Open Source in Health Care:HUSM 10 Years of Innovative Effort

Unit Sistem MaklumatHospital Universiti Sains Malaysia

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

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

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.

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.

Health Care1. 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 .

History

Hospital Information System

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

Challenges

Obstacles and Constraints

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

Management Understanding

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

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

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

The Effort

From voluntary to mandatory

Hospital Information Management System (HIMAS),1996

The Tools

The magical Open Source

The Linux

The Free

The Community

The Support

The Openness

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.

Proven and Confidence

Top management confidence and recommendation

User feedback and comments

Acknowledge by other government agency

Accomplishment

Applications List

Lifeline Patient demographic, Appointments, physical folder management, Diagnosis management

POLS Prescription Online System

SPIFU Drug Inventory Management SystemSPIFA Tools Inventory Management SystemAMS Assets Management SystemLIS Laboratory Information SystemSPD Diet Management Systeme-Clips Document Management SystemPADU Computer Technical Complaint Management

Applications List (Cont..)

CSSD Central Sterile Supply DepartmentSticker Vehicle registration sticker FIRAS Film Information Reject Analisyst used by

Radiology departmentICD 10 International Classification of Diseases v10

Attendance Staff attendance record and managementTransfusion Blood Donation Management for Blood Bank

DepartmentMortuary Mortuary ManagementHUSM Formulary Drugs Information DatabaseElectronic Medical Archives(EMA)

Digital Image Medical Records Management System

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

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)

Experience

from what we are

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

Our Pathways

Future Plan

The Plan

● Embrace new technologies● Fundings● Certifications● Education● Standard● Collaboration ● Sharing Expertise / Experience

Thank You