eHealth Updates MALAYSIA

Dr. Fazilah Shaik Allaudin

National eHealth: An overview

Dr. Fazilah Shaik Allaudin

Deputy Director

Telehealth Division

Ministry of Health Malaysia

dr_fazilah@moh.gov.my

M A L A Y S I A

S A R A W A K

S A B A H

I N D O N E S I AI N D O N E S I A

SOUTH CHINA SEA

BRUNEI

KEDAH

PERLI S

PERAK

P.PIN AN G

KELANTANTERENGG ANU

PAHANG

SELANG OR

N.SEM BIL AN

M ELAKA JO HOR

SINGAPORE

THAILAND

W.P.LABUAN

W.P. KUALA

LUMPUR

Country Profile

Malaysia occupies a central position within Southeast Asia

Consist of two land masses separated by South China Sea

Land area: 330,289 sq km

Population (2011) : 28,964,300 million

Multiethnic population:

Malay – 54.9%,

Chinese – 24.4%,

Indigenous - 11.9%,

Indian – 7.4%

Others -1.4%

Estimated about 7.3% are non-citizens

Source : Department of Statistics, 2011

Wellness focus

Person focus

Informed persons

Self-help

Care provided at

home/close to home

Malaysia is to be a nation of

healthy individuals, families

and communities……..

5

Malaysia’s Vision for Health & eight (8) Health Goals

Seamless, continuous

care

Services tailored as much

as possible

Effective, efficient and

affordable services

6

74% : 26% 49% : 51% HCDA study

NHMS2011 – only medical visit)

Payment

Mechanism Line Item Budget Fee for Service

Current Healthcare System

Life Expectancy at Birth

7

Source : Department of Statistics, Malaysia, & Health Fact, Health Informatics Centre, MOH, M’sia , World Health Statistics (2013)

Country

% GDP on Health

(2010)

Life Expectancy

(2011)

Japan 9.2 83

Australia 9.0 82

France 11.7 82

Poland 7.0 76

Chile 7.4 79

United Kingdom 9.6 80

China 5.0 76

Malaysia 4.4 74

Thailand 3.9 74

Singapore 4.5 82

Philippines 4.1 69

Indonesia 2.8 69

56.00

61.60

66.40

68.90 69.50

71.80 71.70 71.60 71.60 71.70 72.00 72.30

58.00

65.60

70.50

73.50 74.30

76.30 76.46 76.40 76.50 76.80 77.10 77.20

50.00

55.00

60.00

65.00

70.00

75.00

80.00

1957 1970 1980 1990 1995 2006 2007 2008 2009 2010 2011 2012

Female

Male

AGE

YEAR

LIFE EXPECTANCY AT BIRTH, MALAYSIA ( 1957 - 2012)

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

1957

1960

1970

1980

1990

1995

1999

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Selected Vital Statistics, Malaysia (1957- 2011)

Source : Department of Statistics, Malaysia, & Health Fact, HIC, MOH, M’sia

World Health Statistics (2013)

IMR

NMR

TMR

CDR

8

Country

% GDP on Health

(2010)

Infant Mortality

Rate (2011)

Japan 9.2 2

Australia 9.0 4

France 11.7 3

Poland 7.0 5

Chile 7.4 8

United Kingdom 9.6 4

China 5.0 13

Malaysia 4.4 6

Thailand 3.9 11

Singapore 4.5 2

Philippines 4.1 20

Indonesia 2.8 25

Legend IMR – Infant Mortality Rate NMR – Neonatal Mortality Rate CDR – Crude Death Rate TMR – Toddler Mortality rate

9

Distribution of Government Health Clinics Distribution of Private Health Clinics

Distribution of MOH Hospitals Distribution of Private Hospitals

Distribution of Health Facilities in Malaysia Source : Mapping Study of Health Facilities & Services, IKU MOH, 2013

10

Public & Private Sector Resources and Workload (2011 & 2012)

Source: Health Informatics Center (HIC) , Health Facts 2012 , Family Health Development Division, NHMS 2011 , Unpublished Data National Health Account (MNHA),MOH, Human Resource MOH

53%

64%

82%

40%

49%

9%

47%

36%

18%

60%

51%

91%

0% 20% 40% 60% 80% 100%

Health Expenditure RM Billion (2011)

