4EXAM. HIS - Introducodajbcvsovbation (3).ppt
- 1. HIS an introduction Mengistu Y. (MPH-HI, Ph.D fellow)
- 2. What is health information? • Health information has been variously described as the “foundation” for better health, • as the “glue” holding the health system together, and • as the “oil” keeping the health system running
- 3. • HIS is an integral part of the health system, the operational boundaries of which include: • … all resources, organizations and actors that are involved in the regulation, financing, and provision of actions whose primary intent is to protect, promote or improve health
- 4. • However, the health information field is complex.
- 5. On the demand side • there are different users and uses of information • people and patients, • communities, • service providers, • programme managers, • policy-makers, • providers of funds, • global agencies and organizations.
- 6. All need information on a range of health- measurement areas including • mortality and morbidity rates; • disease outbreaks; • determinants of health (such as nutrition, environment, and socioeconomic status); • access, coverage and quality of services; • costs and expenditures; and • equity
- 7. On the supply side • various tools and methods are available including • vital registration and census systems; • household, facility and district surveys; • routine clinic-based data; • disease surveillance systems; • national health accounts; and • modeling.
- 8. • Unfortunately, supply and demand in the health information field are not currently in equilibrium, with an oversupply of data coexisting with large unmet needs for information.
- 9. Renewed interest in health information • The demand for good-quality health information is growing – driven by 1. the move towards performance-based resource allocation and 2. significant increases in the resources for health
- 10. Benefits of investing in health information • Detect and control emerging and endemic health problems; • monitor progress towards health goals; and promote equity. • Empower individuals and communities with timely and understandable health related information; and drive improvements in quality of services. • ·
- 11. • Strengthen the evidence base for effective health policies; • permit evaluation of scale-up efforts; and enable innovation through research. • Improve governance; mobilize new resources; and ensure accountability in their use.
- 12. WHAT IS A HEALTH INFORMATION SYSTEM? • HIS is a set of components & procedures organized with the objective of generating information for the health care management decisions at all levels of the health system. • It is universally accepted that health information is essential for health decision- making at all levels of the health pyramid.
- 13. Goal of health information systems • The ultimate objective of a health information system is to produce information for taking action in the health sector. Performance of such a system should therefore be measured not only on the basis of the quality of data produced, but on evidence of the continued use of these data for improving health systems operations and health status. • Rhino 2003
- 14. Domains of health information 1. Health determinants 2.Health system inputs 3. Health system outputs 4. Health outcomes
- 16. Health information subsystems • Disease surveillance and outbreak notification • household surveys. • Registration of vital events and censuses • Data collection based on patient and service records and reporting from health workers, • Programme-specific monitoring and evaluation • Administration and resource management
- 17. • “The function of a health information system is to bring together data from all these different subsystems, to share and disseminate them to the many different audiences for health information, and to ensure that health information is used rationally,effectively and efficiently to improve health action.” Health Matrix network
- 18. WHO ARE THE MAIN ACTORS IN THE HEALTH INFORMATION SYSTEM? • A health information system should generate information for different uses by different health system actors. • Some of these actors operate at macro-decision level (for example, strategic planning, allocation of resources, and evaluation) while others operate at micro-management level (for example, case management)
- 19. Levels of production of health information and use of health information
- 20. HIS characteristics • Given the range of actors involved and the diversity of potential data items, it is imperative that the health information system has the following interlinked characteristics:
- 21. HIS characteristics … 1. The ability to identify detailed and disaggregated information items useful for decision- making at various levels within the health care system that are also immediately relevant at the level of data collection. 2.The ability to screen and channel to central level only what is most essential and detailed enough for strategic decision- making and policy analysis.
- 22. HIS principle • the different users of health information at different levels demonstrates three important principles
- 23. HIS principle … • 1. Different types of health-related data are needed at different levels of the health care pyramid – not all items of information need to be reported at every level.
- 24. HIS principle … 2. Those working at the periphery, closest to patient management, need more detailed information on clients seen and services provided than those working at the central level.
- 25. HIS principle … 3. In order to avoid overburdening health care workers at the peripheral level, managers and planners should consider carefully what type of data should be generated at each level.
