2017 Infokes Sesi 7 GYS Standard dan Interoperabilitas Informatika Kesehatan Update

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 informatika 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
CARE

CLINIC
Faskes
Faskes
Healthcare
Faskes

Social

BPJS
Health
Kes

SEP

Individual
Data

Insurance

P-CARE

Facility

INDIVIDUAL
PRACTICE

HRIS

SIHA

KARTINI

SI STBM
INA-CBGs
KOMDAT

SITT

MoH

DHIS2

Data Source

SIP

E-LOGISTIK
HIS

SI GIZI
SURVEILANCE
REPORT Lainnya
Lainnya
Lainnya
Others

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 eHealth Strategy Toolkit

Tipe data yang dikumpulkan
Data Administratif

Data Klinis

 demographic information about the

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

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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
 Investasi

 ………

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

 ICD 10

 Obat

 ICD 9CM

 Billing

 ICD-O

 Unit layanan

 UMDNS

 Panamaan tempat tidur

 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-exchange-data/

EHR evolution
Evidence-based
practice
Combine with
PHR
Goal: Consumer
empowerment

Collector
Phase 1
Create
data/information,
Unidirectional
Goal: intention

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

GartnerGroup generation of EHR (Amatayakul, 2009)

Health
Information
exchange
Goal: Integrated
health service

Mentor
Phase 5

Point-to-point interface
Laboratorium

Interface 1

Keuangan

Interface 3

Pendaftaran

Radiologi

Interface Engine
Keuangan

Pendaftaran

Laboratorium
Interface Engine

Radiologi

Interoperabilitas
Process Interoperability
Technical
Interoperability
Semantic
Interoperability

Integrasi Data Level
Kabupaten/Kota
TB

AIDS

Data access
& use

Vaccine

IDSR

DHIS2

PROVINCE:
Integrated data warehouse
& dashboard used by all

MCH

DHIS2

Malaria

DISTRICT:
Integrated data
warehouse &
dashboard

Others

TB

AIDS

Vaccine

MCH

Others

Puskesmas – Health facility

IDSR

Malaria

PUSKESMAS:
Programs use DHIS2,
both data use and
reporting

Sistem Informasi Logistik
Distribution
Reporting

Promoting Drug
Standard

Internet
Web Services

Pharmacy Warehouse
MoH

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

Pharmacy
Warehouse PHO

Medical Product
Distribution

Internet
Web Services/
txt File

Monthly report
Pharmacy
Warehouse DHO

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

PRIVATE

SEP SYSTEM
SIMPUS

e-Puskesmas

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

Local
repository

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 (idn





hdd.depkes.go.id)
Tersedia standar internasional
Adanya dukungan kebijakan (Peraturan pemerintah)
Keragaman sistem informasi
Inisiasi integrasi sistem dan interoperabilitas

Tatakelola interoperabiltias
Organization
Structure
Recognize

Physical
Infrastructure
Application and
Demo

Management
competence

Finance

Activities

Infrastructure

Proposed
standards

Human resource

Interoperability
Testing

Activity/Research

Advocacy

Maintenance

Knowledge
management

Technical
Competence

Acknowledge

Endorse by
stakeholder

Human
Resources

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