A HEALTH INFORMATION SYSTEM IN FIJI

1
A HEALTH INFORMATION SYSTEM IN FIJI
Discussion on the Implementation of a National
Health Number and the Methodology of
Synchronizing a Number of Remote Databases
Peter G Kerrison peterkerrison_at_yahoo.com Health
Information Systems Advisor Fiji Health Sector
Improvement Program A joint Project of the
Governments of Australia and the Fiji
Islands Implemented by JTA International,
Brisbane, Australia August 2004
2
Fiji Overview

• Population 820,000 (approximately) reasonably
  mobile.
• Geographically consists of 2 main islands, large
  number of smaller outlying islands. Medically
  split into 3 Divisions.
• Government Medical facilities 3 Divisional
  hospitals (200, 300, 500 bed) 19 sub-divisional
  hospitals (20-80 bed) 3 specialty hospitals 75
  health centres 100 Nursing stations
• 1 Private Hospital
• 95 medical services in Fiji provided by
  Government.
• Patients move between facilities regularly (own
  accord or transfer).

3
Technical Infrastructure

• LAN installed at each facility running Windows
  2000 or XP operating systems. Each network runs
  autonomously.
• Application developed utilising MS Access 2000
  (user interface) and Visual Basic for
  Applications (all data processing and talking to
  database).
• MS SQL Server V7.0 is used as the database
  management system.
• Structure of the database is identical at each
  facility. A "control" table is customized at
  each site to indicate facility name, predefined
  unique ID code and number (e.g Lautoka Hospital
  code LAU, Installation number 32), primary key
  counters and specific facility information.
• Structure of DB is kept relatively simple to
  alleviate the need for a specialist DB
  administrator. Complex data integrity checks
  programmed into the PATIS application.
• The predefined number precedes all primary key
  counters, ensuring all primary key values are
  unique for each facility and thus enabling data
  from all installations to be combined.

4
Patient Information System (PATIS) - Overview

• PATIS is currently installed at 15 major
  facilities throughout Fiji, including the 3
  divisional hospitals.
• Proposed to complete implementationthroughout
  the countries major facilities byDecember 2005.
• PATIS principally supports the inpatient
  process, theatre, pharmacy, radiology, dental,
  pregnancy and outpatients. Laboratory is
  currently being implemented.
• Virtually all new, changed and deleted dataat
  each facility is distributed to all other
  facilities nightly enabling patients to use
  onemedical identity number (National Health
  Number) at any PATIS facility.
• Originally designed as a statistical, planning
  system. Has been modified and adapted over time
  to be a very useful clinical tool enabling
  medical personnel to track and/or view patient
  services, monitor doctor shopping.

PATIS Installations December 2003
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National Health Number (NHN) National Health
Card NHC

• When a person firsts presents at a facility
  running PATIS they are issued with a unique NHN
  and NHC.
• Cards are produced with a label printer and
  laminator. Cards cost approximately AUD10 per
  hundred.
• NHN is a 9 digit number. 1st 2 digits indicate
  the facility the patient where the patient was
  registered.
• Number is used for all patient services in
  hospitals and is suitable for sequential or
  terminal digit filing of records.
• NHN assists in the clinical care of patients
  enabling medical personnel to view patient
  service history.
• A review and reorganization of medical record
  units is inherent in all PATIS implementations.
• Confidentiality?

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NHN/NHC Issues
As data is utilised more and more for clinical
purposes it is imperative that data is entered
accurately and duplicate registrations are
monitored and reduced.

• Public Awareness

• Search Parameters

• Duplicate Registration

• Training
• Train the Trainer
• Why as well as how
• Introduction to Computers
• Use of equipment
• Public relations training

7
Data Replication

• Process whereby data from each installation is
  synchronised with data from all other
  installations.
• Simple and reliable method required to
  synchronize the databases utilising reasonably
  limited technical and communications
  infrastructure available at some facilities.
• Process is controlled from the MoH CO Server with
  selected processes happening on each installation
  server.
• New, changed and deleted data is extracted from
  each installation (except reporting facilities),
  transmitted to MoH CO (via standard telephone
  lines), consolidated, then distributed to each
  installation and loaded.
• The extraction process, including transmission to
  MoH CO, is known as the "One-Way replication".
• The distribution and loading of the consolidated
  file is know as "Two-Way replication".

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Data Replication - Timing
MoH Central Office

• 1915 hrs - Get One-Way Data (Extraction)
• 2100 hrs - Load Hospital Extraction Data (One-Way
  Load) - Extract Consolidated Data
  (Two-Way)
• 2115 hrs - Send (Put) Two-Way Consolidated Data
  to Hospitals
• 0200 hrs - Get Reports
• 0700 hrs - Replication Maintenance and Status
  Reporting

(Link via WAN to Govt Pharmacy, Div Office Suva)
One-Way Data Transfer (1915-2045 hrs)
2-Way Data Transfer (2115-2245 hrs)
Get Reports (0200-0300 hrs)
Hospital Facilities

• 2300 hrs - Load Consolidated Data (Two-Way Load)
• 0115 hrs Replication Maintenance
• Note DB is for reporting only (no extraction)

• 1900 hrs - Data Extraction
• 2300 hrs - Load Consolidated Data (Two-Way Load)
• 0115 hrs Replication Maintenance

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Data Replication Summary of Processes

• Database Elements
• Table triggers strRecordStatus Field (e.g.
  A32W, C32W)
• System Tables (Control, Table Names, Status
  Report, Installation).

• Communications
• Blast Professional for DOS, BHOST for DOS (Blast
  Inc, North Carolina, USA)
• Generic scripts to transfer files from facilities
  to MoH CO, or MoH CO to facilities. Transfer
  takes between 3 and 5 minutes depending on file
  size.
• Thoroughly error trapped.

• Extraction, Load Processes
• Visual Basic for Applications, MS Access 2000.
• Thoroughly error trapped.
• Very reliable fast and efficient.

• Reporting
• All processes, including communications, produce
  detailed reports
• A Status report is produced at MoH CO daily
  indicating the "status" of each processes run.

• Issues
• Communications in Fiji is expensive.
• Lines cut-off through non-payment or occasional
  technical faults.
• Power supply problems.
• Minor Blast program problems

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Questions/Discussion