BHR 3205 Health Information Systems-Lecture Notes (1).ppt

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HEALTH MANAGEMENT INFORMATION SYSTEMS
(HMIS)
LEARNING MATERIAL

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Broad Objective
 Discuss the strategic role played by HMIS in
the management of the health system.

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Specific Objectives
 HMIS: An overview.
 Distinguish between Data and Information.
 Define HMIS and its concepts and components.
 Discuss objectives of an HMIS.
 Discuss how data is transformed into information.
 The importance of health information management.
 Evolution of health information systems.
 Discuss the evolution of HIS in the MoH.
 Identify various types of HMIS – DHMIS and CHMIS.
 Define characteristics of good information.
 Discuss the deficiencies in the existing information systems.

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HMIS: an overview
 The development of HMISs is a fast moving field.
 Information technology is changing rapidly.
 Concepts and methods for making the best use of
existing data for managing health services and
resources are quickly evolving.
 Efficiency in information management is becoming
increasingly essential because of the concern for
cost control in services and the way staff spend their
time.

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HMIS: an overview cont.
 In order to reduce data handling while increasing
validity and timeliness, emphasis is being put on use
of health indicators.
 Efficient use of minimum data for managing cases,
clinics and community health is essential.
 There is an urgent need to reform existing health
information systems.

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 Masses of irrelevant or underutilized data are still
being collected at the operational level.
 It is collected by already overburdened health
workers.
 Later, it follows a tedious path of compilation and
upward submission at each level of the health
system.
 With little potential for analysis, let alone managerial
value.

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 Good management is a prerequisite for increasing
the efficiency of health services
 The scarcity of resources that now confronts health
managers has led to a review of policies and
strategies, aimed at improving the effectiveness of
health services.
 The need to do more with less is especially
important because the health sector faces ever
increasing demands while receiving stagnant or
decreasing resources.

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 Decentralization of health services and cost recovery
mechanisms are being introduced.
 Notions such as cost effectiveness and efficiency are
finally being given the attention they deserve.
 Good management is also a prerequisite for
increasing the effectiveness of health services.
 The challenge for health systems is to optimize the
management of service delivery in a way that
minimizes losses in effectiveness.

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 Information support is one of the most frequently cited major
obstacle to effective health services management.
 HMISs are critical for increasing the effectiveness and
efficiency of health services.
 In order for information to influence management in an optimal
way, it has to be used by decision-makers at each management
level.
 Information is critical for undertaking situational analysis, setting
priorities, implementing a programme activity, and evaluating
the outcome of a health intervention

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 Information is crucial at all management levels of the
health services, from the periphery to the centre.
 It is crucial for patient/client management, for health
facility management, as well as for health system
management.
 Not only policymakers and managers need to make
use of information in decision-making, but also care
providers, such as doctors, nurses health
technicians and community health workers.

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 Managers now realize that the tasks required within
the health system such as:
 policy development, strategic planning and
operationalizing health care
vary by level, and that different levels have different
information needs.
 An HMIS can be a critical part of the transition from
a reporting system to the conscious use of
information.

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 One key approach to successful implementation of
HMIS is participation of all stakeholders:
 The user
 The developer (designer)
 The patient
 The health car purchaser (health insurer).
 Too often an MIS is designed top-down, ignoring the
opportunities for building ownership, commitment
and thorough understanding.
 The greatest challenge is the issue of
institutionalizing the HMIS.

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Technology is rapidly changing how we manage health
care information.
 Today’s HMIS managers are expected to:
 manage data
 oversee document and repository systems
 coordinate patient and health resources information
 secure all electronically and manually maintained
information
 supply senior management with information for decision-
making and strategy development
 ensure data quality, and
 direct facility-wide health management information system

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 The term HMIS will be used to encompass both health (patient)
and management (health resources) information systems.
 HMIS can be defined as:
 the effective collection,
 analysis, and
 dissemination
of both health and management information to support :
 individual, organizational, and social decisions related to
 disease prevention and patient care, effectiveness of care,
payment, planning, research and policy analysis, regulation and
accreditation

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 Two types of HMIS – DHMIS and CHMIS
 DHMIS is a facility-based system that generates
information from health facilities such as hospitals,
health centres and dispensaries, private clinics and
nursing homes and mission hospitals.
 CHMIS is a system that generates information
through sources at the community level
 Relevant information is collected by:
CHWs, VHCs, PHC programme

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 This definition describes the functional shift in
paradigm from that of archivist to that of information
manager.
 This course adopts the perspective that information
must be managed as a resource with emphasis on
concepts of information:
 ownership,
 structure,
 content, and
 appropriateness.

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The Health Care Delivery Process
 Several typical images come to mind when one
thinks about this process in a health facility.
 One thinks of health-care professionals such as
physicians, nurses, therapists, and technicians
assisting each other in caring for patients.
 Such a view may also include support personnel
such as receptionists, secretaries, clerks and
maintenance personnel.
 One might think of a variety of buildings that provide
the physical room for delivery of patient care.

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The Health Care Delivery Processcont.
 This view might include physical space such as
surgical theatre, delivery rooms, examination rooms
and in-patient wards.
 To complete this picture, one might also think of a
collection of equipment and supplies necessary to
support the health care delivery process; laboratory
machines, respirators, radiographic equipment,
monitors, and medication charts.

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 All of these components – personnel, facilities, and
equipment – paint the picture of what is essential in
the health-care delivery process.
 Definitely there are other aspects. There is a need
for organization, capital, quality control,
standardization and cooperation.
 Beyond these obvious images and requirements, the
basic question is:
“What is the glue that holds it all together?”

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 Beyond a doubt, a critical element that makes it all
work is exchange of information.
 Like a spider’s web, information and associated
information technologies provide essential links in
supporting the function of organization, the
coordination of activities, the transfer of knowledge,
and the provision of care.