Doctors(excl. Houseman) (2012)

Bed Days (NHMS 2011)

No. of Hospitals (2011)

Outpatient visits (NHMS 2011)

Health clinics (with doctors) (2012)

Public Private

62,349,900

643

58,775,194 62,349,900

146 220

6675

11,947,836 2,590,606

19,555 11,240

19.8 17.7

Key Challenges

Lack of integration & resource maximisation

Changing trends in socio- demography & disease pattern

Over-stretched public services and facilities

Limited appraisal & reward systems for performance

Greater expectations from the people

Managing the growth and pattern of health spending

11

Trends in NCD and Risk Factors in Malaysia

8.3

14.9

20.8

6.5

9.5 10.7

1.8

5.4 10.1

4.3

4.7

5.3

0

5

10

15

20

25

NHMS II(1996)

NHMS III(2006)

NHMS 2011

Pre

vale

nce

(%)

Prevalence of Diabetes, ≥30 years (1996, 2006 & 2011)

Total diabetes

Known

Undiagnosed

IFG

32.2 32.7

12.8

19.8

0

5

10

15

20

25

30

35

NHMS III (2006) NHMS 2011

Pre

vale

nce

(%)

Prevalence of Hypertension, ≥18 years (2006 & 2011)

Total HPT

Known

Undiagnosed

20.6

35.1

8.4

26.6

0

5

10

15

20

25

30

35

40

NHMS III (2006) NHMS 2011

Pre

vale

nce

(%)

Prevalence of Hyper-cholesterolaemia, ≥18 years (2006 & 2011)

Total HChol

Known

Undiagnosed

16.6

29.1 29.4

4.4

14.0 15.1

0

5

10

15

20

25

30

35

NHMS II(1996)

NHMS III(2006)

NHMS 2011

Pre

vale

nce

(%)

Prevalence of Overweight and Obesity, ≥18 years (1996, 2006 & 2011)

Overweight

Obesity

Source: National Health & Morbidity Surveys (NHMS)

13

Changing Demographic Trends

- Increasing Elderly Population (>60 yrs)

COST IMPLICATIONS

• Cost of health care increases exponentially from age 50 onwards

• Main determinants of health care use (in Netherlands) are old-age and disabling conditions

• Aging and population growth contribute to rise of health care cost

• Aging causes a major acceleration in health care cost

Source : Department of Statistics, M’sia

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

0

500

1000

1500

2000

2500

91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08E

lderl

y

(% o

f P

op

ula

tio

n)

Eld

erl

y P

op

ula

tio

n (

'000)

Year

7.39 7.50 8.27

9.15

10.88 11.32

14.36 13.67

11.99

15.05 15.70

16.23

18.43

19.78 19.80

6.51 6.41 6.97 7.84 8.24 8.92

10.36 11.28

12.14 13.14

14.07 13.85 13.85

16.11 17.75

2.9

3.1 3.2 3.2

3.6 3.7

4.2

4.0

3.7

4.0 4.0 3.9

4.6 4.6

4.4

-

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

0.00

5.00

10.00

15.00

20.00

25.00

RM

Bill

ion

Public Sector, (RM million) in 2011 RM Value Private Sector, (RM million) in 2011 RM Value TEH as % GDP

Source: Malaysia National Health 2011 unpublished

Co

nst

ant

20

11

RM

Health Expenditures (1997 – 2011)

15

Malaysia has health informatics framework combining political commitment, governance & policy and interoperability

Political Commitment

Multimedia Super Corridor (MSC) Flagship - 1996

Economic Transformation

Programme (ETP) – 2010

Digital Malaysia – 2010

Governance/Policy

Telemedicine Blueprint 1997

HIMS Blueprint 2006

8,9 & 10th MP ICT technical papers

National Health Policy 2007

ICT Strategic Plan (ISP-1): (2006-2010)

ICT Strategic Plan (ISP-2): (2011-2015)

Interoperability

MOH LHR Business Framework

Health Informatics Standards

IHE Framework & Malaysia

Connectathon

Malaysian Health Information Exchange

(MyHIX)

Malaysia’s Telemedicine Blueprint & HMIS Blueprint

Health Information Management System of 2006 outlines a national approach for the health information management

