Digital Health in Sri Lanka - 1998-2017 'Sustainable Implementation of Digital Health Solutions through

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Digital Health in Sri Lanka - 1998-2017 'Sustainable Implementation of Digital Health Solutions through
Digital Health
         in
     Sri Lanka
‘Sustainable Implementation of
Digital Health Solutions through
    Local Capacity Building’

        1998-2017
Digital Health in Sri Lanka - 1998-2017 'Sustainable Implementation of Digital Health Solutions through
Digital Health in Sri Lanka - 1998-2017 'Sustainable Implementation of Digital Health Solutions through
Digital Health in Sri Lanka

The development of Digital Health in Sri Lanka is a joint effort of the
Ministry of Health (MoH); Information and Communication
Technology Agency (ICTA) of Sri Lanka; the Specialty Board in
Biomedical Informatics, Postgraduate Institute of Medicine,
University of Colombo (PGIM); and the Health Informatics Society
of Sri Lanka (HISSL).

This booklet was compiled and published by the HISSL to
showcases some of the key Digital Health initiatives in Sri Lanka. Sri
Lanka would be happy to share its experience and expertise in
implementing these systems with other countries.

                 This Booklet was compiled by the
               Health Informatics Society of Sri Lanka
                        http://www.hissl.lk
                            info@hissl.lk
Digital Health in Sri Lanka - 1998-2017 'Sustainable Implementation of Digital Health Solutions through
Digital Health in Sri Lanka - 1998-2017 'Sustainable Implementation of Digital Health Solutions through
Table of Contents
The Health Informatics Society of Sri Lanka ............................................... 1
Human Resources for eHealth in Sri Lanka ................................................. 3
Strategic Planning for eHealth in Sri Lanka................................................. 7
PHN and MPI Personal Health Number & Master Patient Index ........ 9
eIMMR Electronic Indoor Morbidity and Mortality Register ............ 10
HHIMS Hospital Health Information Management System................ 13
HIMS Hospital Information Management System ................................. 15
DNMS District Nutrition Management System ....................................... 19
Electronic Patient Information Management System of the National
Programme for Tuberculosis and Respiratory Disorders .................. 21
eRHIMS electronic Reproductive Health Information Management
System ..................................................................................................................... 22
eNCD electronic Non Communicable Diseases System ....................... 24
Registering and Verification of the Electronic Health Information
Systems in Sri Lanka .......................................................................................... 25
"Suwasariya" Telehealth Programme ......................................................... 27
Sri Lanka Stroke Clinical Registry ................................................................ 30
Essential Drug Stock Alert Tracker .............................................................. 32
SLJBMI Sri Lanka Journal of Bio-medical Informatics .......................... 39
A Short History of Health Informatics in Sri Lanka and the Health
Informatics Society of Sri Lanka (HISSL) .................................................. 40
Digital Health in Sri Lanka - 1998-2017 'Sustainable Implementation of Digital Health Solutions through
Digital Health in Sri Lanka - 1998-2017 'Sustainable Implementation of Digital Health Solutions through
The Health Informatics Society of Sri Lanka

The Health Informatics Society               Medical Association with Dr.
of    Sri    Lanka      (HISSL)              Shyam Fernando in the Chair
[http://www.hissl.lk] is the                 and Prof. Tissa Vitharana,
professional association of all              Advisor to the Minister of
those in the field of eHealth in             Science and Technology, as the
Sri Lanka. The inaugural                     Chief Guest. The meeting was
meeting was held on 15th                     attended by 75 people. The
November 1998 at 0900 hrs at                 constitution of the Society was
the       Lionel       Memorial              adopted.
Auditorium of the Sri Lanka

The picture shows from left to right Dr. Vajira H. W. Dissanayake (Founder
Secretary), Prof. Tissa Vitharana, the late Prof. MTM Jiffry and Prof. Shyam
Fernando (Founder President) lighting the oil lamp at the start of the inaugural
meeting.
The primary objectives of                    1. To promote the use of
HISSL are:                                      computers         and
                                        1
Digital Health in Sri Lanka - 1998-2017 'Sustainable Implementation of Digital Health Solutions through
information technology in                4. To improve and facilitate
   teaching,           learning,               continuing     professional
   research and delivery of                    development of members.
   care in the field of health.             5. To improve and facilitate
2. To improve computer and                     research and development
   information       technology                in health informatics.
   literacy of health care                  6. To foster collaboration
   professionals.                              with national, regional and
3. To improve the access by                    international      medical,
   health care professionals                   informatics             and
   to computer hardware,                       professional associations.
   software and information                 7. To     foster    fellowship
   technology services.                        among members.

The picture shows a section of the audience at the inaugural meeting held at the
Lionel Memorial Auditorium of the Sri Lanka Medical Association on 15
November 1998. In the front row from right to left are three Presidents of HISSL
– Prof. Vajira H. W. Dissanayake (Current President), Prof. Resvi Sheriff
(Immediate Past President) and the late Prof. MTM Jiffry.

                                        2
Digital Health in Sri Lanka - 1998-2017 'Sustainable Implementation of Digital Health Solutions through
Human Resources for eHealth in Sri Lanka
The strategy of developing           This is done through the MSc
Human Resources for eHealth          course      in    Biomedical
in Sri Lanka is two-fold.            Informatics       of         the
                                     Postgraduate Institute of
The first strategy is the            Medicine,     University      of
creation of a group of ICT           Colombo (PGIM). The curse is
competent doctors who can            aimed     at   producing       a
work as the interface between        generation of leaders in
the    medical     and     ICT       eHealth in Sri Lanka who can
profession to spearhead the          spearhead                   the
planning,        development,        implementation of ICT in the
implement, monitoring and            health sector in Sri Lanka
evaluation of ICT projects in        working hand in hand with the
the Health Sector in Sri Lanka       administrators and policy
working in close collaboration       makers at the highest level.
with Medical Administrators.

