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Telehealth in Malaysia – An Overview
M.H. Mat Som, A.N. Norali and M.S.A. Megat Ali
School of Mechatronic Engineering
Universiti Malaysia Perlis (UniMAP)
Kampus Ulu Pauh, 02600 Arau, Perlis, Malaysia
E-mail: mhanafi@unimap.edu.my
Abstract- Telehealth is a term used widely nowadays in
conjunction with better ICT growth in the healthcare deli-
very. It integrates the used of telecommunication and in-
formation systems as well as multimedia technologies to
promote healthcare delivery and create health plan for the
individual. The Malaysia’s Telemedicine Blueprint 1997 was
an initiative by the Malaysian government to employ the use
of telehealth in the country healthcare system. There are 4
main components in the blueprint which later restructured
into 7 components in 2000. However, experienced gained
during the years of implementation shows that integration
of the system is important to ensure the survival of the
project with latest technologies. The integration with Inte-
grated Health Enterprise (IHE) in 2007 once again reorga-
nized the telehealth structure in 5 major components name-
ly Lifetime Health Record (LHR) & Services, Lifetime
Health Plan (LHP), Health Online, Teleconsultation (TC)
and Continuing Professional Development (CPD).
Keywords – Telemedicine, telehealth, ICT, LHR, LHP, te-
leconsultation, continuing professional development
I. INTRODUCTION
Malaysia has started the initiative to implement E-
health since the establishment of Malaysia’s Telemedi-
cine Blueprint in July 1997 [1]. At that time the term te-
lemedicine was used and changed to telehealth later on.
The change of term was in conjunction with the aim of
Ministry of Health, Malaysia (MOHM) to keep Malay-
sian’s in the ‘wellness’ paradigm [2]. It is hoped that the
telehealth will play a major role in the future of health-
care by the mean of reversing the healthcare pyramid
from a focus on illness to an emphasis on self-care as
depicted in Fig. 1. World Health Organization (WHO)
distinct the two terms by says that: “If telehealth is un-
derstood to mean integration of telecommunications sys-
tem into the practice of protecting and promoting health,
while telemedicine is the incorporation of these systems
into curative medicine. Telehealth covers education for
health, public and community health, health systems de-
velopment and epidemiology, whereas telemedicine is
orientated more towards the clinical aspects.” A.W. Dar-
kins in his book, insist that the used of telemedicine term
is more realistic to be put as a subset of a wider quantity
named telehealth. Either terms however, focusing on the
use of information technology (IT) as a bridge for clinical
communication promoting the practical delivery of
healthcare where patient and practitioners are remotely
from one another [3].
According to Malaysia’s Telemedicine Blueprint 1997,
the objectives of the telehealth are to strengthen the
healthcare delivery via the use of telecommunications,
information and multimedia technologies. Telehealth are
also used as a tool to reshape the healthcare delivery sys-
tem by becoming more virtual, more distributed and more
integrated resulting in better healthcare delivery and effi-
cient [3].
Fig. 2 shown the data obtained from MOHM on the
expenditure in healthcare sectors. The trend shows that
significant increase across 1999 to 2004 before a slight
decrease in 2005. From 2006 to 2008, the spending in-
creases drastically reaching the highest expenditure
throughout the years. The expenditures proportionally
reflect the numbers of hospitals and beds where in 1999,
the number of hospitals was 114 with 28,163 beds. In
2008 the number of hospitals and beds increases to 130
hospitals with the capacity of 33004 beds [4]. There are
also other factors that contributing to the spending such
as the salary of medical personnel, maintenance of the
existing facilities, subsidy to the medical cost [5] and also
the development of telehealth applications.
