Chapter 4 Health Management Information Systems.pdf

Chapter Four: Health Management Information System
1

Definitions
System - Any collection of components that work together to achieve a common
objective.
Health System - All the activities whose primary purpose is to promote, restore
or maintain health.
Information - Meaningful collection of facts or data.
Information System - Systems that provide specific information support to the
decision-making process at each level of an organization.
Health Information System - 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 system.
The ultimate objective of health information system is not “to gain
information” but “to improve action”
2

Why health information system?
❖Information is crucial at all management levels of the
health services from periphery to the centre. It is
required by policymakers, managers, health care
providers, community health workers.
❖Good management is a prerequisite for increasing the
efficiency of health services.
❖Improved health information system is clearly linked to
good management.
❖“Changing the way information is gathered, processed,
and used for decision-making implies changing the way
an organization operates.”
3

What is wrong with current HMIS?
❖Irrelevance of the information gathered
❖Poor quality of data
❖Duplication and waste among parallel health
information system
❖Lack of timely reporting and feedback
❖Poor use of information
❖The difference in culture between data people and
decision makers: Planning and management staff
rely primarily on “guess” to formulate public notice
hoc decisions rather ‘seek relevant data’.
4

Common subsystems of health information systems
are:
1. Epidemiological surveillance for notefiable
infectious diseases, certain environmental conditions,
and risk factors;
2. Routine service reporting from the basic health
services at community level, health centers,
dispensaries, first-level hospitals, referral hospitals,
and special and tertiary hospitals;
8

3. Special programme reporting systems such as
Tuberculosis Control, Leprosy Control, Malaria
Control, Maternal and Child Health and Family
Planning, Expanded Programme on
Immunization, and HIV/AIDS prevention;
4. Vital registration of births, deaths, and
migration.
9

5. Administrative systems including health
programme budget management, health financial
systems, health personnel systems, health supply
and logistic systems, health training programmes,
health research management, health
documentation management, and managing
external health resources for health; and
10

Surveillance
❖ Systematic ongoing collection, collation, and analysis of data and
the timely dissemination of information to those who need to know
so that action can be taken.
-- World Health Organization
OR
❖ The ongoing systematic collection, analysis, and interpretation of
health data, essential to the planning, implementation, and
evaluation of public health practice, closely integrated with the
timely dissemination of these data to those who need to know.
-- U.S. Centers for Disease Control and Prevention
11

Surveillances…
❖Surveillance is the continuous gathering of health
data needed to monitor the population's health
status in order to provide or revise needed
services.
❖Note the words "dissemination...to those who
need to know" in both definitions. This means that
collection of health data without sharing and using
those data is NOT surveillance.
12

Steps in carrying out surveillance
But surveillance involves carrying out many integrated steps by
many people:
Reporting
❖ Someone has to record the data. This is usually health care
providers who provide clinical care, such as doctors, nurses,
clinical officers, etc. They complete a form recording various
bits of information about patients seen in their practice.
Data accumulation
❖ Someone has to be responsible for collecting the data from all
the reporters and putting it all together. This is often someone
in the Ministry of Health, the local health authorities, or the
organization coordinating surveillance.
13

Data analysis
❖ Someone has to look at the data to calculate rates of
disease, changes in disease rates, etc. This is often an
epidemiologist with specific data analysis and computer
skills.
14

Judgment and action
❖ Someone has to decide, based on the results of analysis, what
needs to be done.
❖ This is often the public health authorities at the local,
provincial, or national level. In emergencies, it is often a joint
opinion of local and national health authorities, the
organization coordinating health, and all the organizations
providing health services.
❖ If any of these steps break down or is unavailable, you will not
have usable information with which to take the appropriate
(and sometimes necessary) public health action.
15

Types of surveillance
I. Passive surveillance
II. Active surveillance
III. Sentinel surveillance
16

I. Passive surveillance
❖ Passive surveillance often gathers disease data from all potential
reporting health care workers.
❖ Health authorities do not stimulate reporting by reminding
health care workers to report disease nor providing feedback to
individual health workers.
❖ Passive surveillance is the most common type of surveillance in
humanitarian emergencies.
❖ Most surveillance for communicable diseases is passive. The
surveillance coordinator may provide training to health workers
in how to complete the surveillance forms, and may even send
someone to periodically collect forms from health facilities.
❖ But little attention is given to individual health workers who
report the information.
❖ The data requested of each health worker is minimal.
❖ Nonetheless, passive surveillance is often incomplete because
there are few incentives for health workers to report.
17

II. Active surveillance
❖ An active surveillance system provides stimulus to health care
workers in the form of individual feedback or other incentives.
❖ Often reporting frequency by individual health workers is
monitored; health workers who consistently fail to report or
complete the forms incorrectly are provided specific feedback to
improve their performance.
❖ There may also be incentives provided for complete reporting.
❖ Active surveillance requires substantially more time and
resources and is therefore less commonly used in emergencies.
But it is often more complete than passive surveillance.
❖ It is often used if an outbreak has begun or is suspected to keep
close track of the number of cases.
❖ Community health workers may be asked to do active case
finding in the community in order to detect those patients who
may not come to health facilities for treatment.
18