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 Just as financial institutions, airlines, and
government institutions cannot operate without
sophisticated and coordinated information
interchange, health-care delivery cannot function
without technologies that support information
management.
 But like the filaments in the spider’s web, information
infrastructures must be appropriately designed and
managed in order to support health-care delivery.

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Specific Objective # 1
Data and Information.
 Data are:
 Facts, events, transactions and so on which have
been recorded.
 The input raw materials from which information is
produced.
 Facts obtained by reading, observation, counting,
measuring, weighing, etc which are then recorded.
 Data are derived from both internal and external
sources

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Data and Information cont.
 Data types:
 Qualitative data: Data that give non-numerical information such
as gender, blood type.
 Ordinal data: Data about order or rank on a scale such as
1,2,3,….or A, B, C, …..
 Quantitative (metric) data: Data obtained from the
measurement of quantities such as time, height, and weight.
 Frequency data (also called Count data): counting the number
of individuals or items that fall into categories such “male” and
“female” yields frequency data.
• Qualitative and ordinal data are referred to as discrete,
because they sort items into separate, or discrete, classes.

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Data and Information.
 Data are facts, images, or sounds that may or may
not be useful to a particular task.
 Frequently data are referred to as non-interpreted
items.
 The number 1955 is a piece of data. However, the
number 1955 has no meaning by itself.
 Depending on the context, 1955 could mean
anything.
 Without contextual reference, the number 1955 has
no particular meaning.

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 Quality of the source of data is mistakenly taken for
granted.
 If the source of data is flawed any resulting
information will be worthless.
 The abundance of data available to organizations
causes problems and means that organizations must
have to be selective in the data they collect.
 Data are collected or aggregated at every level of
health care systems

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Data collection and use
 Are data used as a resource, leading to
improvements in health care?
 In many countries, health care data is not yet used in
these ways.
 If the right data are collected, if they are converted
into information and put to work in making decisions,
the answer can be yes.

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Data collection and use
 Instead, it is simply part of a reporting system:
 data is collected to fill in forms that are passed along to
higher levels of the system;
 it is not especially helpful at the level where it is collected.
 Instead of merely collecting data and passing it
along in a report, a management information system
moves in a circle.
 Data collection leads to self-assessment and
decision-making at each level.

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 Information:
 Is data that have been interpreted and understood
by the recipient of the message.
 Is knowledge and understanding that is usable by
the recipient.
 Must tell the recipient something not already known
which could not be predicted.

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Functions performed by Information
 The reduction of uncertainty – relevant information
helps to reduce the unknown (e.g. in decision-making).
 An aid to monitoring and control – by providing
information about performance and the extent of
deviations from planned levels of performance,
management are better able to control operations.
 As a means of communication – managers need to
know about developments, plans, forecasts, and
impending changes etc.

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Functions performed by Information cont.
 As a memory supplement – by having historical
information about performance, transactions, results
of past actions and decisions available for reference,
personal memories are supplemented.
 As an aid to simplification – by reducing uncertainty
and enhancing understanding, problems and
situations are simplified and become more
manageable.

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Functions performed by Information cont.
 Information can provide a firm basis for health
service management, because it can indicate what is
really happening within the system:
 who is being served,
 whether targets are realistic, and,
 whether they are being met in the specified period of time.
 Information can be used to make better decisions
about the use of scarce resources, and to improve
the quality and coverage of health care services.

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HMIS Perspectives
 Just what is an HMIS?
 Health-related information and its management can
be viewed from various perspectives.
 One way of looking at HMIS is by:
 Categories of data:
 Clinical information includes data that relate to
direct patient care, for example, data relating to
diagnostic test results, procedures, and care and
treatment of the patient.

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Categories of datacont.
 Another category of health-related information is
demographic data, including vital statistics about
patients, health providers, and health institutions
e.g., patient age, sex, and address, location, and
average length of patient stay for a particular
hospital.
 Financial information as it applies to various
aspects of health-care delivery and cost.
 Other categories include published literature, and
health research and epidemiological data.

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HMIS Perspectives cont.
 Control and management of information resources:
 This functional view is often referred to as
information resource management.
 This perspective of HMIS includes a broad range
of responsibilities including:
• strategic information system planning,
• integration and maintenance of all organizational
information technologies, and
• coordination of policies and
• procedures of technology acquisition, implementation,
and operation.

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 A different view of information management is the
concept of the Information Worker.
 This broad view suggests that anyone whose
primary work is handling information can be viewed
as an information manager.
 Health-care information managers include:
physicians, nurses, and therapists, and others such
as medical records/health information professionals,
information system specialists, medical librarians,
epidemiologists, and researchers.

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 Another viewpoint considers managing information
as a Resource.
 The primary functions related to information
management in this context deal with issues
associated with information:
 ownership,
 structure,
 content,
 quality, and
 appropriateness.

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 This viewpoint is a critical contribution to the field for
a number of reasons.
 In order for the information manager to use and manipulate
information, data must be arranged in appropriate structures
that facilitate storage and retrieval.
 In order to promote information manager efficiency, data
must be of high quality and must be supplied to the right
individual at the right time.
 The elements of ownership, quality, content,
structure, and appropriateness also support the
desired outcomes of information resource
management (IRM).

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 Acquisition of sophisticated computer systems and
management and coordination of policies and
procedures relating to information technologies
cannot sufficiently compensate for poorly organized,
unreliable, and inappropriate data.
 Therefore, the foundation for a successful
information system fundamentally rests on the
content, organization, reliability and appropriateness
of its data.