Strategies include: national coordination and partnership

health informatics standards, security standards, privacy protection, and infrastructure readiness

implement key national initiatives like LHR services, electronic reporting system and national data warehouse

establish legal, data protection and security framework

16

• The Telemedicine Blueprint, very much focused into leading healthcare into information age

• A visionary blueprint, unveiled in 1997

• Provides conceptual framework for the future health system by harnessing the power of ICT for transforming healthcare

• The focus of the future health system will be on people and services, with key emphasis on wellness

• The strategies in this blueprint revolved around using technology as the key enabler

Envisaged to transform the Malaysian healthcare system to be more integrated, distributed and virtual with the aim of providing equitable, accessible and high quality healthcare services

Demands an integrated health service that is vision and goal focused and addresses that connectivity must be predominantly via electronic means

In political commitment, Multimedia Super Corridor spearheaded the ICT in Malaysia since 1996

Health Online (MyHEALTH Portal)

Continuous Professional

Development (CPD)

Teleconsultation (TC)

Lifetime Health Record (LHR)

Lifetime Health Plan (LHP)

Group Data Services (GDS)

Consumer Relation Management (CRM) via Call

Center

Focus Areas of Telehealth covers all aspects of Healthcare Service Delivery

Established in 1996. In total of 7 flagships were established to propel Malaysia into the ICT limelight under the MSC Malaysia umbrella

Source : MDEC

1MOCC

17

17

Malaysia is also witnessing a new era of political commitment towards digital economy

18 Source : MAMPU

NKEA CCI is the platform in Economic Transformation Programme for the drive towards ICT in healthcare

19

NKEA projects offer …

The 12 National Key Economic Areas (NKEAs) are at the core of the ETP. A NKEA is

defined as a driver of economic activity that has the potential to directly and materially

contribute a quantifiable amount of economic growth to the Malaysian economy

High Income Nation by 2020: 6% growth thru 2020; Double GNI and reach per capita GDP of US$15K

19 Source : PEMANDU EPP Preso Pack

20 Source : MOH LHR Business Framework, 2006

As there are many players in HC, Lifetime Health Record (LHR) would be the key platform to interoperability

ICT

LHR

HIS/CIS/Others HIS/CIS/Others

Integration

Profile (IHE)

Integration

Profile (IHE)

Upload, Query, Retrieve

Retrieve

Query

MyHIX

Malaysia Health Information Exchange (MyHIX) pilot project (2009) is a precursor to the larger LHR services

Source : MDEC

21

Hospital

Port Dickson

Hospital

Seremban

Hospital

Sg. Buloh

1Gov*Net

MyHIX

PoC

MyHIX

Production

KK SG Chua

MyHIX Proof of Concept with MIMOS (2013)

Source : MIMOS

Enhanced capabilities

•Messaging – reliable data transmission

•Include discharge summary and e-referral

•Compression – adjust to bandwidth

•Encryption - secure

•Authentication – ATNA compliance

•Authorization – ATNA compliance

•MyHIX Web-interface

• view & submit E-Referral

• view & submit medical record for external facilities & non-HIS hospitals

Scenario of integrated health services

My

My Kad

Step 1:Access MCPHIE & perform HRA

Step 2, choice 1: Contact call centre

Step 2, Choice 2: Appointment to see doctor

Step 3:Consultation, EMR created

Seeking advice at point of care CME for decision support

Step 4:LHR repository Step 5: Data Warehousing- Support Health & Financial Planning.

PLHP created

Individual

In addressing interoperability, health informatics standards play a vital role

Health Informatics Standards

National Health Data Dictionary

Malaysian Drug Codes

National Health Informatics Committee

Other initiatives

Functional Requirements Brief

PMS, LIS, RIS, PhIS, OTMS

Country License for SNOMED-CT

Formed HL7 Malaysia

25

Beginning 2008, Telehealth has moved forward towards services integration and information sharing and promoting interoperability through adoption of IHE Framework

