AeHIN Webinar 30 March 2016 NATIONAL ehealth: Malaysia Update

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1 AeHIN Webinar 30 March 2016 NATIONAL ehealth: Malaysia Update Dr. Fazilah Shaik Allaudin Deputy Director Telehealth Division Ministry of Health MALAYSIA

2 Presentation Outline Introduction Country profile MOH Organizational Structure Issues & Challenges Health System Transformation ehealth Strategy Overview of ehealth Initiatives ehealth Capacity Building Summary 2

3 Country Profile Malaysia - Southeast Asia 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 (2014e) 30,261,700 million Multiethnic population: Malay 50.33%, Chinese 21.76%, Indigenous 11.8%, Indian 6.52% Others -0.87% Source : Department of Statistic Malaysia, Department of Statistics

4 Malaysia s Vision for Health & eight (8) Health Goals Malaysia is to be a nation of healthy individuals, families and communities.. Wellness focus Person focus Informed persons Self-help Care provided at home/close to home Seamless, continuous care Services tailored as much as possible Effective, efficient and affordable services 4

5 Current Healthcare System Payment Mechanism Line Item Budget Fee for Service NHMS2011 only medical visit) 74% : 26% 49% : 51% HCDA study 5

6 MOH Organisational Chart - 8 Programmes - ~ 30 Divisions & 6 NIH - 14 Health State Dept (all related units, PKDs, Hosp, Klinik, Institut, Kolej & Makmal)

7 Functions of MOH MOH PUBLIC HEALTH MONITORING & EVALUATION POLICY MAKING REGULATION & ENFORCEMENT TRAINING RESEARCH PERSONAL CARE -Disease Control -Food Safety & Quality -Health Education -HIC - MNHA - Surveillance - H 2 0 Quality - TCM -Drugs - Quality - HTA -Patient Safety - Services - Research - TCM - Human Resources Development - Finance - Infrastructure & Equipment -HTA - Quality - ICT Enforcement Legislation -Professionals - Allied Health -Nursing -Basic -Post-Basic 1 0 Clinics Hospital

MOH s Health Policies Primary health care is

regionalized tertiary care services 8 Greater

8 MOH s Health Policies Primary health care is the thrust of Malaysian health care system, National Referral System supported by secondary care services which are devolved & regionalized tertiary care services 8 Greater equity, accessibility & better utilization of resources

1960 Mother & Child Family Planning Outpatient Services Environmental Health School Health 1980 Mother & child

Services Development of primary healthcare services 2000 Mother & Child Family Planning Outpatient Services

Health Elderly Health Cardiovascular Disease Mental Health Adolescent Programme Sexually Transmitted Infection

Planning Outpatient Services Tuberculosis/ Leprosy Occupational Health Emergency Services Health Informatics

Maintenance Therapy Human Immunodeficiency Virus Dialysis

9 1960 Mother & Child Family Planning Outpatient Services Environmental Health School Health 1980 Mother & child Family planning Outpatient Services Environmental Health School Health Dental Care Pharmacy Services Laboratory Services Development of primary healthcare services 2000 Mother & Child Family Planning Outpatient Services Environmental Health School Health Dental Care Pharmacy Services Laboratory Services Child with Special Need Adult Health Elderly Health Cardiovascular Disease Mental Health Adolescent Programme Sexually Transmitted Infection Tuberculosis/ Leprosy Occupational Health Emergency Services Health 9 Informatics RECENT Mother & Child Family Planning Outpatient Services Environmental Health School Health Dental Care Pharmacy Services Laboratory Services Child with Special Need Adult Health Elderly Health Cardiovascular Disease Mental Health Adolescent Programme Sexually Transmitted Infection Tuberculosis/ Leprosy Occupational Health Emergency Services Health Informatics Rehabilitation Services Dietary Human Papilloma Virus Vaccination Needle Stick Exchange Programme Methadone Maintenance Therapy Human Immunodeficiency Virus Dialysis

10 Extensive secondary & tertiary care services Respiratory Medical Institute Rehabilitation Hospital State Hospital National Cancer Institute National Heart Institute District Hospital

11 Distribution of Health Facilities in Malaysia Source : Mapping Study of Health Facilities & Services, IKU MOH, 2013 Distribution of Government Health Clinics Distribution of Private Health Clinics Distribution of MOH Hospitals Distribution of Private Hospitals 11

