To the Editor:—I would like to introduce the readers of JAMIA to informatics contributions in the Sultanate of Oman health care system. The Ministry of Health provides health care services in a three-tiered system—primary health care (health centers, extended health centers), secondary health care (regional referral hospitals), and tertiary health care (tertiary referral teaching hospitals and a university hospital).
At present, data collection in the primary care tier is performed primarily by a health officer, who does a statistical compilation of the data generated in the clinics. There is no a standard data collection format; the format varies from clinic to clinic. For example, in a general outpatient department clinic, for example, the records include the various diseases seen and the number of patients examined by the general duty doctors. In a diabetes clinic, nurses complete paper reports recording, among other data, the number of patients attending the clinic, their age groups, their medications, whether cases are old or new, and patients' end-organ involvement. These data are then sent on a floppy disk to the regional statistical officer.
At a secondary health care facility (regional hospital), a medical record system collects information for better planning of health services. The source of data is the patient in a direct admission or, if the patient has been referred to the hospital, the referral letter. The medical records department collects all the data. The data entry is done using custom-designed software, which has a user-friendly data entry screen. In addition to the standard information—e.g., demographic information and admission details—the system collects information about the patient's tribe, the name of the sheikh, and whether the patient is local or expatriate (since expatriate patients must pay unless they are employed by the government).
The components of the hospital record are:
Operational information, including basic details about patients admitted to the hospital; admissions in different departments, such as surgery, medicine, and pediatrics; and the ratio of referrals from various hospitals
Tactical information, including the number of available beds in various departments; the number of patients in various wards, and durations of stay; the number of local and expatriate admissions in various wards; and referrals and the type of referrals
Strategic information, which helps in the planning of future health facilities. For example, football/ soccer is very popular, and if many referrals for sports injuries are received from a basic health facility, an orthopedic doctor might be stationed at the facility or doctors there might be trained in sports medicine.
The aggregated details from the medical records help create a morbidity profile, and this statistical result helps in planning future hospitals and deciding the types of facilities (e.g., oncology) to be included in a new hospital. The collected data have relevance to the health care of this country, since they provide a basic patient record database that can be used to develop the system further and a central registry of patients, especially patients with chronic diseases like diabetes and hypertension.
At the tertiary health care facility (referral tertiary teaching hospital and the university hospital), a well-developed integrated health care system consists of data on patient management, medical records, pharmacy, clinical physiology, laboratory management, nurse scheduling, and finance and administration. The information can be accessed by doctors and nurses from desktop terminals in wards as well as clinics.
Scope for Improvement
Even the best systems may be improved. Areas of the existing system in which changes are needed include some patient details; lists of completed procedures, e.g., laboratory investigations, surgical procedures, and radiographic or other special examinations; and allergies and special conditions, such as glucose-6-phosphate dehydrogenase deficiency or sickle cell anemia.
Suggestions for further development in the secondary health care area include:
The system should be accessible to health workers, so that a medical records person is not always needed to handle the system.
Minimal training of staff in referral clinics should be provided, so that appointments can be generated in the clinics themselves.
Planning for the Future
The awareness of informatics among health care providers at the primary health care level is nil. At the regional level, health care providers do not access the hospital system, since only the medical records system is in place. Current plans are to implement a more comprehensive laboratory system along with investigative databases, and to integrate these with the total system. Doctors and nurses are being given a preliminary introduction to use of the system.
At the tertiary level, doctors and nurses learn to use the system on the job.
At present, there are no plans for implementation of medical informatics at the primary health care level, and there is no specific curriculum for medical informatics in the university medical college. There is also no one specifically trained in medical informatics in Oman. We do, however, have a two-pronged strategy aimed at 1) an integrated health care management system and 2) medical informatics education. These proposals are applicable to our particular system of health service.
Integrated Health Care Management System
We are planning an integrated health management system, beginning at the primary health care level. An integrated health care system at this level should cater to the needs of the institution, which may be an health center or an extended health center (polyclinic).
Stage One—Computerized medical records system, laboratory, and radiology records and automated reporting system that can be accessed by a health care provider from anywhere in the health care facility
Stage Two—Networking of this system with the secondary health care facility (regional referral hospital), so that any patient admitted, treated, and discharged from a regional hospital can be followed up at a primary health care facility, with the primary care physician having on access to the detailed patient record from the regional hospital
The secondary health care facility (regional hospital) should have a full-fledged integrated hospital system (IHS) that includes the patient record and records of investigative (e.g., laboratory and radiology) and surgical procedures that have been performed. Digital cataloguing of x-rays and other images would be desirable.
The tertiary health care facility already has a system, which needs to be upgraded and networked with the primary and secondary health care facilities (Figure 1▶). A master network would be useful, given the geography of this country and its large area. For example, a patient's initial treatment and follow-up for hypertension or diabetes may occur at health care facilities in different regions. With central networking and use of the patient's ID, the health care provider could access the patient's records, including details of medications, previous hospitalizations, and the course of the disease up to now. This information would help the health care provider provide efficient, cost-effective, and precise patient care.
Figure 1.
Strategic vision of interconnecting information systems in support of Oman's health care system.
Medical Informatics Education and Training
Training Students.
We plan to introduce a medical informatics course as part of the curriculum of the medical school at Sultan Qabus University. The university can create the course or collaborate with institutions already running such a course, such as the Royal College of Surgeons in Edinburgh, Scotland.
Training Health Care Providers.
Once a core of trained medical informatics people is in place, a phased program for training other health care providers could begin. Health providers at the primary health care level should be trained first. They can be trained first in basic computer skills and eventually in medical informatics. This core group of health care providers trained in medical informatics can become master trainers of other providers at the various health facilities.
Medical informatics workshops, seminars, discussions, and presentations can be used to introduce people to this field. At these presentations, health care providers can test-drive a system to discover its uses and benefits. Having health care providers as master trainers and trainees means that everyone speaks “the same language,” and trainees will not have to deal with too much computer jargon.
Innovations in the education system combined with an integrated health system will allow the people of Oman to experience the best possible health care.