Health Information Management: Malaysian Experience

Datin Dr.S.Selvaraju
Health Informatics Center
Ministry of Health, Malaysia
selvaraju@moh.gov.my

ABSTRACT
The evolution of Health Information Management in 1.2 Health care in Malaysia is provided by the
public and private sectors and nonMalaysia has started from a basic statistical
governmental organizations. The major provider
reporting system through papers to an ICT enabled
and financier of health services is the Ministry
Health Information Management System. The
of Health (MOH). Basic health care through
building blocks to facilitate the implementation of
health facilities is currently available to and
such system are through the development of Health
accessible to more than 95 % of the population
Informatics standards and a mechanism for the
of Peninsular Malaysia and about 70 % of the
adoption of such standards. The legislative support
population in Sabah and Sarawak. Secondary
required to enabler a wider adoption by all
and tertiary care services are now widely
stakeholders is vital for successful implementation
available in government hospitals and private
.This paper provides the historical perspective of the
hospitals across the country. In 2005, there were
2,877 primary health care clinics, 125 public
transformation of Health Management Information
hospitals (including institutions) under the
System to Health Information Management System,
MOH and 9,410 doctors working in public
the challenges and the way forward in realizing a
hospitals.
National Integrated Health Information System .
1.

INTRODUCTION
1.1. Malaysia is composed of Peninsular Malaysia 1.3. Over the past few decades there has been an
increasing role of the private sector in the
and the states of Sabah and Sarawak on the
provision of health care for the country.
island of Borneo. The total land area is 330
However, there is inadequate integration
252
square
kilometers.
Malaysia,
a
between public and private health services.
constitutional monarchy with a non-elected
There were 225 private hospitals in 2005
upper house and an elected lower house, is
compared with 50 hospitals in 1980, mostly
comprised of 13 states and three federal
located in urban areas. Doctor to population
territories. In 2005 Malaysia has a population
ratios in 2005 ranged from 1 doctor per 1,268
of 26, 127,700 million, more than 60% of who
populations in Peninsular Malaysia to 1 doctor
live in urban areas. The population is relatively
per 2,765 populations in Sabah and 1doctor per
young with 42.3% being below the age of
2,115 populations in Sarawak. In 2004 there
20years &6.6%aged 60years and above. Its
were 8,836 doctors in private hospitals
ethnically diverse people are comprised of 65%
accounting for 46% of total number of medical
Bumiputera, 26.1% Chinese, and 7.6% Indian.
practitioners but private hospitals only
Life Expectancy (LE) at birth for both genders
accounted for 21% of the total hospital beds in
has increased over the years. Malaysians enjoy
the country.
a relatively high overall standard of health. In
1990, the LE for males and females were 68.8
years and 73.5 years respectively. The LE for
males and females in 2005 had improved
further to 70.6 years and 76.4 years
respectively

1.4. The Healthcare delivery System that is 2. EVOLUTION

OF
HEALTH
strategically designed to improve the health
INFORMATION MANAGEMENT IN
status of the population is one that focuses on
MALAYSIA
wellness and empowerment. It provides focus
on the individual and community responsibility
HISTORICAL PERSPECTIVE
for health. Health system will be able to
support the access to right information at the
2.1. The collection and collation of health
right time to make the right life style choices.
information for routine statistics reports
Access to an individuals, longitudinal medical
was developed since colonial days and
and health record will support continuity in
which was further strengthened to a Health
care. The use of ICT as an enabler to further
Management Information System. During
improve health care delivery is being planned
the British Civil Administration days
within the following context:
(1874-1941), health information and events

1.4.1.

Informed
and
knowledge
individual and population that
will give consumers more access
and involvement in healthcare
decision making and be more
responsible in taking care of their
own health

1.4.2.

A proactive wellness and illness

management through competent
and knowledgeable healthcare
providers

1.4.3.

The delivery of service in a

networked environment based on
care network concept. Sharing
of information and resources
shall be the thrust for efficient
and effective delivery of
services.

1.4.4.

There will be a provision for

services to be offered from home
where applicable where patients
can have access to health
information and being able to
interact with healthcare providers
through multimedia network.

1.5. During the Eighth Malaysia Plan (2000-2005)

concerted efforts were undertaken to provide a
stronger platform for the countrys transition
towards knowledge based economy. There was
increasing effort on the promotion and use of
ICT in various sector including health sector
.For the Ninth Malaysia Plan ( 2006-2010)
efforts will be intensified for the wider
adoption and use of ICT .The government is
committed to enhance ICT related skills and
competencies as well as info structure
expansion.

