Bridging healthcare’s data divide: Malaysia pioneers global interoperability standards

Despite significant advancements in healthcare technology, achieving data interoperability — the seamless sharing and exchange of data — remains a persistent challenge in healthcare.

Interoperability has proven difficult to achieve as service providers use a wide range of unique information systems, each with its own data formats, structures, terminologies and capabilities. Without a standardised exchange mechanism between these systems, patient data continues to remain largely in siloes, leading to fragmented, inefficient care.

This year, however, Malaysia marked a significant step in global healthcare interoperability. It has become one of the first countries in the world to successfully implement the International Patient Summary (IPS), an emerging global standard for health data sharing.

What the International Patient Summary seeks to achieve

IPS is a standardised set of basic clinical data (such as medications, allergies, results and procedures) identified to be critical for safe and secure care. It is driven by the World Health Organisation's Global Digital Health Certification Network (GDHCN), which aims to provide a globally recognised digital mechanism for the issuance and verification of health information.

The Ministry of Health Malaysia’s Director of the Digital Health Division, Dr Mahesh Appannan, noted that the decision to pilot IPS was an extension of the ministry’s digitalisation drive, that of the Hajj pilgrims’ health examination programme.

All pilgrims travelling to Saudi Arabia for the Hajj Pilgrimage need to complete a health examination before their trip. In the past, the results of the examination were recorded in a physical book provided by Lembaga Tabung Haji (the Malaysian Hajj pilgrims fund board) for review by the Saudi authorities.

This process was digitalised in 2023. Now, Hajj health examiners input screening results and medical information digitally into the MySejahtera app (within the Hajj Health Record tab), which pilgrims can easily access.

To fully digitalise this process, the ministry needed to ensure interoperability with Saudi digital health systems, so that Saudi health facilities can extract and interpret data within the digital health records.

“When we heard about the opportunity to implement IPS, we approached the WHO to ask if we could join. We have already digitalised the end-to-end process for Hajj and have made sure to follow the relevant global standards in interoperability, such as Fast Healthcare Interoperability Resources (FHIR) and Health Level-7 (HL7). We also understood that Saudi Arabia was already developing the devices necessary to read the data,” said Dr Mahesh. 

Once the go-ahead was received, Dr Mahesh and his team immediately got to work reviewing IPS requirements, setting up technical architecture, and liaising with their Saudi counterparts.

With all hands on deck, the team managed to have the system go live after just three weeks. The roll-out in early May came just in time for the start of Hajj travels, enabling the country’s almost 32,000 pilgrims to easily share their health information with Saudi facilities via a QR code when need be.

Scaling up the use of IPS

This project was presented at the World Health Assembly in May 2024 to great interest from other nations, revealed Dr Mahesh. Several countries have sent in inquiries about Malaysia’s IPS implementation journey.

However, he pointed out that a key barrier to scale lies in differing data protection laws amongst different countries. Initiatives related to the sharing of personal health data may face legal issues in countries with stricter data privacy and security regulations.

“But healthcare is moving from institution-centricity to person-centricity. I think countries will relook their regulations to allow more interoperability and data sharing. The IPS empowers the individual to choose what information they want to share with the care provider. I think that’s the beauty of this initiative,” he added.

Next step: Malaysia Patient Summary

Riding on the success of their IPS pilot, Dr Mahesh and his team are now looking at developing a Malaysia Patient Summary (MPS) – one that is customised to Malaysia’s healthcare system.

“This will still be globally interoperable, but we would have our choice of what goes into the summary, the types of history we would want to share, the consent we need from patients to share data, and so on. We will likely have more information that we want to share within Malaysia, so IPS is probably going to be a subset of MPS,” explained Dr Mahesh.

“We have commenced discussions with different healthcare players, and many are excited because, at the end of the day, we know we have a common client – our patients – and a common goal to ensure their data is at their disposal.”

Ultimately, Malaysia envisions a “1 Citizen, 1 Record” system, where each Malaysian citizen has only one consolidated health record accessible across all government and private health facilities, noted Dr Mahesh. This would greatly improve the efficiency of health facilities across the nation while delivering more convenience and continuity of care for their patients.