           The stakeholders of the MSc and MD courses

The course was initiated in          between the University of
2007 as a joint project              Colombo, Sri Lanka and the
                                 3
Digital Health in Sri Lanka - 1998-2017 'Sustainable Implementation of Digital Health Solutions through
University of Oslo, Norway by              Informatics, University of Oslo
Prof. Vajira H. W. Dissanayake,            with the support of Prof. Resvi
the current President of HISSL,            Sheriff, the Director of the
and Prof. Sundeep Sahay,                   PGIM, who was at that time
Professor, Department of                   also the President of HISSL.

The first batch of MSc graduates with the Members of the Director PGIM and the
            Members of the Specialty Board in Biomedical Informatics

The course was supported by a              Informatics course in January
NOMA grant funded by Norad                 2017. This would enable the
and     managed     by     the             successful    graduates       to
Norwegian      Center       for            become board certified as
International Corporation in               specialists     in        Health
Higher Education (SIU). How                Informatics in Sri Lanka. This
the stakeholders partner to                would make Sri Lanka one of
produce specialists for Sri                the few countries in the world
Lanka is shown in the figure in            to have such specialists.
the previous page.
                                           The second strategy is the
So far 90 graduates have                   development of ICT awareness
graduated from the course.                 and literacy among the health
They are deployed across the               workforce. This is done
public health sector in Sri                through various workshops,
Lanka both at central and                  seminars and conferences
regional level. The PGIM                   organized by the HISSL and
commenced the MD in Health                 the Ministry of Health. The
                                      4
Major eHealth Conferences             ones listed below.
organized by the HISSL in the
past few years include the

2010: eHealth Sri Lanka 2010 Conference [http://www.hissl.lk]
2012: eHealth Symposia were held in Colombo, Galle, Kandy, and
      Jaffna as part of the 125 th Anniversary Celebrations of the Sri
      Lanka Medical Association
2014: eHealth Sri Lanka 2014 Conference [http://www.hissl.lk]
2015: eHealth Asia 2015 Conference [http://www.ehealthasia.org]
      with the Minister of Health Honorable Dr Rajitha Senaratne
      as the Chief Guest.

2016: 24th Triennial Conference of the Commonwealth Medical
      Association 2016 on Digital Health for Health and Wellbeing
      [http://www.cma2016.org] with the President of Sri Lanka
      His Excellency Maithripala Sirisena as the chief guest

                                  5
The following upcoming conferences will be hosted by HISSL in Sri
Lanka:
2017: 2nd Commonwealth Digital Health Conference – 10 to 12
October

2018: Asia Pacific Association of Medical Informatics 2018 – 9 to
12 October

                                 6
Strategic Planning for eHealth in Sri Lanka
Strategic planning for eHealth        Champika      Wickramasinghe
in Sri Lanka began with the           who succeeded him in 2013,
establishment of the National         the National eHealth Technical
eHealth Steering Committee            Committee has developed the
in the Ministry of Health in          following national eHealth
June 2010. Working under the          Base Documents.
directions of this committee          - National eHealth Policy
and Dr. S.R.U. Wimalaratne,           - National eHealth Standards
Director        (Information),           and Guidelines
Ministry of Health, and Dr.           - National eHealth Strategy

The national eHealth Policy           Its mission is to facilitate
articulates      the   guiding        adoption of ICT solutions
principles for eHealth in the         appropriately       in      the
healthcare sector of Sri Lanka.       healthcare sector of Sri Lanka
Its vision is to streamline the       to improve the quality,
adoption and use of ICT in the        efficiency, patient safety, and
Healthcare Sector of Sri Lanka.       cost effectiveness of health
                                  7
care thus contributing to              is the acceptance of a uniform
achieve the goals set out in the       personal      health   number
National Health Policy.                (PHN) to be used across the
The Standards and Guidelines           health care services to identify
and the Strategic Plan are             patients. The PHN has now
aimed at achieving this vision         been officially endorsed.
and mission. A parallel process

                                   8
PHN and MPI
   Personal Health Number & Master Patient Index

The Health Ministry is in the          Health Number (PHN). This
process of implementing the            will allow the Ministry to
National Healthcare Recipient          capture the true disease
Identification    System      to       burden of the country as
enable it to consolidate all the       opposed to the individual
interactions of a particular           incidences that are being
person with the healthcare             captured now.
system to his/her Personal

                         The format of the PHN

The MoH has also taken steps           benefit to the healthcare
to introduce a Master Patient          recipient, where all his/her
Index (MPI) at district level          medical records are in one
initially with the intention of        place. These initiatives are
scaling it up to national level.       aimed        at      ensuring
This would further enhance             interoperability       among
the development and use of             electronic    health   record
Personal Health Records in the         systems within the country.
future, which would be a great

                                   9
eIMMR
 Electronic Indoor Morbidity and Mortality Register
 The first system approved for country wide implementation in the
                     Health Sector in Sri Lanka

Collection of nationwide real          Health        for     nationwide
time data on indoor morbidity          deployment. It is currently
and mortality (IMMR) is                implanted in over 400 (63%)
challenging.    The   eIMMR            health care institutions (out of
system developed by Dr.                a total of 635 secondary and
Nadish Kariyawasam and Dr.             tertiary care institutions).
Buddika Dayaratne is now               These institutions account for
making this possible in Sri            approximately 70% of the
Lanka.                                 total nationwide hospital
                                       admissions in Sri Lanka. There
Initially developed as an MSc          are 1738 user accounts. The
student project in 2009 with a         database now contains over
grant of Rs. 50,000/- from the         15 million records. It is hoped
HISSL. It has now been taken           that all institutions will use the
over by the Ministry of Health.        eIMMR system for reporting
It is the first software tool          their statistics by the end of
approved by the Ministry of            2017.

