Pengembangan SIM RS Berbasis Open Systems Strategi adopsi sistem informasi di rumah sakit nirlaba, RS Pendidikan dan mekanisme dukungan komunitas Terminologi e-health cukup luas, mulai dari aspek makro sampai aspek mikro kesehatan Patient’s safety umumnya dikaitkan dengan aspek mikro (pelayanan kesehatan langsung)  fokus on using information technology to support health services Majority of IT in healthcare services relates to electronic health record and or electronic medical record Guardian Y. Sanjaya gysanjaya@gmail.com

Outline 1. Cakupan sistem informasi rumah sakit 2. Adopsi sistem informasi di RS 3. Peluang Open Source SIM RS 4. Tatakelola sistem informasi internal RS 5. Sustainabilitas SIM RS & dukungan komunitas

Cakupan sistem informasi RS Kegiatan Pendukung Sarana Umum Pelayanan: Ex: Rekam medis, keuangan, manajemen NILAI TAMBAH Cepat Efisien 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 Sarana Pelayanan Radiodiagnostik: Ex: X-ray, Sarana Pelayanan Laboratorium: Ex: Kimia Klinik Kegiatan Utama PELAYANAN PASIEN MASUK Registrasi Admisi masuk PEMERIK-SAAN MEDIS AWAL Riwayat penyakit Vital sign Pemeriksaan fisik DIAGNOSIS Diagnosa klinik Diagnosa keperawatan PERSIAPAN TINDAKAN MEDIS Pemeriksaan penunjang dan skreening TINDAKAN MEDIS Tindakan operasi Pemberian obat-obatan REHABILITASI Rehabilitasi fisik Pola hidup PELAYANAN PASIEN PULANG Discharge Summary Rujukan Surat keterangan Information systems could support any above activities Adoption from Porter’s value chain

SIM RS & Pelayanan Kesehatan SIM RS = EHR Amatayakul, 2009 (AHIMA)

Pertanyaan penting Apakah SIM RS mahal? Bagaimana strategi adopsinya?

Adopsi SIM RS di Amerika Davis, 2009. HIMSS Analytics

Adopsi SIM RS di Korea

Pola adopsi SIM RS Cara adopsi Sisi baik Sisi kurang baik Outsource Instant Brand name Relatif mahal Susah dimodifikasi (closed code) In-house Sesuai bisnis proses Relatif lama Sistem analist dan tim IT yang handal Open Source Relatif cepat, customable, dapat menyesuaiakan bisnis proses Dukungan komunitas yang ‘labil’ Tim IT yang kuat Mix Customable - SDM yang ‘mumpuni’ Open Source

Road Map SIM RS Waktu Collector Documenter Helper Partner Mentor Evidence-based practice Combine with PHR Goal: Consumer empowerment Collector Phase 1 Documenter Phase 2 Health Information exchange Goal: Integrated health service Create data/information, Unidirectional Goal: intention Helper Phase 3 Partner Phase 4 Point-of-care data capture, Simple Alert system, Result management Goal: Efficiency Mentor Phase 5 Longitudinal record DSS in acute care and ambulatory Goal: efficiency, patient safety GartnerGroup megkategorikan berdasarkan perkembangan insutri ICT yang ada saat itu. Sehingga tahapan pada GartnerGroup lebih ke arah historitical aspect of EHR from many health facilities. Collector: Hanya fungsional untuk menampilkan hasil Tidak ada fungsionalitas SPKK, knowledge management, communication unidirectional Documenter: Data capture occurs at point of care Simple CPOE system with drug-drug and drug-allergic alerts are provided Simple documentation exist with minimal collection of discrete data Graphic and tabular display for results management capability is included Helper: Sudah ada fungsi longitudinal record DSS system untuk membantu pengambilan keputusan yang terintegrasi Waktu GartnerGroup generation of EHR (Amatayakul, 2009)

Peluang Open Source Care2x OpenMRS

Keamanan, privasi,Integritas, Lingkungan SIM RS Peluang Open Source Application Governance SIM Sosio-teknis, Aspek Keahlian, penerimaan Keamanan, privasi,Integritas, aksesibilitas Tatakelola, Struktur Organisasi Pembiayaan Infrastructure Data collection (too much or too little) Completeness Accuracy Timeliness Single identification (for integration and interoperability) Integrated to existing system (ex: electronic medical record) Sustainability and nation-wide usage (funding, regulation) Ability to interface with Electronic Health Records (EHRs) Incentives for providers to purchase and use a registry Funding for hospital IS Data integration and sharing for national level Sustainability issues: maintenance and adapting to future needs) Legal issues of confidentiality and who has access to the data Communication and outreach to educate providers about registries and EHRs

Siapa melakukan apa? Komposisi tim SIM RS (Tribal survey, 2009) Decision Support Management System Clinical and Administration Strategic Planning Periodic Queries Operational Systems Data Transaction Management Control Operational Control Schedule, On demand reports Tatakelola SIM RS menentukan sustainabilitas sistem dan pengembangan lanjutan

Memperkuat sistem open source Gov. Praktisi Profesi Akademisi Industri Upaya percepatan adopsi (SIM RS Generik, UHC) Penyusunan Regulasi (UU PP, Permenkes, Petunjuk Teknis, Standardisasi) Pengembangan mandiri (motivasi, efisiensi) Penggunaan aplikasi open source Penguatan komunitas melalui working-working group (SNI, standards, Clinical Informatics) Penelitian pengembangan sistem Pendampingan implementasi Sosialisasi pengalaman (knowledge sharing) Customisasi/pendampingan sistem Support community development Open source merupakan satu peluang yang harus didukung dari sisi aspek regulasi, dukungan komunitas dan bahkan industri NETWORKING

Maps of health facilities in Indonesia, per April 2011 Why HIS training? There are 33 Provinces in Indonesia, each province has 3-29 Districts, and each district has 5-45 sub-districts. There are health offices in every administrative levels. Government own primary care (Puskesmas) and district hospitals is the most distributed healthfacility in indonesia. Primary care available in every sub-district (more than 9000) and secondary hospital is available in every districts (more than 500) All government-owned primary cares are coordinated by District health office within a district level (there are 500+ District health office) More than 2.000 hospitals (private and government own) Source: BNPB and Ministry of Health, 2011

Proposed scaling up model Capacity building Other Hospitals Piloting Hospitals (center of excellences) Sister hospitals Technical support IS Staff Capacity building Advanced Technical support Technical support Community Development NGOs Local Vendors Universities Puskesmas/DHO Technical Staff Non profit Teaching Hsp. Initiator Group (Core team) Open Source SIM RS Coordinate Development Partnership Open Development and Support

Sampai mana RS mau mengadopsi SIM RS? Clinical and administration systems Using Information Technology Tools Knowledge Networks Rules

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