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Specific Objective # 2.
HMIS: concepts and components.
 Concepts
 Health
 Management
 Information
 System

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 System:
 A set of interrelated elements or components, each
contributing to the achievement of a common objective.
 The objective in the case of an HMIS then is to improve
health services management through optimal information
support.
 The elements and relationships consist of
 Resources
 Technologies
 Activities
 Actors

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 HMIS components:
 Is a combination of:
 People resources – information systems
specialist; end users
 Hardware resources (equipment) - machines
 Software resources (processing methods) –
programmes, procedures
 Data resources – data, knowledge bases

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 The HMIS manager must have a fundamental
background in systems theory and information
systems concepts to be effective in carrying out
managerial roles.
 It is important to know the components of an
information system and how they fit in the context
of an organization.
 The delivery of health care is built on the use of
information systems.

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HMIS: concepts and components cont.
 For example, when a laboratory test, such as a
complete blood count (CBC), is ordered for a patient,
the physician relies on an information system to
communicate the request and document test results.
 Specifically, the physician relies on the information
system to notify nursing or laboratory personnel that
a specimen needs to be collected, to notify the
laboratory that a CBC needs to be performed, and to
document the results of the CBC in a permanent
record.

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 The creation of a patient bill is another good
example of the important role information systems
play in health care.
 The billing department relies on several information
system databases to produce a patient bill.
 Before a bill can be produced, the billing clerk must
have information about the length of stay of the
patient; the type of services provided by the health-
care facility; patient demographics such as name,
sex, and address; the final diagnoses and
procedures performed; and diagnostic and
procedural codes such as ICD-9

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 The decision to add a new service by a health-care
facility is dependent on the collection and analysis of
information.
 A health-care facility may be considering adding a
new type of radiology modality.
 The purchase of equipment and renovation of
facilities may be extremely costly.
 Before making such a large investment, the
administrator will rely on several types of information
systems to collect and analyze data.

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 Some of these information systems may be external
such as those that provide data on community
demographics or competitors.
 Other information systems may be internal to the
organization such as those that provide information
on the demographics of past patients, referrals to
other institutions, treatment profiles of facility
providers, and cost data.
 Both sources (Internal and External) are very crucial
for managerial decision making processes.

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 The above examples provide a snapshot of the types
of information systems that help support the health-
care delivery process.
 It is important to keep in mind that information
systems are present in many varieties, all of which
support the clinical, operational, and managerial
facets of health care delivery.

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Information System Concept
 A system is a group of components that interact to
accomplish a goal or an objective.
 A central principle of a system is that its components
interact with each other through defined
relationships.
 Through this interaction, the components are able to
create something greater than the sum of their parts.
 In addition to defined relationships with component
parts, systems must be able to function in a dynamic
environment.

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Information System Concept
 They must be able to self-adapt or have controls that
respond to a changing climate.
 If a system fails to accommodate the environment or
if the interactions among its component parts fail, the
system becomes nonfunctional and disintegrates.
 An information system is composed of a group of
components (people, work processes, data, and
information technologies) that interact through
defined relationships to accomplish a goal.

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Information System Concept cont.
 Information systems must be able to adapt to
environmental change.
 A problem with one component will likely adversely
impact all other components within an information
system.
 When information system problems arise, it is crucial
that all information system components and
relationships be examined.

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 HMIS managers must understand the components of
information systems and how information systems
affect the organization, individuals within the
organization, and interested publics outside the
organization.
 Information systems provide opportunities to improve
internal operations, create competitive advantage in
the marketplace, improve patient-care delivery,
enhance research, and provide better service.
 Information systems risk occurs when the systems
are not well integrated, are poorly managed, or do
not support the goals of the organization.

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 In today’s complex environment the need for
systems thinking is imperative.
 Such understanding is essential for health
information management professionals to perform
their functions effectively.
 A fundamental understanding of systems concepts
and the contribution of interrelationships between
system components of people, work processes,
data, information technologies, and the organization
is integral to getting the job done well.

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 A large part of the job of a health information
manager is problem solving, which may be in the
context of:
 How best to design an information system,
 How an implementation plan should be
developed,
 How end-users can best be trained.

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 System Elements
 Systems have three principles elements:
 inputs,
 processing mechanisms and
 outputs.
 Feedback provided by the system influences
future inputs.

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 Classification of Systems
 A system may be simple or complex.
 It may be an open or a closed system.
 Systems can also be categorized as stable or
dynamic.
 They can be referred to as permanent or
temporary.

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 An open system interacts with its environment – that
is, inputs and outputs flow beyond the boundary of
the system.
 All living organisms are open systems because they
have a high degree of interaction with their
environments.
 Health-care facilities, are open systems.
 Inputs are received from the environment (e.g.,
patients, raw materials) and outputs (services,
products) flow back into the environment.

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 The people component of an information system will
usually be involved with three processes of input,
manipulation, and output of data or information.
 The work practices of an organization are an
important information system component.
 Work practices must be efficient and effective if an
information system is to function optimally.
 The data component is the foundation of any
information system

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Information System Components
 An information system is a group of interrelated and
self-adapting components working through defined
relationships to collect, process, and disseminate
data and information for accomplishment of specific
organizational goals.
 Each information system must be evaluated in terms
of its contribution to meeting the goals of the
organization.

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Information System Components
 Originally, a health information system was oriented
to collection of information on disease (‘surveillance’)
and on health service output (workload statistics).
 Currently, an HMIS is expected to provide specific
information support to the decision-making process
at each level of the health system.
 The ultimate objective of an HMIS is therefore not “to
gain information” but “to improve action”

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Specific Objective # 3:
Objectives of an HMIS
 Broad:
 Determination of information needs.
 Data gathering and information processing.
 Information dissemination, utilization and
storage.

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Specific Objective # 4: cont.
 Specific Objectives
 Enable the DHS managers to determine their own
health needs and select their health program
priorities.
 Provide health managers and planners with
information they require with regard to key areas of
the service delivery system.
 Enable health managers to monitor health program
performance in meeting DHS needs.

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Objective #1:
Determination of information needs
 Information system managers must answer
questions such as:
 What information is needed at what level?
 How much of it is needed?
 How, when, and by whom will it be used?
 In what form is it needed?

