2.1. The collection and collation of health information for routine statistics reports was developed since colonial days and which was further strengthened to a Health Management Information System
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During the British Civil Administration days (1874-1941), health information and events1.4.1.
Informed and knowledgeindividual and population that will give consumers more access and involvement in healthcare decision making and be more responsible in taking care of their own health
1.4.2.
A proactive wellness and illness management through competent and knowledgeable healthcare providers1.4.3.
The delivery of service in a networked environment based on care network concept. Sharing of information and resources shall be the thrust for efficient and effective delivery of services.1.4.4.
There will be a provision for services to be offered from home where applicable where patients can have access to health information and being able to interact with healthcare providers through multimedia network.Were recorded and documented as a by-product of the services provided by the Medical Department. Data were generated at the services outlet, namely at hospitals, static (outdoor) dispensaries, traveling dispensaries maternal and child welfare centers, municipal clinics, leper settlements and mental institutions. Some form of procedure existed for recording into registers and collection of medical and health data on some predetermined formats. .Sanitary inspectors and public health nurses in the course of their work carried out the collection of data for the public health activities.
While in the hospitals, static (outdoor) dispensaries and institutions for special diseases this was done by hospital assistants and nurses. The data collection was coordinated by Medical Branch of the Medical Departments in each State. The annual State Health Situation Assessment Report was given to the Medical Department Headquarters (one for Straits Settlement States and the other for the Federated Malay States) to prepare an annual report on the health situation of the country as a whole.
1.5. During the Eighth Malaysia Plan (2000-2005) concerted efforts were undertaken to provide a stronger platform for the country’s transition towards knowledge based economy. There was increasing effort on the promotion and use of ICT in various sector including health sector .For the Ninth Malaysia Plan ( 2006-2010) efforts will be intensified for the wider adoption and use of ICT .The government is committed to enhance ICT related skills and competencies as well as info structure expansion.
2.2 During the period from 1948 to 1962, the gathering of health information rested with the Medical Services under the Ministry of Social Welfare. There was minimal effort at coordination of health information although the quantity and variety of data had increased as a result of more diversified health activities. In 1963, with the formation of Malaysia, the Ministry of Health and Social Welfare becomes the Ministry of Health. The responsibility for health information was still with the
Medical Services Division which continued to be involved in the collection of workload statistics for report writing purposes.
2.3. By the second half of the 1960’s, a Medical Records and Health Statistics Unit were set up.
It functioned as a data coordination unit for the Ministry of Health (MOH). In 1972, the Operation Research Unit was also set up. The primary function of this unit was to monitor the development of the National Health Management Information System (NHMIS).
To further improve the health information system, the World Health Organization (WHO) was requested in 1975 to study and recommend improvements to the existing system. The study recommendation included the establishment of a comprehensive information system through a Health Management Information System Development Project (NHMISDP) The Information and Documentation System (IDS) Unit in the Ministry of Health was established in 1981 to replace the Medical Records and Health Statistics Unit and the Operations Research Unit.
2.4 With the establishment of the HIMS systems medical records officers were trained and posted in all large hospitals to responsible for the compilation of the hospitals statistics. The statistics for public health was continued to be compiled by public health nurses, medical assistants and public health inspectors. The IDS unit at Ministry of Health continued to produce annual reports for use at the national and international level
2.5. The last two decades saw a very rapid growth in the use of ICT in health care. The Tele-health Project launched in 2000 paved the way for the need to provide standards for data collection to provide for interoperability and to produce reports with high degree of data quality and integrity. The subsequent deployment of HIS in public and private hospitals enabled health care providers to produce reports of better quality. However this did not solve the interoperability issue as the disparate systems were using their terminology and data definitions. This again resulted in problems related to data mining and analysis at the national level
2.6 Strengthening of the Health Information Management was one of the supporting goals determined to achieve the objective of the 9MP.to ensure the Integrated Health information Management for the country.
The Health Informatics Center established in 2006 at the Ministry of Health will be the custodian of all health and health related information in the country
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3. CHALLENGES
3.1 DATA QUALITY, ACCURACY, TIMELINESS
In general, health information required for national and international use is not adequate and often, is not timely for effective and efficient management. The information collected is from MOH facilities only and hence incomplete for analysis for population health status from the whole country perspective.
