Informatika pada FasilitasPelayanan Kesehatan

Guardian Y. Sanjaya

gysanjaya.blog.ugm.ac.id

Outline

• Konteks sistem pelayanan kesehatan

• Perspektif sistem informasi untuk pelayanan perorangan

• Perspektif sistem informasi untuk manajemen organisasi

• Perspektif sistem informasi untuk sistem kesehatan

• Contoh informatika pada fasilitas kesehatan: Electronic Medical/Health Records

• Beberapa isu penggunaan informatika pada fasilitas kesehatan

Organizational model of health services

Essential Public Health management function

Lippeveld, Sauerborn. 2000. A framework for designing health information systems

Sistem Jaminan Kesehatan Nasional dan Daerah

Badan

Jaminan

Kesehatan

Peserta

JaminanPenyedia

Layanan

Puskesmas

Dokter Praktik

Klinik Pratama

Rumah Sakit

Apotik

Laboratorium

Regulator

Memberi pelayanan

Mencari pelayanan

Peran Regulator:

1. Regulasi sistem pelayanan

kesehatan (rujukan

bertingkat)

2. Regulasi standar pelayanan

kesehatan, kompetensi

pelayanan masing-masing

level, standar obat dan alkes

3. Monitoring sistem

kesehatan

Client/Patient Management Perspective

Essential Public Health management function

Lippeveld, Sauerborn. 2000. A framework for designing health information systems

Client/Patient Management Perspective of informatics• Effectiveness and efficiency of patient care

• Patient safety and quality of care– Patient identification

– Accessibility of patient informations=

– Electronic prescription

– Clinical decision support systems

• Reduce cognitive load

• Evidence-based practice

• Clinical research

Health Unit Management perspective

Essential Public Health management function

Lippeveld, Sauerborn. 2000. A framework for designing health information systems

Health Unit Management perspective of Informatics• Accuracy and transparency of information (relating to patient care,

human resources, billing, financials, etc.)

• To support management decisions for the purpose of service improving organization and customer/client management

• Assist health facilities in routine reports, both internal report (Management, Owners) and externally (DHO, Ministry of Health)

• To ‘communicate’ with others in order compliance to regulation (health insurance, referral systems, emergency medical services)

Information output for organization management• Information for decision making

• Management of hospital resources (logistics drugs)

• Human Resource management (capacity building, human resource planning)

• Financial management (billing, claims, assets)

• Payroll and remuneration

• Routine reporting • Contributing to health systems monitoring and evaluation

Health systems management perspective

Essential Public Health management function

Lippeveld, Sauerborn. 2000. A framework for designing health information systems

Health systems management perspective of informatics• Sources of health data for the macro system (DHO, Ministry of

Health)

• Secondary use of data to assist in program planning, evaluation and monitoring of the health system, research

Electronic based health information systems

input outputmodel

Database

Data SourcesDataManagement

Information

Compilation, integration

Graphic

Tabuler

Maps

Reports

Health profile

Specific analysis

Mon-Ev

Research

Visu

alization

Usage

Contoh: Output Laporan Rutin Rumah Sakit

• Indikator pelayanan dasar: BOR, ALOS, TOI, Rata-rata kunjungan

• Ketenagaan: Rasio perawat dengan TT, rasio dokter dengan jumlah kunjungan

• Pelayanan RS• Pelayanan rawat inap: Jumlah kunjungan, pasien keluar hidup, pasien keluar meninggal (<48

jam dan >48 jam), lama dirawat, hari perawatan.• Pelayanan IGD: DOA, Meninggal di IGD, Jumlah pasien rujukan, dirujuk• Pelayanan Rawat Jalan, Penunjang Medis (Lab, Radiologi, Farmasi)

• Morbiditas dan mortalitas

• Data kunjungan pasien• 10 besar penyakit rawat inap dan rawat jalan• Kunjungan rawat jalan dan rawat inap

Permenkes 1171/Menkes/SK/2011

Data Dasar

Data Ketenagaan

Data Pelayanan

Morbiditas dan Mortalitas

Pengunjung RS

Data dasar rumah sakitIndikator pelayanan rumah sakitFasilitas tempat tidur rawat inap

Pelayanan rawat inap, Rawat darurat, Gigi dan mulut, Kebidanan, perinatologi, Pembedahan, Radiologi, Laboratorium, Rehabilitasi medik, pelayanan khusus, Kesehatan Jiwa, KB, Pelayanan resep, dll

Data ketenagaan rumah sakit

Penyakit rawat inapPenyakit rawat jalan

Pengunjung rumah sakit, Kunjungan rawat jalan10 besar penyakit rawat inap dan rawat jalan

Permenkes No. 75 Tahun 2014 tentangPuskesmas• Pasal 43

1) Setiap Puskesmas wajib melakukan kegiatan sistem informasi Puskesmas.

