To overcome the growing incidence of chronic diseases, as mentioned in Section 2.2, the Government of Malaysia includes a range of services from the public system, from primary-care clinics to tertiary care centres (Yasin et al. 2012). The primary healthcare facilities within a typical district would consist of a district hospital and a number of large primary-care clinics or health clinics, Klinik Kesihatan (Yasin et al. 2012). These clinics provide ambulatory primary care for acute medical and surgical, maternal and child health, and also the management of chronic diseases (Yasin et al. 2012). Thus, health clinics provide treatment for both communicable diseases and primary prevention of chronic diseases (wellness programs such as a diabetes program, early detection of cancer, screening for cardiovascular risk factors for women aged above 40 years, as well as a tobacco-cessation program) (Yasin et al. 2012). However, because the Malaysian public health system has a strong focus on communicable disease surveillance and control, and on maternal and child health, especially in primary care (Yasin et al. 2012), capacity for the prevention of chronic diseases is limited.
Thus, the secondary and tertiary prevention of chronic diseases (early identification and treatment, disease and disability limitation, rehabilitation and palliative care) are provided by specialty and sub-specialty services (Medical Development Division 2011). In the Tenth Malaysia Plan 2011–2015, the government continued to upgrade and expand its health facilities across both urban and rural areas. It specifies strengthening and consolidating provision of secondary and tertiary care services, and further extending primary-care services to underserved areas. Moreover, the plan states that the government has put its effort into moving towards wellness and disease prevention. This is because Malaysia faces higher incidences of chronic conditions
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such as diabetes, hypertension and cardiovascular diseases. For example, as reported in Tenth Malaysia Plan 2011–2015, from 1996 to 2006, Malaysia saw a dramatic increase in the prevalence of behaviour-linked diseases, including a 43% increase in hypertension, 88% increase in diabetes and 250% increase in obesity (Tenth Malaysia Plan 2011–2015), as shown in Figure 2.2.
Figure 2.2: Prevalence rates of key chronic diseases in Malaysia (Tenth Malaysia Plan 2011– 2015)
Moreover, as stated in the Eleventh Malaysia Plan 2016–2020 (Economic Planning Unit 2015) and Country Health Plan, 2011–2015 (MOH Malaysia 2011), one of the basic principles of future healthcare delivery that may ensure a healthy population and reduction in cost for curative care is the preventive care that has become a focus for the health sector in the country. The effort for preventive care is documented in the Country Health Plan, 2011 (MOH Malaysia 2011).
Furthermore, the Malaysian Government developed the 10-year NSP-NCD for 2010– 2014, and recently NCP-NCD for 2016–2025 to improve the health status of the population, expanding the scope of chronic disease prevention and control while maintaining current preventive activities (MOH Malaysia 2010, 2016). Table 2.5 outlines the chronic disease national targets for Malaysia by 2025 (MOH Malaysia 2016).