III. Sentinel surveillance
❖ Instead of attempting to gather surveillance data from all health
care workers, a sentinel surveillance system selects, either
randomly or intentionally, a small group of health workers from
whom to gather data.
❖ These health workers then receive greater attention from health
authorities than would be possible with universal surveillance.
❖ Sentinel surveillance also requires more time and resources, but
can often produce more detailed data on cases of illness because
the health care workers have agreed to participate and may
receive incentives.
❖ It may be the best type of surveillance if more intensive
investigation of each case is necessary to collect the necessary
data.
❖ For example, sentinel influenza surveillance in the United States
collects nasopharyngeal swabs from each patient at selected
sites to identify the type of influenza virus. Collection of such
data from all health workers would not be possible. 19

Vital events
❖Vital records are the records of events recorded as
part of a civil registration system.
❖They include such events as live births, deaths,
fetal deaths, marriages, divorces and other related
occurrences, such as adoptions and legitimations.
❖Civil registration systems are established by law to
meet the specific needs of Governments and of
the individuals subject to the jurisdiction of the
civil registration law.
20

❖The records generated by the requirements of the
civil registration process have two main kinds of
uses.
❖First, they have importance as legal records
documenting the facts surrounding each
registered vital event.
❖ Second, the records may be aggregated to form a
body of vital statistics which, collectively, convey
important information about the persons
described in the statistics in summary form.
21

For Individuals
❖Civil registration records of birth supply legal proof
of identity and civil status, including name, age,
parentage, place of birth, nationality and
legitimacy.
❖Death records provide legal evidence relevant to
claims to inheritance of property, insurance
benefits and the legal right of a spouse to remarry.
❖Marriage and divorce records are essential for
establishing entitlements for tax deductions,
inheritance rights, alimony and the right to
remarry.
22

For government
❖Records documenting individual vital events serve
many administrative and governmental purposes.
❖Birth records facilitate public health activities,
such as post-natal care of mother and infant,
infant and child immunization, and infant feeding
programmes.
❖Death records are also used to identify specific
infectious diseases requiring public health follow-
up.
23

Uses of vital statistics
❖The aggregation of information taken from
individual civil registration documents produces
a body of summary data or vital statistics.
❖The data are essential for measuring levels and
trends of population size, structure and
geographic distribution.
❖In combination with periodic census data,
population projections based on those statistics
are an essential component of the planning
process for economic and social development.
24

Uses of vital statistics for public health
❖Trends in mortality by age, sex and cause of death
are key indicators of health and disease in a
population.
❖Information about the relative impact of specific
diseases on mortality can serve to direct priorities
for the prevention, treatment or research for those
conditions.
❖Data about live births, fetal deaths and infant
deaths are essential for programmers of prenatal
and post-natal care of women, and for infant
survival and growth.
25

❖Vital statistics are used for administrative planning
in other areas, such as housing, education, social
security and insurance.
❖Planning for production of consumer goods and
services often takes vital statistics data into
consideration.
26

Characteristics of vital data
1. Vital data are personal in nature
2. Vital records are legal documents
3. knowledge that those records will be reviewed by
others may influence the way the supplier of the
information (informant) provides the data
27

Protecting confidentiality
❖Protecting the confidentiality of vital records has three
purposes:
a) Protecting the privacy of individuals;
b) Improving the accuracy and completeness of data;
c) Enhancing research based on civil registration
documents
28

Types of VR
I. Civil registration
II. Sample registration
III. SAVVY
IV. Census and surveys
29

Sample registration systems
❖Implementation of VR with a high degree of resource
input and quality control in a selected number of
population clusters that are randomly selected from a
national sampling frame.
❖Combine both active registration and periodic household
surveys to assess the levels of missed events.
30

SAVVY
❖Sample registration with verbal autopsy
(SAVVY), employs random sampling of
clusters, and
❖Enumeration and mortality surveillance
methods developed in research demographic
surveillance systems.
31

Censuses and surveys
❖Population censuses (typically conducted at
intervals of 5–10 years or longer) are a main
source of demographic data.
❖Census data are frequently complemented by
nationally representative household surveys
conducted in samples of the population, such as
the Demographic and Health Survey (DHS)
32

Comparison with other data collection methods
Some comparison of different data collection methods
Rapid assessment Surveillance Survey
Often collects qualitative or
semi-quantitative data
Collects quantitative data Collects quantitative data
Collects wide variety of
data
Collects limited data Can collect wide variety of
data
Collects data on
convenience sample of
people and facilities
Often tries to collect data
on every case of illness
Usually collects data on
sample of population
Collects data at a single
point in time
Collects data over ongoing,
prospective time period
Collects data at single point
in time
Collects only data for
numerator of prevalence
and incidence rates;
Denominator must come
from separate source
Collects only data for
numerator of incidence
and prevalence rates;
Denominator must come
from separate source.
Collects data for numerator
and denominator, allowing
calculation of prevalence or
incidence rates
33

Development steps of HIS
Management
Information
System
Clinical
Information
System
MIS
CIS
GMIS
Geographical
Management
Information System
42

Chapter 4 Health Management Information Systems.pdf

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Chapter 4 Health Management Information Systems.pdf