi: type="PQ" value="182" unit="mg/d. L"/> <interpretation. Code code="H"/> <reference. Range> <interpretation. Range> <value xsi: type="IVL_PQ"> <low value="70" unit="mg/d. L"/> <high value="105" unit="mg/d. L"/> </value> <interpretation. Code code="N"/> </interpretation. Range> </reference. Range> Struktur informasi/ messege untuk setiap aktivitas Pasien baru Admisi pasien Pemeriksaan fisik Hasil pemeriksaan penunjang Diagnosis Tindakan medis Obat

Kategori standard Classification, vocabulary, and terminology standards; Data interchange standards; and Health record content standards

Pengembangan 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. Brooks. 2010. Standards and Interoperability in Healthcare Information Systems: Current Status, Problems, and Research Issue

Standard Development Organization (SDOs) IHTSDO SNOMED-CT Regenstrief Institute LOINC WHO International Family of Classification HL 7 DICOM NLM Rx. Norm

Isu yang berkaitan dengan standar 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 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 serta menggunakan informasi tersebut. Antar sistem di dalam organisasi kesehatan (EMR) Antar sistem lintas organisasi kesehatan (EHR) Kebutuhan interoperabilitas Arsitektur interoparabilitas (Open. HIE) Penggunaan standar data kesehatan (terminologi dan klasifikasi) Protokol komunikasi/standar message (HL 7)

Maturitas model interoperabilitas http: //caristix. com/blog/2012/11/hl 7 -survival-guide-chapter-1 -how-to-integrate-and-exchange-data/

EHR evolution Evidence-based practice Collector Phase 1 Create data/information, Unidirectional Goal: intention Combine with PHR Documenter Phase 2 Point-of-care data capture, Simple Alert system, Result management Goal: Efficiency Helper Phase 3 Partner Longitudinal record Phase 4 DSS in acute care and ambulatory Goal: efficiency, patient safety Waktu Gartner. Group generation of EHR (Amatayakul, 2009) Goal: Consumer empowerment Health Information exchange Goal: Integrated health service Mentor Phase 5

Point-to-point interface Interface 1 Keuangan Laboratorium ce rfa 2 e Interface 3 Pendaftaran Radiologi

Interface Engine Keuangan Sh are Laboratorium da ta Interface Engine ta ar Sh a ed ta da are Sh Pendaftaran Sh are da ta Radiologi

Interoperabilitas Process Interoperability Technical Interoperability Semantic Interoperability

Integrasi Data Level Kabupaten/Kota TB AIDS Data access & use Vaccine IDSR MCH DHIS 2 Malaria DHIS 2 PROVINCE: Integrated data warehouse & dashboard used by all DISTRICT: Integrated data warehouse & dashboard Others TB AIDS Vaccine MCH Others Puskesmas – Health facility IDSR Malaria PUSKESMAS: Programs use DHIS 2, both data use and reporting

Sistem Informasi Logistik Distribution Reporting Promoting Drug Standard Internet Web Services Pharmacy Warehouse Mo. H Data Bank E-Logsitik Mo. H Output 202. 70. 136. 60: 8181/e-logistics Internet Pharmacy Warehouse PHO Medical Product Distribution Internet Web Services/ txt File Pharmacy Warehouse DHO Monthly report Primary Care Information Systems . txt based information sharing

SIM BPJS dan SIM Faskes (SIMRS, SIMPUS) PHC SYSTEMS CLIENT REGISTRY P-CARE Information exchange WEB SERVICE CARD ID REFERRAL ID SIMPUS e-Puskesmas OTHERS Admission registry SEP SYSTEM WEB SERVICE SEP ID INA-CBGs (DRG) CLAIM SIKDA PRIVATE HOSPITAL SYSTEMS SUPPLY DATA PUBLIC WEB SERVICE Membership verification CARD ID REFERRAL ID

Arsitektur Pertukaran Data Kesehatan https: //ohie. org/

Finance/Bank Telemedicine Lab. Systems Community health workers Systems Primary Care Systems Pharmacy Systems Hospital Systems Healthcare Providers Emergency Medical Services Medical Suppliers Public Insurance Providers Community/NGOs Distribution channel Government Private Insurance Providers Pharmaceutical company Personal Health Records Payors Supply Chain Personal Health Portal Public Health Research Others Health Information Exchange Client Registry Health Provider Registry Health Facility Registry Terminology Standard Indicators and Data Elements Shared Health Records Health Managament Information Systems

Goal of EHR: Health Information exchange Model Consolidated: Central Repository System Praktek Pribadi Rumah Sakit Puskesmas Dinas Kesehatan Klinik/RS Swasta

Goal of EHR: Health Information exchange Federated: independence repository system Cloud Computing Electronic Exchange Praktek Pribadi Puskesmas Dinas Kesehatan Klinik/RS Swasta Rumah Sakit

Goal of EHR: Health Information exchange Patient Manage model Rumah Sakit Klinik/RS Swasta Dinas Kesehatan Praktek Pribadi Puskesmas

Bagaimana mencapai interoperabilitas? Regulatory frameworks Information Structure Technical Infrastructure Supportive and interoperable ICT Systems Access information • Laws and regulation • Standard (terminology, registry) • Communication networks, Electronic directory, Identification, Authentication, information structure • Electronic Health records, administrative support systems, national patient’s summary, decision support, prescription support • Access across organization and boundaries • Accessibility for citizen Mansoor, Majeed. 2010. Achieving Interoperability among Healthcare Organizations

Peluang interoperabilitas Standar terminologi kesehatan mulai dikembangkan (idnhdd. depkes. go. id) Tersedia standar internasional Adanya dukungan kebijakan (Peraturan pemerintah) Keragaman sistem informasi Inisiasi integrasi sistem dan interoperabilitas

Tatakelola interoperabiltias Organization Structure Physical Infrastructure Human Resources Proposed standards Interoperability Testing Advocacy Maintenance Knowledge management Technical Competence Acknowledge Endorse by stakeholder Infrastructure Activity/Research Application and Demo Activities Human resource Recognize Management competence Finance ICT equipment Health competence

Kesimpulan 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

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