12 And many more. Challenges in Health

13 Towards Health System Transformation 13

14 Issues & Challenges ( ) Intersectoral collaboration Integration in Legislation, Regulation & Enforcement Health Facilities & ICT P&D Increase Disease Burden promotion & prevention Issues & Challenges in Health Quality & Safety in Health Limited Accessibility to HC Health Human resource planning Long waiting time & Congestion Financial Risk Protection & increase healthcare cost Sustainabilit y of HC system & Financing People satisfaction High work load 14

ensuring universal coverage for health care needs of population based on

15 National Health System Transformation Agenda A restructured national health system that is responsive and provides choice of quality health care, ensuring universal coverage for health care needs of population based on solidarity and equity. Service Delivery Financing Organisational Work in Progress 15

16 Source : EPU, May

Planning for 11 th Malaysia Plan (2016-2020) Focus Area/Strategies 1. Strengthening Primary Healthcare 2. Health System Delivery and Work Process Reengineering 3.

17 Planning for 11 th Malaysia Plan ( ) Focus Area/Strategies 1. Strengthening Primary Healthcare 2. Health System Delivery and Work Process Reengineering 3. Human Resource and Organisational Capacity Development 4. Infrastructure Planning and Development 5. ICT Transformation for Health 6. Public-Private/Interagency Collaboration 7. Enhancing Healthcare Financing Mechanism 8. Creating a Healthy Ecosystem towards healthy lifestyle and disease prevention IMPROVED WELL BEING OUTCOME 1. Quality, responsive and sustainable healthcare system; 2. Reduction on disease burden and risk factors 3. Healthy environment and food safety 17

18 ehealth Strategies 18

19 Malaysia s health informatics multi platforms Political Commitment National Commitment Governance/Policy Standards & Interoperability Multimedia Super Corridor (MSC) Flagship Gov*Net (MAMPU) 1GovUC (MAMPU) Telemedicine Blueprint 1997 HIMS Blueprint 2006 MOH LHR Business Framework Health Informatics Standards Economic Transformation Programme (ETP) 2010 Digital Malaysia 2014 (absorbed into NKEA) PDSA (MAMPU) 1Gov Cloud (MAMPU) 1GovEA (MAMPU) Open & Big Data (MAMPU) Digital Opportunities RMK-11 (EPU/SKMM) 8,9 & 10 th MP ICT technical papers National Health Policy 2007 ICT Strategic Plans (ISP) RMK-11 Plan IHE Framework & Malaysia Connectathon Malaysian Health Information Exchange (MyHIX) SNOMED-CT Country License 19

National ICT Governance NATIONAL STRATEGY AUTHORITY NATIONAL IT COUNCIL (NITC) GOVERNMENT IT AND INTERNET COMMITTEE (MAMPU) ICT TECHNICAL COMMITTEE (MAMPU) IMPLEMENTATION COUNCIL MEETING (ICM)

20 National ICT Governance NATIONAL STRATEGY AUTHORITY NATIONAL IT COUNCIL (NITC) GOVERNMENT IT AND INTERNET COMMITTEE (MAMPU) ICT TECHNICAL COMMITTEE (MAMPU) IMPLEMENTATION COUNCIL MEETING (ICM) FLAGSHIP COMMUNICATION COMMITTEE (FCC) Policy, Strategy & Planning NATIONAL HEALTH INFORMATIC COMMITTEE MOH ICT STEERING COMMITTEE TELEHEALTH STEERING COMMITTEE Coordination and Monitoring SECURITY ICT COMMITTEE TECHNICAL COMMITTEE ICT HEALTH MINISTRY ICT PROJECT GOVERNANCE COMMITTEES Operation Level COMPUTER EMERGENCY RESPONSE TEAM (MOH CERT) ICT PROJECT TEAMS MAMPU - Malaysian Administrative Modernisation And Management Planning Unit

ICT Challenges in MOH Policy & Procedures Standardisation

Limitation of infrastructure availability e.g.