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Table 2.5: Chronic disease targets for Malaysia 2025 (Ministry of Health Malaysia 2016)
Indicator Global target
Malaysian
baseline Target (2025) 1. Risk of premature mortality
from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases
25% relative reduction
20% 15%
2. Prevalence of current tobacco use in a person aged 15+ years
30% relative reduction
23% 15%
3. Mean population intake of sodium 30% relative reduction 8.7 grams 6 grams 4. Prevalence of insufficient physical activity 10% relative reduction 35.2% 30.0%
5. Harmful use of alcohol (prevalence of heavy episodic drinking)
10% relative reduction
≤1.2% ≤1.2%
6. Prevalence of raised blood pressure
25% relative reduction
32.2% 26.0%
7. Prevalence of diabetes and obesity
Halt the rise ≤15% ≤15%
Thus, the role of prevention and control of chronic diseases in reducing morbidity and mortality is crucial in Malaysia. Chronic diseases, which include heart disease, stroke, diabetes, cancer, mental illness and chronic respiratory disease, present a huge challenge in the next few decades, globally as well as for Malaysia (MOH 2011). Based on the above issues, the Malaysian Government has invested effort towards preventive care, with such effort reflected in the objectives of the development of the Specialty and Subspecialty Framework for 10MP (Medical Development Division 2011). There are a few general objectives of the framework. First, to provide adequate and effective specialty and sub-specialty services for the secondary and tertiary prevention of diseases (early identification and treatment, disease and disability limitation, rehabilitation and palliative care). Second, to improve access to specialty and sub-specialty services appropriate to the needs and resources available. Third, to improve the delivery and quality of specialty and sub-specialty services. Fourth, to address rising costs as well as ensure efficient use of resources for specialty and sub- specialty services towards a sustainable health system. Fifth, to strengthen human capital planning and development with the right numbers, skill-mix and required competency towards sustainable specialty. Sixth, to adopt appropriate technology and new interventions for the management of diseases to improve the quality of specialty
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and sub-specialty services towards better outcomes (Medical Development Division 2011). Nevertheless, these initiatives had little impact, and therefore, this research is focusing on preventive care.
The hospital information system
Previous studies suggest that the adoption of HIS can result in significant improvement in preventive care (Bauer et al. 2014b; Hameed et al. 2016; Jabbour et al. 2003; Nohara et al. 2015), and is crucial to improving the processes and outcomes in healthcare organisations (Ozok et al. 2014). For example, Ahmad and Tsang (2013) state that using HIS improves the process measure for diabetes. The patient registry feature could enable the identification of pre-diabetic patients, and patient progress could be tracked using weight-monitoring tools connected to the system. Moreover, HIS is used to capture body mass index as structured data to produce a list of obese patients. This helps patients engage in their own health and encourages them to benefit from preventive care (Ahmad & Tsang 2013). Moreover, Bauer et al. (2014b) highlight the use of HIS in helping improve the accessibility of patient records, convenience and increasing the quality of care, while at the same time helping reduce healthcare costs. Thus, the delivery of preventive care services can be effectively delivered when supported by HIS.
The adoption of HIS can be traced back as early as the 1960s (Borzekowski 2009). For example, hospitals in the United States of America began to adopt IT in the 1960s with the goal of improving operational quality and reducing costs (Borzekowski 2009). Based on his study, which uses eight years of data analysis from 1987 until 1994, Borzekowski (2009) found nearly 3,000 American hospitals with more than 100 beds had adopted a HIS. Globally, the adoption of HIS has been progressing across hospitals in North America, Europe, the Asia Pacific, Africa and the Middle East, as presented in Table 2.6.
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Table 2.6: Adoption of hospital information systems globally
Region Country/City
North America USA (Peng, Dey & Lahiri 2014)
USA (Adler-Milstein, Kvedar & Bates 2014) USA (Adler-Milstein & Bates 2010)
USA (Ahmad & Tsang 2013)
USA and Puerto Rico (Geanuracos et al. 2007) USA (Overhage, Grannis & McDonald 2008) New York (Howland et al. 2015)
Canada (Zinszer et al. 2013) New York (Shih et al. 2011) Europe England (Warrick et al. 2011)
Asia Pacific Australia and New Zealand (O’Sullivan, Billing & Stokes 2011) Japan (Yoshida, Imai & Ohe 2013)
Nepal (Watkinson-Powell & Lee 2012)
Malaysia (Amin, Hussein & Isa 2011; Ismail, Abdullah & Shamsuddin 2015; Lee, Ramayah & Zakaria 2012; Haque et al. 2013; Zakaria & Yusof 2016)
Indonesia (Handayani, Rahman & Hidayanto 2013) Vietnam (Vu & Nguyen 2010)
Africa Uganda (Were et al. 2010a)
Kenya (Bernardi 2017; Oluoch et al. 2014)
Middle East Iran (Ahmadian et al. 2014; Ehteshami et al. 2013; Hosseini et al. 2014; Moghaddasi et al. 2018)