                      Web interface of the eIMMR

                                  10
11
HHIMS
   Hospital Health Information Management System

                                         The Main objective of this
                                         government funded project is
                                         to improve quality, safety,
                                         efficiency      and      patient
                                         centeredness       in    service
                                         delivery of the Sri Lankan state
                                         health sector using ICT. This
Many        developed       and          focuses on improving the
developing countries around              quality and efficiency of the
the world have realized the              health care services provided
advantages of incorporating              by the government hospitals
Information                 and          in Sri Lanka by implementing
Communication Technology                 electronic medical records
(ICT) into the health sector. Sri        systems in 300 government
Lanka is also looking into               hospitals      covering      the
development of electronic                National Hospital, Teaching
health solutions for the                 Hospitals, Provincial and
preventive      and     curative         District General Hospitals,
healthcare sectors of the                Base Hospitals and selected
country. The Information and             divisional             hospitals
Communication Technology                 throughout the country by the
Agency of Sri Lanka (ICTA,               end of 2018.
currently operates under the
Ministry                       of        The Digital Health project
Telecommunication           and          promotes Electronic Health
Digital Infrastructure) with             Records (EHR). EHRs are the
the intention of making Digital          next step in the continued
empowered nation, initiated              progress of healthcare that can
“Digital     Health     Project”         strengthen the relationship
collaboration with Ministry of           between patients and doctors.
Health.                                  The data, the timeliness and its

                                    13
availability    will      enable         software solution. It was
providers to make better                 developed in PHP 5.5.9 with
decisions and provide better             Codeigniter v2.0.1 framework
service to the Sri Lankan                which requires Apache 2.4.7
health sector stakeholders               environment. If it is a local
including decision makers.               deployment ICTA propose a
The ICT Agency of Sri Lanka,             server with 8 GB memory and
developed the ‘Hospital Health           1 TB hard drive in latest
Information         Management           Ubuntu server distribution.
System’ (HHIMS) on the
request        of        medical         HHIMS software is being used
practitioners                and         successfully in several state
administrators        of      the        sector hospitals like National
government health sector                 Hospital of Sri Lanka-Accident
back in 2010. It is a free and           service (premier trauma care
open source software solution            institute in Sri Lanka), Base
(FOSS).     It    includes     an        Hospital-Avissawella , District
Electronic Medical Record,               Hospital      Dompe,        Base
Patient              Admission,          Hospital-Panadura            and
Appointment and           Queue          General      Hospital-Ampara.
Management,                Clinic        HHIMS was implemented in
Management,          Laboratory          Karawanella BH in 2011 as
Information System (LIS),                HHIMS version 1.0 where
Pharmacy Stock management,               ICTA took the initiative to fund
Notification,               OPD          and proceed with the project
Management, Questionnaire,               with     all   aforementioned
Report, Ward Management,                 features. Then HHIMS was
User Management, Permission              implemented in Dompe DH
and PACS modules and other               (2011, V1.1), Avissawella BH
modules as in the figure below.          (2013, V1.3 customized) and
Performance         management           Panadura BH (2014, V1.3).
dashboard is also included in            ICTA has selected 3 major
HHIMS.                                   government       hospitals     -
                                         Homagama BH, Horana BH
HHIMS     is   a   web    based          and Galagamuwa BH to
                                    13
implement and pilot the latest          from     government      health
version (v2.7) of HHIMS with            sector. Final outcome of this
facilitating Wi-Fi enabled              project is to improve quality
network          infrastructure.        and efficiency in service
Homagama and Horana BH                  delivery,         governance,
systems were started in mid of          accountability and effective
2016        which     currently         use of resources of the
operational in all sections of          government hospitals.       As
OPD setup with enhanced                 result of that availability of
usability and user friendliness         updated, accurate information
from the lessons learnt from            for patient care will be found.
initial implementations and             That helps improve the
resource personnel.                     capacity of health authorities
This project aims to increase           to detect emerging and re-
the EHRs coverage of the                emerging diseases and take
selected hospitals up to 80%            necessary preventive actions
from the total patients who             in future.
access the health services

                                   14
HIMS
       Hospital Information Management System
Development                 and         implemented in four hospitals
implementation of Hospital              at the moment. The laboratory
Information        Management           module of the HIMS is
System (HIMS) for the large             deployed at the National
hospitals in the state health           Cancer Institute Maharagama
care was initiated in 2013. The         and it is in initial stages of
solution focused on enhancing           implementation       in  other
service delivery, streamline            hospitals.
the information management,             Computer resource centres
sustainability     and      cost        (IT training centres and
effectiveness. Requirements of          Computer maintenance units)
key stakeholders were taken             were       established    with
into consideration in the               capacity to provide the
development process and the             necessary training to users
solution       adopt       agile        and        maintenance      of
development       methodology           equipment to ensure smooth
enabling accommodating end              operation of the system. Its
user needs. The scope of the            mandate is to maintain the
HIMS       project     includes         LAN and end user training to
development of Hospital ICT             improve the ICT literacy. The
infrastructure, improvement             developers who are stationed
of end user ICT literacy and            at the National Cancer
implementation of the HIMS.             Institute Maharagama carry
Further, improvement of                 out further improvement of
software system, building               the software and perform
hospital       capacity       to        maintenance.
maintenance the system and
ICT infrastructure were also            The software development
considered. Core modules of             was a collaboration between
the HIMS (Master Patient                the Ministry of Health and the
Index, Ward Management                  University of Kelaniya. The
Module & MRO module) were               software was designed in a
                                   15
modular way and initially               capture a PHN issued from
focused on inpatient care at            other hospitals. The system is
the hospital. Admission/                completely interoperable with
discharge       and       clinic        the eIMMR system, the official
registering    module       was         indoor     morbidity      and
developed      initially    and         mortality reporting system of
implemented as the base                 the Ministry of Health, thus
module. HIMS is capable of              allowing automatic transfer of
issuing     unique       patient        IMMR data from HIMS to
identifier, Personal Health             eIMMR.
Number (PHN), and it can

