Personal health information systems:

Electronic based Patient Oriented Information systems

Guardian Y. Sanjaya
gysanjaya@gmail.com
 Aspek apa saja yang ada pada
Patient oriented information systems
Biaya
Patient safety
Kemudahan akses informasi
Medical record informasi pasien
Kontennya: anamnesis - terapi
Indikator/outcome pelayana
?
 Apa yang Anda ketahui?
Health informatics?
?
Electronic medical record?
Status pasien scr electronic
Electronic health record?
Profil kesehatan
Personal health record?
Individu
 Outline
Information systems and health
informatics
Electronic medical record and electronic
health record
Personal health record
Some example of PHR
Information Systems
vs
Health Informatics
 Definisi Sistem Informasi
Sistem
Komponen penyusun
Interkonektifitas antar komponen
Informasi
Data yang telah dikompilasi, dianalisa, diinterpretasi,
dan atau dirubah bentuknya agar dapat digunakan
untuk tujuan tertentu (AHIMA, 2006)
....a set of components that work together to
achieve a common purpose (Amtayakul, 2009)
 Sistem Informasi Kesehatan
WHO 2003: integrated effort to collect,
process, report and use of health
information and knowledge to influence
policy making, programme action and
research
HMN 2003: The ultimate objective of HIS
is to produce information for taking action
in health sector
 Information Life's Cycle
Essential indicators
Feedback Definitions
Program changes Tools
Policies Reporting: completeness
Resource allocation Collect
Collect Verification: data checks
Adjustment

Use
Use Process
Process
Multiple indicators Error and adjustment
Context Indicator computation
Overall performance Performance assessment

Interpret
Interpret Analyze
Analyze

Present
Present
Visualization of data
Formats for communication
 Informatika Kesehatan
Informatika (Informatics)
.... the science and art of turning data into information
(Hebda, 2009)
.... the study of the application of computer and statistical
techniques to the management of information (Academic
Medical Publishing & CancerWEB, 1997)
Informatika Kesehatan
.... the application of computer and information science in
all basic and applied biomedical sciences to facilitate the
acquisition, processing, interpretation, optimal use, of
communication of health related data (Hebda, 2009)
... integrated effort to collect, process, report and use of
health information and knowledge to influence policy
making, program action and research WHO 2003:
 Informatika Kesehatan
Informatika Kesehatan Masyarakat
... the systematic application of information and
computer science and technology to public health
practice, research and learning (Friede, et al. 1995,
Yasnoff et al. 2000, O'Carrol, 2003)
Informatika Kedokteran
.... the aplication of information science and
technology for patient care and medical decision
making (Hebda, 2009)
Informatika Keperawatan
Informatika Klinis
Consumer Health Informatics
 Kenapa informatika?
Efisiensi usaha, biaya
Keselamatan pasien dan kualitas pelayanan
Identifikasi pasien
Sistem pendukung keputusan
Aksesibilitas data kesehatan
Cognitif load tenaga kesehatan
Evidence-based practice
Penelitian
 TIK Dalam HIS
Data check (Duplication ID, Immunization
Data collection control)
INPUT

Data Cleaning/Validation Data type/template (number, date, string)

Completeness (compulsory filled)
Autocomplete (age versus DOB)
Role (Male and pregnancy)

Compute data (health indicators, regular

PROCESS

Analysis reports)
Presentation Present data (dashboard executif, number
of visitation, monthly revenue, etc),
Alert and reminder

Interpretation Interprete data according to health indicators

OUTPUT

Decision making (human intervention

Ex: Major couse of morbidity/Mortality)
Eletronic medical record
vs
Electronic health record
(Sub)sistems informasi apa yang ada di
tempat Anda?
Bridging systems
SIMRS (Pendaftaran, billing, pelaporan, logistik)
Electronic medical record (anamnesis
diagnosis)
Document repository
INA-DRG,
Sistem akuntansi
Sistem SDM
???
 Porters value chain
Sarana Umum Pelayanan: Ex: Rekam medis, keuangan, manajemen
Kegiatan Pendukung

Sarana Khusus Tindakan Medis dan Rehabilitasi: Ex Ruang OK, Bersalin, ICU, Fisioterapi

Sarana Pelayanan Rawat Inap: Ex: Ruang perawatan

Sarana Pelayanan Farmasi: Ex: dispensing, Inventori barang liquid, stok obat

NILAI
Sarana Pelayanan Radiodiagnostik: Ex: X-ray,
TAMBAH
Cepat
Sarana Pelayanan Laboratorium: Ex: Kimia Klinik
Efisien

PEMERIK- DIAGNOSIS PERSIAPAN TINDAKAN REHABILITA PELAYANA

Kegiatan Utama

SAAN TINDAKAN MEDIS SI N PASIEN

PELAYANAN MEDIS Diagnosa MEDIS PULANG
PASIEN AWAL klinik Rehabilitasi
Tindakan
MASUK Diagnosa Pemeriksaa fisik
operasi Discharge
Riwayat keperawatan n penunjang Pemberian Pola hidup Summary
-Registrasi penyakit dan obat-obatan Rujukan
-Admisi masuk Vital sign skreening Surat
Pemeriksaa keterangan
n fisik
 Dimana informasi pasien?

Radiologi Operasi

Farmasi Lab

Rekam Medis

Registrasi Pasien Hospital

Services
Mediator

Billing Gizi

Outpatient Inpatient
 EMR or EHR?