II. MSC TELEHEALTH FLAGSHIP APPLICATIONS
Telehealth was incorporated by the Malaysian gov-
ernment under the Multimedia Super Corridor (MSC)
project, Telehealth Flagship. The project is one of the 7
flagship applications of MSC grouped under the ‘Multi-
media Development Flagship Application’ and has long-
Person
Community
Tertiary
Primary
Secondary
Professional as partners
Individual Self-care
Friends and family
Community networks
Professional as facilitators
Professional as authorities
RM
cent
Figure 1. Transformation of healthcare delivery pyramid
2010 IEEE Symposium on Industrial Electronics and Applications (ISIEA 2010), October 3-5, 2010, Penang, Malaysia
978-1-4244-7647-3/10/$26.00 ©2010 IEEE 660
term objectives towards Malaysia’s
V
project was intended to reshape the h
e
from illness focus to self care emphasi
telecommunications, information and
nologies. It is hoped that the healthcar
e
more virtual, equitable, affordable, t
e
p
ropriate, environmentally appropria
t
friendly, resulting in efficient health
c
enhanced quality of life [1].
In year 2000, telehealth unit was
MOHM to implement this telehealt
h
Generally, the flagship aims to devel
o
namely Mass Customized/Personalize
d
tion and Education (MCPHIE), Contin
u
cation (CME), Teleconsultation and Li
f
(LHP) [3].
A. Mass Customized/Personalized
H
and Education (MCPHIE)
The MCPHIE project objectives is t
o
ble, reliable and high quality health i
n
viduals using information technology
net, multimedia technologies and mas
s
It is to encourage individuals to take
c
state and consequently support the go
v
to enhance and promote the nation’s he
a
B. Continuing Medical Education (C
M
CME was developed to enhance or
u
ledge of healthcare professionals thro
u
tional and learning activities using ap
p
dia information technology. The idea
o
to avoid the healthcare personnel from
position to attend these kinds of cours
versities and training colleges. There
services offered in CME project whic
h
courses, virtual library and finally the
o
community services [3, 6].
The electronic courses can be form
a
or modular distant learning. The form
a
was programs and courses offered b
y
MOHM colleges while the latter was
programs and modules packed with c
Figure 2. Financial expenditure of the he
a
V
ision 2020. The
e
althcare structure
s by incorporating
multimedia tech-
e
services become
e
chnologically ap-
t
e and consumer
c
are delivery and
setup under the
h
flagship project.
o
p 4 pilot projects
d
Health Informa-
u
ing Medical Edu-
f
etime Health Plan
H
ealth Information
o
provide afforda-
n
formation to indi-
particularly inter-
s
communications.
c
are of their health
v
ernment approach
a
lth [3].
M
E)
u
pgrade the know-
u
gh distant educa-
p
ropriate multi
m
e-
o
f this project was
leave their current
es offered by u
n
i-
were three main
h
are the electronic
o
nline professional
a
l distant learning
a
l distant learning
y
universities and
a structured study
ontent and know-
ledge with reasonable depth
a
topic.
The virtual resources or lib
r
the healthcare professionals
b
work. The support provided w
e
to the sources of informatio
n
medical journals, e-
b
ooks, me
d
credited sources of medical rel
a
The online professional c
o
other hands, utilize the inter
n
mail and related technologies
t
ment for the healthcare profes
s
interact and communicate elec
t
C. Teleconsultation
A teleconsultation provides
care professionals to consult h
e
ly via appropriate multimedia
The basic implementation of t
h
offline method such as e-m
a
change and also via real time
v
ing [3].
D.
L
ifetime Health Plan (LH
P
LHP was a personalized h
e
vidual. It was designed to pro
care, informing the individua
l
with relevant medical inform
a
health of individual at the hi
times. In order to impleme
n
application of LHP was cons
i
Support System (CSS), Healt
h
ment and Support Services (
H
Lifetime Health Plan (PLHP) [
3
III. T
ELEHEALTH FLAGSHI
P
In October 2004, the unit h
the Medical Services Program
m
the telehealth project was re
v
reorganized into the 7 com
p
Health Record (LHR), Person
a
(PLHP), Health Online, Cont
i
opment (CPD), Teleconsultat
i
Group Data Services (GDS)
health once again reorganized
of Integrated Health Enterp
r
MOHM in 2007. The new
s
from the previous one except
i
that is Lifetime Health Recor
d
time Health Plan (LHP), Heal
t
(TC) and Continuing Profess
i
[9].
A.
