SLIDES ON MIS, HMIS, IHIP BY COMMUNITY MEDICINE DEPARTMENT RIMS, MANIPUR

1. Presenters: Jupitar Sanasam & Avantika Gupta
Moderator: Prof. Brogen Singh Akoijam
Management Information System

2. OUTLINE
1. What is MIS
2. Evolution of MIS
3. Why is MIS important
4. How to organize MIS
5. Current trends in MIS
6. Advantages & Limitations
7. Conclusion

3. “It can be defined as a system, which provides the required
information to each level of management at the right time, in the
right form, covering the desired quantity and quality, so that it may
form the basis of decision-making”
MANAGEMENT INFORMATION SYSTEM
(Davis G.B. and Oslon M.H. Management Information system
Conceptual foundation, structure and Development)

4. Basic terms
Management:
Process of planning, decision
making, organising, leading
motivation and controlling the
human resources, financial,
physical, and information
resources of an organisation to
reach its goals efficiently and
effectively
Information:
The processed data that
helps the management in
planning, controlling and
operations
Data:
Data means unstructured
raw facts, observations or
unevaluated messages in
isolation
System:
A collection of
components that work
together to achieve a
common objective

5. Important concepts in healthcare management
Effectiveness:
How well the objective is met
Efficiency:
How well the health sector is using its resources to achieve that goal
Equity:
• Access to healthcare is the basic right of all people
• The absence of unfair and avoidable or remediable differences in health among population
groups defined socially, economically, demographically or geographically

6. Scope of Management (Health)

7. Management cycle
Planning
Organization
Implementation
Evaluation

8. Health information sources
Information from other sectors
System organized on a national scale
Information as a result of purposeful effort
or as an outcome of activities at local level
Findings of special surveys

9. Health information sources
Information from other sectors
System organized on a national scale
Information as a result of purposeful effort
or as an outcome of activities at local level
Findings of special surveys
• Population censuses, Civil
registration system
• Periodic reports by health
ministry, or other ministries
on political economic and
social situation
• Five year development plans

10. Health information sources
Information from other sectors
System organized on a national scale
Information as a result of purposeful effort
or as an outcome of activities at local level
Findings of special surveys
• Routine service records and
registers maintained by
health personals at different
levels
• Periodic work done and
activities undertaken by
health personal

11. Health information sources
Information from other sectors
System organized on a national scale
Information as a result of purposeful effort
or as an outcome of activities at local level
Findings of special surveys
• Undertaken for objectives
such as case detection for
TB, leprosy, blindness and
malaria etc.
• Ongoing surveillance for
communicable disease,
cancer registry etc

12. Health information sources
Information from other sectors
System organized on a national scale
Information as a result of purposeful effort
or as an outcome of activities at local level
Findings of special surveys
• Social, demographic and
economic status,
developmental activities,
village water supply system
• Educational system and
extension of education in
various fields such as
agriculture, animal
husbandry

13. Decision Support
system
Management
Information system
Office support system
Transaction support system
Executive
support
system
Tacit Knowledge
Explicit Knowledge
Information
Basic Data
Operation Support
system
Management
support system
Types of information system

14. Decision Support
system
Management
Information system
Office support system
Transaction support system
Executive
support
system
Types of information system
•Ensures that all of the
contractual, transactional,
and customer relationship
data is stored
•Includes daily accounting,
sales registry etc.
Routine work like daily data
entry, process documents
and daily report
•Creates reports/information for
managers
•Corrective decision and action
•Helps to take decision on a
small scale, e.g. management of
human resources
•Takes inputs from MIS, DSS,
and other side information for
future planning and decision

15. Uses of health information
• Measurement of community health & Community diagnosis
• Finding solution to health problems
• Prioritization & Planning of interventions
• Directing and controlling health programmes

16. • Development of procedures, definitions, classification and methods
of collection, analysis, storage and retrieval of data
• Establishing administrative standards
• Determination of met and unmet health needs

17. • Monitoring & evaluation of health programmes
• Carry out Information-Education-Communication activities for
community and decision-makers
• Demand social support for health activities
• Support health legislation

18. Characteristics of health information (WHO)
• Population based
• Problem oriented
• Avoid unnecessary agglomeration of data
• Employ functional and operational terms (e.g. episodes of
illness, treatment regimens, Lab test)