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Determination of information needs
 Output requirements:
Management must begin with an
examination of the output requirement e.g.
by classifying information based on the level
(strategic, tactical and operational) in the
organization at which it will be used

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Objective #2:
Data gathering and information processing
 The purpose is to improve the overall quality of
information.
 Components:
 Evaluation – Determining how much confidence
can be based in a particular piece of information.
The credibility of the source and reliability and
validity of the data must be determined.
 Abstraction – Involves editing and reducing
incoming information in order to provide
managers with only the information that is
relevant to their particular tasks.

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Objective #2:
Data gathering and information processing
 Indexing – Classifying information for storage and
retrieval purposes.
 Dissemination – Getting the right information to right
manager at the right time. This is the overriding
purpose of an HMIS.
 Storage – Provide for storage of information to
permit its use again in needed.

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Objective #3:
Information use
 Information use depends on:
 Quality (accuracy)
 Form – how it is presented
 Timeliness
 Relevance
 Major goal:
Provide the right information to the right decision
maker at the right time.

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HMIS
 In summary, an HMIS integrates data
collection, processing, reporting and use of
the information necessary for improving
health service effectiveness and efficiency
through better management at all levels of
the heath system.

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Characteristics of good information
 Good information is that which is used and which
creates value.
 Good information is:
 Relevant for its purpose
 Sufficiently accurate for its purpose
 Complete enough for the problem
 From a source in which the user has confidence
 Communicated to the right person

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Characteristics of good information
 Communicated in time for its purpose
 That which contains the right level of detail
 That which contains the right level of detail
 Communicated by an appropriate channel of
communication
 That which is understandable by the user

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Specific Objective # 4:
Transformation of Data into Information
 Information system processes are typically identified
as input, process, and output with a feedback
relationship between each element.
 Regarding input, we would expect that a health
information system would have the capability of
gathering, capturing, or collecting raw data.
 Regarding processing data, we would expect that
the information system would be able to convert or
manipulate raw data into some useful type of output
and either store or transmit data or output.

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 Processing or manipulation can include performing
calculations, making comparisons, selecting
alternative actions, or merely storing data or future
use.
 Output is defined as the product produced from
information system processes.
 The output may be the production of useful
information from raw data or it may be the production
of new data (transformed data) used as input into
another system.

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 Reports, documents, summaries, alerts, and
decision actions are all examples of information
output.
 It is important that every information system have a
feedback process.
 Feedback can take the form of assessing outputs of
system processes and determining whether or not
adjustments or changes to input or processing
activities are required.
 Feedback is used to influence future inputs to the
system.

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Health information management
 Health information may refer to patient educational
materials, public health literature, health knowledge
in published format, or data in a clinical record.
 Management is often associated with planning,
control, and implementation.
 It is important to recognize that information
management means different things to different
people.
 With such definition variety, the vision of a
profession may become obscure to external
stakeholders, and even to professionals themselves.

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Health information management cont.
 Traditional Definition of Information Management
 The information management function has been
identified with control and management over
information resources.
 From this perspective, the integration of diverse
disciplines, technologies, and databases is included.
Achieving integration involves planning for
information systems and management of both
people and technology.
 Frequently this broad scope of information
management is referred to as information resources
management or IRM.

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 Others have taken the view that information
management involves the personal management of
information.
 This perspective suggests that anyone who handles
information rather than physical goods is an
information worker and thus an information manager.
 This perspective views the practice of medicine as
inextricably entwined with the management of
information.

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 That medical providers are information managers is
apparent as they continually handle medical
information through resources such as the hospital,
medical library, and patient medical records.
 Professionals such as medical librarians and
biostatisticians both perceive that their primary tasks
involve the management of health information.
 Thus, it is evident that the term health information
management is not exclusive to a single profession.

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 Health information management professionals must
play new roles and take on new functions.
 They must be visionaries and strategists.
 They must understand the full scope of health
information and the role it can and must play in
delivering quality health care.
 Technology is changing their profession, and they
must change with it.
 They must actively seek new and better ways of
conceptualizing and completing their work.

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Traditional Roles of Medical Records
Professionals
 Traditional tasks of medical records practitioners
involve:
 planning, developing, and implementing systems
designed to:
 control, monitor, or track the quantity of record
content, flow, storage, and retrieval or quantitative
data collection

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Professionals cont.
 These traditional activities principally center around:
 the paper medical record or clinical reports as
opposed to
 ensuring the appropriateness, quality, timeliness,
or completeness of the information itself.
 In addition, traditional tasks have usually been
confined to a single department (i.e., medical
records department).
 In very few instances have tasks crossed
departmental lines.

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Professionals cont.
 Few tasks specifically address issues relating to
determination of the completion, significance,
organization, timeliness, or accuracy of information
contained in the medical record or its usefulness in
decision support.
 Because of increasing information complexity in
health-care enterprises, managers must view the
world from a systems perspective, which entails a
new type of problem solving.

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Professionals cont.
 A systems perspective views the whole organization
and beyond rather than focusing primarily on a
department.
 Thus, the health information manager must look
globally for answers to problems.
 The focus must be interdepartmental as well as
inter-organizational.

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Requirements for Role Change
 The complexity of information systems and their
associated tasks has become overpowering and is
frequently associated with cost.
 An estimated 25 to 40 percent of a hospital’s
operating costs is related to information handling.
 On average 26 percent of all employee activity in a
hospital is related to information handling

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Requirements for Role Change
 Both external and internal forces have increased
health-care enterprise dependence on information to
operate and manage their organizations, justify
costs, prove quality, and remain competitive.
 The increasing information dependence has
emphasized the need for transformation of
information handling roles.