          .
                        The components of HIMS

Three developers provide                required by different hospitals
around the clock maintenance            are also being addressed by
service of the HIMS. They are           the      same       developers.
also involved in development            Implementing hospitals are
of other modules. They are              not bearing any cost for the
being stationed at the IT               software and the source code
laboratory of the National              of the software is the property
Cancer Institute Maharagama.            of the Ministry of Health.
The Ministry of Health and two          Knowledge of the end users to
international donors provided           adopt a computer based
the funds required for the              system and proper change
project. Minor customizations           management         are     very
                                   16
important aspects in HIMS              provided to the direct users of
implementation        and              the system.     Implementing
sustainability.                        HIMS is having many positive
                                       impacts on the health system.
                                       With the implementation of
                                       the Master Patient Index time
                                       taken for patient registration
                                       will be minimized and patients
                                       who are already registered in
                                       the system need not submit
                                       personal       details      on
                                       subsequent admissions. At the
                                       end of the care process an
A nurse updating clinic records        indoor      mortality      and
                                       morbidity report (IMMR) is
All hospitals adopted gradual          generated for each and every
implementation         process         inward patient at the Medical
allowing users to familiarize          Records Office (MRO).
with the software. After period
of successful parallel running         With the implementation of
of both systems, manual and            MRO module of the HIMS the
digital system, a compressive          system utilises the patient
evaluation was carried out             information entered at various
before shifting to the digital         care points to generate the
system. The Ministry of                IMMR. The IMMR generated
Health’s requirement to keep           with the ICD 10 code can be
paper base documents was               automatically transferred to
replaced     with     printouts        the eIMMR system of the
generated from the system.             Ministry of Health. In the
                                       future the Ministry of Health is
Training programmes are                gearing up to adopt using the
being carried out on basic             PHN to identify IMMR records
computer skills covering all           thus minimizing errors and
categories of staff and                duplications.     With      the
software specific training is          introduction of the laboratory
                                  17
management module patient               being carried out at the
investigation reports will be           implementing hospitals.
saved to the patient profile.           This     sustainable    model
                                        adopted by the project team
Sri Lanka spends about 2% of            allowed the Ministry of health
the GDP on Health. The                  to own a Hospital Information
government absorbs a huge               Management System with a
cost to provide free health care        very minimal cost. The
services.     The      software         Ministry need not fund each
development model that was              and every hospital to purchase
adopted has saved millions of           software.         Furthermore
rupees to the government. For           maintenance is carried out by
the last three years the cost of        staff members who are
software development was                already in the health sector
only Rs. 3.5 million rupees.            with no additional burden to
Since the source code belong            the national health budget.
to the Ministry of Health any
government hospital that is
willing to implement the
software will get it free of
charge and the necessary
modifications                and
maintenance support will be
provided free of charge.The
method adopted to develop
trained personal to maintain
the network and the hardware
is unique. The Ministry of
Health with the help of
University     of     Moratuwa
trained selected staff from the
hospitals to carry out above
functions and the necessary
tools were also provided.
Training of hospital staff is
                                   18
DNMS
         District Nutrition Management System

Sri Lanka is                          monitor
seen as a                             children in
model for                             their areas.
delivery of                           The second
high quality                          component
health care in a                      was a web
low resource                          application to
setting. The                          enable
nutrition                             healthcare managers to
indicators of children                monitor the nutrition status
however give a different              of children across the country.
picture. The government of            The third component alerted
Sri Lanka decided to address          different government
this issue with a national            agencies in the health sector,
action plan coordinated at the        social services sector, and
highest level of government –         agriculture sector to take
the Presidential Secretariat.         personalised interventions
The Health Informatics                aimed at households that had
Society of Sri Lanka (HISSL)          malnourished children using
was invited to develop the            risk factor data gathered by
District Nutrition Monitoring         public health midwives, and
System to support the multi-          enabled them to monitor the
sector action plan for                effectiveness of the
nutrition.                            interventions.

The system consisted of three         The software backbone of the
components. The first                 system was DHIS 2. The
component was a smart                 financial support came from
phone app to be used by               Unicef. The first phase of
public health midwives that           implementation commenced
enable them to track and              in June 2016. This involved

                                 19
deploying the system in 3             nutrition-monitoring-system-
districts – Nuwara Eliya,             dnms/]. WSA has been
Matale, and Polonnaruwa. 604          initiated in 2003 in the
public health midwives were           framework of the UN World
trained and they commenced            Summit on the Information
using the system. A post              Society (UN WSIS). It
implementation evaluation             contributes to the UN
and a field level review is           SUSTAINABLE
currently underway to further         DEVELOPMENT GOALS
strengthen implementation             AGENDA by recognizing local
activities. The Project Team          digital content with an impact
lead by Dr. Roshan                    on society, demonstrating the
Hewapathirana and Dr.                 richness and diversity of
Pamod Amarakoon won the               innovative applications.
award for the best early stage
app in South Asia at the
mBillionth awards of the
Digital Empowerment
Foundation in New Delhi,
India in July 2016; the
Commonwealth Digital Health
Awards in October 2016, the           .
eSwabhimani National ICT                   The team accepting the
Awards in November 2016,                     mBillionth Award
and the World Summit Award
2016 after having been placed
first among entries from 178
countries at the World
Summit Awards (WSA)2016.
[https://www.worldsummita
wards.org/winner/district-

                                 20
Electronic Patient Information Management System
   of the National Programme for Tuberculosis and
                Respiratory Disorders