19. • Express information briefly and imaginatively (e.g. Tables, charts,
percentages
• Facility for data feed back must be present

20. “A mechanism for collection, processing, analysis, and
transmission of information required for organising and
operating health services and also for research and training”
(Conference on HIS, WHO/EURO, 1973)
Health Information System (HIS)

21. HIS and MIS
• MIS has a more specific and limited objective and scope
• It provides information support necessary for decision
making for effective management of health organization
• MIS also involves evaluation and monitoring
• MIS implies immediate action on information

22. Resources
Indicators
Data sources
Data
management
Information
products
Disseminati
on and use
Components of HIS
Legislative, regulatory,
and planning framework,
ICT, manpower and
finance
Indicators which determine
health system inputs,
outputs, and outcomes, and
health status
Population based (Census,
surveys, and civil
registration) Institute based
data, occasional health
surveys, research
Collection, storage, quality-
assurance, flow, processing,
compilation, and analysis
Data transformed into information
basis for evidence and decision
making
Value enhanced by making it
readily accessible to decision
makers

23. Health Management Information System
(HMIS)
It is a Government to Government (G2G) web-based Monitoring
Information System that has been put in place by Ministry of
Health & Family Welfare (MoHFW), Government of India to
monitor the National Health Mission and other Health programmes
and provide key inputs for policy formulation and appropriate
programme interventions

24. Objective of HMIS
• To provide reliable, latest and useful health information to all levels of health officers
and administrators
• To amend health policies and working system on the basis of feedback, received
from health information system
• To provide information about periodically and time bound programmes and for mid
term evaluation
• To contribute towards achievement of objectives of health policies and programmes.
• To increase efficiency and quality in health management.

25. Year and event Content
1982 MIES- Management information and
Evaluation system was tried to be introduced
but has not taken roots
1983 national
health policy
Envisaged a nationwide organizational setup
to procure essential health information
1983-85 Development of HMIS with WHO
collaboration and National Informatics Center
(NIC)
Evolution of HMIS

26. Year and event Content
1986-88 HMIS version 1.0 in four participating state of
Gujarat, Haryana, Maharashtra and Rajastan
1989 Field testing of the HMIS in one district of
Gujarat, Haryana, Maharashtra and Rajasthan
1990-95 Implementation efforts in 13 states and Union
Territories in phased manner
Evolution of HMIS Contd.

27. Year and event Content
1996 March
review meeting
To take note of the changes suggested by the
implementing states and revise the HMIS 2.0
1997 CBHI
organised a
workshop
To take note of the changes suggested by the
implementing states and revise the HMIS 2.0
21st Oct, 2008 HMIS web portal started under NRHM
4th April, 2021 Virtual launch of IHIP
Evolution of HMIS Contd.

28. IMPORTANCE of HMIS
• It transforms data inputs into information output for use by
decision makers
• Produces information needed by Patients, communities, service
providers, program managers, policymakers, providers of funds,
global agencies and organizations
• Identification and allocation of manpower and other resources

29. • Effective and efficient uses of resources
• Performance evaluation of program
• Detect and control emerging and endemic health problems
• Monitor progress towards health goals; and promote equity

30. OUTLINE
1. What is MIS
2. Evolution of MIS
3. Why is MIS important
4. How to organize MIS
5. Current trends in MIS
6. Advantages & Limitations
7. Conclusion

31. Steps of Organizing HMIS

32. 1. Definition of Information requirements
Relevant
Valid
Accurate
Ease of
handling
Useful
Adequate
Reliable
Timely
Complete
Action-
oriented
Economics
Levels of decision-
making
Review the existing
system
Format of information

33. 2. Define data needs of relevant units within health system
Determine the data elements needed
Identify the indicators needed by each level to perform
its functions
Differentiating data (routine data collection system vs
special studies)

34. Major data elements
• ANC care
• Intra-natal care
• Post natal care
• Child immunization
• Family planning
• Mortality
• Patient services
• Adolescent health
• Laboratory testing
• Other programs under NHM
Key performance indicators
(KPIs)
• % of 1st trimester registration
• % PW received 4 ANC
• % PW fully immunized
• % institutional deliveries
• % C-Section
• Sex ratio at birth
• % children fully immunized
• OPD/IPD per lakh population
• % male/ female sterilization

35. 3. Determine the most appropriate & effective data flow
Flow of data in most of the states
follows the bottom up approach
SC
SC
SC
PHC
PHC
PHC
CHC
CHC
District
Hospital