84
Requirements for Role Change cont.
 The traditional tasks performed by health information
managers, which were primarily event driven and
departmentally focused, do not work any longer in
the current complex and competitive environment.
 An entirely new bundle of information services,
called health information brokerage services, is
essential to meet today’s needs.

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The Health Information Manager as an
Information Broker
 A broker acts as an agent in making contracts and
sales.
 The broker acts as an intermediary between a client
or customer and a product or service that the
customer desires.
 In the case of an information broker, the broker acts
as an intermediary between a client and an
information product or group of services.
 In the health-care environment, the client or
customer can be any number of professionals,
departments, or groups.

86
Information Broker cont.
 The tasks of a health information manager should be
information based and should transcend
departmental and organizational boundaries.
 The information services consist of four domains of
practice:
 policy development.
 information engineering,
 information analysis,
 information retrieval,

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 Although the health information manager will
interface with many different types of information
sources, most functions will focus primarily on
operational and clinical data relating to episodes of
patient care and to other patient or clinically related
data.
 In this case, operational and clinical data may
include data related to episodes of patient care such
as results of tests and procedures, continuous
quality improvement data.

88
 Other patient and clinically related data may include
patient demographics, community demographics,
and epidemiological databases.

89
Information Systems and the Organization
 It is common knowledge that the introduction of
information technology produces change and stress
within an organization.
 The importance of organizational goals as a driving
force for the design, development, implementation,
and evaluation of information systems cannot be
overemphasized.
 Too frequently, information systems are deployed
that do not adequately support the work practices of
the organization or organizational goals.

90
Information Systems and the Organization
 Any organizational change will require appropriate
information systems to support the implementation of
such change.
 The development of strategic information systems is
critical to the success of the organization.

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Levels of Organizational Decision Making
 How can an information system be developed that
will support organizational goals and work practices?
 To answer this question, knowledge of
organizational levels of decision-making is
necessary.
 Strategic - What goals are to be achieved
 Tactical – How goals are to be achieved.
 Operational – How goals are implemented.

92
The evolution of health information
systems
 Historically, information systems within organizations
were composed of manual processes or activities.
 The management of these manual systems was
principally left to individual departments.
 Traditionally, each department maintained its own
records, prepared its own reports, and stored its own
information.
 The introduction of computers and their increasing
use in health care during the last two decades
witnessed some breakdown of strictly departmental
systems.

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systems
 The daily hospital census and admission/discharge
list compilation was usually a function of the medical
record department.
 When computerized admission and discharge
systems were implemented in hospitals in the 1980s,
census calculation was no longer a departmental
function.

94
systems
 The computer and its associated databases replaced
the departmental ownership of the census data.
 Thus, computerization made it possible for
centralization of stored data files and made multiple
use of data feasible.
 Even with the trend toward computerization and
centralization of data files, the traditional
departmental philosophy toward information systems
did not disappear.

95
Evolution of Information Systems in
Health Care
 At the outset, health information systems were
oriented to collect information on diseases
(“surveillance”) and on health service output.
 An information system is supposed to provide
specific information support to the decision-making
process at each level of an organization.
 The ultimate objective of health information systems
is therefore not to gain information but to improve
action.

96
HMIS
 Applied to the health sector, we can now define
health management information systems as a set of
components and procedures organized with the
objective of generating information which will
improve health care management decisions at all
levels of the health care system

97
Evolution of HMIS in MoH, Kenya
 Historical Development
 HMIS is an integral part of a health system
infrastructure
 It is through this system that information will be
shared among facilities, DHS, and WHO member
states.

98
 1970
 The MoH became conscious of the need for more
useful data to assist:
 Formulation of health policies
 The setting of priorities
 The evaluation of health care programmes
 1974 – the idea of an HMIS was conceived with the
creation of a Vital Health Statistics Unit
 1975 – the creation of an Evaluation and Research
Unit

99
 1980 – the two units – VHSU and ERU were
combined to form Health Information System
Department
 1983 – Health Planning and Information Project was
initiated with the aim to strengthen the Health
Management Information Unit at all levels.
 1987 – The Information and Planning Systems
Project (IPS) was initiated.

10
0
HIS DEPARTMENT - 1980
 The functions of this dept were:
 Collection, processing and analysis of health and
management (administrative) data,
 Improvement of the quality of health data, review
and modify, where necessary the reporting systems
to enhance the utilization of data by end-users,
 Assist in the training of health personnel in medical
record keeping and program evaluation techniques,
 Dissemination of health information to end-users
within the ministry and other relevant organizations.

10
1
HIS DEPARTMENT - 1980
 HIS was also charged with the task of implementing
and managing the national health information
system,
 Was also charged with the responsibility of providing
other departments within the MoH with information
necessary for planning purposes
 Function as a data bank for various types of data in
the ministry

10
2
HIS Dep’ts - Sections
 Computer
 Statistical and medical records
 DHMIS
 Computer section was to:
 Assume a leadership role in the support of
computerization process in HIS and other
sections of the MoH

10
3
 Computer section was to:
 Initiate awareness programs for senior managers on
the use of computers through workshops and
seminars
 Computerize all its vita statistics received from the
districts,
 Assist the Finance and Personnel departments in
computerizing their budgetary and personnel
activities respectively

10
4
 Statistical and Medical Records:
 Dealt with collection, analysis, and presentation of
morbidity data
 Other activities included – Questionnaire design,
carrying out health and other ad hoc health surveys
 Medical Records:
 Storage and retrieval of data
 Coding and indexing of diseases and surgical
procedures

10
5
DHMIS Section
 DHMIS Section
 Established with the support of IPS & USAID
 Objective
 Track down basic information from HIS forms
for the immediate use by the DHMTs

10
6
DHMIS Section
Purpose:
 Help the DHMIS more objectively ascertain
where they were having problems.
 Enable DHMIS to identify immediate
problems on their respective areas.
 Engage in objective planning of the district-
wide and facility-based activities within the
DFS framework