Were recorded and documented as a byproduct of the services provided by the

Medical Department. Data were generated
at the services outlet, namely at hospitals,
static (outdoor) dispensaries, traveling
dispensaries maternal and child welfare
centers, municipal clinics, leper settlements
and mental institutions. Some form of
procedure existed for recording into
registers and collection of medical and
health data on some predetermined
formats. .Sanitary inspectors and public
health nurses in the course of their work
carried out the collection of data for the
public health activities.
While in the hospitals, static (outdoor)
dispensaries and institutions for special
diseases this was done by hospital
assistants and nurses. The data collection
was coordinated by Medical Branch of the
Medical Departments in each State. The
annual State Health Situation Assessment
Report was given to the Medical
Department Headquarters (one for Straits
Settlement States and the other for the
Federated Malay States) to prepare an
annual report on the health situation of the
country as a whole.
2.2 During the period from 1948 to 1962, the
gathering of health information rested with
the Medical Services under the Ministry of
Social Welfare. There was minimal effort
at coordination of health information
although the quantity and variety of data
had increased as a result of more
diversified health activities. In 1963, with
the formation of Malaysia, the Ministry of
Health and Social Welfare becomes
the
Ministry of Health. The responsibility for
health information was still with the

Medical Services Division which continued to

be involved in the collection of workload
statistics for report writing purposes.

2.6 Strengthening of the Health Information

Management was one of the supporting
goals determined to achieve the objective
of the 9MP.to ensure the Integrated Health
information Management for the country.
The Health Informatics Center established
in 2006 at the Ministry of Health will be
the custodian of all health and
health
related information in the country.

2.3. By the second half of the 1960s, a Medical

Records and Health Statistics Unit were set up.
It functioned as a data coordination unit for the
Ministry of Health (MOH). In 1972, the
Operation Research Unit was also set up. The
primary function of this unit was to monitor the
development of the National Health
Management Information System (NHMIS). 3. CHALLENGES
To further improve the health information
system, the World Health Organization (WHO)
3.1 DATA QUALITY, ACCURACY,
was requested in 1975 to study and recommend
TIMELINESS
improvements to the existing system. The study
recommendation included the establishment of
In general, health information required for
a comprehensive information system through a
national and international use is not adequate
Health Management Information System
and often, is not timely for effective and
Development Project (NHMISDP) The
efficient management. The information
Information and Documentation System (IDS)
collected is from MOH facilities only and
Unit in the Ministry of Health was established
hence incomplete for analysis for population
in 1981 to replace the Medical Records and
health status from the whole country
Health Statistics Unit and the Operations
perspective.
Research Unit.
2.4 With the establishment of the HIMS systems
medical records officers were trained
and
posted in all large hospitals to responsible for
the compilation of the hospitals statistics. The
statistics for public health was continued to be
compiled by public health nurses, medical
assistants and public health inspectors. The IDS
unit at Ministry of Health continued to produce
annual reports for use at the national
and
international level
2.5. The last two decades saw a very rapid
growth in the use of ICT in health care. The
Tele-health Project launched in 2000 paved the
way for the need to provide standards for data
collection to provide for interoperability and to
produce reports with high degree of data
quality and integrity. The subsequent
deployment of HIS in public and private
hospitals enabled health care providers to
produce reports of better quality. However this
did not solve the interoperability issue as the
disparate systems were using their terminology
and data definitions. This again resulted in
problems related to data mining and analysis at
the national level

The current HMIS data collected is based on

formats
developed for a predominantly
annual system of data collection. Over time,
additional information
requirements
to
monitor the new activities have resulted in
adhoc collection of information. This has
resulted in use of data sets which are nonstandardized, where the data definition used
were different, values varied. Data for
research is collected by different research
organization for specific purposes
The private sector hospitals are required to
submit
returns as per Private hospitals
Act regulation .however the quality and
timeliness of the data is so varied between
hospitals thus causing problems for
meaningful data analysis. Currently there is
very
little
provision for information
collection from private clinics and NGOs.
3.2 ICT IN HEALTH CARE
Healthcare is an information intensive
service. It is inevitable that as long as an
individual has had an encounter with the
health care system, the health information
ought to be stored in some kind of record,
probably kept in the providers
memory,
paper and computer media for recording
health information. Taking cognizance that
gathering and reporting healthcare