36. 4. Conversion of data into information
5. Time bound collection, processing and transmission of
data / information
• Frequency and exact point of time at which these steps are to
be achieved is to be laid down and strictly adhered to
• Processing at different levels in the upward flow would tend
to convert bits of data into useful information.
6. Develop training programs according to needs and
levels of target groups

37. District
Hospital
CHC
Sub-
Centre
PHC
Monthly report
NRHM/DH/3/M
5th of following
month
District
HQ
State
HQ
Monthly report
NRHM/CHC/3/M
5th of following
month
Monthly report
NRHM/HSC/3/M
5th of following
month
Monthly report
NRHM/PHC/3/M
5th of following
month
Data capturing unit
Report submitted electronically
Quarterly report
NRHM/DHQ/2/Q
10th of month of
quarter
Monthly report
NRHM/DHQ/3/M
10th of following month
Annual report
NRHM/DHQ/1/A
5th April
Quarterly report
NRHM/SG/2/Q
10th of month of
quarter
Annual report
NRHM/SG/1/A
15th April
Response for state collected
All states submitting their
reports to centre
National HQ
Report generation at different
levels

38. 7. Analysis, regrouping and presentation of information
• In order to make the system flexible
enough for all the states without much
complexity, the concept of data
aggregation unit (DAU) was devised
• DAU is the place where the data is
collected and consolidated
• Certain basic requirements:
Availability of Computers,
Internet
Trained Personnel – Nodal M
& E Officers
HSC
HSC
HSC
PHC
PHC
Block HQ
CHC
District Hospital
SDH
District HQ DAU
State HQ

39. 8. Interpretation, comparison, evaluation
HMIS
Reports
Standard
reports
Analytical
reports
Live reports

40. Key Objectives
Comparative
assessment
Highlights
inequities
Facilitates
use of exiting
HMIS data
Visual
presentation

42. 9. Feedback, identification of problem
HMIS Checking
When?
Monthly checking of entered data at district and
facility level

43. Validation is performed by
comparing values of ≥ 2 data
elements that are comparable
Common
validation
rules

44. 10. Decision-making and activity planning
11. Monitoring and evaluation of system
12. Periodic review of MIS

45. Performance of HMIS at a glance
Currently around 2.06 Lakh health facilities are reporting data
every month
Performance at glance: 6th Jan, 2020

47. 5th April, 2021

48. Integrated Health Information Platform (IHIP) is a web-
enabled near-real-time electronic information system that
is embedded with all applicable Government of India's e-
Governance standards, Information Technology (IT), data
& meta data standards to provide state-of-the-art single
operating picture with geospatial information for managing
disease outbreaks and related resources

49. IDSP
Functional
Needs
IDSP Data
and
Information
Products
IDSP Portal
Users
Envision integrated near real-time eSurveillance
Empower
public
health
surveillance
workforce
Ensure
sustained
financing
&
continued
leadership
Embed innovation for data quality, accessibility
IDSP ICT
Master
Plan
4
pillars
3
components

50. Key features
of IHIP Near real-
time
information
Single
operating
picture
Integration
of data
Geospatial
epidemiology
Public
health
surveillance
attributes
One health
approach
Person
Place
Time
Geocode

51. Cross sectional view
of IDSP information
system
Single
operating
picture

52. One
health
approach
One Health:
Interconnectedness of human
health, animal health and the
ecosystem
IHIP
Ministry of Health &
Family Welfare
Ministry of
Agriculture &
Farmers Welfare
Ministry of Home
Affairs
Ministry of Environment,
Forest and Climate
Change(MoEFCC)
Ministry of Earth
Sciences
Ministry of Electronics
& Information
Technology

53. Geospatial
epidemiology Can describe & analyse
geographic variations among
diseases
NIC portal:
• Maintains data of public health
assets such as schools, airport
locations, road networks, geographic
& political boundaries
• Hosts vast amount of high resolution
satellite imageries that are of use to
emergency preparedness & response
activities

