In our latest interview we had the pleasure to talk with Dr. Sanji De Sylva, Head of Clinical Adoption for Malaffi.
Malaffi, (an initiative of the Department of Health – Abu Dhabi), is a Health Information Exchange (HIE) platform being implemented across the Emirate of Abu Dhabi. Malaffi is aimed at improving the way healthcare is delivered by increasing efficiency and quality as well as enhancing patient safety and outcomes. Malaffi enables connected healthcare facilities and authorised healthcare professionals across the Emirate of Abu Dhabi to access and share patients’ medical information.
Can you tell me about yourself and your organisation?
I am a physician by training and I have worked in the UK, New Zealand, Australia and Qatar; I moved into the health information system or clinical information system space almost 20 years ago.
One of the biggest projects I have worked on was the implementation of an Electronic Medical Record system across 15 hospitals and 25 primary healthcare centres in Qatar.
My role at Malaffi as the head of clinical adoption means that my team and I are responsible for ensuring that the clinical design of the HIE platform is fit for purpose from a clinical perspective. It also involves ensuring that the data we are receiving from the providers is clinically valid, displayed correctly, is relevant and adds value to the end-users.
Malaffi is the first HIE in the Middle East that will connect all healthcare services providers in Abu Dhabi into a single platform which can be accessed by physicians, nurses, and other users who are at the point of care from within their own EMR system. This means that Malaffi improves the efficiently and accuracy of clinical decisions by providing the clinician with a summary of the patient’s information recorded at other healthcare facilities outside of that organisation, within the Emirate of Abu Dhabi.
While designing Malaffi our priority was to make the system as user-friendly as possible and so we successfully implemented a single sign-on access to Malaffi. This means that Malaffi is embedded directly in the facility’s EMR, which saves the user from having a separate login and patient search. With Malaffi, once the clinician logs in into their EMR and opens a patients’ file, the Malaffi file for the same patient is one-click away. The landing page that opens in the Malaffi HIE, is what we call the ‘Delta View’, which shows a summary of the patients’ information that was recorded outside of that organisation. This provides an instant overview of the patient’s clinical information, and enables the making of better informed clinical decisions.
Besides Delta View, Malaffi includes variety of different views of the data that the clinician can utilise to find the type of information that they need.
Where are you up to with the project?
As of now, out of the 1,900+ facilities in Abu Dhabi, we’ve connected more than 400, whom are using 7 unique electronic medical record systems. For example, one of the largest providers has over 70 facilities with one centralised EMR, which means by integrating with one EMR, we had access to data from over 70 facilities.
Currently, more than 15,000 end-users have access to the Malaffi HIE. In order to make sure that the users are comfortable and know how to use Malaffi, we have a centralised training programme in place. That includes classroom training for the super-users and end-user training through an online learning management solution.
From a clinical perspective, we capture data across eight different data domains. We initially focus on the patient demographics as being able to correctly link the patients from different facilities within the HIE is integral to the concept of having one unique HIE patient record for each patient in Abu Dhabi. This means that regardless where patients are seen in the healthcare system, the information can be matched to their Malaffi record and can be shared between the different healthcare facilities.
We also capture diagnoses, allergies, chronic problems, medications (prescribed, dispensed and administered), clinical notes (e.g. discharge summaries), lab and radiology reports and procedures (both minor or major surgical). These are the current data domains, and as we continue to grow and clinical requirements change, we are looking to increase the scope of the that data.
As Malaffi already houses more than 38 million unique clinical records for 3 million unique patients, and we have started to work on providing population health insights to support public health initiatives that will improve the health and wellbeing of the population of the Emirate. We are at the same time working on launching the patient application, which will allow patient to have access to their Malaffi file to empower them in better managing their own health.
What have been some of the challenges and learnings from the project so far?
One of the biggest challenges for us is meeting the aggressive onboarding time frames, which creates challenges in terms of co-ordinating the connection of different facilities onto the HIE. On the flip side, it is also positive because it has helped us and the providers keep up the momentum towards our goal of connecting all providers.
Other challenges have included working with healthcare facilities to ensure that the participants who are connecting to Malaffi have the capability to meet the required interoperability standards. There has been a significant amount of support from our provider/participants during the onboarding process to help them achieve what’s required from a clinical informatics perspective, as well as helping them meet the technical messaging standards required to get their data into our system.
Over the next 12 – 18 months we will focus on end-user adoption. These are efforts focused at ensuring that clinicians understand the benefits and value of using Malaffi in their daily practice and ultimately recognise the benefits for their patients. We have already received several use cases/examples from clinicians who have shared with us how the Malaffi HIE has significantly benefited their patients.
What advice would you give to someone working on a similar project knowing what you know now?
It is important to clearly understand how the HIE will clinically benefit end users as well as understanding the market’s EMR maturity and providers’ clinical workflows. This combined with the type of clinical data that will be captured, and the understanding of how the HIE will be used by clinicians will guide the HIE design.
When designing the system, one should make sure the HIE is user-friendly, can be accessed seamlessly and is designed in a way that can be navigated easily, ensuring the user can quickly find the required information. This is very important because clinicians have limited time to spend with a patient, especially in outpatient clinics or GP surgeries.
Another consideration is to identify a set of data standards that you want to maintain as your base standard and then ensure that the market can meet that. An example from our project is that we are looking to have all our lab tests and results coded in LOINC codes because it is the most comprehensive lab coding system. It would not only allow us to store the data consistently to support analytics, but also improve the way data is displayed to clinicians.
We are also considering standardising the coding of certain clinical data from the perspective of being able to push data back out into the EMRs in the future. This functionality is being requested by a lot of our providers. For example, instead of having to open the HIE to view information, they want us to dynamically push patient information or present alerts about allergies and medications at the time of prescribing in their EMR. To achieve this, one needs to have common coding standards within the EMRs and the HIE. To understand the coding landscape and the challenges associated with being able to move the market in a direction which uses standardised coding, are some of the other key considerations when designing and implementing an HIE.