The      Electronic    Patient        TB case surveillance. Hence,
Information       Management          funded by the GFATM, the
System for Tuberculosis is a          system is moving towards
successful programme-wide             being developed into a
DHIS2 implementation. The             comprehensive,      integrated
National    Programme      for        solution   for     respiratory
Tuberculosis Control and              disease management and
Chest Diseases (NPTCCD)               reporting. The project is
commissioned               the        coordinated by Dr. Pramil
implementation in 2013 for            Liyanage and it received the
Tuberculosis         aggregate        Commonwealth Award for
reports. Currently it has             Application of eHealth to
evolved into both aggregate           Reach SDGs with Special Jury
and individual records and has        Mention         at         the
been designed to encompass            Commonwealth Digital Health
TB and other respiratory              Awards in 2016.
diseases         such       as
COPD/Asthma        and   Lung
Cancers. Data is captured
through the chest clinics and
at field levels. With the
emergence of multi-drug
resistant TB, the WHO and the
Global Fund (GFATM) have
highlighted the importance of

                                 21
eRHIMS
      electronic Reproductive Health Information
                  Management System

The Reproductive Health               will be expanded to capture all
Management         Information        public health information
System (RHMIS) is the main            required by the Family Health
source of data for national           Bureau, the main government
health indicators in maternal         agency        involved        in
and child health, family              coordinating maternal and
planning, adolescence and             child health care in Sri Lanka.
women’s        health.    The         System will be expanded to
electronic       Reproductive         capture other public health
Health            Management          data     such     as     special
Information System (eRHMIS)           surveillance data.
was designed to replace the
paper-based system which               eRHMIS has now been fully
consists of nearly 25 data            implemented island wide with
collection formats.                   all MOH offices in the country
                                      reporting     their   statistics
The system is planned to be           electronically.
developed and implemented
in a phased out manner.
During the phase 1, Maternal
and Child Health (MCH) data
will be captured at Medical
Officer of Health (MOH) level
in aggregated format. It is
planned to capture data at
Public Health Midwife (PHM)
level where the services are
provided as disaggregated
data of individuals. eRHMIS

                                 22
The Data Entry Screen of eRHMIS

An eRHMIS User Training Workshop

               23
eNCD
    electronic Non Communicable Diseases System

This DHIS2 based system                 capturing is done at Mobile
implementation            was           NCD Clinics, Healthy Lifestyle
implemented to support the              Clinics and NCD clinics in
Non-Communicable Disease                preventive care institutions.
Unit of the Ministry of Health.
From 2014 to 2016 the system            The next phase of the project is
was able to replace the paper           expected to incorporate Road
based data gathering on                 Traffic Accidents Surveillance.
Diabetes, Hypertension and              It is also planned to enable
Cardio-Vascular Diseases in             mobile      supported      data
the community. The data                 capture at mobile NCD clinics.

Handing over of the system by the development team to the Minister of
Health Honorable Maithripala Sirisena (the current President of Sri
Lanka) on 24 January 2014 by Prof. Vajira H. W. Dissanayake. Dr. Deepal
Wijesooriya who led the team that developed the system is also in the
picture.

                                   24
Registering and Verification of the Electronic Health
          Information Systems in Sri Lanka

Most of the Health Information            electronic Health Information
Systems in Sri Lanka are                  Systems      of    the     State
currently being computerized.             Healthcare Sector that covers
This is meant to improving the            one or more of the following
efficiency, reliability and               areas:
meeting expectations of the               ● Systems that manage
stakeholders. Many software                   Personally      Identifiable
are being developed, piloted                  Data      of     healthcare
and implemented in the state                  recipients.
healthcare sector. Sometime               ● Clinical         information
there is duplication of effort.               systems.
The       “National      eHealth          ● Systems managing medical
Guideline       &     Standards               equipment       and/      or
(NeGS)” which is applicable                   medical supplies.
for       electronic      Health          ● Systems              handling
Information Systems of both                   aggregated data of one or
the     state    and      private             more medical conditions
healthcare sectors is now in                  including risk factors and
effect. The state healthcare                  outcomes        of       the
sector has now recognized the                 condition(s).
requirement for a mechanism               The process will address the
to ensure adherence of the                issues arising in emerging
electronic health information             electronic health information
systems to the NeGS and other             systems early in their life
legal and ethical requirements            cycle, ensure that the systems
to ensure interoperability,               cater to the requirements, and
legality and sustainability of            identify overlapping systems
these systems.                            catering to the same scope and
The scope of this initiative is to        facilitate comparing such
create a registry of the                  systems which in tern would

                                     25
facilitate the implementation           to be accepted and to
of the NeGS. The processes and          responded              online.
the formats were presented at           Furthermore the paper based
technical level forums for              system will be continued in
suggestions     and     critical        parallel till the web based
analysis. The way forward               mechanism is streamlined. A
include       the      further          hand book will be prepared on
improvement to the formats/             the process to guide the
processes according to the              researchers,       developers,
suggestions,                the         implementers     and     other
recommended version to be               stakeholders of electronic
National eHealth Steering               health information systems.
committee for approval, pilot
testing of the process,
development of the web based
system to enable the proposals