2) Sistem Informasi Puskesmas sebagaimana dimaksud pada ayat (1) dapatdiselenggarakan secara eletronik atau non elektronik.

3) Sistem informasi Puskesmas paling sedikit mencakup: a. pencatatan dan pelaporan kegiatan Puskesmas dan jaringannya;

b. survei lapangan;

c. laporan lintas sektor terkait; dan

d. laporan jejaring fasilitas pelayanan kesehatan di wilayah kerjanya.

Permenkes No. 75 Tahun 2014 tentangPuskesmas• Pasal 44

1) Sistem Informasi Puskesmas merupakan bagian dari sistem informasikesehatan kabupaten/kota.

2) Dalam menyelenggarakan sistem informasi Puskesmas, Puskesmas wajibmenyampaikan laporan kegiatan Puskesmas secara berkala kepada dinaskesehatan kabupaten/kota.

3) Laporan kegiatan Puskesmas sebagaimana dimaksud pada ayat (2) merupakan sumber data dari pelaporan data kesehatan prioritas yang diselenggarakan melalui komunikasi data.

Information technology (informatics) in healthcare

“eHealth as the use of information and communication technologies (ICT) for health. In its broadest sense, eHealth is concerned with improving the flow of information, through electronic means, to support the delivery of health services and the management of health systems”(WHO-ITU)

“....is any combination of information technology and people's activities using that technology to support operations, management, and decision-making.....” (Sebis, 2009)

• “ … is concerned with improvements in a variety of human and organizational problem-solving endeavors through the design, development, and use of technologically based systems and processes that enhance the efficiency and effectiveness of information in a variety of strategic, tactical, and operational situations”. (McGraw-Hill Science & Technology Encyclopedia)

Components Description Examples

Individual electronic health information

Services that support the collection and storage of health information for an individual.

• Electronic health records (EHR)• Electronic medical records (EMR)• Personal health records (PHR)

Health-care communicationsand collaboration

Services that enable health-care providers electronically to communicate and share information with other such providers as part of providing care to an individual

• Electronic referrals and specialist letters• Electronic health event summaries,

prescribing and test ordering• Access to an individual’s EHR and test results• Health-care provider and service directories• Care plan management• Appointment booking and management

Health-care service delivery tools

Services that support health-care providers in making diagnosis and treatment decisions, and in managing the delivery of care to an individual, whether electronically or in person.

• Medications management• Prescription and test ordering decision

support• Clinical decision support• Alerts monitoring and management• Chronic disease management• Real-time clinical data access and analysis• Telemedicine (telehealth) and mobile health

(mHealth)

WHO-ITU. 2012. National eHealth Strategy Toolkit

Contoh: Sistem Informasi Manajemen RS –Permenkes No 82 Tahun 2013• Sistem Informasi Manajemen Rumah Sakit (SIMRS) adalah suatu

sistem teknologi informasi komunikasi yang memproses dan mengintegrasikan seluruh alur proses pelayanan Rumah Sakit dalam bentuk jaringan koordinasi, pelaporan dan prosedur administrasi untuk memperoleh informasi secara tepat dan akurat, dan merupakan bagian dari Sistem Informasi Kesehatan.

• Arsitektur SIMRS paling sedikit terdiri atas: • Kegiatan pelayanan utama (front office);