Sumber: Google image

 Kenapa EMR/EHR?
Tujuan Primer
Ketersediaan informasi yang sifatnya longitudinal
Komunikasi antar klinisi terkait patient care
Tujuan Sekunder
Medikolegal
Quality management
Education
Research
Public and population health
Policy development
Health service management, billing, finance and reimbursment
 Komponen EHR

Ta O mb
tak rga iay
ne lia is,

As la, S asi
Ke io-te k

elo nis aan

pe
pe ah kn

pe tru
rim n,

Pe
n
So As

aa

k
s

Used as primary

ktu
source of

r
information at
point of care

EHR

Collect data Provide

from multiple Decision
sources Support

Aspek
Keamanan, privasi,
Integritas,
aksesibilitas
Source: Amatayakul (2009)
 Komponen EHR
Klinis Administratif
Dokumentasi klinis Sistem registrasi pasien
Dokumentasi keperawatan (Admisi, Discharge, and
Laboratorium transmission/referal)
Sistem informasi farmasi Billing sistem
Radiology Sistem informasi SDM
Emergency department Quality assurance (ex: Bed
management)
Monitoring sistem (ICU)
Sistem pendukung
keputusan klinik
 Berbagai Level EHR
Evidence-based
Collector practice
Combine with
Documenter PHR Health
Phase 1 Information
Goal: Consumer
empowerment exchange
Create
Phase 2 Helper
data/information, Goal: Integrated
Unidirectional health service
Point-of-care data
Phase 3 Partner
Goal: intention
capture,
Longitudinal Phase 4 Mentor
Simple Alert record
system,
DSS in acute
Result care and
Phase 5
management ambulatory
Goal: Efficiency Goal: efficiency,
patient safety

Waktu

GartnerGroup generation of EHR (Amatayakul, 2009)

 Goal of HER: Health Information exchange

Model Consolidated: Central Repository System

Central Database
Praktek Pribadi
Rumah Sakit

Klinik/RS Swasta
Dinas Kesehatan
Puskesmas
 Goal of HER: Health Information exchange

Federated: independence repository system

Cloud Computing
Electronic Exchange

Local Local Local Local

Local repository
repository repository repository repository

Praktek Pribadi Dinas Kesehatan Klinik/RS Swasta Rumah Sakit

Puskesmas
 The National Health Information Taiwan

DOH
CDC

BOH
HIN Admin

NHI head-
SC quarter
HCA
IDC

600
NHI local
Hospitals
offices
100
HIS
NHI VPN
5,000
Pharmacy
17,000 IDC Internet Data Center
Clinics SC Service Center
HIN Health Information Network
NHI VPN Virtual Private Network
Goal of HER: Health Information exchange

Patient Manage model

Standard
Interoperabilitas
Rumah Sakit

Patient's
repository
Klinik/RS Swasta

Dinas Kesehatan

Puskesmas
Praktek Pribadi
 What is PHR?
...universally accessible, layperson
comprehensible, lifelong tool for managing
relevant health information system, promoting
health maintenance and assisting with chronic
disease management via an interactive,
common data set of electronic health information
and e-health tools
The ePHR is owned, managed and shared by
the individual or his/her legal proxy and must
be secure to protect the privacy and
confidentiality of the health information it
contains

HIMSS, 2008
 What is PHR?
.. any tools or application that enables a
patient (or guardian, the mom) to create,
review, annotate or maintain a record of
any aspect(s) of their health condition,
medication, medical problems, allergies,
vac- cination history, visit history or
communica- tions with their healthcare
providers (Sittig, 1998)
 Format PHR
Web site independen
Pasien sendiri yang melengkapi isi dari RKP tidak praktis bagi
pasien
Portal khusus pasien
Digunakan dalam proses klaim (administrasi) walaupun
beberapa informasi klinis tertentu sudah ada
Portal EMR
EMR yang didesain khusus untuk bisa diakses dan dimodifikasi
(hal-hal tertentu) oleh pasien
Consumer-centric RKP
Dapat menyimpan data dari berbagai sumber dan format, dapat
dilihat riwayat pencatatan sebelumnya dan dapat diakses bagi
yang memiliki otoritas
Tobachman et al, 2002
 Contoh PHR
Patient-centered
Paper based Cina
Smart card Negara Eropa, Taiwan?
Media penyimpanan portable
Online Google Health
Penyedia layanan 'tidak memiliki' isi dari
rekam kesehatan ini
 Content of the Smart Card
Category Contents

Personal Name, ID number, date of birth, gender, issuing date.

information

NHI related Major illness/injury, infant note, prenatal exam for pregnant
information women, insured person code, insured person identity note,
period of card validity, available frequency of medical treatment,
accumulated expense of medical treatment, accumulated
expense, co-payment, personal insurance premium.

Medical data drug allergies, long-term care prescriptions, ambulatory

section care prescriptions, and certain medical examinations

Miscellaneous Personal immunization records and willingness to

section donate organs
 Kenapa PHR
Keunggulan
Share informasi antar
penyedia layanan diatur oleh
pasien (patient-centeredness)
mengatasi masalah privasi
dan confidentiality
Informasi bisa lebih kaya
(nutrisi, status gizi, riwayat
konsumsi obat dan suplemen,
pola hidup dll)
Memperkuat tanggung jawab
pasien terhadap kesehatan
dan riwayat medisnya
Kelemahan
Kesadaran pasien masih
rendah untuk memahami
konsep RKP, termasuk konsep
privasi dan kerahasiaan data
medis
Compliance dari penyedia
layanan kesehatan terhadap
media RKP
Peraturan perundangan
berkaitan dengan pencatatan
masih terpusat pada penyedia
layanan
USB-Based PHR
 Beberapa isu penggunaan PHR
Privacy and confidentiality
Data security
Decision support
Legal-regulatory requirement

Cushman et al, 2010

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