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.

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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 centralized system allows authorized 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 cases:

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

• Receiver - These are source systems authorized 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.

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API

Below are the related APIs for this use case:

No	API Function	Method	API
1	Send Bundle	POST	[base]
2	Retrieve Bundle by patient identifier	GET	[base]/Composition?_include=Composition:*&type=64285-0&subject.identifier=@patientIdentifier
1	Retrive Bundle by custodian	GET	[base]/Composition?_include=Composition:*&type=64285-0&custodian=@organizationId
1	Retrieve Bundle by authored date range	GET	[base]/Composition?_include=Composition:*&type=64285-0&custodian=@organizationId&date=ge(YYYY-MM-DD)&date=le(YYYY-MM-DD)

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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 summarize a patient health screening record.

Resource By Integration Point

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

Integration Point	Profile/Questionnaire Related	Mandatory	Sample Data
Record Summary	CompositionHealthScreening (MY Core)	Required	HS Composition
Patient	Patient (MY Core)	Required	Patient Conditional Create
Encounter	Encounter (MY Core)	Required	Encounter Conditional Create
Diagnosis	Condition (MY Core)	Optional	Condition
Vital signs	Panel Vital Sign (MY Core)	Optional	Vital Sign Panel Transaction Bundle
Anthropometry	Panel Anthropometry (MY Core)	Optional	Anthropometry Panel Transactional Bundle
Smoking History	Smoking History (MY Core)	Optional	Smoking History
Alcohol Use History	Questionnaire-Audit-10	Optional	Alcohol Use History
Lab Diagnostic Report	DiagnosticReport (MY Core)	Optional	Diagnostic Report Transaction Bundle

Refer to each integration point at Profile/Questionnaire Related for further details.

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Bundle Details

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

{
    "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
            }
        }
    ]
}