L
ifetime Health Record (
L
time Health Plan (LHP)
LHR as represent by its na
m
an individual’s health record
fo
lated since the first use unt
i
a
lthcare industr
y
a
nd breadth on a particular
r
ary was developed to help
b
y supporting their daily
e
re by the means of access
n
via the internet such as
d
ical database and any ac-
a
ted information [7].
o
mmunity services on the
n
et applications such as e-
t
o create a virtual environ-
s
ionals of similar interest to
t
ronically.
a platform for the heal
t
h-
e
althcare providers remo
t
e-
information technologies.
h
is teleconsultation was via
a
il or electronics data ex-
v
ideo and audio confere
n
c-
P
)
e
althcare plan for the indi-
vide a continuous medical
l
and healthcare providers
a
tion to maintain state of
ghest state possible at all
n
t this project, there sub-
i
dered namely the Clinical
h
care Information Manage-
H
IMSS) a
n
d Personalized
3
].
P
APPLICATIONS UPDATE
as been restructured under
m
e. Following the upgrade,
v
iewed and the scope was
p
onents namely Lifetime
a
lized Lifetime Health Plan
i
nuing Professional Devel-
i
on (TC), Call Centre and
[8]. The structure of tele-
following the introduction
r
ise (IHE) framework by
s
tructure is almost similar
i
t has 5 major components
d
(LHR) & Services, Li
f
e-
t
h Online, Teleconsultation
i
onal Development (CPD)
L
HR) & Services and Life-
m
e is a plan that summarizes
fo
r lifetime that is accu
m
u-
i
l each time he visits his
661
healthcare provider. This plan offer services that facilitate
the integration between healthcare providers and promote
participation of individuals towards self-care [1, 8].
Meanwhile, the core service of LHP is to provide life-
long wellness plans for individuals. In other words, it is a
structured care activities for the individual based on vari-
ous health relation event in their life. It includes activities
such as health promotions, illness care plans for specific
disease and conditions, alert and reminders and also mon-
itoring health status [8].
Looking at the objectives of LHR and LHP, they are
essentially interconnected and share the same goals.
Since previously both of these applications were embed-
ded in a LHP project. In order to make it possible, several
components must be in place before these applications
can be deployed.
In 2002, there are only 4 hospitals that running the
Clinical Support System (CSS) [1]. CSS comprises of
several components such as Hospital Information System
(HIS), Clinical Information System (CIS) and Pharmacy
Information System (PIS) that recorded health informa-
tion specific to an individual. However, in 2010 there are
17 hospitals being implemented with such application
where 3 of them being carried out in Keningau, Lahad
Datu and Bintulu [10]. The rapid increasing in numbers
shows that average of almost 2 hospitals were employed
with the application every year. The implementations of
this system however, are costly given that training and re-
training need to be provided to the end user such as doc-
tors and nurses.
Hospital Selayang was the first paperless and filmless
hospital deployed with HIS or Total Hospital Information
System (THIS). Rather than developing the system in
house, MOHM has appointed several vendors to equip
the hospital with appropriate applications. The reason for
this was to boost up the capability to run the HIS within
required time and to catch up with current technology.
The system was successfully employed until the times
when the 20 vendors updating their respective applica-
tions. The main problem arises was integration between
one application with another. Learning from the expe-
rience, the second paperless and filmless hospital, 272-
bed Putrajaya Hospital adopted not more than 2 vendors
for running the THIS [11].
Considering the delay of implementation for this
project, a new initiative was introduced in 2009 known as
Malaysia Information Exchange (myHIX) by MOHM
with cooperation from Multimedia Development Corpo-
ration (MDeC) [11]. It is aimed to record clinical summa-
ries electronically of individual once they are discharged
by respective healthcare providers. This is to ensure the
continuity of care rather than have episodic information.
Currently the project was implemented in 5 hospitals and
1 clinic which are Putrajaya Hospital, Putrajaya Clinic,
Tuanku Ja’afar Hospital (Seremban Hospital), Port Dick-
son Hospital, University Kebangsaan Malaysia Medical
Center (UKMMC) and National Heart Institute (IJN)
[12]. The principle of operation for myHIX is illustrated
in Fig. 3 [14].