Promotes unbiased selection and coordinated use of healthcare AND

IT standards to address specific clinical needs

Enables seamless health information movement within and between

enterprises, regions, nations

Common framework for harmonizing and adopting multiple

standards

Regional Deployment

IHE Europe

IHE North America

France

USA

Canada

IHE Asia-Oceania

Japan

Korea

Taiwan

Netherlands

Spain Sweden UK Italy

Germany

Norway

China

Austria

Australia

Malaysia

Global Development

Radiology

Cardiology

IT Infrastructure

Patient Care Coordination

Patient Care Devices

Laboratory

Pathology

Eye Care Radiation Oncology

Public Health, Quality and Research

• a non for profit organization • Develop framework and methodology for integration • based on solving real-world issues

Source : MDEC

Malaysia through MDEC is a member of IHE

F o r G o v e r n m e n t

• (i) Solve interoperability needs

• (ii) Reduce cost of integration

F o r B u s i n e s s

• (i) Coexistence of different systems

• (ii) International standards adoption

F o r C i t i z e n s

• (i) Better treatment decisions

• (ii) Health empowerment

A platform in creating an interoperable environment in ICT Healthcare industry and in ensuring conformance to Health ICT standards by health ICT solutions towards achieving seamless and integrated healthcare services in the public and private

healthcare sectors in a cost-effective manner.

2008

• 2 products

• 2 companies

2009

• 6 products

• 6 companies

2010

• 12 products

• 18 companies

2011

• 14 products

• 13 companies

Annual event of MSC Malaysia IHE Connectathon

Source : MDEC

Source: The Global Observatory for eHealth (GOe) of World Health Organization (WHO) Survey Report 2009

Enabling environment- Policies and strategies to support the information society

Infrastructure- Access to information and communications technologies

Content - Access to information

Cultural and linguistic diversity, and cultural identity

Capacity - Human resources knowledge and skills

National centers for eHealth

eHealth systems and services

Lack of legal policies and regulations

No data provided to GOe

Initiatives being undertaken

mHealth, eHealth intiatives are being undertaken

National multiculturalism policy for eHealth

No data provided to GOe

No data provided to GOe

WHO Survey Report 2009: Key action areas of eHealth in a country

28

29

MOH has numerous ICT related strategies over the years across multiple Malaysia Plans

Telemedicine

Blueprint

MOH has developed a health ICT framework, supported by a legal framework and standards

OPERATIONAL LAYER (Point of Care/Point of Service)

COLLABORATIVE LAYER/ENTERPRISE WIDE

CONSUMER LAYER

Patient Portal Professionals Portal

Shared Records

National Data Warehouse

Licensing & Credentialing

HIS / CIS/EMR Admin / Finance Monitoring /

Reporting

Public Portal/Services

Monitoring & Evaluation

Promotion & Surveillance

Regulation & Enforcement

Legal Framework for Information Sharing, Privacy, Confidentiality & Security

Connectivity 1Gov*Net

STANDARDS

30

Some key systems in MOH

Patient Care • HIS : 15 • SPP : 6 • TPC : 88 • OHCIS : 10 clinics • Blood Bank System

Quality/Performance • e-NIA/KPI

Regulation/Surveillance/Licensing • eNotis • Disease Registries • MedPC • FOSIM • QUEST • HIMS

Enterprise Wide • National Data Warehouse • Case Mix • MyHIX/LHR • Teleconsultation Consumer base • MOH Portal • MyHEALTH • MyCPD • Virtual Library • MedGlobin

Research • Patient/Disease Registries

Management

• Several Systems (30)

31

mHealth Initiatives – The New Frontier

MySMS

• single # for all Govt agencies (IOD/DOD, broadcasting, community services, aduan etc)

• eKL : reminders for appt/rescheduling/cancellation

• SMS Drugs: ‘take & go’

• Ask the Expert : health info on demand

Mobile Dengue (apps)

• Hotspots, Aduan

• SMS Alert

Remote Home Monitoring – private providers

Mobile Teleconsultation – pilot in Cardiology services

CSR by Telcos – Target population, follow-up reminders

Mobile Apps – used by HC providers

32

MOH*Net MyLoca Data

Centre

Cyberjaya

Internet

MOH HQ State

Health

Dept

Health Office/

Health Clinics/

& Dental

Labs &

Institution

Hospitals

Putrajaya

Campus

Network

(PCN)

MOH’s ICT Infrastructure: Connectivity & Data Centre

33

Note:

