Health Information System

1. Health Information System

2. Definition of HIS “A mechanism for the collection, processing, analysis and transmission of information required for organizing and operating health services, and also for research and training” WHO Chronicle Report, 1973

3. Distinction between Data Information • facts and statistics used for reference or analysis • facts or knowledge provided or learned • what is conveyed or represented by a particular sequence of symbols, impulses, etc.

4. Data “Discrete observations of attributes or events that carry little meaning when considered alone ”

5. Information “Data is transformed into information by reducing, summarizing and adjusting them for variations” Ex: Age and sex composition of the population for comparison over time and place

6. How should be HIS? • Population-based • Problem-oriented • Avoid unnecessary agglomeration of data • Employ operational and functional terms • Ex: Episodes of illness, treatment regimen, lab tests • Express information briefly and imaginatively • Ex: Tables, percentages, charts • Provision for feedback of data

7. Components of HIS • Demography and vital events • Environmental health statistics • Health status • Mortality, morbidity, disability and quality of life • Health resources • Facilities, beds, manpower • Utilization and non-utilization of health services • Attendance, admissions, waiting lists • Indices of outcome of medical care • Financial statistics (cost, expenditure)

8. Uses of HIS • Measure health status of people; quantify their health problems and medical and health care needs • Local, national and international comparisons of health status • Planning, administration and effective management of health services and programmes • Assessing whether health services are achieving their objectives in effectiveness and efficiency • Assessing attitudes and degree of satisfaction • Research into particular problems

9. Sources of Health Information • Census • Registration of vital events • Sample Registration System (SRS) • Notification of diseases • Hospital records

10. Sources (continued) • Disease registers • Record linkage • Epidemiological surveillance • Other health service records • Environmental health data • Health manpower statistics

11. Census • Most important source • Collecting, compiling and publishing • Demographic data • Economic data • Social data • First in 1881, then every 10 years • Usually conducted at the end of first quarter of first year in a decade • Last census was in March, 2011

13. Primary function - provides demographic information • Contains • Social and economic characteristics of people • Conditions of life, work and income • Frame of reference - planning, action and research • Methods: • De-facto method: persons are enumerated according to their location at the time of enumeration; used in India • De-jure method: Used in developed countries like USA; persons are assigned according to their “usual” place of residence and not according to their location at the time of census

14. Registration of Vital events • Reliable source if complete and accurate • Precursor of Health statistics • 1873 – Births, Deaths and Marriages Registration Act • 1969 – The Central Births and Deaths Registration Act • Of late – Lay reporting by Voluntary Health Guides

15. Sample Registration system (SRS) • Initiated in 1965 • Dual record system by enumeration of births and deaths + half yearly survey as a check • National and State levels • Covers the entire country • More reliable • Major source of health information in India

16. Notification of diseases • First health information sub-system • 1897 – Epidemic Disease Act • 1930 – Madras Public Health Act • International Health Regulations • Cholera • Plague • Yellow Fever • International Surveillance - Louse borne Typhus, Relapsing Fever, Polio, Influenza, Malaria, Rabies, Salmonellosis

17. Notification of diseases • Limitations: • Covers only small part • Under-reporting • Atypical and sub-clinical cases escape • Rubella • Non-paralytic polio • Advantages: • Fluctuations in disease frequency • Early warnings – new occurrences/outbreaks

18. Hospital records • Basic and primary source of information • Role of MRD is very vital • Drawbacks: • “Tip of iceberg” • Highly selective • Population served cannot be defined • Only numerator provided, not denominator

19. Hospital records • Advantages: • Precise diagnosis • Medical and surgical procedures • Lab data • Complications • Great value in planning of Health Care Services

20. Disease registers • “Registration > Notification” • Register: • Permanent record established • Follow up cases • Basic statistical tabulations prepared • Morbidity registers

21. Record linkage • Medical Record Linkage: Assembly and maintenance for each individual in a population, of a file of the more important records relating to his health • Drawback • Volume of data that can accumulate • Applied in: • morbidity measurement • chronic disease epidemiology • family & genetic studies

22. MARRIAGE PROCEDURES BIRTH Medical records ABSENCE FROM WORK DISCHARGE HOSPITAL ADMISSION

23. Epidemiological surveillance • Set up in the epidemic countries were special/eradication programs have been instituted for the epidemic disease • Eg: for Malaria, TB, Leprosy etc. • Drawbacks: • Relates to certain segment of general population only • Used for administrative purposes rather than for monitoring

24. Health manpower statistics • Very important statistical data • Relates to number of • Physicians • Dentists • Pharmacists • Veterinarians • Hospital nurses • Medical technicians, etc Classified by age, sex, specialty and place of work

25. Maintained by • State medical/dental/nursing councils • Directorates of Medical Education • Use • provides information about occupation • “Health Information of India” - Published by Government of India (Ministry of Health & Family Welfare)

26. Population surveys • surveys supplement the routinely collected statistics • “Health survey” • surveys related to morbidity, mortality, nutritional status • “Morbidity survey” • surveys related to diseases suffered by patients • Health survey includes:- • Surveys for evaluating the health status of a population • Surveys for investigation of factors affecting health and disease • Surveys relating to administration of health services

27. SURVEY METHODS • Health interview (face to face) survey • Health examination survey • Health records survey • Mailed questionnaire survey 1.Health interview survey • Invaluable method of measuring subjective phenomena • perceived morbidity, disability and impairment, opinions, beliefs, attitudes • population based data

28. 2.Health examination survey Information about morbidity carried out by team of doctors, technicians and interviewer expensive and done on an extensive scale 3.Health records survey Collection of data from health service records Cheapest Not population based, not reliable, no standardization

29. 4.Mailed questionnaire method no interviewer simple and cheap can be sent from any place by mail not applicable for illiterates, non response

30. Other routine statistics • Demographic • population density • movement • educational level • Economic • tobacco • dietary fats • domestic coal • Social Security Schemes • medical insurance

31. Non-quantifiable information • Required by health planners and decision makers • Health policies • Health legislation • Public attitudes • Program costs • Procedures • Technology