2017 Infokes Sesi 7 GYS Standard dan Interoperabilitas Informatika Kesehatan Update

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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}

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 _{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?

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MoH

SI GIZI HRIS

SI STBM Faskes

FaskesHealthcare _Faskes Facility

Lainnya REGISTRY

SURVEILANCE

VITAL STATISTIC REPORT

Lainnya_Lainnya Others

BPJS Kes HEALTH

FACILITY REGISTRY

MEMBERSHIP

SEP

P-CARE

Social Health Insurance

Individual

Data

Aggregate

Data

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Sistem Informasi digunakan di semua level organisasi

kesehatan

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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.

 _AnEHR is a computerized health record used to capture, store, access and share summary information for a patient between health-care

organizations and providers.

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 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

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 _Data_standards  _Resistensi

 _{Regulasi dan tatakelola}

 _{Privasi dan kerahasiaan data}  _{Mekanisme insentif}

 _Investasi

 ………

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 _{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

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 _{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

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 _{Struktur informasi/ messege}

untuk setiap aktivitas

 _{Pasien baru}

 _{Admisi pasien}

 _{Pemeriksaan fisik}

 _{Hasil pemeriksaan penunjang}

 _Diagnosis

 _{Tindakan medis}

 _Obat

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codeSystem="2.16.840.1.113883.6.1"

displayName="GLUCOSE^POST 12H CFST:MCNC:PT:SER/PLAS:QN"/> <statusCode code="completed"/>

<confidentialityCode code="N"

codeSystem="2.16.840.1.113883.5.25"/>

</referenceRange>

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 _{Classification, vocabulary, and terminology standards;}  _{Data interchange standards; and}

 _{Health record content standards}

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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

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 IHTSDO  SNOMED-CT

 _{Regenstrief Institute} _LOINC

 _WHO _{WHO International Family of Classification}

 _HL7

 _DICOM

 _NLM _RxNorm

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 _{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

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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 (OpenHIE)}

 _{Penggunaan standar data kesehatan (terminologi dan klasifikasi)}

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Maturitas model interoperabilitas

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EHR evolution

Collector

Phase 1 Documenter

Phase 2 Create

data/information, Unidirectional

Goal: intention Point-of-care data capture,

Simple Alert system, Result management Goal: Efficiency

Longitudinal record

DSS in acute care and ambulatory Goal: efficiency, patient safety

Helper

Phase 3

Evidence-based practice

Combine with PHR

Goal: Consumer empowerment

Health Information exchange Goal: Integrated health service

Partner

Phase 4 Mentor

Phase 5

GartnerGroup generation of EHR (Amatayakul, 2009)

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Point-to-point interface

Keuangan

Pendaftaran

Laboratorium

Radiologi

In

te

rf

a

ce

1

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Interface Engine

Interface Engine

Pendaftaran

Laboratorium

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Interoperabilitas

Technical Interoperability

Semantic Interoperability

Proce

ss I

nte

rop

era

bi

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TB MCH

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

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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

Distribution

Reporting

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INA-CBGs (DRG)

HOSPITAL SYSTEMS

SEP SYSTEM

WEB SERVICE

CLIENT REGISTRY P-CARE

WEB SERVICE

PRIVATE CARD ID

REFERRAL ID

SEP ID

P

UBLI

C

CARD ID REFERRAL ID

C

LAI

M

SIM BPJS dan SIM Faskes (SIMRS, SIMPUS)

Membership verification

Admission registry

SUPPLY DATA

PHC SYSTEMS

SIKDA

e-Puskesmas OTHERS SIMPUS

HOSPITAL SYSTEMSHOSPITAL _SYSTEMS Information

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Arsitektur Pertukaran Data Kesehatan

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Health Information Exchange

Healthcare Providers Payors Supply Chain Personal Health

Portal Others

Community health workers

Systems Hospital

Systems Lab.

Systems

Pharmacy Systems Primary Care

Systems

Private Insurance Providers Public Insurance Providers

Pharmaceutical company Distribution

channel Medical Suppliers

Personal Health Records

Public

Health Research

Government Community/NGOs

Client Registry

Health Provider

Registry

Health Facility Registry

Terminology Standard

Shared Health Records

Emergency Medical Services

Health Managament

Information Systems

Telemedicine Finance/Bank

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Goal of EHR: Health Information exchange

 Model Consolidated: Central Repository System

Central Database

Praktek Pribadi

Puskesmas

Rumah Sakit

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Local repository

Goal of EHR: Health Information exchange

 Federated: independence repository system

Praktek Pribadi _Puskesmas Dinas Kesehatan Klinik/RS Swasta Rumah Sakit

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Goal of EHR: Health Information exchange

 Patient Manage model

Praktek Pribadi Puskesmas

Rumah Sakit

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•Laws and regulation

Regulatory 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 citizen

Access information

Bagaimana mencapai interoperabilitas?

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 _{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}

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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

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 _{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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