Towards an integrated health information system in the former Yugoslav Republic of Macedonia

A technical mission to provide support for strengthening the health information system in the former Yugoslav Republic of Macedonia took place on 18–20 May 2015, with the participation of Mr Clayton Hamilton, Unit Head, eHealth & Innovation, WHO/Europe. The mission was organized as part of the biennial collaborative agreement (BCA) 2014–2015 between WHO and the Ministry of Health.

The aim of the mission was to meet with different national stakeholders in order to gain an understanding of:

  •  the current roles and needs in terms of health information management;
  • the processes and reporting hierarchies for capture and exchange of health information;
  • the underlying information technology systems supporting health information and the delivery of clinical services;
  • potential gaps in information flow and their causes; and
  • other issues and concerns that may hamper efforts to integrate health information or to further develop the national eHealth platform.

During the mission, roundtable discussions took place with representatives from relevant institutions, including the Ministry of Health, National Public Health Institute, Public Health Centre in Skopje, Institute of Epidemiology, State Statistical Office, Office for Management of Registers of Births, Marriages and Deaths, Ministry of Justice, National Health Insurance Fund etc. Participants discussed the current health information system, including the Ministry of Health database "My Appointment", and challenges that the country faces, as well as key areas needing immediate improvement. Participants agreed that a multi-stakeholder effort should be in place in order to build an integrated health information system and that establishing a formal governance mechanism and developing a national health information system strategy under the national Health 2020 umbrella are key priorities.

WHO will continue to support these activities within the context of the National Health 2020 Strategy. The next workshop on the integration of the national health information system is scheduled for the last week of June 2015 to discuss development of a public health module in the integrated health information system.

"My Appointment" ("Moj termin")

"My Appointment" was introduced in the country in 2010, initially to test the technical feasibility for implementing an integrated health information system. Since its launch, it has expanded to more than 5000 healthcare providers and service points, integrating over 1000 applications and systems, including secure e-health records, pharmacy prescriptions, a performance-based pay module, automated provider credentialing, specialist referrals, ambulance service management, public booking interface for health interventions and medical equipment, etc. The system also has features for health policy and resource planning, hospital patient workflow tracking, service billing, healthcare inventory management, general practitioner and specialist practice records management, etc.

In a very short time, health system performance has improved; for example, the waiting time for radiology scans and specialist visits has been reduced from 15 months to less than 7 days. Currently under expansion, "My Appointment" will integrate both curative and preventive services, screening outcomes and risk factors, and will be used for health resource planning and management and improvement of healthcare access and quality.

Health information system structures

According to the latest amendments of the healthcare law, a directorate for eHealth is envisaged to be established as a separate structure within the Ministry of Health. The directorate will aim to support further development of the integrated health information system, as well as concepts for health policy development based on data from this health information system. This structure's mandate is stipulated by the same law, positioning it to serve also as a central coordinative mechanism of the health information system.

WHO support for upgrading the health information system

In 2012, WHO/Europe and the WHO Country Office commissioned a review of the national health information and civil registration systems in order to better understand the extent to which they are harmonized to produce quality, health-related data with a focus on mortality data. The purpose of this review was to assess the quality and flow of health and demographic statistics in the country, especially as regards the integration and use of birth, death and cause of death information.

As part of the BCA 2014–2015 between WHO and the Macedonian Ministry of Health, WHO supported the development process of an online public health self-assessment tool linked to the national health database "My Appointment" to monitor the national public health system. The aim is to incorporate regular monitoring and implementation into a national public health action plan to be developed as part of the National Health 2020 Strategy.