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