information have to be shared within a care network 3.5 RESOURCES

concept in an enterprise wide environment, all
stakeholders have to take concrete steps to break the
An investment in health informatics
deadlock and overcome the grappling issue of data
infrastructure requires a corresponding
sharing and information flows that we are currently
investment in human resources to ensure that
facing .One of the major impacts of ICT in
the infrastructure is appropriately developed,
healthcare is in the field of health and disease
implemented, maintained and evaluated. It is
surveillance. By leveraging the technology, on-line
important to have adequate numbers of skilled
notification of disease and incidents is made
and competent IT staff. In view of the high
possible to support epidemiologists in their
cost of skilled IT personnel, the big question
capability of pursuing early warning and alert to
seems to be not only whether there will be
potential disease outbreak. Integrating
IT
and
enough ICT funds to hire them, but rather
advancement in technology into healthcare will
whether there is enough knowledgeable
change the way we do things. The key issue is in
expertise and skills resource in the country.
addressing how IT influences the way we work and
There is a need for more people, better training
manage our patients taking into consideration the
and development and career prospects as
business process reengineering which is driven by
professionalism is fundamentally important to
the vision to achieve value-added objectives of our
making ICT more attractive.
Thus, the
business functions.
challenge is being able to identify and assign
train staff on core IT competencies. Getting
people on board in leading the project planning
3.3. EVIDENCE BASED PLANNING /
is also vital as well as retaining this topnotch people whose expertise is very valuable
PRACTICE
especially for future undertaking.
The advent of Clinical Practice Guidelines and its
use has facilitated the use of evidence based clinical
It appears that the vast deployment of IT in our
practice in patient care. However the use of
day today business may not be still possible in
information for evidence based planning in
view of lack of infrastructure capability and
measuring
health
outcomes
requires
the
capacity.
Thus investment in ICT
development of National Data Sets that allows for
infrastructure in terms of adequate storage
comparison between different health care providers.
space, high bandwidth LANS and WANS,
The formulation of data sets for specific diseases
wireless technology and planned replacement
and conditions through a consensus driven approach
of workstations, need to be addressed.
is critical for wider acceptance and
compliance
within the clinical fraternity
3.4. MEDICAL INFORMATICS
The growth of medical/ health informatics has
provided a new impetus in the formulation of
policies and strategies towards Health Information
Management in Malaysia. This field of specialty
that is rather is new started with the launching of the
Tele Health project. Since then there has been a
considerable interest in the field both in the public
and the private sector. The establishment of the
Malaysian Health Informatics Association and the
HL 7 Malaysia International affiliate status has
provided the platform for experts to share
experiences and get involved in some of the works.
The government driven projects such as the Tele
Health project including the Lifetime Health Record
(LHR) provides the ground for all stakeholders to
participate .The challenge is the extent of
participation from the private sector and industry
partners

4. DISCUSSIONS
4.1. POLICY AND GOVERNANCE
The thrust for the government to strengthen
the Health information Management system
in the country in order to achieve the goals set
in the plan period provides an impetus in
moving forward towards an Integrated Health
Information Management System .In order to
ensure greater compliance by all stake holders
the National Health Policy on Health
Information Management is absolutely
essential .The issues that need to be addressed
includes

Confidentiality & Privacy

Security & data protection
Consent
User access
Role of stakeholders
Infrastructure support
Health informatics standards
Capacity and Capability
building

Such issues can only be addressed through a

National Coordinating Body responsible for the
collection and storage of all health and health
related information. The membership should be
drawn from all stakeholders to allow for ownership
and accountability amongst all interested parties.
Such a mechanism will also provide a forum to
accommodate the specific needs of all stakeholders.
The information needed for research, policy
planning and outcomes measurement should be
built integral to all operating systems developed
/deployed in the country .A national approach for
the coordination of health information in the
country will allow for maximizing the potential of
various initiatives implemented in the country and
therefore will allow to maximize the ICT
investments for purposes of making available
accurate quality information meant for all types of
user.

4.2 LEGISLATIONS & REGULATIONS

Currently there is no single legislation that
mandates the provision of health and health
related information for compilation and analysis
of medical statistics in the country. There are
several Acts and regulation such as the Tele
Medicine Act, Private Health Care Facilities Act,
CDC Act, Medical Act, etc which regulates the
information required for the enforcement of the
Act. Such Acts are very much service driven and
serves the specific purpose. As such much of the
information collected currently is very much
dependent on the information that is gazette for
collection. Any additional information required
cannot be collected due to lack of provision in
the Act. There is no provision for incentives for
care providers to deploy IT to facilitate
information provision. In addition the issue of
consent and confidentiality in relation to
information sharing within an enterprise has to
be adequately addressed through the Data
Protection Act. Experiences from other countries
show that legislative support facilitative the

Implementation of ICT initiatives for e.g.