54. Near real-
time
information
High-level architecture
(based on health surveillance informatics principles and best practices)
Application
Module
Approach and Capabilities Data Integration
Data collection
IDSPApp on handheld devices
IDSP web portal /store-forward
Line listings and aggregate
Automated geo-tagging of all
appropriate fields
Data
Management
Near real-time
Lossless data storage
Integration of IDSP data with
relevant datasets from GoI/CRS,
and other entities.
Data Analytics
and Forecasting
Location based alerting algorithm
for analysis and projection
Automated alert generation
Automated Geospatial trend analysis
and visualization
Data visualization
Results displayed on navigation maps,
satellite imagery and other modes
Dynamic dashboard (mapped to
time, place, person and custom rules)
Business
Intelligence and
reports
Automated outputs
Custom Summary, PDF, on-screen
display
Custom reports made available at
all levels on relevant reports to
ANM; DSU, SSU and CSU
Documentation
and Support
Cloud server (NIC BSNL)
Standalone server
Scalability to all states and within
each state; API based data exchange
Use of
innovation
Provide
opportunities
for private
sector
engagement

55. A vision to monitor public health for action in near real-time

56. Integration
Proposed integration of data sets through IDSP Data Linked Record System

57. India’s integrated health information architecture

58. IDSP’s current data collection effort at state level

59. IDSP’s access to ICT infrastructure
Mobile
computing
platform
Store-and-
forward

60. What are the essential differences between previous and
new IDSP portal?
Capture aggregate data
only
Paper-based data
collection
Not to link data from S, P
& L forms
Weekly surveillance
Monitor only 13 health
conditions
IDSP Capture disaggregate data at
all levels
Analysis provided on mobile
phones
Link data from S, P, L, EWS
1 & 2 forms
Integrate with ongoing
surveillance programs
Monitor >33 health
conditions
Capture real-time data
IHIP

61. Sr.
No.
State (Total no. of
Districts)
No of Districts
implementing
IHIP
No of Districts (ever) Reported
S
Form
P
Form
L
Form
Issues in implementation
1 Andhra Pradesh (13) 13 13 13 13 Training completed
2
Himachal Pradesh
(12)
12 12 12 12
Training completed
3 Karnataka (30) 30 29 30 30
Tablets distributed in all Districts. Training of HWs to be
completed in District Ramnagaram by next week and data
entry will be started.
4 Kerala (14) 14 10 14 12 Integration between E health & IHIP
5 Odisha (30) 17 6 12 8
Computer & internet connectivity issues.
Training completed in 11 Districts out of 17.
Tablets distributed in all Districts.
6 Uttar Pradesh (75) 10 2 10 10
Training completed in all 75 Districts. Tablets distributed
only in 10 implementing Districts. Proposal for computers
to be sent with gap analysis and justification.
7 Telangana (33) 33 32 33 33
Hyderabad has no S form reporting unit, Hence not
reporting.
Total (207) 129 104 124 118
1st Phase IHIP Reporting Status (26.11.18 - 16.09.2019)

62. Sl.
No.
State
Districts covered in ToT
training
Plan for District. Training
(Initiated or not)
1. Arunachal Pradesh 19/25 Planned in Sep-Oct 2019
2. Uttarakhand 14/14 October 2019
3. Assam 27/27 To be initiated
4.
Meghalaya
(along-with Assam)
State level officials only To be initiated
5.
Nagaland
(along-with Assam)
1/10 To be initiated
6. Sikkim (along with Assam) -- To be initiated
7. Madhya Pradesh 51/51 Ongoing, Completed in 24/51
8. Gujarat 33/33 On-going
9.
Dadar & Nagar Haveli (along-with
Gujarat)
1/1 To be initiated
10. Daman & Diu (along-with Gujarat) 2/2 To be initiated
11. Haryana 5/22 Planned in September.
12. Goa 02/02 Completed
13. Maharashtra 36/36 To be initiated
14. Manipur 16/16 Planned in November
15. Bihar 38/38 On-going
2nd Phase IHIP implementation status

63. WHO personnel facilitating
training of participants from DSU
on IHIP-IDSP at Manipur
Health officials trained on IHIP in
Mokokchung, Nagaland
• WHO has supported refresher
‘trainings of trainers’ for all
state-level officers, and
trainings of > 2500 have been
completed
• At the district-level, trainings
and refresher sessions have
been completed in >600
districts, in which >64,000
participants were trained