10
7
DHMIS Section
 Help DHMIS members to become:
 Better managers
 Be more efficient
 Be effective/harmonious

10
8
DHMIS Section
 DHMIS Features:
 Flexible use
 Unit companion – compare facilities data
 Use of graphics to assist DHMIS to focus on
exceptionally high or low performance
 Facilitate easy spotting of serious under
reporting
 Sharing of work among DHMIS members

10
9
 Implementation:
Through -
 DHMIS quarterly report forms
 A generic District Health Annual Report

11
0
 Main features:
 Relevant information compiled at the District
HIS office is extracted, processed and made
available regularly to the DHMT for purposes
of –
Action planning
Supervision
Impact assessment

11
1
 Very little new information was to be collected
 Most of it was already available from the regular
bureaucratic and recording mechanisms as the district
 Extraction and processing of information is done by
identified members of the DHMT
 Information their availed to the DHMT
 DHMIS Collection Tolls
 26 Forms - 15 Admve Information
- 11 Health Information

11
2
 Admve:
 DHMI Health Care Financing Expenditure
Report
 Expenditure Returns Report ( R-11)
 Development Project Status Report
 AIE Checklist
 Monthly Vehicle Booking, Permanent
vacancies etc

11
3
 Health
 Immunization
 Pregnancy Care and Outcome Report
 Health Education
 I. P. Statistics Report
 Top Five Diagnosis
 UNICEF – Murang’a, Kitui, Baringo, Embu, Kitale
Mombasa, Mombasa Municipality

11
4
 FINLAND - Bungoma
 AMREF – Nyamira, Nyandarua
 SIDA - Kisumu, Uasin Gishu, Kisumu
Municipality

11
5
 1994 – CHMIS – Bungoma – KFPHEP
Aim: Complement the existing DHMIS
Objectives:
 To develop and install a relevant and easily used
HMIS at the rural health facilities.
 To extend to facility-based information committees
the same advantages enjoyed by the DHMIS i.e
 Ready access to a rage of information needed to
signal problems and to plan the appropriate
responses.

11
6
 Data Collection Tools
 15 Forms > 6 Health
> 8 Admve
> 1 Summary
 1995 – STAB – ODA – Coast
Staff Tracking & Budgeting Computerized
Dept

11
7
Staff Tracking & Budgeting Computerized Dept.
Objective:
 Basic Payroll cleansing
 Improvements in personnel records DMS
 Developing and system fro Intra-min
redeployment

11
8
HEALTH INFORMATION NEEDS AT THE
DISTRICT LEVEL:
 General Socio-economic and Environmental
information
 Physical characteristics and climate of the district
 Community organization; economic dev’t,
occupational and daily activities
 Organization of local government and
administration

11
9
HEALTH INFORMATION NEEDS
 Demographic information
 District population size, age, sex
structure, urban-rural balance and
geographic distribution (important for
location of new facilities).
 Vital statistics, migration patterns and
population growth rate.
 Family structure and composition.

12
0
 Health Status Patterns and Trends
 Frequency of common lifestyle risk factors for
communicable/non-communicable diseases e.g
AIDS, TB, Cancer & Diabetes as well as patterns
in diet, smoking and use of legal and illegal
substances
 Common causes of morbidity, disability and
locally epidemic diseases

12
1
 Important underlying factors influencing health
status such as education, food availability,
housing, water supply and excreta disposal
 Access, utilization, coverage and Quality of Health
Care
 Pregnancy (fertility control, antenatal, delivery and
postnatal care)
 Nutritional status (breastfeeding, growth
monitoring, malnutrition)

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2
 Immunization coverage.
 Environmental health (water supplies, excreta
disposal, household hygiene, house
construction).
 Control of communicable/non-communicable
diseases.
 Utilization of outpatient and inpatient health care
facilities for acute/chronic diseases.

12
3
 Resource Mobilization, Allocation and Utilization
 Number, capacity and distribution of governmental,
non-governmental and private:
 Facilities
 Personnel
 Programmes
 Sources and flows of health finances, budget
allocation and expenditure

12
4
 Staffing: training, deployment and distribution of
categories of health staff and their remuneration
 Availability and performance of management
support, transport, logistics and supplies.
 District Health System Management Process
 Planning (strategies, plans, technical guidance for
preparation of district operational plan)

12
5
 Coordination (cooperation within the health
sector, intersectoral health and development
activities, the role of community groups and
private sector.
 Monitoring and evaluation (the extent to which
indicators decided by the DHS are used)

12
6
HEALTH INFORMATION NEEDS- MoH
 Summary:
 HIS Dept. Personnel (MoH Hq)
 Information from all other health care providers in
the DHS
 Outcome/impact
 Information needed for formulation of
comprehensive policies and intervention.

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7
 DHS Managers
 General socio-economic
 Catchment population
 Demographic
 Access and coverage
 Resource mobilization, allocation and utilization
 Administrative information (personnel, finances,
facilities).

12
8
 Information from all other health care providers in
the DHS
 Information provides a district health profile
necessary for the planning and management of
the DHS.
 Information needed for effective and efficient
allocation of health resources.

12
9
 PHC Providers
 Preventive and therapeutic strategies
 Need to know which strategies achieve the best
outcomes.
 Institutions/Organizations
 Outcome and impact
 Need to know how best to ensure the health and
productivity of their employees.

13
0
 General Public
 Environmental and social determinants of health
 Need to know how to avoid illnesses and improve
longetivity.
 Patients
 Options for their on-going care
 For effective decision-making for better care.

13
1
HMIS Characteristics
 Make it simple and sustainable
 Start small, adding slowly as users gain skills and
confidence.
 Use data that is easily available or already there.
 Use a minimal number of tools (forms) for
collecting data and self assessment.
 Focus only on critical or essential information
needed to make pertinent decision.