• Kegiatan administratif (back office); dan

• Komunikasi dan kolaborasi

Permenkes 82 Tahun 2013 Tentang SIMRS

Pendaftaran• Pendaftaran

• Pendaftaran Melalui Telepon• Pendaftaran Bayi Baru Lahir

• Daftar Data Pasien

• Daftar Kunjungan Pasien

• Asuransi

• Laporan• Rekap Pendaftaran Pasien Rawat Jalan• Pencarian Data Asuransi

Pembayaran/Billing• Bill Rawat Jalan

• Deposit Rawat Inap

• Bill Rawat Inap

• Depo Rawat Jalan

• Gizi Rawat Jalan

• Laporan• Laporan Rawat Jalan• Laporan Rawat Inap• Pencarian Data Asuransi

Permenkes 82 Tahun 2013 Tentang SIMRS

Laboratorium• Daftar Order Lab

• Daftar Pemeriksaan Lab

• Hasil Pemeriksaan Lab

• Daftar Aps

• Daftar Pasien Rawat Inap

• Daftar Pasien Rawat Jalan

• Sisipan

• Laporan• Register Pelayanan• Jaspel• Pencarian Data Asuransi

Radiologi• Daftar Order Radiologi

• Daftar Pemeriksaan Radiologi

• Daftar Aps

• Daftar Pasien Rawat Inap

• Daftar Pasien Rawat Jalan

• Laporan• Register Pelayanan• Jaspel• Pencarian Data Asuransi

Permenkes 82 Tahun 2013 Tentang SIMRS

Rawat Inap• Daftar Pasien Rawat Inap

• Permintaan Makan

• Data Kamar

• Pencarian Pasien

• Laporan• Laporan Harian• Laporan Harian Pasien Keluar• Sensus Harian• Buku Register• Jaspel• Pencarian Data Asuransi

Farmasi dan Logistik• Pengeluaran

• Daftar Pengeluaran

• Permintaan

• Daftar Permintaan

• Pengambilan

• Daftar Pengambilan

• Perencanaan Pengadaan

• Daftar Perencanaan Pengadaan

• Laporan Bulanan

• Laporan Harian

• Laporan Stok

Permenkes 82 Tahun 2013 Tentang SIMRS

• Sistem Back Office• perencanaan,

• pembelian/pengadaan,

• pemeliharaan stok/inventory,

• pengelolaan Aset,

• pengelolaan SDM,

• pengelolaan uang (hutang, piutang, kas, buku besar dan lainnya).

• Payroll system

Contoh Penggunaan Informatika: Electronic Medical/Health Records• An EMR is a computerized medical record used to capture, store and

share information between health-care providers in an organization, supporting the delivery of health services to patients.

• An EHR is a computerized health record used to capture, store, access and share summary information for a patient between health-care organizations and providers.

WHO-ITU. 2012. National eHealth Strategy Toolkit

Cakupan Fungsi EMR dari Price et al. (2011)

1. Health InformationPatient information, medical summary, clinical documentation

2. Laboratory managementOrder, review, result, interconnection, shared

3. Diagnostic imagingOrder, review, interpretation, interconnection, shared

4. Prescription managementOrder, decision support, dispensing

5. ReferralsInternal and external transmission of data

6. Decision supportPoint-of-care reminder, chronic disease management

7. Electronic communicationCommunication internal and external organization

8. Patient SuppportData sharing with patient (PMR), individual health promotion

9. Administrative processesScheduling, billing, tracing medical records

10. Practice reportingSecondary use of data for clinical evaluation, routine reporting

Jha et al. 2009. Use of electronic health records in U.S. hospitals.

Clinical Decision support Systems

Function Example

Alerting Highlighting out-of-range laboratory value

Reminding Reminding the clinician to schedule mammogram

Critiquing Rejecting an electronic order

Interpreting Interpreting the electrocardiogram

Predicting Predicting risk of mortality from a severity-of-illness score

Diagnosing Listing the differential diagnosis for patient with chest pain

Assisting Tailoring the antibiotic choices for liver transplantation and renal

failure

Suggesting Generating suggestions for adjusting the mechanical ventilator

Health Information Exchange

Healthcare Providers Payors Supply ChainPersonal Health

PortalOthers

Community health

workers Systems

Hospital Systems

Lab. Systems

Pharmacy Systems

Primary Care Systems

Private InsuranceProviders

Public Insurance Providers

Pharmaceutical company

Distribution channel

Medical Suppliers

Personal Health Records

Public Health

Research

Government

Community/NGOs

Client Registry

Health ProviderRegistry

Health FacilityRegistry

Terminology Standard

Shared Health

Records

Emergency Medical Services

Health Managament Information

Systems

TelemedicineFinance/Bank

Indicators and Data Elements

Health Information Exchange

https://ohie.org/

PCEHR Australia

National E-Health Transition Authority (NEHTA) Australiawww.nehta.gov.au

Kesimpulan

• Fasilitas pelayanan kesehatan memiliki peran penting dalam sistempelayanan kesehatan (individu, mikro dan makro)

• Kompleksitas ini mendorong fasilitas pelayanan kesehatanmenggunakan sistem berbasis elektronik

• Berbagai macam pendekatan TIK sudah digunakan di organisasikesehatan untuk mendukung:• Pelayanan kesehatan perorangan

• Manajemen organsiasi

• Pelaporan rutin