                                   26
"Suwasariya" Telehealth Programme

Instantaneous access to free           information.      Its   services
medical advice or health               aimed for empowering and
information on disease details         mobilizing communities for
as well as disease prevention          the improvement of their
from      qualified    medical         quality of life through health
professionals or from a                promotion             principles.
recognized institute is a vital        Implemented as a tri-lingual
factor in community health             health education information,
promotion. Electronic media is         advice and guidance service by
now frequently used as a tool          the Health Education Bureau
for health-related information         from which Sri Lankans within
and communication in recent            the country and abroad can
years.    Sometimes medical            access and seek help in the
care seekers appear to be              language of their choice.
using the Internet to enhance          Suwasariya has two main
their own medical care by              components,         a     health
using the information online           educational        web       site
to diagnose a problem.                 (http://suwasariya.gov.lk/)
                                       and a 24/7 health related help
Identifying above situation            seeking call centre (Hot line-
and     needs,    Suwasariya           +94710107107, email and
(Healthnet) was designed and           SMS).
developed as a national                Following types of health
programme to educate and               educational      services     are
promote health of Sri Lankan           provided by Suwasariya web
people by Health Education             site and call center.
Bureau (HEB) which is the               ➢ Provide       guidance      to
center of excellence in Sri                 resolve non-emergency
Lanka for health education,                 medical issues.
health     promotion     and            ➢ Education on personal
publicity      of      health               conditions         needing
                                  27
discussion with a doctor.               face with a doctor.
➢ Providing       information          ➢ Provide services to who
  about disease prevention                are abroad working or
  and treatment.                          travelling and in need to
➢ Provide clarifications on               discuss health issue with a
  health publication and                  Sri Lankan doctor in his or
  other communications .                  her mother tongue.
➢ Personalized advice on              Services are provided by
  Nutrition,          Healthy         consultant         community
  Lifestyle, and Personal             physicians and medical officers
  Hygiene.                            who are well experienced in
➢ Education and guidance              preventive and curative sectors
  on     Sexual      problems         in Sri Lanka. It is supported by a
  difficult to discuss face to        group of other government
                                      health institutes.

                                 28
29
Sri Lanka Stroke Clinical Registry

Stroke is the third leading              Association of Sri Lanka,
cause of hospital death                  Association of Sri Lankan
worldwide. It is the main cause          Neurologists, Ministry of
of adult disability. Effective           Health, Health Informatics
management of strokes is                 Society of Sri Lanka and other
hindered by many factors and             healthcare providers.
one of the most important
issue is lack of reliable                The SLSCR provides individual
epidemiological             data,        and health related information
indicators, prevalence pattern           of patients, generates real-
leads to reduced quality of              time data from the patient
care given in acute, chronic             records         for      health
and rehabilitative phases of             management         at   various
the      affected       patients.        administrative levels, and
Therefore the need to develop            facilitate clinician to access
a Stroke Clinical Registry was           accurate patient information.
crucial to improve the
management, treatment, and               The           implementation
rehabilitative care. Hence the           commenced with a detailed
objective of this initiative was         requirement analysis and an
to design, develop and pilot             architectural design for the
the web based Sri Lanka                  electronic Health Information
Stroke     Clinical     Registry         Management System and
(SLSCR) for the management               creating data components.
of Stroke patients. The project          The system was developed
was     funded      by     World         using Free and open source
Federation of Neurology and              software such as PHP and
World                     Stroke         MySQL in order to minimize
Organization through Ministry            cost and was piloted at Stroke
of Health. The core team                 Unit of National Hospital, Sri
included professionals from              Lanka. During the pilot phase
the       National        Stroke         software underwent testing
                                    30
for any issues of system                data.   The     system     was
functionalities, Graphical User         introduced to the Colombo
Interphase, data entry and              South    Teaching     Hospital
analysis      reports     were          (Kalubowila),     Mulleriyawa
documented and resolved.                Base Hospital, and the
                                        Teaching Hospital Batticaloa.
After                successful         Upto February 2017, data of
implementation at the Stroke            more than 5300 stroke
Unit of the National Hospital of        patients were captured in to
Sri Lanka, the system was               the system. It is planned to
introduced to the Teaching              introduce the system to all the
Hospital (TH) Kandy, TH                 Stroke units, Tertiary Care
Karapitiya, TH Jaffna and               Hospitals and all District and
District General Hospital               Provincial General Hospitals
(DGH)      Chillaw.    Nursing          by the end of 2017.
officers were trained to enter

                                   31
Essential Drug Stock Alert Tracker

The health status in Sri Lanka          each institution is not
is well above the regional              available at the RMSD or at the
health indicators and it clearly        regional and provincial health
reflected    in   the     heath         offices. Therefore they are not
indicators. However lack of             able to take steps to replenish
pharmaceutical supplies in              stocks in a timely manner. As a
government          healthcare          result most of the shortages of
institutions is a major                 pharmacy items in health care
complaint from the general              institutions are not due to the
public.                                 shortage of drugs at RMSD or
                                        MSD but due to this poor
The Medical Supplies Division           communication          between
(MSD) issues pharmacy items             RMSD and health institutions
for the region to their Regional        or unequal distribution of the
Medical Supplies Division               items from the RMSD. As drug
(RMSD). Ministry of Health              stocks are maintained in a
institutions receive pharmacy           manual drug stock register,
supplies directly from the              there is no active alert
MSD. Provincial health care             mechanism to make alert the
institutions receive their              head of the institution or
pharmacy      supplies     from         officer in charge of the drugs
RMSD and there is a Divisional          store to low stock early and
Pharmacist in the RDHS office           inform the RMSD to supply
to monitor and regulate this            stocks in a timely manner.
process.
                                        To overcome these problems a
Each     health    institution          simple web based application
maintains their drug stock              was developed to establish a
within their own drug store.            timely information flow. This
However with the present                Essential Drug stock alert
manual system, real time drug           tracker was developed and
stock status information of             integrated to the Provincial
                                   32
Health information System               system in the Colombo district
(PDHIS).                                (2015/8/21) 16.24% of items
                                        were at zero stock level and
Each health care institution            only 55.56% items were at
was given a user name and               satisfactory stock level. By
password to log into the                January 2017 zero stock level
system. The Officer in charge           had reduced to 0.4% and
at the drug store can log into          satisfactory stocks level had
the system and enter the                increased up to 85.4%. The
pharmacy items received from            Zero stock level in Kalutara
the RMSD and items issued               district showed a decline of
from the drug store to the              23.42% which was the highest
wards, clinics and OPD during           reduction compared to the
the week. Each institutions             other two districts. However
average daily usage is entered          satisfactory stock level had
into the system and from that           only indicated an increase of
their     reorder    level    is        19% by January. The success
calculated. There is a color            of the system was recognized
code system implemented and             by      the    Commonwealth
the user dash board visualize           Medical Association (CMA)
the available stock with the            and the South Asian Digital
color code. This system was             Empowerment        Foundation
deployed in all regional                (DEF) by awarding this system
hospitals in the Colombo                a Commonwealth Digital
district (2 base Hospitals and 9        Award and Manthan Award
divisional hospitals) from              respectively in 2016.
August 2015. It was extended
to the hospitals in the                 The team: Dr A L Fareed -
Gampaha        and     Kalutara         Provincial Director of Health
districts in October 2015.              Services, Western Province,
Currently there are 42 health           Dr Anil Samaranayake -
institutions in the Western             Deputy Provincial Director of
Province using the system. At           Health Services, Dr Vajira
the commencement of the                 Nanayakkara – Consultant
                                   33
Community Dental Surgeon,            Mohamed Rikaz Sheriff –
Dr Lasantha Ranwala - Chief          (Formerly) Medical Officer
Designer and (now Registrar          Health Informatics, Dr Sandun
in Health Informatics and            De Silva – District Registered
formerly) Medical Officer            Medical Officer ,Office of
Health Informatics, Office of        Regional Director of Health
Regional Director of Health          Services, Colombo
Services, Colombo, Dr