13
2
 Keep it logical, transparent and culturally
acceptable.
 Make clear, specific, standardized guidelines for
use at each level.
 Don’t strive for excessive precision.
 Send all processed information to one end
receiver (focal person) who is responsible for
aggregation and dissemination.

13
3
 Keep calculations easy by rounding off target
population percentages to easy figures.
 Don’t rely on computers at peripheral level.
 Ensure it is easy and Comprehensive
 Collect only data that can be analyzed and used
to monitor progress towards objectives.
 Base indicators on objectives set for normal
clinical and preventive activities.

13
4
 Encourage analysis and self-assessment as
routine activities.
 Encourage comparability by using the same tools
and the same target population.
 Facilitate supervision and in-service training.
 Respect existing systems and do not change too
much at once.
 Organize information according to activities.
 Build in feedback integrally.

13
5
 Keep it flexible
 Allow space for growth in stages (must know,
useful, nice to know)
 Feed into and use other data collection activities
and systems.
 The system should be able to be changed by
mutual agreement as the situation changes.
 The system should be easily adapted to fit the
needs of one or more particular users.

13
6
 Promote integration
 Encourage teamwork and integration at all levels.
 Cover all activities that can significantly determine
the success or failure of operations at all levels.
 Ensure a balance between clinical and
administrative support activities.
 Institute ritualized self-assessment and analysis
by supervisors and local health teams.
 Stimulate feedback to other health-related sectors

13
7
 Design:
 Network all existing internal information systems:
 Patient information.
 Personnel information.
 Diagnosis information.
 Financial information.
 Logistics information.
 Care and Treatment information.
 District-wide Management information.

13
8
 Network all existing internal peripheral systems.
 Network with all other existing health care providers
in the neighbourhood.
 Data Sets (User Information Requirements)
 The designed information system needs to
provide at least some information in each of the
following categories.
 General socioeconomic and environmental
information.

13
9
 Data sets:
 Demographic information.
 Health status patterns and trends.
 Access, utilization, coverage and quality of health
care.
 Resource mobilization, allocation and utilization.
 District Health System Management Processes
(planning, coordination, monitoring and
evaluation).

14
0
 Information Partnership
 Partnership between data users and collectors
helps to avoid embarrassing errors and greatly
reduces external criticism of the information.
 Partnership be formed as early as possible in the
data collection process.

14
1
 Questions
 The first priority of this partnership should be to
answer the following basic questions:
 Why are we collecting this information?
 Exactly what questions are we trying to answer?
 Who should be given the information?
 How will the information be used?
 What data products should be produced in what
formats and how often?

14
2
 Reporting, Dissemination and Utilization:
 Value – If data is not valued, there is little
incentive to ensure: - high quality data collection,
processing and analysis and information use in
the managerial process.
 Level – Every level of the organization needs to
understand why and how data is collected,
tabulated and analyzed at each level to improve
decisions on priorities and resource allocation.

14
3
 Feedback:
 Aggregated data and analytic information should
be reported back to:
 Those who collect the data
 Managers
 Information officers should seek feedback on the
HMIS from health workers and other system
users (stakeholders) at each level.

14
4
 Dissemination:
 To be effective, an active data dissemination
program must take the initiative.
 The staff must leave their officers and take their
valuable data products, i.e. information services
to those whom they know can use them.
 Reach out to data and information users for their
counsel and advice.

14
5
Information System compatibility
 Systems incompatibility has resulted from the
absence of a strategic direction framework for
coordinating such development.
 Incompatibility of existing islands of HMISs is
impeding effective management of health services.
 Duplication of efforts which results from
incompatibility of these systems is very expensive in
light of the existing severe resource constraints.

14
6
Information System compatibility
 Harmonize the existing different HMISs within the
entire MoH and make them compatible.
 Standardization of data collection tools should be
encouraged to facilitate comparison of service
outcomes.
 Existing CHMISs and DHMISs should complement
each other.
 Systems compatibility cannot be achieved without
coordinating developments of different institution-
specific HMIS activities.

14
7
Information System Sustainability
 Sustainability of HMISs activities is clearly an area of
concern in the MoH, Kenya.
 Almost all HMIS initiatives in the MoH, Kenya have
been donor driven.
 There is no budgetary line item for the operation and
maintenance of the existing HMISs.
 Radical departures from existing MoH information
systems which cannot be sustained with the
available scarce resources should be avoided.

14
8
Resources & Managerial Support
 HMISs require managerial support in the provision of
resources and adequate long-term funding for:
 Systems development.
 Computers.
 Training staff.
 Supplies.
 Communication equipment.
 Transport to the field.

14
9
 Support requires knowing not only who the opinion
leaders are, but also how they feel about the system.
 Systems design must take into account the
phenomenon of acceptance or rejection by
personnel who use the system.
 This calls for the pre-implementation evaluation
criteria (to be discussed later).
 Thus it is important to recognize that a complete
evaluation of employee’s attitudes must be
conducted.

15
0
 Where there is resistance to the system due to
inadequate knowledge, skills and right attitudes abut
the system, special educational programs must be
undertaken:
 To show employees the potential benefits of the
system for both the health system and
themselves.
 To assure them that the system does not threaten
their security (if that is the case).

15
1
 The designers of the information systems should
take account of the setting and attitudes of personnel
on the systems that are being introduced.
 The HMIS personnel and users must be involved in
al the activities.
 The HMIS personnel and users must be oriented on
what the introduced system is all about.
 To avoid a possible organizational sabotage of the
system, employee attitudes at several levels must be
evaluated.

15
2
 An evaluation must also be made at senior levels.
 If an evaluation indicates that the health care
managers’ role is likely to be anything less than
active, the success of the system is likely to be in
jeopardy.
 Top management’s attitude is the crucial
determinant in the ultimate attitude of the system’s
operating personnel.