Interoperability Performance Scalability Future readiness

~5% of total MOH CAPEX Cost High CAPEX for implementation

CAPEX for continuous upgrade Benefit realisation in

21 ICT Challenges in MOH Policy & Procedures Standardisation Healthcare information sharing Governance Infrastructure Limitation of infrastructure availability e.g. LAN & Devices Obsolescence System Integration & Interoperability Performance Scalability Future readiness Support & Maintenance Significant budget constraint; ICT ~5% of total MOH CAPEX 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 Skills & Expertise Change and adoption 21

ICT Issues in 10 th Malaysia Plan (2011-2015) Inadequate and inconsistent funding Fragmented ICT Implementation at MOH Incomplete readiness of ICT infrastructure at

22 ICT Issues in 10 th Malaysia Plan ( ) Inadequate and inconsistent funding Fragmented ICT Implementation at MOH Incomplete readiness of ICT infrastructure at health facilities Inadequate data for strategic planning and management Inadequate ICT skills and competency Technology Process To be addressed in 11 th MP People 22

23 Standards & Interoperability ICT Infrastructure & Connectivity Applications & Systems Health Information Exchange (HIE) People (Skills & Expertise; Change & Adoption) Monitoring & Evaluation Sustainability Architecture Model for ICT in Health Health System Transformation GOAL Pillars Enterprise Architecture National ehealth Policy & Strategy Legal Framework & Policy Foundation Leadership & Governance

24 Alignment of ISP to others Source : Pasukan PSTM Nov

25 Source : PSTM Team Nov

26 Public Sector ISP (Focus on Digital Government) Source : MAMPU ISP

27 Malaysia 1GovEA Framework Source : MAMPU Oct

28 MOH Enterprise Architecture Roadmap Competency Foundation Change Management Capability Foundation Development Capability Delivery (ehealth) Capability Increment (ehealth) Awareness Competency Building EA Office Establishment Maturity Assessment Repository Work Packages of 7 Strategic Outcomes Repository 7 Strategic Outcomes 28

29 Overview of ehealth Initiatives 29

30 Client/ Citizen Health Portals escheduling/ eappointment efollow-up/ econsultation Personalized Lifetime Health Plan Self Monitoring Note: 1. Health Apps Integration 2. Integration to external systems is also required; however not reflected here Patient Management Medical Record Management PhIS LIS General Specialties Sub-Specialties Patient Management System & Billing Order Management School Health Ward/Clinic Management Billing & Payment BBIS CSSD CLINICAL DOCUMENTATION PRIMARY CARE Health Education & Counselling Clinical Notes & Dental Charting Personnel Management Patient Care/ Population Care EIS Order Management Diet & Catering OTMS Clinical Decision Support System 30 FMIS Teleconsultation & Remote Monitoring Health Information System Staff Management (Rostering) Administrators Tool PACS BI/EIS CCIS RIS Cardio MS Institutional systems LDR OIS/RT Population Health L i f e t i m e H e a l t h R e c o r d National Case Mix egov Apps (Adm/HR/Fin) Surveillance/ Monitoring Monitoring/ Evaluation (inc QA) Disease/Patient Registries HIMS Health Financing Professional Registries HR Development / Training Regulation/ Enforcement Licensing/ Credentialing N a t i o n a l D a t a W a r e h o u s e

31 Quick Wins ( ) for MOH Note 2 Hospitals MOH: <30% with HIS system Note1 WAN Note3 Health Clinics Note 3 Dental Clinics Note 3 Supporting Facilities MOH: <10% with TPC MOH: <5% with OHCIS LAN and DEVICES required 1 LAN 2 3 DEVICES APPLICATIONS Note 1: Note 2: Note 3: WAN Connectivity is undertaken by MAMPU under 1Gov*Net SPP development/roll-out for MOH hospitals commenced PhIS development/roll-out for MOH facilities commenced TPC/OHCIS development & roll-out commenced 31

32 Infrastructure & Connectivity Internet Note: 1. MOH*Net migration to 1Gov*Net 2. Managed services by MAMPU 3. MOH Data Centre to be migrated to Public Sector Data Centre 4. 85% facilities connected to 1Gov*Net 5. Target of connectivity 100% by 2015 (except Rural Clinics) MOH*Net Putrajaya Campus Network (PCN) 1Gov*Net (Monitored via NKEA CCI) MyLoca Data Centre Cyberjaya 20Mbps 20Mbps 6Mbps Mbps Hospitals Source: BPM, MOH MOH HQ State Health 32 Dept Health Office/ Health Clinics/ & Dental Labs & Institution

Hospital Information Systems in MOH 17 hospitals Commercial HIS 9 hospitals Sistem Peng. Pesakit (SPP) Total: 142 hospitals 10 hospitals Sistem Peng. Pesakit Dlm.

