2016 Infokes Sesi 7 GYS Standard dan Interoperabilitas 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

www.healthinformaticsforum.com

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 Faskes
Healthca CLINIC
Faskes
Faskes
CARE
re

Social
BPJS
Health
Kes
Insuranc
e

SEP

Individual
Data

P-CARE

Facility

INDIVIDUAL
PRACTICE

SIHA

HRIS

KARTINI

SI STBM
INA-CBGs

MoH

KOMDAT
E-LOGISTIK
SI
GIZI
SURVEILANCE
Lainny
REPORT Lainny
Lainny
aa
Others

a

REGISTRY

VITAL STATISTIC

SITT

DHIS2
SIP

Data
Source

HIS

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 eHealth 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,

machine-readable meaning of specific terms and messaging
standards permitting the electronic exchange of information
in a consistent manner

Terminologi dan klasifikasi
Standar Lokal/Nasional

Standar Internasional

Sosio-demografi
Obat

ICD 10
ICD 9CM

Billing

ICD-O

Unit layanan
Panamaan tempat tidur
…….

UMDNS
LOINC
NANDA, NOC, NIC
…….

Message Protocol (HL7 V3)

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  WHO International Family of Classification
HL7
DICOM
NLM  RxNorm

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 (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-

Evidence-based
practice

Collector
Phase 1
Create
data/informatio
n,
Unidirectional
Goal: intention

Document
er
Phase 2
Point-of-care
data capture,
Simple Alert
system,
Result
management
Goal: Efficiency

Combine with
PHR

Helper
Phase 3
Longitudinal
record
DSS in acute
care and
ambulatory
Goal:
efficiency,
patient safety

Waktu

GartnerGroup generation of EHR (Amatayakul, 2009)

Goal: Consumer
empowerment

Partne
r
Phase 4

Health
Information
exchange
Goal:
Integrated
health service

Mentor
Phase 5

Interface 1

Keuangan

Laboratorium

In

e2
ac
f
r
te

Interface 3

Pendaftaran

Radiologi

Keuangan

Sh
are

Laboratorium
da

da
e
r
a
Sh

Pendaftaran

ta

Interface Engine

at a
d
e
ar
h
S

ta
Sh

ar e

da

ta

Radiologi

Process Interoperability
Technical
Interoperability
Semantic
Interoperability

DHIS2

TB

AIDS

Data access
& use

DISTRICT:
Integrated data
warehouse &
dashboard

Vaccine
IDS
MC
R
H

DHIS2

Malaria

PROVINCE:
Integrated data warehouse
& dashboard used by all

Others

TB
Vaccine

AIDS

MC
H
Others

IDS
R
Malaria

Puskesmas – Health facility

PUSKESMAS:
Programs use DHIS2,
both data use and
reporting

Distribution
Reporting

Promoting Drug
Standard

Internet
Web Services

Pharmacy Warehouse
MoH

Data Bank
E-Logsitik
MoH
Output
202.70.136.60:8181/e-logistics

Medical Product
Distribution

Internet
Web Services/
txt File

Pharmacy
Warehouse DHO

Monthly report

Internet

Pharmacy
Warehouse PHO

.txt based
information
sharing

Primary Care
Information
Systems

PHC
SYSTEMS

CLIENT
REGISTR
Y

P-CARE
Information
exchange

CARD ID
REFERRAL ID

WEB
SERVICE
PRIVATE

SEP SYSTEM
SIMPUS

ePuskesmas

OTHERS

Admission registry

WEB SERVICE
SEP ID

INA-CBGs
(DRG)

CLAIM

SIKDA

HOSPITAL
HOSPITAL
HOSPITAL
SYSTEMS
SYSTEMS
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

Central Database
Praktek Pribadi
Rumah Sakit

Puskesmas

Dinas Kesehatan

Klinik/RS Swasta

Goal of EHR: Health Information exchange
Federated: independence repository system
Cloud Computing
Electronic Exchange

Local
repository

Praktek Pribadi

Local
repository

Puskesmas

Local
repository

Dinas Kesehatan

Local
repository

Klinik/RS Swasta

Local
repository

Rumah Sakit

Goal of EHR: Health Information exchange
Patient Manage model

Standard
Interoperabilitas

Patient's
repository

Rumah Sakit

Klinik/RS Swasta

Dinas Kesehatan

Praktek Pribadi

Puskesmas

Bagaimana mencapai interoperabilitas?

Mansoor, Majeed. 2010. Achieving Interoperability among Healthcare Organizations

Peluang interoperabilitas
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

Tatakelola interoperabiltias

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