Open Source in Healthcare: HUSM 10 Years of Innovative Effort

Transcript

1. Open Source in Health Care: HUSM 10 Years of Innovative

   Effort Unit Sistem Maklumat Hospital Universiti Sains Malaysia

2. Hospital Universiti Sains Malaysia • Teaching hospital under Universiti Sains

   Malaysia located at Kubang Kerian, Kelantan. • Under Higher Education, not KKM. • 1983 - Current. • http://www.h.usm.my

3. Hospital Statistics • 740 patient beds • 35 wards •

   43 clinics • 10 labs supported by ISU • About 1,500 outpatients daily with total of more than 2 Million • About RM 80 millions spent on medicine annually

4. Applications Statistics • Lifeline (Patient Demographic) manage more than 800,000

   patient data. • Daily patient encounter about 1,400 - 1,600. • Out Patient encounter recorded up to 3,143,618 tuples. • In Patient encounter recorded up to 311,605 tuples. • Patient appointment list out 2,066,462 tuples. • These numbers are increasing as we speak.

5. Information System Unit • A unit directly under the Hospital

   Director, Dato' Dr. Zaidon Kamari • Started with 4 IT personnel initializing the Total Hospital Information System effort at year 2000 lead by en Azuddin Ab Rahman. • Now consist of 7 Analysts and 15 Programmers focusing all effort on application development. • Under restricted and limited resources on both expertise and budget. • Development under Linux environment. Application is multi platform.

6. Health Care 1. Complex • Multidisciplinary, Multi-resources • Lots of

   medical equipment and new technology • New research and findings • Types of facilities • Variations of policies and standard practice guidelines/operating procedure • Millions of data / terms used • Variations of forms (in data entry) 2. Large Scale • The United States alone spends 16% of its GDP (gross domestic product) 2009. • In comparison, the Malaysian Government’s healthcare spending is RM35 Billion (RM 35,148,955,576.02)(2008) Health Facts 2009, Kementerian Kesihatan Malaysia .

7. History Hospital Information System

8. Development Chronology • 2000 ◦ Information System Unit HUSM ◦

   2 developers, 2 supports • 2001 - Patient Registrations • 2003 - Laboratories • 2006 - Pharmacy (Store) • 2007 - Paperless Progress Notes (initialized) • 2008 - AMS, CSSD, Radiology • 2009 - Online Prescription • 2010 - Blood Bank, System Attendance • 2011 ◦ Awarded RM 400K by Treasury ◦ 22 developers + 15 temporary developers

9. Challenges Obstacles and Constraints

10. Limited Budget • Low-end user PC • Not enough PC

    for user • Obsolete PC still being used by user • Using normal PC as server • Limited high-end devices / peripherals • Limited number of PC and server acquired each year

11. Management Understanding • Unconventional procedure • Insecure with Open Source

    • Doubt IT staff ability, judgement and decisions • Inability to comprehend the nature of IT workers

12. Low Acceptance from User • Mostly senior staff reluctant to

    use • Computer illiterate • Digitalization requires training and learning • Out from their 'comfort zone' • High-dependent on the old traditional method • Misunderstood by being involved with the development • Uneasy with new changes

13. Project Development Constraints • Insufficient skills and knowledge ◦ employed

    staff mostly is fresh graduates • Low exposure to Open Source ◦ geographically isolated from active community ◦ environment • Staff adaptation, motivation and support • Insufficient training ◦ availability and expensive

14. The Effort From voluntary to mandatory

15. Hospital Information Management System (HIMAS),1996

16. The Tools The magical Open Source The Linux The Free

    The Community The Support The Openness

17. Continuous Exposure to Open Source Changing the scenario Something that

    once feared became something to proud of User learned to be part of the development team.

18. Proven and Confidence Top management confidence and recommendation User feedback

    and comments Acknowledge by other government agency

19. Accomplishment

20. Applications List Lifeline Patient demographic, Appointments, physical folder management, Diagnosis

    management POLS Prescription Online System SPIFU Drug Inventory Management System SPIFA Tools Inventory Management System AMS Assets Management System LIS Laboratory Information System SPD Diet Management System e-Clips Document Management System PADU Computer Technical Complaint Management

21. Applications List (Cont..) CSSD Central Sterile Supply Department Sticker Vehicle

    registration sticker FIRAS Film Information Reject Analisyst used by Radiology department ICD 10 International Classification of Diseases v10 Attendance Staff attendance record and management Transfusion Blood Donation Management for Blood Bank Department Mortuary Mortuary Management HUSM Formulary Drugs Information Database Electronic Medical Archives (EMA) Digital Image Medical Records Management System

22. Technologies • OS: Linux Slackware, Ubuntu, Windows and Mac OS

    X • Programming Languages: Java, C++, PHP, Ruby, Perl, XML, Bash, ZPL II, XHTML, PHP and CSS • Database: MySQL, Sybase (Integration) • Web Server: Apache • Revision Control: Subversion and Git • Frameworks/Library: jQuery, JasperReport, Rails, Smarty • Monitoring Tools: Nagios, Cacti • Project Management: Redmine • Hardware Involved: Mifare 1K Card, MyKad, Biometrics, Lab Machines

23. Cost Implications • 60% - Developers salary • 40% -

    Desktops, Servers and Maintenances • 0% - Softwares and Licences, Upgrades, Add-on, etc • ~ RM 5Mil (2000-2008) • Ownership - 100% (OURS)

24. Experience from what we are

25. Traits and Role Takes time to convince people Let them

    see and try rather than hear Involvement make them felt the ownership Friend and colleagues

26. Our Pathways Future Plan

27. The Plan • Embrace new technologies • Fundings • Certifications

    • Education • Standard • Collaboration • Sharing Expertise / Experience

28. Thank You