Health Management Information Systems and Integrated Health Information Architecture

1. Health Management Information Systems and Integrated Health Information Architecture

2. Learning Objectives • Students should build an understanding of • Different types of health information systems (HIS) • Integrated Health Information Architecture (IHIA) • Why is it important to have an IHIA perspective • Tools for enabling an IHIA • A social systems perspective towards IHIAs

3. Key concepts • System • Health Information Systems • Health Management Information System • Electronic Medical Records • Human Resource Information System • Logistics Managament Information System • IHIAs • Data warehouse • Data, Information, and Knowledge • Social systems perspective

4. A System • A system can be conceptualized as interconnected components with processes around: • Input • Throughput • Output • Feedback. • Example: An Educational system • Input: resources, students, teachers, schools etc • Throughput: teaching, group work, exams etc • Output: students with degrees, skills, experiences etc • Feedback: quality of teaching, employment of students Ny Powerpoint mal 2011

5. Health Information Systems (HIS) • A healthinformationsystem denotes processes of input, throughput, output, and feedback around health related information • The goal of an HIS is to is to produce relevant information that health system stakeholders can use for making transparent and evidence-based decisions for health system interventions (HMN 2005) Ny Powerpoint mal 2011

6. Information part of the larger Health System

7. HIS has multiple meanings • For the health managers, it means aggregate data; Health Management Information System (HMIS) • For the nurses and doctors, it means data related to patients; (electronic) medical records (EMR) • For the lab technicians, it means data related to blood samples and test results; laboratory information system • Similarly, for human resources, logistics, finance, etc • Thus, HIS is a much broader term which encompasses these various information systems

8. Ny Powerpoint mal 2011

9. Health Management Information System (HMIS) • Focus on the needs for health management • Processes of PODC - (Planning, Organizing, Directing & Controlling). • The collection and use of information in order to make decisions regarding the effective and efficient allocation of resources. • Emphasis is on routine (service) aggregate data and its analysis over time and across geographical space Ny Powerpoint mal 2011

10. Management Process Decision making (about effective & efficient allocation of resources) Gathering Information Ungathered Gathered Information Information Unallocated Effectively & efficiently Resources allocated resources Decision Decision implementing/resource allocation Achievement of desired aim

11. Electronic Medical Records (EMR) • Are related to patient care, and focus on patient data (name, age, symptoms, medical history, test results etc), and is collected longitudinally over time • Functionality is around patient care, registration symptoms, test results, medicine prescription, referrals, billing, etc. Ny Powerpoint mal 2011

12. EMR: Supports patient workflow Hisp India

13. Human Resource Information System (HRIS) • For the management of human resources, with data related to staff (name, profession, diplomas, salary, etc) • Functionality of the system is geared towards managing hiring, distribution, payment, education, training, and certification of staff, over time Ny Powerpoint mal 2011

14. Source: Good Health at Low Cost 25 Years on What make a successful health system?

15. Countries with a Critical Shortage of Health Care Providers N. Engl. J.Med 2007, 2564-67

16. Logistics Management Information Systems (LMIS) • Related to the logistical tasks around distributing health related commodities, such as vaccines, medicines, instruments, etc • Functionality for inventory management, ordering and procurement, tracking commodities, certifying suppliers, forecasting etc Ny Powerpoint mal 2011

17. Integrated Health Information Architectures (IHIAs) • An overall framework for how these various information systems work together and speak to each other (HMIS, EMR, HRIS, etc) • Integrated: • Working together, sharing definitions and data • Integrated has different meanings to different people: here it means they can speak to each other and share data across the subsystems • Architecture • Collection of sub-systems; organized to form a whole, but have different roles • An architecture describes their roles and relationships Ny Powerpoint mal 2011

18. IHIA is a system of systems, and their roles and relationships IHIA HMIS Laboratory IS LMIS EMR HRIS Ny Powerpoint mal 2011

19. Why is it important with IHIAs? • To share data • Build powerful analysis by combining data sources and study cross-cutting indicators • Improve quality by reducing duplication and manual transmission of data • Resource optimization • Reduce duplication of data collection • Reduce development and maintenance of overlapping systems Ny Powerpoint mal 2011

20. Example: Connecting HR and clinical data Service delivery data comes from many sources HMIS Patient records Health worker deployment also data comes from many sources Payroll at Ministry of Finance, HR System at Ministry of Health Licensure and Registration from councils Training information systems Connecting these two data sets among multiple systems allows new questions to be asked and answered What facility is most in need of nurse midwives? Which districts should we target training for chronic diseases? Where should we prioritize financial incentives to retain health workers? DRAFT

