Tantangan Penerapan EHR di Indonesia Fakultas Kedokteran Universitas Gadjah Mada Tantangan Penerapan EHR di Indonesia Lutfan Lazuardi Dipresentasikan pada acara Seminar Nasional Keperawatan SIM

FUNCTIONAL HEALTH SYSTEM Leadership and Governance Health Workforce Health Service Delivery H E A L T F O R FUNCTIONAL HEALTH SYSTEM Healthcare is a very INFORMATION INTENSIVE industry. Dr Annie Stanley Thakore #CARE #elets_hlf Health Information System Access to Essential Medicines & Technologies Health Financing

Apa itu EHR Sistem berbasis elektronik yang bertujuan: Improves patient safety and quality Increases efficiency Reduces cost Emphasizes privacy, security and confidentiality IOM (1997)

Definisi EHR menurut IOM Includes: longitudinal collection electronic health information for and about persons, where health information is defined as information pertaining to the health of an individual or health care provided to an individual immediate electronic access to person- and population-level information by authorized, and only authorized, users; provision of knowledge and decision-support that enhance the quality, safety, and efficiency of patient care; support of efficient processes for health care delivery. IOM (1997)

Primary and secondary uses of EHR Patient Care Delivery Patient Care Management Patient Care Support Processes Financial and Other Administrative Processes Patient Self-Management Education Regulation Research Public Health and Security Policy Support IOM (1997)

eHealth is the cost-effective and secure use of information and communications technologies in support of health and health-related fields (WHO) "eHealth is the single-most important revolution in healthcare since the advent of modern medicine, vaccines, or even public health measures like sanitation and clean water” Denise Silber (2003) at the European Commission "eHealth is the cost-effective and secure use of information and communications technologies in support of health and health- related fields, including health-care services health surveillance health literature health education, knowledge and research World Health Organization , Ninth plenary meeting, 25 May 2005 Committee A, seventh report

perubahan paradigma 70s – Billing dan administrasi 80s – sistem informasi klinis 90s – medical imaging, LIS 2000s – patient safety

perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented

http://www.naturalnews.com/038889_doctors_guns_statistics.html

Berhasilkah?

30% decline in medication events 25% decline in complication of procedure, test, or treatment

Health Offices 554 Primary Health Centers 9799 Hospitals 2461

1292 rumah sakit

Kompetensi Perilaku Regulasi Perilaku organisasi Infrastruktur Standar mutu data Maintenance

Perlu standar? Non Standard Standard Data demografi Data klinis pasien Register Klinisi Manajemen RS Klinisi Manajemen RS Register Data Lab Repositori Data Lab Repositori

Data Types Numerik Kode standar Kode Teks Terstruktur Image Signal Interpretasi Image Signal

A New Socio-technical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120130/#!po=19.6970 Sittig et al. (2010) Sittig, Dean F., and Hardeep Singh. “A New Socio-Technical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems.” Quality & safety in health care 19.Suppl 3 (2010): i68–i74. PMC. Web. 24 Aug. 2016.

Top 10 reasons HER implementations are failing https://www.juran.com/blog/emrehr-implementation-failure-a-summary/ Ryan Walker (2010) EMR/EHR Implementation Failure: A Summary

Berhasil atau gagal? Informatics factors (10%) Socio-technical factors (90%)

Hospital Executive Information System

Sanjaya et al. (2012) No Kode ICD Adopsi Terminologi #Visit % 1 J00 Nasofaringitis akut [common cold] 10,998 20.9 2 J02 Faringitis akut 5,540 10.5 3 M25 Kelainan-kelainan lain pada sendi, tidak terklasifikasi ditempat lain 4,414 8.4 4 K04.1 Nekrosis pulpa 3.931 7.5 5 L23 Dermatitis kontak alergi 3.216 6.1 6 K29 Gastritis dan duodenitis 2,667 5.1 7 I10 Hipertensi esensial 2.416 4.6 8 R51 Sakit kepala (pusing) 2.399 4.5 9 R50 Demam tanpa diketahui penyebabnya 2.314 4.4 10 K00.6 Gangguan-gangguan erupsi gigi 1.824 3.5 Sanjaya et al. (2012)

Photo credit: Jojok

SIMKES Fakultas Kedokteran Universitas Gadjah Mada lutfan.lazuardi@ugm.ac.id SIMKES Fakultas Kedokteran Universitas Gadjah Mada