February 2007

MIRTS: Malaysia’s Answer to National Health Record

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“He who has health has hope; and he who has hope has everything” – Proverb.”When health is absent, wisdom cannot reveal itself, art cannot manifest, strength cannot fight, wealth becomes useless, and intelligence cannot be applied” – Herophilus. “The first wealth is health” -R.W. Emerson.

With the advent of Internet technologies, governments across   the globe are trying to provide efficient and effective e-service to its citizens. We see the implementation of e-governments with various flagship applications. One of them is health and wellness, which should be the top priority agenda of every government and citizen of the world.  In Malaysia, one of these flagship applications of e-governments is e-Health. In order to keep Malaysians healthy and fit, we need information systems that are accessible 24/7, with complete longitudinal health records. One such proposed pragmatic system is the Malaysian Immunization Registry and Tracking System (MIRTS), which can maintain a repository of immunization records of all Malaysians.

MIRTS is conceived as a computerized registry of preschool-aged children and their immunization records. The purpose of the registry is to assure that children remain up-to-date with their immunizations and that their vaccination records are available when they are needed – when changing doctors and at the time of daycare/preschool and school entry. More specifically, to allow the Ministry of Health to manage better the immunization data, to generate factual data on the progress of immunization in the country, forecast the wellness of children in Malaysia, manage the operations better and optimize its cost.

The term e-Health covers all forms of electronic healthcare delivered over the Internet, ranging from informational, educational and commercial 'products' to direct services offered by professionals, non-professionals, businesses or consumers themselves. It also includes a wide variety of clinical activities that have traditionally characterized telehealth, but delivered through the Internet. Simply stated, e-Health is making healthcare more efficient, while allowing patients and professionals to do the previously impossible.

While other industries have captured the value of the Internet early on, the scale and scope of the Malaysian healthcare system perhaps presents the greatest potential in Internet-based applications.

Access, cost, quality, and portability have been concerns in the healthcare arena. Evidence suggests that both health consumers and doctors are frustrated with the maze involved in the healthcare delivery. Fortunately, e-Health appears to be helping to resolve many of the challenges confronting the healthcare industry. Looking at the practice of industrialized countries, just in the past few years, the following e-Health services have emerged:

1. Health portals or health information sites, which empower consumers and physicians through customized education and online community experience. 

2. Connectivity and communications solutions, which streamline administrative workflow, thereby reducing waste and inefficiencies. 

3. e-commerce, including online health insurance and drug prescriptions.

As the technology evolves, we could see even greater value-added Internet applications, including sophisticated chronic disease management tools. And as the market matures, a consolidation of all the online services will become likely. We could have a truly 'Integrated Delivery System,' with attendant quality, access, and low cost. The Internet could serve as a panacea to all of the complicated challenges confronting healthcare. Technology can never displace the expertise and personal care that only healthcare practitioners can deliver, but we believe that the Internet can go a long way in facilitating communication, and streamlining tedious and time-consuming administrative work, that often curtails the time of the doctor with patients, and education of both physicians and patients.

Here we attempt to discuss how Internet technologies and ICT can be deployed to look after the well being of the citizens and residents of Malaysia as part of the e-health program.

The Problem Statement

It is not uncommon to meet citizens who visit the hospitals and clinics only when they are unwell. The general awareness on the efficacy of preventive medicine needs to be reinforced through campaigns, especially in developing countries. Statistics from the UNICEF states the fact that deaths are averted by immunization. The estimated number of deaths averted by immunization in 2003 was more than 2 million, as well as an additional 600,000 hepatitis-B-related deaths, that would otherwise have occurred in the adulthood from liver cirrhosis and cancer.

MIRTS is conceived as a computerized registry of preschool-aged children and their immunization records. The purpose of the registry is to assure that children remain up-to-date with their immunizations and that their vaccination records are available when they are needed – when changing doctors and at the time of daycare/preschool and school entry. More specifically, to allow the Ministry of Health to manage better the immunization data, to generate factual data on the progress of immunization in the country,  forecast the wellness of children in Malaysia, manage the operations better and  optimize its cost.

Immunization helps the body to develop protection against a particular disease, so that if at a later stage the body comes into contact with that disease, it will be able to fight it off. A person needs immunization for each disease that he/she wants to develop protection against. Fortunately, childhood immunizations in Malaysia are free. If we look at the present challenges facing immunization in Malaysia, we find that there is no systematic nationwide immunization plan, the process of immunization is getting more complex as new vaccines are developed, hospitals have home-grown systems for immunization, hospitals do not regularly share or transfer medical patient records, and physicians have no access to a child's complete immunization history. Neither do most parents are aware of the immunization status of their children. Scattered records, created by mobile citizens, non-use of interoperability standards by the hospitals and the absence of tracking system to remind parents compounds the problem.

MIRTS as a Solution

The solution proposed is in the form of a web-based system named MIRTS, which is conceived as a centralized repository of immunization records of all Malaysians using Standardized Healthcare Level 7 (HL7) interoperability protocol. This centralized repository is capable of simple data aggregation and delivery and saves all records. It also ensures smooth interoperability and facilitates easy integration with other systems.

MIRTS will be beneficial to both parents and children. Research has shown that both parents and physicians overestimate the rates at which children are fully immunized. Parents are often unaware of immunization schedule; physicians often overlook 1-2 vaccinations. This is becoming a huge problem with the rapid changes in vaccination recommendations for children.

MIRTS can:

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