Introduction

In Malaysia, a significant portion of the adult population struggle with chronic health conditions. According to the National Health and Morbidity Survey (NHMS), an estimated 3.9 million people aged 18 and above (nearly 1 in 5) have diabetes. Additionally, high blood pressure affects 6.4 million people (around 3 in 10), and high cholesterol affects 8 million people (around 4 out of 10).

The Malaysian Ministry of Health (MOH) established the National Health Screening Initiative (NHSI) to address this growing concern. NHSI aims to detect, prevent, and manage non-communicable diseases (NCDs) through early intervention. This initiative reflects the Ministry's recognition of health screening as a vital public health strategy, similar to the behavioral science approaches that proved successful in mitigating the Covid-19 pandemic.

HIE Scope & Role

The Health Information Exchange (HIE) (using the MY Core Specification as the exchange standard) serves as a central platform for consolidating health screening data collected from various sources.

This centralised system allows authorised healthcare providers to easily retrieve patient screening records for further evaluation and treatment.

Diagram 1 below shows an overview of the flow for this use case:

Actor

Below are the actors involved in this use case:

• Sharer - These are source systems that conduct health screenings and contribute the data to the HIE.

• Receiver - These are source systems authorised to access patient screening information stored in the HIE.

Take note that a Source System can function as both Sharer & Receiver depending on its role in the patient care journey.

API

Below are the related APIs for this use case:

Resource Breakdown

Following the International Patient Summary implementation guide format of exchanging information, a Composition will be used as the FHIR® resource of choice to summarise a patient health screening record.

Resource By Integration Point

Below is the list of integration points identified for this use case:

Refer to the links at the Profile/Questionnaire Related column for further details.

Bundle Details

Diagram 2 below is a simplified example of how each FHIR® Resource is utilised in a bundle:

Health Screening Bundle

The Bundle will be sent from the sharer source system as a "Transaction" to be stored directly in the FHIR® server. Example in the link below:

• HS bundle

Conditional Create Patient & Encounter

The Patient & Encounter resources are required to be sent using a Conditional Create when provided in the Bundle to prevent duplicates of the same Patient/Encounter Resource. For further reading please refer to HL7® FHIR® Conditional Create. Below is an example snippet of the Bundle.entry.request.ifNoneExist:

        {
            "resourceType": "Bundle",
            "type": "transaction",
            "entry": [
                {
                    "fullUrl": "patient-placeholder",
                    "request": {
                        "method": "POST",
                        "ifNoneExist": "?identifier=http://fhir.hie.moh.gov.my/sid/patient-mrn|PEKA-921005806671A"
                    },
                    "resource": {//resource details
                    }
                }
            ]
        }
        

        {
            "resourceType": "Bundle",
            "type": "transaction",
            "entry": [
                {
                    "fullUrl": "encounter-placeholder",
                    "request": {
                        "method": "POST",
                        "ifNoneExist": "?identifier=http://fhir.hie.moh.gov.my/sid/encounter-id|PEKA-ENC-12345"
                    },
                    "resource": {//resource details
                    }
                }
            ]
        }
        

It is required for the sharer source system to comply and supply ifNoneExist search parameter as specified in the snippet for Patient and Encounter Resource.