33 Hospital Information Systems in MOH 17 hospitals Commercial HIS 9 hospitals Sistem Peng. Pesakit (SPP) Total: 142 hospitals 10 hospitals Sistem Peng. Pesakit Dlm. (SPPD) 106 hospitals Manual Product CERNER FISICIEN isoft Profdoc SPP SPPD Hospital 1. Selayang 2. Sultan Ismail JB 1. Putrajaya 2. Sultanah Nur Zahirah KT 3. Sultan Hj Ahmad Shah 4. Institut Kanser Negara (IKN) 1. Serdang 2. Ampang 3. Sg. Buloh 4. Sultanah Bahiyah 5. Sultan Abdul Halim 6. Lahad Datu 7. Keningau 8. K.Batas 9. Pekan 10. Shah Alam 1. Bintulu 1. Tunku Jaafar 2. Port Dickson 3. Kajang 4. Tg. Ampuan Rahimah* 5. K.Lumpur* 6. Raja P. Bainun 7. Bentong 8. HRPZ KB 9. Taiping (*OP module) 1. HSA JB 2. B. Pahat 3. Melaka 4. Kajang 5. HKL 6. HTAA 7. HTAR Klang 8. HQE KK 9. P.Pinang 10. Sbrg Jaya 33

34 Sistem Pengurusan Pesakit (SPP) Overview 34

Primary Care-Oral Health System Overview Delivering

the rakyat by enabling Integrated Primary Healthcare

unified primary care system) Self Monitoring Outreach

Clinics Dental Clinics Source: TPC-OHCIS Team MOH

1Gov*Net UTC/RTC Clinics nlin e fflin Pilot 12 sites

35 Primary Care-Oral Health System Overview Delivering improved health care practices and better services to the rakyat by enabling Integrated Primary Healthcare Services (Effective and efficient services through unified primary care system) Self Monitoring Outreach Programme HPT DM Schools Community TPC-OHCIS Health Clinics Dental Clinics Source: TPC-OHCIS Team MOH Community Clinics MAMPU Datacenter 1Malaysia Clinics 1Gov*Net UTC/RTC Clinics nlin e fflin Pilot 12 sites 2016; nationwide rollout in phases over RMK11 (1061 Health Clinics & 629 Dental Clinics e

Objectives To meet the NKRA Health sector transformation towards a more efficient and effective health system in ensuring universal access to healthcare.

36 Objectives To meet the NKRA Health sector transformation towards a more efficient and effective health system in ensuring universal access to healthcare. Support National Medicine Policy objective to monitor provision of quality, safety and efficacy of drug and ensure drug availability. Single standardize system which will optimize resources, improve efficiency in service delivery and to prevent unnecessary cost. Functional Scope 1. Order Management 2. Outpatient Pharmacy 3. Inpatient Pharmacy 4. Pharmacy Inventory 5.Ward Pharmacy Source: PhIS Team MOH Nov 2015 Pharmacy Information System (PhIS ) Overview Project Scope Target completion : Clinical Pharmacokinetic Services (TDM) 7. Drug Information & Consumer Education 8. Adverse Drug Reaction (ADR) Monitoring 9. Medication Therapy Adherence Clinic (MTAC) 10. Medication Counseling 11. Manufacturing of Parenteral Nutrition, IV Admixture, Eye Drops, Galenicals, Radiopharmaceuticals and Cytotoxic Drug Reconstitution 12.Data Mining & Decision Support

37 TELECONSULTATION PROJECT

38 Lifetime Health Record (LHR): Key to interoperability ICT Source : MOH LHR Business Framework,

39 Started small with MyHIX V1.0 (2011) Conform to Integrating Healthcare Enterprise (IHE) Standard Framework Discharge/Visit Summary from the EMR HIS/CIS/Others HIS/CIS creates EMR (Electronic Medical Record) CDA Upload, Query, Retrieve Integration Profile (IHE) LHR MyHIX Retrieve CDA Integration Profile (IHE) Query HIS/CIS/Others CDA CDA = Clinical Data Architecture

40 MyHIX V2.0 (Project initiated 2015) MyHIX 40

41 Participating MOH facilities for MyHIX 2.0 HRPZII Data Center HSNZ Public Sector Data Centre (Managed by MAMPU of PM s Dept) H. Bentong HPJ KKPJ HTJS HPD