B. Health Online
Health Online was developed to promote individuals to
take care of their health by providing health information
and education via user friendly web portal interface. This
application is the successor of previous application
known as MCPHIE. The MyHEALTH Portal website
was launched in 2005 by MOHM and maintained by
groups of people in healthcare industries. The articles
published in the website were written by people from
medical and allied healthcare professionals with specific
expertise in their field. These people are appointed by the
content committee and the articles submission will be
reviewed by other similar experts before being published.
This procedure is done to verify and ensure the reliability
of the articles [13].
More than 600 topics addressed in the portal generally
aimed to provide information related to health promotion
and illness and injury prevention [10, 14]. However, there
are also articles that cover the medical conditions and
diseases specific to target groups. Besides grouped the
articles into several target groups namely kids, teenagers,
prime years and golden years, the articles are well orga-
nized by providing tabs for nutrition, oral health and
mental health. In addition, there are also articles about the
medications that address the popular medication nowa-
days. Search form is also provided allowing users to
search for topics of interest.
Health Risk Assessment launched in third quarter 2009
is targeted to advice users about their health are in place
and currently addressing the obesity, mental health,
smoking activities, physical activities, diabetes and heart
diseases. The risk assessment s conducted by preparing
the users with a few simple questionnaires and assesses
their health based on the answers.
In the case of missing information on specific diseases
or symptoms, users can always use “Ask The Expert” by
entering information in the forms provided. More than
200 specialists have been appointed to respond to the
questions [14]. Every form submitted is expected to be
answered within 2 to 14 days.
C. Continuing Professional Development (CPD)
CPD is a replacement for the Continuing Medical Edu-
cation (CME). The concept of CPD is almost similar to
the CME. The program mainly to enhance the capability
and knowledge of medical personnel besides recording all
activities participated. The services provided in CPD such
as virtual library, modular distant learning (MDL), calen-
Send dis charge
summary
Healthcare
Provider 1
Healthcare
Provider 2
myHIX
Register patient
Submit discharge
summary
Submit discharge
summary
Figure 3. Summary of myHIX principle of operation
662
dar of CPD events, online activity
m
directory, complement competency ass
e
itoring and evaluation of CPD [8].
The virtual library is intended to pr
o
health information from various pr
o
MOHM libraries and other global and
h
it can be readily accessible by all M
O
any times [7]. Currently the project is
opment and trial database has been la
u
information and resources from 8 libra
r
namely the MOHM Head Quarters
Kuala Lumpur, Hospital Pulau Pinang,
Bahiyah, Hospital Tuanku Ja’afar, Ho
s
wak, Institute of Health Management (
I
of Medical Research (IMR). All regis
t
sonnel can log on to the library and
a
such as medical journals, e-
b
ooks, me
d
ministry publications.
D. Teleconsultation (TC)
The idea of TC was to help the hos
p
p
roviders without specialist to addres
s
without having them to be there. This
c
the numbers of patient being transferr
e
als. While reducing the cost for the he
a
would also benefit by lessen the inc
o
patients and their family [15, 16].
There are increases in number fro
m
hospitals in 2010 interlinked within th
e
the cases being address can be classifie
d
specifically cardiology, radiology, trau
m
and dermatology [14].
While having TC application withi
n
works, MOHM was also officially lau
n
mary Care (TPC) project in 2005 afte
r
opment [17, 18]. The teleconsultatio
n
also embedded in TPC to enable do
c
rural areas to consult each other and ot
h
out having physically seeing the pati
e
government clinics has been employed
Selangor, Kuala Lumpur, Perlis and S
a
21 million (USD 6.2 million) was spen
t
and infrastructure for the first 42 sites
[
cost is very high, it is found that the T
P
help and the government has announce
d
b
e expanded to Pahang and Sabah w
i
around RM 10 million for equipping t
h
Figure 4. Number of patient registered wit
h
m
onitoring, online
e
ssmen
t
, and mon-
o
vide medical and
o
viders including
h
ealth resources so
O
HM personnel at
still under devel-
u
nched combining
r
ies under MOHM
Library, Hospital
Hospital Sultanah
s
pital Umum Sa
r
a-
I
HM) and Institute
t
ered medical per-
a
ccess information
d
ical database and
p
itals or healthcare
s
the issues raised
c
an help to reduce
e
d to other hospit-
a
lthcare system, it
o
nvenience to the
m
41 in 2000 to 53
e
network. Most of
d
into 4 disciplines
m
a (neurosurgery)
n
the hospitals net-
n
ched the TeleP
r
i-
r
2 years of devel-
n
component was
c
tors in urban and
h
er specialist wi
t
h-
e
nt. Currently, 73
TPC across Johor,
a
rawak. About RM
t
for the equipment
[
11]. Although the
P
C was really a big
d
that the TPC will
i
th the cost to be
h
e site with neces-
sary equipments and infrastr
u
also expected to further the
p
roject that would involve pr
i
Data obtained from the TPC
P
the deployment, there were i
m
tients registered with the TPC
Fig. 4.
