Open Source in Health Care: HUSM 10 Yearsof Innovative Effort

Unit Sistem Maklumat Hospital 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 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 Governments 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 Prescription Online System Drug Inventory Management System
Tools Inventory Management System

POLS
SPIFU SPIFA
AMS LIS

Assets Management System Laboratory Information System Diet Management System Document Management System Computer Technical Complaint Management

SPD e-Clips PADU

Applications List (Cont..)

CSSD Sticker FIRAS
ICD 10 Attendance Transfusion

Central Sterile Supply Department Vehicle registration sticker Film Information Reject Analisyst used by Radiology department International Classification of Diseases v10
Staff attendance record and management Blood Donation Management for Blood Bank Department

Mortuary Management Mortuary HUSM Formulary Drugs Information Database

Electronic Medical Digital Image Medical Records Management Archives System (EMA)

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