- 26. Where are we coming from? Tons of data . . . little or no information . . . limited sharing
- 27. Where do we want to go? Research based solutions for sustainable Health Information Systems systems – models – strategies - mechanisms
- 28. Exercise - Information types Consider which category of information (operational, tactical or Strategic) each of the following belong to and to whom the information would be most appropriate? 1. Present pulse rate of a patient 2. Occupancy on a daily basis for a single hospital ward over the past month 3. Total number of admissions to the pediatric department at the hospital for diarrhoea and vomiting by month for the past year 4. Total number of infant deaths in each of the Regions in the past year 5. Daily urine output for a ward based renal patient 6. Total reported number of new HIV infected individuals in Ethiopia in the past year
- 29. HMIS: Definition • A HMIS is a system of record-keeping, reporting, processing, analysis, interpretation, use, and feedback of information. • A system designed to produce information to be presented to the management to assist in decision-making and to enable it to ascertain the progress made by the organization in the achievement of its major objectives (WHO 1971)
- 30. HMIS • MIS focuses on routine activities & provides operational information
- 31. HMIS provides information on: – Health status (through surveillance, surveys) – Health-related interventions and services (activities, progress, quality) (through surveillance, program monitoring and evaluation)
- 32. Management cycle Where are we now? Situation Analysis Where do we want to go? Objectives Where did we reach? Evaluation Which route shall we take? Strategy Is everything going according to plan? Monitoring Identifying constraints Taking action How shall we travel there? Plan of Activities HMIS
- 33. Problems in HMIS 1: Design 1. Top-down control, leaving out lower level 2. Unclear objectives and targets 3. Too much working time spent on HMIS 4. No guidelines 5. Not enough skills 6. Not enough staff 7. Fragmentation in services
- 34. Problems in HMIS 2: Collection • Too many records • Too late • Poor quality • Poor lay-out, confusing terminology • Incomplete • Potential exclusion of private and hospitalized patients • Inflexible data collection • Resistance to change
- 35. Problems in HMIS 3: (Self-) Assessment • Data not analysed to produce information, but just forwarded upward • No indicators to assess progress • Presentation not clear, out of date • Management culture does not value information (decision-making on intuitive or political basis only)
- 36. Problems in HMIS 4: Use • Inadequate training for managers • Data not available for the right persons at the right time • No feedback to lower levels, no pressure to use data • Data not used for supervision • Rigid criteria
- 37. A good HMIS system: • Provides all information required • Is easy to implement • Requires minimal staff time • Is consistent with other management and recording systems in place • Is useful for all stakeholders and is used
- 38. HMIS in Ethiopia • The old (AS-IS) HMIS • The new (TO-BE) HMIS
- 39. Old HMIS problems • Weak institutionalization • Uninterested un-standardized recording and reporting • Lack of information use • Poor linkage between data sources • Lack of appropriate ICT support
- 40. Old HMIS problems cont’d • Data collection; – Too much data items; • 400 at HCs, • 500 at WorHO – Irrelevant • Reporting; – Incomplete, Untimely – Redundancy, parallel administrative burden • Data analysis; – Not done at the point of collection
- 41. Old HMIS continued… • Different reporting formats/data definition • Duplication • Uncoordinated initiatives
- 42. Basic principles of the new design • Standardize – Indicators & definitions – Disease list for reporting & case definitions – Client / patient flow & data elements – Recording & Reporting forms – Procedure manual – Information use guidelines • Integrate – Data channel – Client / patient information at facility • Simplify – Reduce data burden – Streamline data management procedures
- 43. BASIC COMPARISION OF ‘As-Is’ AND ‘To-Be cont’d Service level As is To be HP 130-825 data elements Average: 353 50 data elements HC 101-649 data elements Average: 401 108 data elements Hospital 184-858 data elements Average: 457 150 data elements
- 44. BASIC COMPARISION OF ‘As-Is’ AND ‘To-Be cont’d Indicators As is To be Family health 50 21 Disease prevention and control 130 47 Resource 35 28 Health system 30 12 Total 245 108
- 45. Thank you!