IV. D
ISC
U
Healthcare delivery in Mal
a
changing for the better. Mor
e
stalled with applications of te
l
ertheless the current system
m
rallel with new technologies.
Current application must al
s
new information and actions
m
the quality of delivery. For ex
a
users are currently considere
d
numbers of user registered to
t
users and 177 threads as Ma
r
should promote the website m
o
ing more keywords to the pop
google, yahoo and Bing. Se
v
tested using stated search engi
n
keywords failed to return th
e
Portal. In addition, the article
s
signed or written using termin
lic. The respond time for the
“
tion should be reduced to 3-5
As for the health risk assess
m
tionnaires need to be added f
o
to know their health conditio
n
questionnaire that provide less
Aside from MyHEALTH P
o
sihat website [20] which unde
education division, MOHM.
T
similar content with MyHE
A
extras here and there. This is a
c
since these two website could
b
site providing all essential info
r
CPD is indeed a good way
p
ersonnel to gain new know
l
they have learnt. The virtual l
i
as one of the resources to any
healthcare. Every registered
retrieve the data at any time
n
tending the patient.
To improve current telecons
ernment could take initiative t
to expand their operation in t
h
other essential infrastructure
communication technology is
ecute the telehealth plan.
The government might als
o
source technologies. With the
h
trative Modernization and M
a
MAMPU and MDeC, the cost
might be reduced to a situati
o
have all hospitals under MOH
M
cations installed.
h
TPC application
u
ctures [19]. The MOHM
implementation of TCP
i
vate healthcare providers.
P
ortal [18] shows that after
m
pressive numbers of pa-
application as depicted in
U
SSION
a
ysia is in the process of
e
hospitals have been in-
l
ehealth components. Nev-
m
ust always be updated pa-
s
o always be updated with
m
ust be taken to improve
a
mple, MyHEALTH Portal
d
too small based on the
t
he forum. It only has 6174
r
2010 [13]. The ministry
o
re actively such as provid-
ular search engine such as
v
eral searches have been
n
e above with a few related
e
address of MyHEALTH
s
in the portal must be de-
ology familiar by the p
u
b-
“
Ask The Expert” applica-
working days if possible.
m
ent application, the ques-
o
r advance user who wants
n
better rather than simple
reliable answers.
o
rtal, MOHM also has in
f
o-
r the responsible of health
T
his website also addresses
A
LTH Portal except some
c
tually a waste of resources
b
e merged into single web-
r
mation.
to encourage the medical
l
edge and refreshing what
i
brary could be very useful
information related to the
medical personnel could
n
ecessary to help them at-
ultation and TPC, the gov-
o encourage ISP providers
h
e rural areas and provide
facilities. Once the tele-
in place it is easier to ex-
o
consider the use of open
h
elp of (Malaysia Adminis-
a
nagement Planning Uni
t
)
of implementing telehealth
o
n where it is possible to
M
to have telehealth appli-
663
V. CONCLUSION
The overview study of the implementation of telehealth
in Malaysia shows that the government is in the right
track although having some delayed in the execution.
Even though the total expenditure in healthcare industry
increasing each year, it is worth to invest big amount of
money to get better system in place for the future benefit.
However, there are still more rooms to improve in the
current application.
ACKNOWLEDGMENT
The authors would like to thank to the Ministry of
Health Malaysia and other contributors for providing
indispensable information for this study.
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http://www.mscmalaysia.my/codenavia/portals/msc/images/
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