A system breakdown of the Total Hospital Information System used in the northern state of Kedah in Malaysia forced clinicians to go manual for at least a day.

On 11 August, the tHIS went down due to a glitch in one of its application servers, disrupting the services of public hospitals and health facilities across the state, including the 500-bed general hospital Sultan Abdul Halim Hospital, the Sungai Petani public health clinic, and a nurses' training institute. 

WHY IT MATTERS

A system failure typically happens during peak hours when there is a high volume of traffic. 

However, the downtime lasted more than 24 hours and affected an estimated 3,000 patients in Sultan Abdul Halim Hospital, according to local news. 

The tHIS breakdown significantly impacted patient registration and access to medical records, requiring doctors to handwrite their referrals and nurses to confirm with each patient their prescribed medications.

The issue also caused backlogs and delays in treatment, though the extent of these has yet to be confirmed.

The Kedah State Health Department has since activated its business continuity plan to cushion the impact of the system failure, said director Dr Ismuni Bohar in a statement the following day. 

"Corrective actions and system access performance monitoring are now being taken to ensure this issue is comprehensively addressed," Dr Bohari said. "The department will also continue to monitor the developments and ensure that HIS recovery and restoration activities run smoothly so that patient care services are unaffected."

No further details were provided as to when the system would be fully restored.

A plan to migrate the tHIS system to a cloud-based server has been floated following this major IT incident. 

"As part of long-term initiatives, the Ministry of Health and the Kedah State Health Department plan to upgrade the existing [tHIS] system to a cloud-based system to prevent this kind of incident from happening again," Dr Bohari shared.

THE LARGER CONTEXT

In Malaysia, at least a tenth of all public hospitals run with HIS. Among them, 10 general hospitals are known to have adopted the digital tHIS while the rest are using a hybrid or manual system. The tHIS integrates clinical, administrative and financial systems into one paperless system. It was first implemented in the 960-bed Selayang Hospital in Selangor. 

The adoption of an HIS among Malaysian hospitals has been slow due to factors such as limited or lack of technical know-how, lack of financing, and interoperability challenges.

A similar system for the dental sector was also recently reported to encounter various operation challenges, including frequent system failures during peak hours. The Teleprimary Care Oral Health Clinical Information System, which has been used in over 100 clinics nationwide for over two decades now, also has a slow interface that reportedly contributes to inaccurate and outdated patient records.