                                34
SLJBMI
      Sri Lanka Journal of Bio-medical Informatics

The Sri Lanka Journal of Bio-            Dr. B. J. C. Perera with Prof.
medical Informatics (SLJBMI)             Vajira H. W. Dissanayake, Prof.
published jointly by the                 Jayantha Weerasinghe, Dr.
Postgraduate Institute of                Rohana Marasinghe, and Dr.
Medicine of the University of            Roshan          Hewapathirana
Colombo and the Health                   serving as Executive Editors.
Informatics Society of Sri
Lanka is the only Sri Lankan             It is a peer-reviewed open
journal in the field of                  access journal available freely
Biomedical Informatics. The              on the Sri Lanka Journals
fist issue of the Journal was            online platform at the URL:
published in January 2010. It            http://www.sljol.info/index.p
is published quarterly. The              hp/SLJBMI
Editor in Chief of the Journal is

The journal ceased publication after its second issue of the fourth
volume in 2013. It is expected to be revived soon.

                                    39
A Short History of Health Informatics in Sri Lanka
                       and the
   Health Informatics Society of Sri Lanka (HISSL)

In January 1997, a group of
doctors met at the head                HISSL was incorporated as a
quarters of the Sri Lanka              nonprofit company in Sri
Medical Association (SLMA) to          Lanka in the year 1999. HISSL
discuss the formation of a             became a member of the Asia
committee       on      medical        Pacific Association of Medical
informatics. The meeting               Informatics (APAMI) in 1999
ended with the appointment             and a member of the
of a committee with Dr. Shyam          International           Medical
Fernando as the Chairperson            Informatics         Association
and Dr. Vajira H. W.                   (IMIA) in 2011. Dr. Vajira H. W.
Dissanayake as the Secretary.          Dissanayake attended the
The objective of the committee         APAMI meeting in Hong Kong
was to increase awareness              in 2000 and read a paper, Dr.
about medical informatics              Kumara Mendis served in the
among doctors. The main                steering committee of the
activity of the committee was          APAMI meeting in 2003 in
the     publication     of   an        South Korea, and Dr. Roshan
electronic newsletter called           Hewapathirana represented
MediInfo that was emailed to           HISSL when it was admitted as
members of the SLMA. The               a member of IMIA at the IMIA
archive of this electronic             General Assembly in Oslo on
newsletter, which can be               28 August 2011.
accessed                     at
http://www.infolanka.com/o             The main activity of HISSL
rg/mediinfo/,           provide        during its first decade of life
interesting insights in to the         was scientific meetings that it
medical informatics scene in           organized on its own and in
Sri Lanka at that time.                collaboration    with    other

