The document discusses Sri Lanka's national health information system (HMIS). The HMIS includes several components like the hospital information system, preventive health information system, disease surveillance system, and population censuses and surveys. It notes challenges like manual record keeping and a lack of integration between different parts of the system. Future goals include improving data collection and analysis, expanding IT infrastructure, and promoting evidence-based decision making.

1. Health Information System in Sri Lanka Dr Sunil Senanayake MBBS, MSc, MD Director/Health Information by

2. Information System Components of National HMIS: Hospital Information System Preventive Health Information System Disease Surveillance System Population Census Surveys Other special surveys ( NCD Risk Factor Survey )

3. Sources of Information Hospital Information System: Clinical Data Diagnosis of diseases (Using ICD-10) Procedures performed Cancer Registry Cause of Death (Hospital deaths) Hospital facilities Hospital services

4. Sources of Information ctd… Preventive Health Information System: Maternal, Child Health and FP data Food Sanitation, Environmental & Occupational Health data Nutrition data School Health data Immunization data Data from Disease Control Programmes

5. Sources of Information ctd… Disease Surveillance System: Mainly Communicable Diseases Monitoring of disease trends Leading causes of Hospitalization Ischaemic Heart Diseases Hypertension and complications Cancers Diseases of elderly

6. Sources of Information ctd.. Population Census: National Census: Started in 1881 Every ten years (except 1991) Wide range of information

7. Sources of Information ctd.. Surveys: 1. Demographic and Health Survey: Started in 1973 Every five years Support Health Information Confirm Health Information

8. Sources of Information ctd.. Surveys: ctd… 2.Household Income Survey: Nutritional status Energy consumption Common Health Problems Expenditure pattern

9. Sources of Information ctd.. Surveys: ctd… 3. Nutrition Survey: Nutritional status Nutritional disorders Energy consumption Vitamin deficiencies Micro-nutrient deficiencies

10. Sources of Information ctd.. Surveys: ctd… 4. Other Special Surveys (NCD RF Survey): NCD Risk Factor Survey Injury Surveillance

11. Sources of Information ctd.. Other Sources Health Related Data: Alcohol and Drug Information Centre National Dangerous Drugs Control Board & Police Narcotic Bureau Non Governmental Agencies Sri Lanka Customs Trade and Commerce Ministry Food, tobacco, alcohol etc (imports & sales)

12. In the past …………….. -Well established health infrastructure -Very good preventive health care service -Eradication of diseases -One of the world best EPI programmes -Better health Indicators for the investment -Model for low cost health services -- Among many other things …... Some of the remarkable achievements ….

13. Recent past ……. -Health for all by 2000 -Primary Health care approach -MCH and FP -Immunization -Health Education -Disease prevention -Healthy environment etc……

14. Future problems ……. Changing demography Changing disease pattern Changing life styles High expectation of people Equity Responsiveness Technological advances etc……

15. Our strategies …………. -Improve ambulatory care -Concentrate on Non Communicable Diseases -Integrated Disease Surveillance -Rehabilitation in the community -Promote healthy lifestyles -Ensure equity -Exploit IT -Better dialogues between clinicians, public health personnel, researchers & planners

16. Issues There are many Issues: (Hospital) Manual Record keeping system Only inpatient data Only from Government Hospitals ICD10 at Hospital but aggregated groups are transmitted to the centre Doctors do not concern about writing of diagnoses

17. Issues ctd… There are many Issues: (Hospital) ctd… Inadequate human resources Untrained coders Patient record formats No established Medical Record Departments in some hospitals No unique ID Repeated admissions counted as new cases Use of IT is minimal

18. Issues ctd… There are many Issues: (Public Health) Total system is manual Behind time Processing is difficult No/weak data from Estate sector Occupational health Nutrition surveillance Health education NCDs

19. Issues ctd… There are many Issues: (Other) Poor Financial Information No unit cost system No Disease burden study No routine NCD surveillance system HIS policy has not been laid down

20. Challenges Hospital System: Re-designing the hospital record keeping system Changing of record keeping formats Adaptation of ICD 10 at all hospitals Transmitting of data by ICD 10 4 digit level

21. Challenges ctd.. Hospital System: ctd.. Changing of attitudes of doctors Introduction of ICD 10 to basic curriculums Introduction of IT to hospitals (EPR) Development of IT Networks in hospitals Training of users Quality of Medical Records

22. Challenges ctd.. Public Health System: Introducing IT at lowest possible level Development of suitable software Development of routine NCD, nutrition and occupational disease surveillance systems Integration of disease surveillance systems

23. Challenges ctd.. Other Systems: Introduce a Unit cost system Updating of Human Resource Information System Mapping of Health Facilities (GIS) Convincing Policy makers and decision makers on investment in IT in Health

24. Challenges ctd.. The biggest challenge is “get decision makers and policy makers to use information for decision and policy making.” Therefore “evidence based decision making culture” has to be promoted among them.

25. Challenges ctd.. Information dissemination would be one of the strategies that could be adopted to overcome this situation.

26. Dissemination of Information Annual Health Bulletin Annual Administrative report Weekly Epidemiology Bulletin Quarterly Epidemiology Bulletin Annual Family Health Report Census reports DHS reports Survey reports Health Ministry Website

27. Current status of IT Facilities IT Facilities available: Ministry of Health has a Local Area Network with a dedicated e-mail service and Internet services. All the Provincial Health Offices and most of the District Offices are connected to the LAN of the Ministry of Health via dial-up lines for electronic data transfer. Network will be expanded to MOH Offices and large hospitals by end of 2005.

28. Opportunities Millennium Development Goals Health sector master plan WB assisted Health Sector Development project E-Sri Lanka project Government budget monitoring mechanism

29. Thank You! Dr Sunil Senanayake [email_address] [email_address]