which passed several legislations prior to
the implementation of the EHR project.
As much of the information is collected
from patient encounters by various
stakeholders the need for a national minimum
data set to made mandatory will assist in
ensuring appropriate information provided for
continuity in care and measuring outcomes
analysis. The advent of HIS hospitals has
created a new generation of electronic medical
records for easy collection, maintenance and
storage. the medico-legal implications and
legal requirements on the use of electronic
records as against paper medical records has to
be adequately addressed .this becomes
increasingly important inn care network
sharing information between private and public
sector
.therefore
privacy
protection
arrangements have to be made to provide
assurance on the consistency in which records
are handled at the public and private sector

4.3 HEALTH INFORMATICS

STANDARDDS
Standards for health sector data and
communication technology is critical for the
implementation of interoperable services. A
substantive amount of work has been done in
coming up with health informatics standards
required for integrating health information over
the past 5 years. However, there is much more
to be done in view of the sheer volume of the
standards. Immense effort is made to set up
different workgroups to look into the various
field of health informatics standards
development, in which the National Health
Data Dictionary is one of them. What is more
challenging is the maintenance and updating of
these standards, and necessitating constant
review and changes to those standards which
have been developed so that they are current.
The setting up of the National Health
Informatics Committee should be able to
facilitate the enhancement of this development
of standards, protocols and other governance
issues related to health informatics standards
and its utilization. Further more, affiliation and
collaboration with the International Standards
Bodies and IT industries have to be promoted
so as to enhance further the widespread
adoption of the data guidelines and rules for
global information sharing.

o
LHR services
The approach that Malaysia took in realizing the
o
Electronic
Reporting
system
value of health informatics standards as the vital
:HIMS e
element of integration is through the establishment of
o
National Health Data Warehouse
a working committee on the Health Informatics
Standards. The preliminary effort undertaken by this
committee is to establish Special Interest Groups
Ensure the legal, data protection and
(SIGs) on specific areas to develop the Business
security framework is in place to ensure
Functional Model. A National Health Data
secured transfer of all health and health
Dictionary (NHDD) has been developed to provide
related information
standard definition of terms for health care industry.
The Malaysian Drug Codes (MDC) has been
formulated to make available standardized codes for
5. CONCLUSION
medication orders for use in the health care facilities.
The clinical procedures have been listed and coded
In Malaysias commitment towards a
by the stake holders who are involved in health care
paradigm shift in the health care delivery
business. All standards have been approved through
system and with the increasing use of ICT
consensus building held amongst relevant
health information management becomes a
stakeholders. Currently work is underway to convert
crucial and compelling issue. The role of other
these standards into national standards through
stakeholders in providing care becomes critical
Malaysian standards Department that is affiliated to
for the development of Integrated Health
ISO.
Information system. A strong political will and
governance through the establishment of
Health Informatics Center will pave the way
4.4. HEALTH INFORMATION
for the national approach in the management of
MANAGEMENT
health and health related information. The
Way Forward
establishment of the National Health Data
Warehouse which manages information in
A Health information Management blueprint has
compliance to health informatics standards will
been developed that outlines the business case and
allow for evidence based health planning in the
provides an action plan on which all future strategies
country. However the human capital required
and action plans will be based. The Telemedicine
for planning, operations of this national
Blueprint 1996 has provided a conceptual framework
collaborating
on the health care delivery system of the future and
the use of ICT in achieving it. The LHR project will
provide the overriding concept for info structure
framework for implementation in the country to
allow for integration and interoperability. The
Information Technology Strategic plan (ITSP) will
provide for strategies and action plan to support the
implementation of the Health Information
Management Action Plan.
The National Health Information Action Plan is being
developed in consultation with all health information
stakeholders in the public and private sector. Thus it
will provide the thrust for all health information
initiatives in the country. Amongst the key areas that
will be included in the action plan are to ;

Establish a mechanism for National Coordination

and Partnership
Ensure the building blocks such as the Health
Informatics standards, security standards,
privacy protection and infrastructure readiness
Implement key national initiatives that addresses
the needs of all stake holders and includes

REFERENCES
1. Economic Planning Unit, Prime Ministers
Department, Ninth Malaysia plan 2006- 2010,
chapter5
Mainstreaming
Information
&
communications Technology & , Chapter
20
Achieving Better Health Published March 2006
2.

Ministry of Health; Telemedicine Blue Print

Leading Health Care into information Age
published 1997

3. Ministry of Health Malaysia My health; Health

status of Malaysia 2005 published 2006
4. Ministry of Health Malaysia; Ninth Malaysia Plan
TWG paper Transforming Health Services
through ICT unpublished 2005
5. Ministry of Health Malaysia Health Information
Management system Blueprint Towards
Excellence in Health Information Management
unpublished 2005
6. Ministry of Health Malaysia Director Generals
Report 2006 Health Information Management
under publication