                                  40
professional medical colleges             that he continues to hold up to
and      associations.        The         date. Under Dr. Vajira H. W.
inaugural scientific meeting of           Dissanayake’s        leadership,
the HISSL was held on 4 April             HISSL has grown from
1999, and thereafter meetings             strength to strength. The
were held in March 2003 and               foundation for this success
in June 2004. In between many             came in the form of a chance
smaller      meetings         and         introduction of Prof. Sundeep
symposia were held in                     Sahay, Professor, Department
collaboration     with      other         of Informatics, University of
professional medical colleges             Oslo,     Norway       to    Dr.
and      associations.        The         Dissanayake by Dr. Rohan
Presidency of HISSL passed on             Jayasuriya of the University of
to the Late Prof. M.T.M. Jiffry in        New South Wales, Australia in
2003 and to Dr. Kumara                    2007. Prof. Sahay who has
Mendis in 2004. In these early            been involved in developing
years some of the prominent               health informatics in many
personalities who visited Sri             countries offered his support
Lanka and helped and                      for Sri Lanka to do so. In June
encouraged us were Prof. Ian              2007 Prof. Sahay visited the
Purves from the UK, Prof. K. C.           University of Colombo and at a
Lun from Singapore, Prof Yun              meeting at the Postgraduate
Sik Kwak from South Korea,                Institute of Medicine (PGIM) of
and Prof Yu-chuan Jack LI                 the University of Colombo,
from Taiwan. Among them,                  facilitated by HISSL, at the
Prof. Lun’s influence on HISSL            office of Prof Rezvi Sheriff,
was very prominent.                       who at that time, in addition to
                                          being the President Elect of
In January 2008, Prof. Rezvi              HISSL, was also the Director of
Sheriff was elected President.            the PGIM, it was decided to
He held this position until               start a Masters Course in
September 2009 when Dr.                   Biomedical Informatics. After
Vajira H. W. Dissanayake was              the meeting Dr. Dissanayake
elected President, a position             and Prof. Sahay worked on
                                     41
submitting a grant application          laid the foundation to creating
to the Norwegian Center for             a generation of leaders in
International Co-operation in           health informatics who would
Higher Education (SIU) for              work        with       medical
funding to start the course.            administrators hand in hand
They were successful in                 to spearhead the deployment
securing a grant of over a              of health informatics in Sri
million dollars that supported          Lanka. The Ministry of Health
the course until 2014. Today            granted two years paid leave
the course has become self-             for medical doctors and dental
financing and annually upto             surgeons to follow the course.
30 students are taken into              As a result, the course was
follow the course. The grant, in        very popular. So far there have
fact, came from Norad under             been 89 Sri Lankan graduates
its     Norwegian      Masters          from the course in 5 batches
(NOMA) programme that was               and 50 more are currently
managed      by     SIU.     Dr.        following the course. One of
Dissanayake was requested to            the     graduates     was      a
spearhead this project at the           Vietnamese student who went
PGIM. By August 2008,                   back to Vietnam            after
curriculum development was              graduation.
completed, a specialty board
in Biomedical Informatics was           The graduates have been
set up to administer the course         appointed       as     Medical
with Dr. Dissanayake as                 Officers/Dental Surgeons in
Founder Chairperson and Dr.             Health Informatics in various
Roshan Hewapathirana as the             institutions of the Ministry of
Course       Manager,       and         Health and have been
advertisements had been                 spearheading                the
placed to recruit students for          development        of    health
the course. The first batch of          informatics        in     their
students started their training         institutions. This has resulted
in      May      2009.      The         in rapid development of health
commencement of the course              informatics in Sri Lanka with
                                   42
exponential growth expected              graduates of the masters
in the next few years. The               course      at     its     annual
success of the course and the            conferences that have now
impact it has had on the health          taken      an      international
sector in Sri Lanka resulted in          dimension. The first in this
Health Informatics being                 series of conferences - eHealth
recognized as a board                    Sri Lanka 2010 was held in
certifiable medical specialty in         October 2010; thereafter the
Sri Lanka in 2015. The                   conferences       have       been
graduates of the masters                 eHealth Sri Lanka 2013;
course can now follow a two-             eHealth         Asia         2015
year Doctor of Medicine (MD)             (ehealthasia.org); and Digital
course in health informatics             Health for        Health      and
and after two more years of              Wellbeing in collaboration
post MD training, of which one           with the Commonwealth
year is in an overseas country,          Medical Association in 2016
they become eligible to be               (cma2016.org).              These
Board Certified in Health                conferences have resulted in
Informatics.      The      entire        Sri Lanka becoming a hub for
programme is funded by the               eHealth/mHealth and Digital
Ministry of Health. MD                   Health        activities.      In
students, like the MSc                   recognition of this fact the
students, are granted paid               Commonwealth              Medical
leave to follow the course full          Association (CMA) invited
time. The first batch of twenty-         Prof. Vajira H. W. Dissanayake
two MD students was selected             to take on the Presidency of
in November 2016, and they               the CMA with the view to
will go on to become the first           leading a Commonwealth wide
batch to be board certified in           Digital Health initiative. This
the year 2020.                           resulted in the launch of the
                                         Commonwealth Digital Health
In this background HISSL has             Network and the Annual
been showcasing its activities           Commonwealth Digital Health
and the achievements of the              Awards in October 2016 in
                                    43
Colombo. These initiatives are          November 2013, when the
being    driven    with the             World Health Organisation’s
technical assistance of HISSL.          South East Asian Regional
                                        Office (SEARO) adopted a
In January 2010 HISSL joined            Regional eHealth Strategy at a
up with PGIM to launch the Sri          High Level Ministerial Meeting
Lanka Journal of Biomedical             in     Bangkok,       Thailand,
Informatics as an outlet for            President of HISSL, Prof. Vajira
showcasing Sri Lanka case               H. W. Dissanayake was
studies in the field of Health          requested by the government
Informatics. It was a peer              of Sri Lanka to represent the
reviewed open access journal            country and be the signatory
published quarterly online              for Sri Lanka. HISSL has also
(http://sljbmi.sljol.info). Dr.         been working as partners with
BJC Perera served as its                international     development
founding editor in chief. The           organisations such as such as
journal has        had     many         the UNICEF and Bloomberg
challenges      and       ceased        Philanthropies to implement
publication in 2013. It will be         major health informatics
re-launched in 2017.                    projects in Sri Lanka. The
                                        District Nutrition Monitoring
Today HISSL is the major                System App developed by
technical partner of the                HISSL with funding from
Ministry of Health, Sri Lanka           UNICEF, which is used by field
for ICT implementation in the           level public health staff in Sri
country. The Sri Lankan                 Lanka to monitor the nutrition
government has recognized               status of children, won the
the role played by HISSL.               prize for the best early stage
HISSL is represented in the             app in the South Asian region
national eHealth Steering               at the mBillionth Awards
Committee of the Ministry of            Ceremony in New Delhi in July
Health and the Country                  2016. This has been one of the
Coordinating Mechanism of               major milestones in the
the Global Fund. In fact in             transformative process that
                                   44
the Health Informatics sector
in Sri Lanka has been
undergoing as a result of the
work that HISSL has been
doing since 1998. It is
noteworthy that the driving
force for this change has been
the medical professionals
themselves.

In November 2016 the
government of Sri Lanka took
a major step forward for
Digital Health in the country
when the Cabinet of Ministers
accepted a proposal by Prof.
Dissanayake to set up a Sri
Lanka Institute of Digital
Health. The institute will be
established within the next
two years. The opening of the
institute in 2018 would be the
culmination of a 20-year long
journey by HISSL to promote
and       facilitate  Medical
Informatics,           Health
Informatics, eHealth, mHealth
and now Digital Health in Sri
Lanka and the region

                                 45
Published by the Health Informatics Society of Sri Lanka
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