Transcript MALAYSIAN HEALTH CARE SYSTEM

NATIONAL eHEALTH:
“Moving Towards Efficient
Healthcare”
By:
Dr. Fazilah Shaik Allaudin
Deputy Director
Telehealth Division
Ministry of Health MALAYSIA
Presentation Outline
Introduction
 Health System Transformation
 MOH’s Direction
Proposed eHealth Strategy
• Challenges
• Action Plan
• RMK-11 initiatives
• New strategies
 Summary
2
Executive Summary
 eHealth in Malaysia began actively with the era of MSC. We had an era of rapid
build-up and POCs and pilots, which today, is being hampered by budget
constraints.
 Today in healthcare facilities, we have manysystems and the numbers continue
to grow due to functional needs, but we continue to have a large gap on patient
care systems despite its obvious benefits.
 Healthcare is poised for its biggest shake up ever as its transformation to a more
better, efficient and equitable healthcare requires ‘quick wins’ in ICT to be
addressed.
 Today, MOH have promising patient care system (TPC, OHCIS & SPP) that
requires scaling.
 We need to take healthcare to the next level, one that embraces the need for
changes and uses ICT as an enabler.
 The confluence of Big Data, Cloud, Managed and Shared Services combined with
uncertain budgets compels us to rethink our business model.
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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
Current Healthcare System
Payment
Mechanism
Line Item Budget
Fee for Service
74%
49%
NHMS2011 –
only medical visit)
5
:
:
26%
51%
HCDA study
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
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Greater
equity,
accessibility
& better
utilization
of resources
Primary Health Care as thrust of the Health System
2010
2000
1980
1960
Mother & child
Family planning
Outpatient
Environmental
School
Mother & child
Family planning
Outpatient
Environmental
School
Dental
Pharmacy
Lab
Mother & child
Family planning
Outpatient
Environmental
School
Dental
Pharmacy
Lab
Child with Special Need
Reproductive Clinic
Elderly Clinic
Diabetic Clinic
Adolescent
Occupational Health
Emergency
Health Informatics
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Mother & child
Family planning
Outpatient
Environmental
School
Dental
Pharmacy
Lab
Child with Special Need
Reproductive Clinic
Elderly Clinic
Diabetic Clinic
Adolescent
Occupational Health
Emergency
Health Informatics
Hypertension
Rehabilitation Services
HPV
Needle Stick Exchange Programme
Methodone
STI/vice
PLKN
Penjara
K1M
DTS
Growing Scope: Secondary & Tertiary Care in MOH
14 State Hospitals + HKL
(45 services)
26 Major Specialist
Hospitals (26 services)
27 Minor Specialist
Hospitals (10 services )
10 Special Institutions /
Hospitals
66 Non Specialist
Hospitals
(Visiting Specialists)
MOH Hospitals (as of Jan 2014)
8
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
9
Malaysia’s health informatics multi platforms
Political
Commitment
Multimedia Super
Corridor (MSC)
Flagship - 1996
Economic
Transformation
Programme (ETP) –
2010
National
Commitment
Governance/Policy
Standards &
Interoperability
1Gov*Net (MAMPU)
Telemedicine
Blueprint 1997
MOH LHR Business
Framework
1GovUC (MAMPU)
HIMS Blueprint
2006
PDSA (MAMPU)
8,9 & 10th MP ICT
technical papers
1Gov Cloud (MAMPU)
National Health
Policy 2007
1GovEA (MAMPU)
Digital Malaysia –
2014 (absorbed into
NKEA)
ICT Strategic Plans
(ISP)
Open & Big Data
(MAMPU)
RMK-11 Plan
Digital Opportunities
RMK-11 (EPU/SKMM)
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Health Informatics
Standards
IHE Framework &
Malaysia
Connectathon
Malaysian Health
Information
Exchange (MyHIX)
SNOMED-CT
Country License
A new era of political commitment
towards digital economy
Source : MAMPU
11
ETP as a platform for ICT in healthcare
High Income Nation by 2020: 6% growth thru 2020; Double GNI and reach per capita GDP of US$15K
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
Source : PEMANDU EPP Preso Pack
12
12
Towards Health System
Transformation
13
Challenges in Health
And many
more….
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.
Fully implemented transformation
Service
Delivery
Hospital reform
PHC reform
Financing
Organisational
Public Facility autonomy
Strengthening of the current health system
15
MOH’s Policy Direction 2013-2016
Strengthen PHC
• Family doctor
• Preventive care
Public Private
Integration
• Engage GPs
Community
empowerment
• Working with other stakeholders
• Self-empowerment
Care closer to home
• Domiciliary care
• Step down care
16
Planning for 11th Malaysia Plan (2016-2020)
IMPROVED
WELL BEING
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
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OUTCOME
1.
Quality, responsive
and sustainable
healthcare system;
2.
Reduction on
disease burden
and risk factors
3.
Healthy
environment and
food safety
Proposed eHealth Strategy
18
ICT Challenges in MOH
Policy &
Procedures
• Standardisation
• Healthcare
information
sharing
• Governance
Infrastructure
• Limitation of
infrastructure
availability e.g.
LAN & Devices
• Obsolescence
System
Cost
People
• Integration &
Interoperability
• Performance
• Scalability
• Future readiness
• Support &
Maintenance
• 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
• Clinical
Leadership
• Skills & Expertise
• Change and
adoption
Significant budget constraint;
ICT ~5% of total MOH CAPEX
19
ICT Issues in RMK-10
 Inadequate and inconsistent funding
 Fragmented ICT Implementation at MOH
 Incomplete readiness of ICT infrastructure at health
facilities
 Inadequate data for strategic planning and
management
Technology
 Inadequate ICT skills and competency
Process
To be addressed in RMK-11
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People
What is the enabler of MOH vision?
