Postgraduate Annual Research Seminar PARS 2019

Research Title:
Challenges of Healthcare Information System
in Malaysian Public Hospitals: An Early
Investigation

Norsyaliza binti Abd Razak

Information Assurance & Security Research Group
(IASRG)
Universiti Teknologi Malaysia (UTM)

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 Presentation Outline
• Introduction
• Objectives
• Methodology
• HIS Scenario in Malaysia
– Implementation of HIS in Malaysian Public Hospitals
– HIS Revolution in Malaysian Public Hospitals
– Factors of Implementation of HIS
– The Challenges in HIS

• Findings
• Issues in HIS Implementation
• Conclusion
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 Introduction
• Information Technology (IT) has become vital
in healthcare industry including the public
hospitals. The IT has been found to play
significant role in improving patients care
services.
• Tremendous innovation has been introduced
to enhance the performance and healthcare
quality services.

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 Objective
To explore the implementation of HIS in the
public hospital in Malaysia, the challenges and
the current integration issues of HIS in the
Malaysian public hospitals.

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 Methodology
• 2 phases undertaken to gather information to
support the literature:
– Comprehensive literature on HIS implementation in
Malaysian hospital including the challenges and issues. To
identify multiple factors involved in success and challenges
in the implementation of HIS.
– Interview with the HIS users, vendor and healthcare
practitioner. To identify the current status of HIS
implementation on certain hospital and clinics in Malaysia
in different background point of view and to support the
problem exist in the Malaysian healthcare system

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 HIS SCENARIO IN MALAYSIA
• Implementation of the healthcare system in Malaysia
has long been on the run. But it is not fully
implemented on the overall health organization in
Malaysia.
• The problem with the healthcare provider has faced
today are high cost and lack of human resources.
• Hospital Information System claims to reduce
medical error, increase efficiency, cost effectiveness
and increase patient involvement in decision-making
in health care (Lee et al.[3])

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 A. IMPLEMENTATION OF HIS IN
MALAYSIAN PUBLIC HOSPITALS
• Starting with the Telemedicine flagship introduced in
1997 is the Malaysian initiative for providing better
health care services to the society.
• The Malaysian government has introduced three levels
of HIS
– THIS: Total Hospital Information System (>400 beds)
– IHIS: Intermediate Hospital Information System (>200 and
<400 beds)
– BHIS: Basic Hospital Information System (<200 beds)

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• Malaysia has 139 public hospitals with 18
referral and tertiary hospitals with partial or
fully integrated HIS.
• Hospital Selayang and Hospital Putrajaya was
the early hospital equipped with THIS since
the launched of Malaysian Telehealth Flagship
Application starting with Hospital Selayang in
1997 followed by Hospital Putrajaya in 2000
[14].
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Category
Name of Hospitals
of HIS
THIS Hospital Putrajaya, Hospital
Selayang, Hospital Sedang,
Hospital Pandan, Hospital
Ampang, Hospital Sg. Buloh,
Hospital Alor Setar, Hospital
Sungai Petani, Hospital
Sultanah Zahirah, Hospital
Sultan Haji Ahmad Shah, and
Hospital Bintulu
IHIS Hospital Keningau, and
Hospital Lahad Datu
BHIS Hospital Kuala Batas, Hospital
Setiu, Hospital Pitas, Hospital
Kuala Penyu, Hospital Kunak,
Hospital Tunku Ja’afar and
Hospital Port Dickson
Number of
Component of HIS implemented
beds
Patient Management System, Clinical Access More than
Information System, Laboratory Information 400 beds
System, Pharmacy Information System,
Radiology Information System, Picture
Archiving and Communication System
(PACS), Administration Information System,
Financial Information System, System
Inventory System, Personal Information
System
Patient Management System, Clinical Access More than
Information System, Laboratory Information 200 beds
System, Pharmacy Information System
Patient Management System, Clinical Access Less than
Information System 200 beds
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B. HIS Revolution in Malaysia Public Hospital
• Hospital Selayang was the first paperless THIS
hospital in Malaysia and managed by the
Cerner Malaysia Sdn. Bhd. [13].
• Between 2004 and 2008, 14 hospitals has
been implemented HIS. The project was
conducted by one vendor (SPK Bhd.)

