Content:

Introduction

Current Health Services in Malaysia (in brief)

In Malaysia, and as well as in many other (if not all) health institutions around the world, they have their own record keeping system. Patient records are not shared. Here is an example to portray it all:

A clear example will be say Mr. A visits Hospital X for a medical check up and is diagnosed of having a bad digestive disorder. He has to do a lot of follow ups with the doctors in that hospital for a few months until his health condition is at a more stable situation. He is then ‘discharged’ from having going to Hospital X for routine check up. Along the years, he switches jobs and he is not in another state (say Malacca. He visited Hospital X in Kedah when he worked there). His digestive disorder strikes again after 10 years of ‘cool down’ and he is now in Malacca. The situation is a lot worse compared to the previous one. He is admitted to the hospital (say Hospital Y) and the hospital has to phone to Hospital X in Kedah to have his medical records being faxed over.

The government has proposed e-medicine a few years back during the launch of Multimedia Super Corridor (MSC) but it does not seem to have much significantly huge change among the health institutes around the country. Computerization of health institution is still rather slow and the crawl is getting even more mundane if we are to compare to the computerization of commercial sectors in this country.

The Ideal Health Services in Malaysia

One of the most important things that all health institutions in Malaysia should do is to share their patient records with other health institutions within the country. The reason being so is that patients do not stay in one place forever. Sharing of patient information (with certain degree of security measures) will enable the patient to feel free to move around within the country (and around the world) and can still have access to their health information.

The ideal health services should include the following criteria:

1) a standardized representation of data: universal data representation

2) information of the patient is available with disregard of the patient’s geographical location: availability of data

3) the information should be retrievable with the shortest and easiest way even in the most remote places in the world: accessibility of data

4) the information can be updated whenever it needs be anywhere anytime: consistency of data

Thus far, no health institution has yet to provide such a solution. Each health institution is only considering on how to make the information publicly available within the organization or premise and not to any other institution; not even the patients itself.

An ideal health service is a combination of both good health care and excellent availability of information. Good health care can be portrayed by having good doctors, medical facilities and such. Excellent availability of information will rely heavily on information sharing among health institutions in a uniformed way.

Defintion of Criteria:

1) Universal Data Representation

The atomic level of information will be data. Data, in the simplest explanation, will be a collection of raw information without meaning. Data is like a piece of a Lego building block where a piece of it tells nothing. Information, on the other hand is a stream of data that has been pieced together to carry a certain meaning. Analogy: Information is like a model constructed from many pieces of Lego building block.

Data is stored in a ‘box’ called database. These databases are the data repository. Information is formed by obtaining the right data from the database, format or interpret it so that when it is published, it becomes information. So we can easily conclude that data forms information.

But how are we supposed to store these data in the database? Giant software companies have been providing us with a lot of variant of database management system (DBMS) to solve the problem. Each of these DBMS has its propriety design patterned. In short, the format of storing data in each DBMS defers. As an analogy, one company comes out with a rectangle Lego block of 3cm in height, 5cm in width and 10cm in length. Another company produces a rectangle Lego block at dimensions totally different from the first company. This makes the builder having to dedicate himself to selecting Lego block from one of the two companies and not both since their dimension defers and they cannot work together. Let's take a look at an example:

So let’s imagine Hospital X is using Oracle DBMS to store its data and Hospital Y is using SQL Server 2000. The way the way data is represented in these two DBMS are totally different. Security issues aside, Hospital Y will face complications when they wish to obtain data via Internet from Hospital X simply because it requires a different programmatic approach to retrieve the data out from Hospital X’s database. The same is true for Hospital X trying to access data from Hospital Y.

Now the example above just involves two hospitals. A good planning can solve this problem but what happens if there are more than two hospitals involved in this and each of them are using a different DBMS from each other? Imagine the time and effort needs to be spent on retrieving data from any of these DBMS, not to mention even update them.

In order to solve this problem and make the data widely available throughout the world, we need to come out with a uniform way; a standard to retrieving data out from any DBMS disregarding how data is being represented in these DBMS. We need to somehow make sure that updating these databases is as easy as retrieving them so that a person who is not technically skilled in IT can do it.