42 Source: HIC MOH, April 2015

43 ehealth Capacity & Capability Development 43

44 Leadership & Governance Standards & Interoperability Enterprise Architecture Project Management

45 MOH ehealth Capacity Roadmap Leadership & Governance WHO-ITU ehealth Strategy Toolkit, COBIT, ITIL Standards & Interoperability ISO, HL7, ICD-10, IHE, SNOMED-CT Enterprise Architecture IASA Curriculum Path (inc. TOGAF & COBIT) TOGAF by OpenGroup Project Management PRINCE2, PMBOK Structured localized program (Knowledge & Process) Career Path Diploma in IT Fields Masters in Health Informatics (local & Int l) PhD

46 Competency foundation & building NO ACTIVITY DATE OUTCOME 1 AWRENESS PROGRAMME EA & ISP MOH DECEMBER ENTERPRISE ARCHITECTURE (EA) DEVELOPMENT & IMPLEMENTATION PLAN WORKSHOP MOH 4-5 FEBRUARY PARTICIPANTS 50 PARTICIPANTS 3 TOGAF CERTIFICATION TRAINING (By International Body The Open Group) 4 COBIT CERTIFICATION TRAINING (By International Body - ISACA) 5 BITAF (BUSINESS IT ARCHITECTURE FOUNDATION) CERTIFICATION TRAINING (By International Body - IASA) JANUARY 2015, DECEMBER 2015 DECEMBER MOH OFFICERS TOGAF9 CERTIFIED 2 MOH OFFICERS COBIT5 CERTIFIED 9 MOH OFFICERS BITAF CERTIFIED 46

47 Change Management & Competency Building NO ACTIVITY WHO? SERIES 1 SERIES 2 SERIES 3 SERIES 4 1 Awareness & Desire Programme (ADP) STAKEHOLDER 1 session 1 session 1 session 2 BITAF Certification Class EA ARCHITECT 10 pax 10 pax 10 pax 10 pax 3 CITA-F Certification Class EA ARCHITECT 10 pax 10 pax 10 pax 10 pax 4 TOGAF 9.1 Level 1&2 Certification Class EA ARCHITECT 5 pax 5 pax 5 pax 5 pax 5 ARCHIMATE 2.1 Certification Class EA ARCHITECT 5 pax 5 pax 5 pax 5 pax 6 Knowledge & Ability Programme (KAP) STAKEHOLDER 1 session 1 session 1 session 7 CITA-A Certification Class EA ARCHITECT 5 pax 5 pax 5 pax 5 pax 8 Reinforcement Programme STAKEHOLDER 1 session 1 session 1 session 9 CITA-S Certification Programme EA ARCHITECT 2 pax 2 pax 2 pax 2 pax 10 Closure & Showcase Programme STAKEHOLDER 1 session OUTCOME : Complete Package Of Competency For MOH EA Architects 47

48 MOH Malaysia Project Management Program (16 Days) DURATION TITLE SYLLABUS CLASS 1 3 DAYS CLASS 2 3 DAYS CLASS 3 2 DAYS CLASS 4 3 DAYS CLASS 5 2 DAYS CLASS 6 3 DAYS PROJECT INITIATION: LOGICAL FRAMEWORK MATRIX ANALYSIS PROJECT INITIATION: VALUE MANAGEMENT PROJECT PLANNING PROJECT PROCUREMENT & CONTRACT MANAGEMENT PROJECT MONITORING PROJECT AUDIT MICROSOFT PROJECT Logical Framework Approach, Logical Framework Matrix Pre-Lab Value Analysis, Lab Value Mgmt Processes of Project Mgmt, Initiation, HR, Cost, Risk, Quality, Change etc Processes of procurement and contract mgmt. inc drafting of contract Processes of implementation, Control, Deliverables and closure ICT (inc security), Physical, environmental, operational (inc establish checklist) Training of PM tools

49 Illustrative In Summary.. $ Capex Multimedia Super Corridor GTP & ETP STP & Digital Economy 4 MSC pilot projects Numerous achievements Busy & rich times Turnkey projects Direct negotiations Silo implementations THIS Big bang approach Telehealth services reviewed MyHIX TPC pilot & roll-outs 1996 Towards health system transformation Connectivity Ongoing O&M 9MP projects Upgrades Pilots/POCs Roll-outs Lull Scaling Conventional Crawl, walk, run approach Realignment MP to 9MP 10MP 11MP Nationwide roll-outs of major systems Capex to Opex model Integration & Consolidation Managed services Government Shared Services Collaboration/Public Private Partnership Cloud deployment models Mobile Health Social Media Big Data & Open Data TIME 49

50 THANK YOU 50

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