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• Three different THIS hospital in Malaysia
where Hospital Serdang, Hospital Selayang
and UKM Medical Centre as shown

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• According to the study conducted by H. Ismail
[7], [12], there are only 15.2% of the
Malaysian hospitals are system-based and less
than 10% of 139 public hospitals are classified
as HIS.
• This indicates the majority of the public
hospitals in Malaysia remain using a paper-
based method and shows slow progress on
HIS reformation.
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C. Factors of implementation of HIS in Malaysia

• Bulgiba [15] highlighted several factors that influence

to embark the implementation of the healthcare
system :
– Training
– Development of in-house technology
– A coordinating body and question of standards
– Process re-engineering

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D. The Challenges In Healthcare Information System
• Support, human, technology /infrastructure and
software limitation issue are four major
challenges has been identified in HIS
implementation [16]
• The human context in Malaysian Public Hospitals
had the highest effect of HIS adoption. This could
imply the importance of human skills, experience,
expertise, satisfaction and quality of information
for successful adoption of HIS [17]

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• The issue of HIS integration has been addressed
by researchers and is unfortunately still among
the main issues in HIS success that remain
relevant yet unsolved [18].
• Because of the multiple vendors developing
certain applications for different medical
departments and hospitals, there are challenges
when hospitals try to integrate data in order to
enable interoperability and communication
between different systems [19].

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• Integration of medical system between
different hospitals organisation (local and
regional) has been claimed to be a significant
step in creating a complete HIS and provides
benefits to clinicians who need inter-
department collaboration in solving patient’s
cases [20], [21]

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FINDINGS

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 Interviews was conducted among users in Public hospital and
clinics. The respondents consist of physicians, nurse, therapist
and also system developer.
HIS System Data System
Respondent System Used Data Saved
Knowledge Vendor Achieved Integration

Physiotherapist Sistem Pengurusan Heitech

From No
Hospital Tuanku Pesakit (SPP) Padu System and
No System and
Jaafar Seremban Sistem Maklumat Manual
KKM Manual
(HTJS) Pesakit
Physician Partial
Klinik Kesihatan TPC (Teleprimary (Medication
Yes KKM System System
Taman Ehsan Care) still need to
Gombak do manual)
System Developer Sistem Pengurusan From
System and
Hospital Sultanah No Pesakit Dalam KKM System and No
Manual
Aminah (SPPD) Manual
Nurse Manual
Manual in
Klinik Kesihatan No Rekod Pesakit KKM from patient No
Patient Card
Masjid Tanah card /book
Summary of healthcare system case study in selected hospital/clinics
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 Statements gathered from interview session:
“…..Hospital Sultanah Aminah used the old system (Sistem
Pengurusan Pesakit Dalam (SPPD)), that maintained by the ICT
unit in the hospital. The system used crone job for data
achieving between different departments” (PPTM ICT HSA)

“…..We provided new system for Malaysian hospitals known as

Sistem Pengurusan Pesakit (SPP). Only 15 hospitals in
Malaysia have implemented the healthcare system SPP. Every
department in hospital have their own system and provided by
different vendors” (System Engineer (S.E) Vendors)

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General of health system architecture at HTJS (S.E Vendor)

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 The Issues In His Implementation
• Different vendors: different system vendor for
each departments
• Multiple middleware: Many systems, many
middleware. Adds complexity
• Duplication of data: no centralized database
system

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 Conclusion
• Healthcare system in public Malaysia is
partially implemented with most of the
systems are not fully integrated Due to some
reasons/challenges such as human, financial,
and different vendors.
• Future works :
– Impact of the challenges to the
medical/healthcare services.
– Most significant / important factor for successful
HIS implementation.
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End of presentation
Thank you
Q&A

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