15
3
 In a situation where a computerized system is
introduced, an evaluation must also be made at the
department level to determine staff attitude toward
the system and toward each other.
 When a computerized system is introduced, many
changes in the departmental procedures, operations
and interrelationships are required.
 Rapport between departments is necessary for such
relationships to take place.

15
4
 Management support is required for this kind of
evaluation.
 Information systems require strong central
management and support by major decision-makers.
 Current information systems are weak reflecting both
low managerial priority and shortage of critical
resources.
 At present these systems experience considerable
constraints by the lack basic equipment and
stationery as well as basic statistical skills.

15
5
Common deficiencies in the existing
information systems
 Existing HMISs are inadequate in providing the
needed management support.
 Most health care providers in developing countries
equate information systems with:
 filling endless registers with names and addresses of
patients( e.g., sex and age of patients)
 compiling information on diseases
every week or every month and sending out reports
without adequate feedback

15
6
information systems
 The data received are often not helpful for
management decision making because they are
incomplete, inaccurate, untimely, obsolete, and
unrelated to priority tasks and functions of local
health personnel.
 Existing HMISs tend to be “data driven” instead of
“action-driven”.

15
7
Irrelevance of the information gathered
 Many of the data recorded and reported by the
health service staff are not needed for the tasks staff
perform.
 Data collection tends to focus on disease reporting
and only partially addresses management objectives
at the health facility level or at the patient/client level.
 Data that are needed are frequently not collected.
 There is a lack of a consensus between producers
and users of data at each level of the health care
system regarding the information needed.

15
8
Poor quality of data
 Data requirements are frequently chosen without taking into
account the technical skill of the health workers collecting the
data, or the available diagnostic equipment in peripheral health
facilities.
 Health workers receive little if any training in data collection
methods.
 Rarely are there standardized instructions on hw to collect the
data.
 Data quality is also low because of lack of motivation among
health service personnel as they rarely receive feedback on the
data reported to higher levels.

15
9
Duplication and waste among parallel
health information systems
 Often, donor agencies or national programmes
within the MoH develop their own specialized
(parallel/vertical) information systems.
 These parallel systems are mostly under pressure
and receive financial assistance from external donor
agencies.
 These vertically structured systems focus on one
specific disease (e.g. diarrhoea) or a specialized
service (e.g. family planning) or a management
subsystem (e.g. drug management information
system).

16
0
 These vertical systems exist side by side and in
addition to the general routine health information
system, which is considered insufficient and
incapable of delivering the data needed for
programme management.
 The net result is that routine health information
systems become chaotic and bothersome.
 The result is that health workers are drowned in a
multitude of reports to be completed every month.

16
1
 Since the data are not cross-referenced among the
different systems, health care providers and system
managers spend a considerable amount of time
collecting redundant and overlapping information.
 Data transmission does not follow the hierarchical
lines of communication, so that reports often do not
reach their destination.
 Elimination of duplication and waste requires a
unified system rather than better coordination among
the existing parallel structures.

16
2
Lack of timely reporting and feedback
 The process of transmitting, compiling, analysing,
and presenting the data is usually so tedious that by
the time a report is prepared, the data are frequently
obsolete and decisions are often made any
information input.
 Planners and managers face deadlines and time
constraints in their daily decision-making.
 Outdated information, even if of high quality, is of low
value to them.

16
3
Lack of timely reporting and feedback
 Health facilities report data directly to national
programme managers, and line managers at the
district at the district level receive outdated feedback
reports, if any.

16
4
Poor use of information
 Despite the evidence that much of the generated
data is irrelevant, of poor quality, redundant, or
obsolete, there are nonetheless some useful data
sets available.
 Information use is found to be especially weak at the
district, health centre, and community levels.
 Centralization of the information system at the MoH
headquarters is not supportive of the current efforts
to decentralize decision-making and build capacity at
the district level.

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5
 Planning and management staff rely primarily on “gut
feelings” to formulate ad hoc decision rather than
seek pertinent information.
 The chaotic status and inefficiency of most existing
information systems in developing countries are
linked to the structural weaknesses of the system
and lack of integration in the overall health system.
 Historically information systems were not
intentionally planned to provide management
support to the health system in an integrated way.

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6
information systems
 Too much of the wrong kind of information and not
enough of the right kind.
 Information is scattered throughout the organization
that it is difficult to locate answers to simple
questions.
 Vital information is sometimes suppressed by
subordinates or by managers in other functional
areas.
 Vital information often arrives long after it is needed.

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7
information systems
 Poor quality, incompleteness and lack of timeliness
of much of the data being generated by existing
institutional record-based HIS.
 Information systems are not manned by experts –
professionals.
 Staff (clinical and nurses) required to do excessive
data recording and reporting.
 Data collected and reported by health service staff
are not needed for the tasks the staff perform.

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8
information systems
 Data routinely collected by health service are
frequently considered to be of dubious validity and
not reliable. Nobody seems to care!
 There is inconsistency in recording of diseases
because case definitions are not clear.
 HIS has no reliable information about people who
have no access to health services or about those
who use the private sector facilities.
 No information about planning and monitoring
purposes.

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9
information systems
 Little attention is given to improving the presentation
of the information once it has been processed.
 Little analysis and use at collection points – no
feedback for data sent to the higher levels.
 Little attempt is made to present the information in
the form of comparisons that are readily understood
at district levels.
 Poor dissemination and use of the information.

17
0
information systems
 Shortage of resources – inadequate staff, untrained
staff, no space, no equipment, no supplies,

17
1
Efforts to reform health information
systems
 The first efforts to systematically collect, analyse,
and report data for improved management in
developing countries were undertaken by national
programme managers of vertically structured HISs.
 Foreign assistance to the health sector was typically
focused on programmes rather than the entire health
system.
 Since such projects were accountable to their
respective donors, information on performance had
to be collected.

BHR 3205 Health Information Systems-Lecture Notes (1).ppt

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