64. Information on IHIP
Disease summary Dashboard
Real-time Lab confirmed cases of health conditions
Summary downloadable real-time charts
Real-time view of lab-confirmed cases of
And progression and daily/weekly monitoring of activity
Real-time end-to-end management of outbreaks
Manage health facilities along with the list of health
workforce, essential and emergency medicines and supplies
within them.
View heatmaps and distribution of lab-confirmed cases.
Time place and person (patient case summaries)

65. 13th Dec, 2019:
Manipur becomes
the first in North
East to implement
IHIP
IHIP in Manipur
Less reporting

66. NMIS
(Nursing
management
information
system)
KAMIS
(Kala-Azar
Management
Information
System)
NCCMIS
(National
Cold Chain
Management
Information
System)
eVIN
MERA
ASPATAAL
(MA)
Web based
Malaria
Management
Information
Systm
NIKSHAY /
NIKSHAY
AUSHADHI
TMIS
(Training
Management
Information
System)

67. ANMOL
Launched
on World
Health Day,
2016

68. 12 Dec, 2019:
Health & Family Welfare Minister L
Jayantakumar Singh distributed 20
ANMOL (ANM On Line) tablet to
the nurses serving in Tengnoupal
District

69. COVID-19 & MIS
•Data analytics and
forecasting underpin
decision making
•Provides information
on effectiveness of
policies and decisions
•Facilitates MIS

70. Objective: To avail real-time health
data of patients in home isolation
for prompt response

71. Manipur: NHP for COVID-19

72. Advantages of MIS in Healthcare
Informed
decision
making
Planning
Monitoring
Evaluation
Inter-
operability
at various
levels
Increased
patient
satisfaction
Research
Easy
data
handling
Integrated
warehouse of
information
Increased
EWAR
Data
standardi-
zation
Cost-
effective
Patient
engage-
ment
Data
security
Account-
ability

73. BUILDING
BLOCKS FOR
VISION 2035:
Public Health
Surveillance in
India
Architecture
Proposed flow of
information

74. Limitations of MIS in Healthcare
Private sector involvement
Systemic errors
Unclear expectations
Training needs assessment at all levels
Non-quantifiable indicators (quality of care)
Feedback mechanism
Lack of motivation

75. Conclusion
HMIS is a tool which helps in gathering, aggregating, analyzing
and then using the information generated for taking actions to
improve performance of health systems
Vision of IHIP is an essential part of India’s National Digital
Health Plan and NHP 2017 goal towards greater accountability
Critical step in any MIS is effective utilization of the information
generated, which requires strengthening of management

76. Conclusion
To enable IHIP
implementation:
Hands on trainings to be conducted for all
manpower
Identification of data entry point within existing
manpower
Procurement and Distribution of Tablets at the
earliest
Proposal for unavailable logistics to be made in
PIP after gap analysis and justification.

77. References
• WHO. Developing Health Management Information Systems: A PRACTICAL GUIDE FOR
DEVELOPING COUNTRIES. Regional Office for Western Pacific:WHO;2004 [cited 2021 June 23].
Available from:
https://apps.who.int/iris/bitstream/handle/10665/207050/9290611650_eng.pdf?sequence=1&isAllowe
d=y.
• Ka M, Periyasamy AG, Venkatesh U, Kishore J. A situation model of integrated health information
platform in India: an anticipated review. IJCPH. 2020 Mar;7(3):1197.
https://www.ijcmph.com/index.php/ijcmph/article/view/5929.
• MoHFW (Statistics Division). Score Card User Manual Using HMIS Indicators. New
Delhi:MoHFW;2008 [cited 2021 June 23]. Available from: https://nrhm-
mis.nic.in/GuideLine/Guidelines%20for%20developing%20Score%20Card.pdf.

78. References
• HMIS. HMIS MANAGERS’ MANUAL User Manual for Web Portal & DHIS2.
New Delhi:MoHFW;2011 [cited 2021 June 22]. Available from: https://www.nrhm-
mis.nic.in/Part%20A%20HMIS/Understanding%20Health%20Management%20Info
rmation%20Systems/Manager's%20Manual.pdf.
• IHIP. Mission. New Delhi:MoHfw;2021 [cited 2021 June 26]. Available from:
https://ihip.nhp.gov.in/idsp/#!/mission.
• HMIS. State Fact Sheet: FY 2018-2019 (April -March). New Delhi:MoHFW;2018-
19 [cited 2021 June 24]. Available from: https://nrhm-
mis.nic.in/hmisreports/analyticalreports.aspx.

79. THANK
YOU