Digital Health in Sri Lanka

‘Sustainable Implementation of Digital Health Solutions through Local Capacity Building’

1998-2017

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 [email protected]

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

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 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 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 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 125th 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

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

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

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

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

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

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-

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

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

The Data Entry Screen of eRHMIS

An eRHMIS User Training Workshop

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.

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

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

"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.

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

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

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.

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

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

Published by the Health Informatics Society of Sri Lanka