FOSS and Development: A Case Study for Meeting the Health Millennium Development Goals

FOSSAP II, Seam Reap, Cambodia

Presentation to:

Dr Molly Cheah

Primary Care Doctors’ Organisation Malaysia

in collaboration with GHC Medical Informatics Sdn Bhd

1 September 2005

PCDOMPrimaCare

Primary Care Doctors’ Organisation Malaysia (PCDOM)

Primary Care Doctors’ Organisation Malaysia (PCDOM)

Agenda

Introduction – who we are

MDGs – focussing on Health

PCDOM PrimaCare – a tool towards achieving MDG targets

Free & Open Source in Health IT – Issues impacting good practices

Discussion – Collaborative Strategies

Who we are

Primary Care Doctors’ Organisation Malaysia (PCDOM)

Primary Care Doctors’ Organisation Malaysia (PCDOM)

PCDOM – Profile & Community

Not-for-profit & Pofessional incorporated 1996

Membership of Doctors (General Practitioners)

Initiatives include:

http://pcdom.org.my built on zope & plone

PrimaCare EHR & clinic management system

Primary Care Network Services - PNS

Global collaboration with non-profits:

WorldVistA to develop MyVistA Hospital Information System

Primary Care Doctors’ Organisation Malaysia (PCDOM)

Health IT Initiatives

repeatable & affordable solution

need for information to support improved patient care & management decision support

support & enhance the National Health Information Technology Initiatives of MOH

tool to achieve the Health MDGs

positioning Malaysia regionally & globally as a leader in leveraging FOSS in health sector (ASEAN Framework for Liberalization of Health Services)

Millennium Development Goals (MDGs)

Primary Care Doctors’ Organisation Malaysia (PCDOM)

Primary Care Doctors’ Organisation Malaysia (PCDOM)

MDGs – unprecedented political support & achievable

Millennium declaration in 2000 by 189 world leaders

Overarching Goal towards poverty elimination & sustainable devlopment

8 goals, 18 targets and 42 indicators

Primary Care Doctors’ Organisation Malaysia (PCDOM)

MDGs – people-centered, time bound & measurable

Eradicate extreme poverty & hunger

Achieve universal primary education

Promote gender equality & empower women

Reduce child mortality*

Improve maternal health*

Combat HIV, AIDS, Malaria & other diseases*

Ensure environmental sustainability

Develop a global partnership for development

PrimaCare –
Tools towards Achieving MDG Targets

Primary Care Doctors’ Organisation Malaysia (PCDOM)

Primary Care Doctors’ Organisation Malaysia (PCDOM)

What is PrimaCare V4

Web-based cross-platform using open source software – Linux, Apache, PostgreSQL, PHP

System consists of eight modules:

system administration

clinic management

patient management

Financial management

pharmacy management

billing management

schedule management

asset & supply management and

medical resources

Application of ICPC2 coding and classification system mapped onto ICD10

Built-in clinical decision support system using content developed by GPs.

Primary Care Doctors’ Organisation Malaysia (PCDOM)

Why Undertake the Project 1

Most practices are still paper-based

Improve the quality of primary health care, including outcomes of care and extend the role of General Practitioners (GPs) by facilitating new value-added service through creative use of ICT

Introduce better resource management to clinics for improved efficiency

Minimize duplicated efforts among clinics through a “central service”

Current available systems are vendor driven, hence not-patient centered, proprietary, expensive and do not meet needs of GPs

No attempt at standardized approach

Primary Care Doctors’ Organisation Malaysia (PCDOM)

Why Undertake the Project 2

Need to complement the Govt’s National Telehealth Initiative

Impending introduction of the National Healthcare Financing System makes computerization of clinic functions inevitable

Inability of MOH to collect data from GPs despite regulatory provisions

Need for timely & appropriate information

Need for clinical decision-support system that is evidence based for appropriate practice

Need for research and evaluation in general practice – additional training does not equate to better care / performance

Strategy - How We Started

Focus on an enabler – Computerization and ICT (FOSS)

Obtain support via appropriate funding – DAGS under the realm of the National IT Agenda

Identify issues and problems

Involving GPs themselves – through content development

Develop platform to facilitate communication – pilot.pcdom.org.my

Motivation and training

Primary Care Doctors’ Organisation Malaysia (PCDOM)

Version 4 Technologies

PosgreSQL - Enterprise level relational database management system.

PHP 5 - a general-purpose scripting language that can be embedded into HTML. Version 5 includes object-oriented programming.

php.MVC - the framework where the business logic code and presentation code can be separated out easily and cleanly.The framework support easier efforts for internationalization.

Propel - the object persistence framework that encapsulates the data row in databases as individual objects.

Creole - a database abstraction layer that provides a consistent set of query language for querying the underlying Database Server.

Smarty - a template engine that provide tools to automate tasks commonly dealt with at the presentation layer of the system.

Free & Open Source in health IT:
Issues

Primary Care Doctors’ Organisation Malaysia (PCDOM)

Primary Care Doctors’ Organisation Malaysia (PCDOM)

The Open Source Model = Applies Evidence Based Medicine Process to Software

Primary Care Doctors’ Organisation Malaysia (PCDOM)

Free Software – Philosophy

The freedom to run the program, for any purpose (freedom 0)

The freedom to study how the program works, and adapt it to your needs (freedom 1). Access to the source code is a precondition for this

The freedom to redistribute copies so you can help your neighbor (freedom 2)

The freedom to improve the program, and release your improvements to the public, so that the whole community benefits (freedom 3). Access to the source code is a precondition for this

http://www.gnu.org/philosophy/free-sw.html

Primary Care Doctors’ Organisation Malaysia (PCDOM)

Free Software – Issues

“You should also have the freedom to make modifications and use them privately in your own work or play, without even mentioning that they exist. If you do publish your changes, you should not be required to notify anyone in particular, or in any particular way.”

“The freedom to use a program means the freedom for any kind of person or organization to use it on any kind of computer system, for any kind of overall job, and without being required to communicate subsequently with the developer or any other specific entity.”

http://www.gnu.org/philosophy/free-sw.html

Primary Care Doctors’ Organisation Malaysia (PCDOM)

Free Software – Implications

Position of responsibility of promoter of programme

How do you prevent non-health professionals using it – professional & legal issues

Changes in clinical work flows impact how patients are being cared for - good practices

That the software do no harm in a clinical setting

Non-allowable procedures that discriminate specific patient care

Who is responsible when changes in source codes affect the outcome of care?

http://www.gnu.org/philosophy/free-sw.html

To provide guidance on Policy Formulations related to FOSS

Primary Care Doctors’ Organisation Malaysia (PCDOM)

In Summary

PrimaCare is available to health professionals

It is extremely well integrated

It is championed by Health Professional Organisation

It is open source

The innovative collaborative model:

Effective tool to address health MDGs’ issues & targets

you are in control

creates the collaboration power by aggregating demand/users

it can be SUSTAINABLE

it will be contagious

SUSTAINABLE, IT WORKS, AND WELL INTEGRATED

Thank you

Primary Care Doctors’ Organisation Malaysia (PCDOM)

Please visit us at…

http://pcdom.org.my

http://primacare.org.my

PowerPoint Presentation

Molly Cheah

2005-08-26T12:11:49