21. Example: Calculating deliveries per midwife Data warehouse Statistical data Number of deliveries aggregated and shared Number of midwives aggregated and shared Human resource system Medical records Data and functionality on each staff Data and functionaity for each delivery

22. Tools for enabling an IHIA • Data warehouse • Standards and interoperability Ny Powerpoint mal 2011

23. Data warehouse • A database compiled from differerent sources, designed to process and present data for a multiplicity of users, based on their needs • For an IHIA, a data warehouse should contain data from all the subsystems related to health, including service data, census, surveys, environmental data etc. • Also called an integrated data repository Ny Powerpoint mal 2011

24. The HMN model of a data warehouse/integrated data repository Ny Powerpoint mal 2011

25. The benefits of a data warehouse • Availability of different data sources in one place: for creation of indicators for analysis • Can combine different data sources • Enables business analysis intelligence • Enables data mining • Customized outputs for different users • Enables the possibility of new systems and data sources being plugged in (and out) Ny Powerpoint mal 2011

26. Example: availability of various data in one place – from Sierra Leone Nutrition and population Malaria Antenatal & population Deliveries and population Immunization & population Data Quality

27. Example: Dissemination and presentation: Customized dashboards Ny Powerpoint mal 2011

28. Example: Dissemination and presentation

29. Standards and Interoperability • Standards allows the various subsystems of an IHIA to share data • Standard data definitions • Data exchange standards • When subssystems can share data and work together as an IHIA, they are interoperable • Contentious area: a «standard» is not just created and accepted by all Ny Powerpoint mal 2011

30. Data, Information, Knowledge: founding blocks of an (H)IS Increasing usefulness Ny Powerpoint mal 2011

31. From Data to Knowledge Data-is raw material in form of numbers, characters, images. This is the basis of creating information after analysis Information: is a meaningful collection of data organized with reference to a context (time, other facilities, denominators) Knowledge: when information is analyzed, communicated and acted upon, it becomes knowledge Data Information Knowledge

32. Example of value chain from Data to Knowledge • Data: 23 children with Malaria in a district • Context makes Information: There are 1425 children in this district. This gives a incidence rate of 1.6% • Analysis and action creates Knowledge: This is not so high, but higher than last month and the neighbouring district. Why is this? We must check if they have enough bednets to distribute at the facilities Ny Powerpoint mal 2011

33. A social systems perspective: ”Airplanes don’t fly, airlines do” • An IHIA does not exist in a vacuum: • It is not only about technology and software • An IHIA is not built from scratch • There are existing structures in all countries, the IHIA grows out of this • A social systems perspective helps us to understand the complexity of the IHIA Ny Powerpoint mal 2011

34. A social systems perspective • People, routines, organizations, institutions, tools (such as a data warehouse, and paper forms), legislature, instructions etc • These exist in a context, shaped by history, social, institutional and political conditions • It can be seen as a social web of ministry officials, vendors, other government entities, international organizations, NGOs, involvement of evolving technology and infrastructure Ny Powerpoint mal 2011

35. A social system is a complex system • The HIS consists of thousands of staff, who collect, process, analyse and use health data in a variety of ways, with the help of various tools, enforced by legislation and shaped by the larger social system they are part of. • HIS are thus complex systems • It is not the technology that is the HIS, but the social system as a whole. Socio-technical systems Ny Powerpoint mal 2011

36. HIS development from a social system perspective • An HIS is never built from scratch, but exists as a social system. There is always a history associated, which has to be engaged with • The introduction of new routines, new technology etc. thus takes place in a highly complex and embedded setting, and will thus not be simply overruled • Unintended consequences are the order of the day – things dont happen to as we plan Ny Powerpoint mal 2011

37. HMN study of over 60 countries assessment • Mostly countries from low and middle-income countries • Main findings • Data management and resources are the areas in which most countries struggle

38. Overall score, 54 countries

39. Across income levels...

40. Common problems I • Policies for HIS • Access • Routines • Ownership • Standards • Human resources • With right skills? • HIS Staffing not prioritized

41. Common problems II • Data management • Fragmented, no central HIS unit • Appropriate technology • Information use • Too much collected, too little used • Little incentive to use information locally

42. Recap • IHIAs consist of many systems which speak to each other • A data warehouse is a key tool in the development of IHIAs • IHIA is much more than technology, and requires a social systems perspective to it’s understanding • Data is not knowledge; it requires to be sensitively cultivated Ny Powerpoint mal 2011