1.MOH*Net in final stages of migration to 1Gov*Net

2.Managed services by MAMPU

3.MyLoca Data Centre to be migrated to Public Sector Data Centre

4.58.4% facilities connected to 1Gov*Net (2570 of 4419)

5.Target of connectivity 100% by 2015 (KPI of Minister of Health)

6.Audit by MAMPU/PEMANDU: Overall utilization <50%

20Mbps

20Mbps 6Mbps 10-30 Mbps

(Monitored via NKEA CCI)

1Gov*Net

Five critical challenges in MOH

34

Policy & Procedures

• Standardisation

• Healthcare information sharing

• Governance

Infrastructure

• Limitation of infrastructure availability e.g. LAN & Devices

• Obsolescence

System

• Usability

• Performance

• Scalability

• Future readiness

• Support & Maintenance

Cost

• High CAPEX for implementation of systems

• High OPEX for O&M&S of these systems

• Ongoing CAPEX for continuous upgrade

• Benefit realisation in monetary terms

People

• Clinical Leadership & engagement

• Change management

Significant budget constraint; ICT ~5% of total MOH CAPEX

<10%

Source: GIS, IKU (MOH)

TPC deployed to 88 of 985 Health Clinics over 7 States in Malaysia

35

2%

Source: GIS, IKU (MOH)

OHCIS deployed to 11 of 449 Dental Clinics in Johor & Selangor

36

4. Patients Interaction with PHC System

1. Integrated Primary Healthcare System (TPC &

OHCIS) & pilot roll-out (10MP)

2. Nationwide roll-out with flexibility to different levels of

primary health care facilities (beyond 2015)

3. Integrated with Secondary Care (beyond 2015)

The Way Forward for TPC-OHCIS

2013

2015 2020

33 of 142 MOH hospitals utilize HIS in varying levels of functionalities ranging from patient billing up to EMR

38

Source: GIS, IKU (MOH) 38

23%

39

2001 2002 2003 2004 2005

Appointment of consortium for THIS

Selayang Putrajaya KK Putrajaya

2000

Mid-term Review RMK-8

K. Batas L. Datu Serdang

Pandan Ampang Sg Buloh

1994

Roll-out of SPPD Legacy System for Patient Billing

Over 7MP & 8MP, our implementation mode was ‘big bang’ with mainly commercial HIS with EMR

40

2007 2008 2009 2010 2011

Appointment of Govt Consultant

2006

HIS Way Forward

3 Hospitals , HISPRO negotiation

LOA 9 January 2009 HISPRO kick-off

SPP go live, HTJS, HPD

H.Ipoh Go live

2013

SPP outpatient HTAR, HKJG & HKL

2012

HoSHAS

Bintulu

HSNZ

NCI

From 9MP (2006) onwards, our approach became incremental and included tailor made systems

Medical Record Management

Patient Management

Ward Management

Billing & Payment

Staff Management

Order Management

SPP

OpenHIS

Pharmaniaga

3rd Party Product

CSSD LIS/ BBIS

PhIS

CMS/ LDR

BI/EIS

CCIS PACS

Medical

CD OpenHIS

Surgical O&G

Peads & Neonate

Emergency & Trauma

Ortho

Others

Diet & Catering

Administrators Tool

Future Clinical Documentations

Future Enhancements

National Client

Integration

MyHIX/LHR

Case Mix

eGov Apps

Surveillance/ Monitoring

Quality Monitoring

Disease/Patient Registries

HMIS

Health Financing

Health Portals

eScheduling/ eAppointment

eFollow-up/ eConsultation

Professional Registries

Wellness Services

(MyHEALTH)

OTMS

OpenHIS

Home Monitoring

41 TPC-OHCIS

The vision of HIS@KKM

Opthal

ORL

Nursing Psychiatry

N

at

io

na

l

Da

ta

W

ar

eh

ou

se

FMIS

Integration

Other specialties

Conclusion

Healthcare is poised for its biggest shake up ever as it transforms to a more better, efficient, quality and equitable healthcare

Proposed transformation in 3 areas: health service delivery, organisation and financing

We need to take MOH to the next level, one that embraces the need for changes and focuses on the ways to get there

ICT is one of the key building block in national health reform strategies & to enable efficiency, quality, improved outcome and innovation in health care delivery

42

THANK YOU dr_fazilah@moh.gov.my

43