A nation of healthy individuals, families and communities….
Citizen
Communities
Nation
•Achieve better
outcomes
•Improved population
health
•Decreased cost
burden
Integrated Healthcare Delivery
Integrated Healthcare IT System /
Connected Health
Key
Enabler!
Legal Framework & Policy
Leadership & Governance
Sustainability
Monitoring & Evaluation
People (Skills & Expertise;
Change & Adoption)
Health Information Exchange
(HIE)
Applications & Systems
ICT Infrastructure &
Connectivity
Standards & Interoperability
Action Plan for ICT
Health System Transformation
GOAL
Pillars
Enterprise Architecture
National eHealth Policy & Strategy
Foundation
Five initiatives in RMK-11 (2016-2020)
1
Develop National eHealth
Strategy
2
•Focus on strengthening the current health
Implementation of
infrastructure and systems
system with robust ICT infrastructure/systems
3
Lifetime Health Record:
‘1 person 1 record’
4
5
•Focus on establishment of EA, integration and
Health Data Warehouse
•Focus on integration & interoperability,
accessibility to data and patient engagement
Establish Health IT
Workforce Development
Program
•Focus on capacity and capability building
Collaboration and Smart
Partnership
•Focus on delivering core business and tapping
strength of others
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The activities for each initiatives (2016-2020)
Health Information System
Patient Care/
Population Care
Client/
Citizen
Patient
Management
Ward/Clinic
Management
National
Order
Management
Health Portals
eScheduling/
eAppointment
eFollow-up/
eConsultation
Personalized
Lifetime Health
Plan
Staff
Management
(Rostering)
MyHIX/LHR
RIS
Medical Record
Management
Billing &
Payment
Diet & Catering
Administrators
Tool
Case Mix
eGov Apps
(Adm/HR/Fin)
LIS
PhIS
BBIS
CSSD
FMIS
OTMS
PACS
CLINICAL DOCUMENTATION
General Specialties
Sub-Specialties
BI/EIS
Clinical Decision
Support System
CCIS
Cardio MS
LDR
OIS/RT
Institutional systems
Health Apps
1.
Integration
2. Integration to external
systems is also required;
however not reflected
here
Monitoring/
Evaluation
(inc QA)
Disease/Patient
Registries
Self Monitoring
Note:
Surveillance/
Monitoring
PRIMARY CARE
Patient
Management
System & Billing
Clinical Notes &
Dental Charting
Order
Management
Personnel
Management
School
Health
Health
Education &
Counselling
EIS
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Teleconsultation
& Remote
Monitoring
Population
Health
Regulation/
Enforcement
Licensing/
Credentialing
N
a
t
i
o
n
a
l
D
a
t
a
W
a
HIMS
r
e
Health Financing h
o
u
Professional
s
Registries
e
HR
Development
/ Training
DATA JP
SOURCEN
MOH
National Health Data Warehouse
Licensing/
Credentialing
Client
Registry
Shared
Records
(LHR)
Provider
Registry
Wellness
Services
(Personalized)
Monitoring &
Evaluation
Patient
Portal
Regulation/
Enforcement
Facility
Registry
Promotion/
Surveillance
Terminology
Services
1Care Access Layer
Registration
Information Exchange Infrastructure Services
(HIE)
Scheduling
QUICK
WINS
Eligibilit
y Check
Prescription
Wellness
Visit
Summary
Referral
Claim
Provider (Public &
Private)
Enrolment
Capitation &
Risk Adjustment
Quality
Incentive
s
Verification
Fin & Acct
Penalty
Claim
Security
Management
Privacy
Management
Prescription
Registration
View
Eligibility
Dispensing
Check
Interaction
Adverse
Provider Payment
Future ICT Architecture Overview (Conceptual)
Allergy
Claim
Community
Pharmacy
‘Quick Wins” for MOH
MOH: <30% with HIS system
Note 2
Hospitals
MOH: <10% with TPC
Note3
Note1
WAN
Health Clinics
MOH: <5% with OHCIS
Note 3
Dental Clinics
LAN and DEVICES required
Note 3
Supporting Facilities
1
LAN
2
DEVICES
3
APPLICATIONS
Note 1:
WAN Connectivity is undertaken by MAMPU under 1Gov*Net
Note 2:
SPP development/roll-out for MOH hospitals commenced
PhIS development/roll-out for MOH facilities commenced
Note 3:
TPC/OHCIS development & roll-out commenced
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Infrastructure & Connectivity
Internet
Note:
1.MOH*Net in final
stages of migration to
1Gov*Net
MyLoca Data
Centre
Cyberjaya
MOH*Net
2.Managed services by
MAMPU
1Gov*Net
3.MyLoca Data Centre
to be migrated to
Public Sector Data
Centre
(Monitored via
NKEA CCI)
Putrajaya
Campus
Network
(PCN)
4.70% facilities
connected to
1Gov*Net
20Mbps
Hospitals
20Mbps
5.Target of connectivity
100% by 2015
MOH HQ
State
Health
28 Dept
6Mbps
10-30 Mbps
Health Office/
Labs &
Health Clinics/
Institution
& Dental
In Summary……..
Illustrative
$ Capex
Multimedia Super
Corridor
GTP & ETP
STP & Digital Economy
Towards health system transformation
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
Connectivity
Ongoing O&M
9MP projects
Lull
2010
1996
7MP to 9MP
2012
Upgrades
Pilots/POCs
Roll-outs
Scaling
Conventional
“Crawl, walk,
run” approach
Realignment
2013
2015
10MP
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
2016
2017
11MP
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2020
TIME
THANK YOU
[email protected]
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