2) Availability of Data

Computer systems nowadays are usually networked together to harness it’s processing and availability power. In huge enterprise situation, companies under the same umbrella of influence will expand their system’s availability to all its branches worldwide in a Wide Area Network (WAN). The employees within the company can share data and use these data without any single idea of where the data is stored. A portion of the data could be stored in a server at Site A while the second portion of it in Site B. What the employees feel is that it seems like the data comes from one single place or site. That is availability of data. The data is available to all the employees in that company who is connected to the WAN.

In health care, this kind of implementation is not widely (if not at all) being implemented. Local Area Network might be common but WAN is still giants leaps away from reality. Even if LAN exists, it is greatly under utilized in Malaysia.

Implementation of WAN with a universal data representation through the usage of XML can greatly make the data, particularly data of the patients, available to all the health care institution branches. Physicians and even the patients do not have to manually ask for a transfer of information from a branch to another. Everything is computerized and with a search through the enterprise database, everything is available.

Even if the patient is in Site A but his information is stored in Site B and another portion of it is stored in Site C when he visited Site C, the physician who is attending this patient can just make a database search and all these data will appear on screen for the physician. Data is available without exposing any deep technical expects of how things work.

For management purposes, we can group all data in one area, say all patients’ x-ray data is stored in Site A and all patients’ personal data is stored in Site B. The drawback comes when one of these sites break down, the whole network breaks down. It is recommended to have the patients’ database localized to the first site he visited in the past and updates are done in the current site where the patient is geographically at. Security of site is enhanced and availability of data is greatly upheld in such implementation.

But such method is very hard to implement if we are to use today’s technique of how database is managed. Ease of management and site security do not make good couples if married. A new set of solution has to be devised to meet such a challenge.

3) Accessibility of Data

In a WAN implementation, data within the organization is available to all the staffs of the organization for as long as the staffs have some access to the WAN in general. They can use Virtual Private Network (VPN) if they are out of the coverage of the WAN. They can resort to the use of GPRS if they are at a very remote place.

Now, there does not seem to have any issue of accessing the data up to now but consider this: “How these data are is accessed?” Many a time these data is accessed using a desktop computer or laptop if the employee is at an off site environment without the WAN influence. This means that data can only be accessed with a certain device.

Many a time, we do not bring laptops or bulky equipment with us all the time. A physician is not expected to bring a laptop everywhere he goes since that laptop could hinder his mobility. He might prefer bringing something small – a ‘laptop replacement’ perhaps. He decides to bring a small personal digital assistance (PDA).

PDA is a mobile devices and it is a new trend by the current standard. Programming PDA is a rather new thing. PDA’s architecture is very different to that of a laptop or desktop. It has smaller screen and no keypad for keystrokes. From just one glance, most of us will think that this is a bad replacement for a laptop and thus conclude that to access these data I have either need to have a laptop or a desktop.

To make the assumption that one needs a laptop or a desktop to access one’s enterprise database is a myth by today’s standard. PDA, though small, they are as powerful as a laptop or desktop given proper software or design. Implementation of PDA as a ‘laptop replacement’ has make data accessible anywhere; the true concept of mobile workers.

Accessibility of data is all about ways of how user accesses data using any devices regardless of location where the user is at. This is easier said than done when we consider that each devices run on different platforms and operating systems.

4) Consistency of Data

We begin this elaboration with an example:

Supposing the patient has been admitted to a hospital say Hospital Z which has no record of the patient. What Hospital Z’s management can do is to open a new record to document this patient’s condition. That sounds rather simple but when it comes to prescribing medication for the patient, the real problem starts to surface. Suddenly the nurse at the dispensary of Hospital Z does not know that this particular patient is allergic to certain antibiotic and accidentally prescribed the wrong antibiotic to him. The patient returns to Hospital Z and informed the nurse of the wrong prescription and gets his replacement. The nurse then updates the database of that particular patient to indicate that he is allergic to some certain antibiotic. Then the next problem arises! Hospital X and Hospital Y are not informed about this particular patient’s allergy. If the patient visits Hospital X and physicians in Hospital X give him the wrong antibiotic prescription, he is going to have a hard time with his health. Hospital X finds out this and soon gives him a replacement and update the patient’s record in Hospital X (by then this patient is already very grumpy since his medication has been wrongly prescribed twice).

Hospital X does not know that all these information is already available in Hospital Z when the patient visited that hospital. Duplication of data happens thus no consistency in storing and maintaining data.

Inconsistency of data is very resource wasting and as a side effect, it makes the whole information system or very hard to manage. This gets worse when there is no uniform way of presenting data.

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