The current HMIS data collected is based on formats developed for a predominantly annual system of data collection. Over time, additional information requirements to monitor the new activities have resulted in adhoc collection of information. This has resulted in use of data sets which are non- standardized, where the data definition used were different, values varied. Data for research is collected by different research organization for specific purposes
The private sector hospitals are required to submit returns as per Private hospitals Act regulation .however the quality and timeliness of the data is so varied between hospitals thus causing problems for meaningful data analysis. Currently there is very little provision for information collection from private clinics and NGOs.
3.2 ICT IN HEALTH CARE
Healthcare is an information intensive service. It is inevitable that as long as an individual has had an encounter with the health care system, the health information ought to be stored in some kind of “record”, probably kept in the provider’s memory, paper and computer media for recording health information. Taking cognizance that gathering and reporting healthcare
information have to be shared within a care network concept in an enterprise wide environment, all stakeholders have to take concrete steps to break the deadlock and overcome the grappling issue of data sharing and information flows that we are currently facing .One of the major impacts of ICT in healthcare is in the field of health and disease
surveillance. By leveraging the technology, on-line notification of disease and incidents is made possible to support epidemiologists in their capability of pursuing early warning and alert to potential disease outbreak. Integrating IT and advancement in technology into healthcare will change the way we do things. The key issue is in addressing how IT influences the way we work and manage our patients taking into consideration the business process reengineering which is driven by the vision to achieve value-added objectives of our business functions.
3.3. EVIDENCE BASED PLANNING / PRACTICE
The advent of Clinical Practice Guidelines and its use has facilitated the use of evidence based clinical practice in patient care. However the use of information for evidence based planning in measuring health outcomes requires the development of National Data Sets that allows for comparison between different health care providers.
The formulation of data sets for specific diseases and conditions through a consensus driven approach is critical for wider acceptance and compliance within the clinical fraternity
3.4. MEDICAL INFORMATICS
The growth of medical/ health informatics has provided a new impetus in the formulation of policies and strategies towards Health Information Management in Malaysia. This field of specialty that is rather is new started with the launching of the Tele Health project. Since then there has been a considerable interest in the field both in the public and the private sector. The establishment of the Malaysian Health Informatics Association and the HL 7 Malaysia International affiliate status has provided the platform for experts to share experiences and get involved in some of the works.
The government driven projects such as the Tele Health project including the Lifetime Health Record (LHR) provides the ground for all stakeholders to participate .The challenge is the extent of participation from the private sector and industry partners
3.5 RESOURCES
An investment in health informatics infrastructure requires a corresponding investment in human resources to ensure that the infrastructure is appropriately developed, implemented, maintained and evaluated
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It is important to have adequate numbers of skilled and competent IT staff. In view of the high cost of skilled IT personnel, the big question seems to be not only whether there will be enough ICT funds to hire them, but rather whether there is enough knowledgeable expertise and skills resource in the country.There is a need for more people, better training and development and career prospects as professionalism is fundamentally important to making ICT more attractive. Thus, the challenge is being able to identify and assign train staff on core IT competencies. Getting people on board in leading the project planning is also vital as well as retaining this “top-notch” people whose expertise is very valuable especially for future undertaking.
It appears that the vast deployment of IT in our day today business may not be still possible in view of lack of infrastructure capability and capacity. Thus investment in ICT infrastructure in terms of adequate storage space, high bandwidth LANS and WANS, wireless technology and planned replacement of workstations, need to be addressed.
4. DISCUSSIONS
4.1. POLICY AND GOVERNANCE
The thrust for the government to strengthen the Health information Management system in the country in order to achieve the goals set in the plan period provides an impetus in moving forward towards an Integrated Health Information Management System .In order to ensure greater compliance by all stake holders the National Health Policy on Health Information Management is absolutely essential .The issues that need to be addressed includes
• Confidentiality & Privacy
• Security & data protection
• Consent
• User access
• Role of stakeholders
• Infrastructure support
• Health informatics standards
• Capacity and Capability building
Such issues can only be addressed through a National Coordinating Body responsible for the collection and storage of all health and health related information. The membership should be drawn from all stakeholders to allow for ownership and accountability amongst all interested parties.
Such a mechanism will also provide a forum to accommodate the specific needs of all stakeholders.
The information needed for research, policy planning and outcomes measurement should be built integral to all operating systems developed /deployed in the country .A national approach for the coordination of health information in the country will allow for maximizing the potential of various initiatives implemented in the country and therefore will allow to maximize the ICT investments for purposes of making available accurate quality information meant for all types of user.