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Open Source in Healthcare: HUSM 10 Years of Innovative Effort

Amree Zaid
December 30, 2011

Open Source in Healthcare: HUSM 10 Years of Innovative Effort

A presentation from Hospital Universiti Sains Malaysia about how they build their hospital solutions using open source tools. Presented by Mr Yusdirman Bin Yusoff.

Amree Zaid

December 30, 2011
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Transcript

  1. Open Source in Health Care:
    HUSM 10 Years of
    Innovative Effort
    Unit Sistem Maklumat
    Hospital Universiti Sains Malaysia

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  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

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  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

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  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.

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  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.

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  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 .

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  7. History
    Hospital Information System

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  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

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  9. Challenges
    Obstacles and Constraints

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  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

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  11. Management Understanding
    ● Unconventional procedure
    ● Insecure with Open Source
    ● Doubt IT staff ability, judgement and decisions
    ● Inability to comprehend the nature of IT workers

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  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

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  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

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  14. The Effort
    From voluntary to mandatory

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  15. Hospital Information Management System
    (HIMAS),1996

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  16. The Tools
    The magical Open Source
    The Linux
    The Free
    The Community
    The Support
    The Openness

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  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.

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  18. Proven and Confidence
    Top management confidence and recommendation
    User feedback and comments
    Acknowledge by other government agency

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  19. Accomplishment

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  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

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  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

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  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

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  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)

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  24. Experience
    from what we are

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  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

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  26. Our Pathways
    Future Plan

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  27. The Plan
    ● Embrace new technologies
    ● Fundings
    ● Certifications
    ● Education
    ● Standard
    ● Collaboration
    ● Sharing Expertise / Experience

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