Health Management information system

1. Health Management information system Presenter: AkashRanjan Moderator: Dr. D.G.Dhambhare

2. Frame work: HMIS 1 Health Informatics 2. HMIS – Concept, 3.Framework for designing HMIS 4.Identifying information needs and indicators 5.Data collection methods 6.Data transmission, data processing (Use of information) 7.Management of HIS 8. Approaches to strengthening HIS 9. HMIS in NRHM 10. HMIS in Wardha 11. Benefits and Challenges 12. References

3. 1. Health Informatics • Discipline at the intersection of information science, computer science and health care. • Deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health • Tools include computer, clinical guidelines, information and communication system. • HIS is a component of Health informatics, enables the health system in better decision making and ultimately for the betterment of quality of health care.

4. Introduction • “Health Information systems”- “A system that provides specific information support to the decision-making process at each level of an organization” • It integrate data collection, processing, reporting, and use of the information necessary for improving health service effectiveness and efficiency through better management at all levels of health services. • Information is crucial at all management levels of the health services, from the periphery to the centre • The challenge for the health system is to optimize the management of service delivery in a way that minimize losses in effectiveness

5. Fig1: Information support to each step in the management cycle

6. 2 Framework for designing HMS Components of Health Information System

7. A Health Information System can broken down in two components: • Resources: • Persons (e.g. planners, managers, statisticians, epidemiologists, data collectors) • Hardware (e.g. registers, telephones, computers); • Software (e.g. carbon paper, report forms, data-processing programs) • Financial resources. • Aset of organizational rules. • the use of diagnostic and treatment standards • definition of staff responsibilities, • supply management procedures • computer maintenance procedures

8. Organization model of Health Services

9. 3 Identifying information needs and indicators • Indicator- “A data element placed in a given context so that it becomes information that can be acted upon and can be used for programme monitoring and management. • Proxy of a situation • Type of indicators • Count Indicators: Measure the number of events without a denominator eg. Number of newly detected cases of Tuberculosis 2. Proportion Indicators: Expressed as percentage, numerator is contained in denominator Proportion Indicators = Number of PHC’s without delivery table Total number of PHC

10. 3 Rate Indicators: Measures the frequency of an event during the specified time, usually expressed per 1,000 or 100,000 population Eg. Rate Indicator= No of cases of malaria in children of age <5 yr X k Mid year population of children of age <5yr Basic measure of disease occurrence 4. Ratio Indicator: Numerator is not included in denominator eg Ratio indicator= No of Male deaths due to HIV No of female deaths due to HIV Classification of indicators: 3 types • Based on logical framework of system • Programme Indicators: Family planning, reproductive health & nutrition • Monitoring & Evaluation indicators:

11. Classification based on logical framework • Input indicators-indicate resources invested in the system, e.g., number of doctors per 100,000 people. • Process indicators-indicate activities of the health system, e.g., percentage of doctors trained in safe delivery skills • Output indicators-indicate achievements made in specific health strategies e.g. percentage of women who received 3 ANCs • Outcome indicators-indicate achievements of a health programme or health system. e.g institutional delivery rate, breastfeeding in one hour rate etc • Impact indicators-indicate achievements in health status of particular group of people e.g. Maternal Mortality Ratio, Infant Mortality Rate, Total Fertility Rate etc.

12. Data Quality: • Data quality refers to the extent to which data measures what they intend to • Parameters of data quality are: • Completeness • Timeliness • Accuracy • Data entry errors • Systemic errors • What to do if the error has been found in report? • Go back to the registers and check the value, correct it • Staff understands meaning of this data element • In the forthcoming month, check the value

13. 5 Data transmission, data processing • Data Transmission: Transfer of raw data from lowest level to higher levels of health system for the purpose of data processing • well designed information system will ensure relevant not only for the decisions that must be made by higher levels, but also for day to day m/m at the health centre level

14. Vertical data Transmission-transfer of information between levels of health care system

16. Horizontal data transmission-Transfer of data among actors and consumers at the same level of health care system. • Purpose: • Provide data that is directly relevant to decision making at lowest level of HCS. • data that are useful to inform decision making but that require further processing in order to do so. • community actors and consumers have access to compiled information from the health system Data processing: • Goal: To present information, that aids decision making at all levels of health care system • Produces information that is useful for decision making, that is presented in a summary form that is most comprehensible to a wide range of players in the health care system.

17. 6 Management of HIS Elements of Health Information system(HIS) Management • The basis for HIS management is a solid management structure, including affordable HIS resources and a well established set of organizational rules

18. 7. Approaches to strengthening health information systems • Plethora of irrelevant or low-quality data. • Make decisions based on “gut feeling” • Characteristics of health information system development approaches that are likely to fail • The folly of pursuing the grand design • HIS restructuring for central-level data accumulation(Page 145) • Collection of non useful data. • Information needs based on detailed decisions (lengthy data) • Mistaking computerization for HIS restructuring • Donor-driven health information system

19. Characteristics of HIS development approaches that are likely to succeed • Start every HIS development effort with the definition of indicators • Apply an evolutionary, problem-directed approach for improving the HIS • Include policy analysis as a full part of HIS assessment • Enable broad participation in the health information system design process, but ensure technical soundness throughout by the use of a HIS design team • Introduce information technology in an effective, efficient, and sustainable manner

20. 8. HMIS in NRHM

21. One of the major contributions of NRHM has been to put in place a nationwide HMIS • Quality of data reported increasing but the challenge now is to make the information available to Programme Managers, and help them to use it for improving service delivery and health outcomes

22. HMIS Portal • To enable capturing of public health data from both public and private institutions • Initially rolled out up to the District Level and now being expanded to the Sub District/Block level facility wise data entry • Objectives • To enable user to preview, compare, modify and forward data to the next level. • The data stored by using the Data Entry Application would be transformed and will be used for Statistics, Analytical & Ad-hoc reporting. • To consolidate the data entered at facility, sub-district level/block, district level, at the state level and further at national level and store it into the central database

23. HMIs portal is a reservoir of health related information of MOHFW. • It is divided into two domains, Public and Secured. • The information available in the public domain is accessible to all and anyone can view and download the reports in this section. • The information in the secured domain is accessible to a selected set of users of HMIS Portal. This is secured by a user ID and password provided by GoI. • The secured domain is for the Block/District/State and National Level users, to enter and view the data.

24. Flow of Data: Bottom up PHC PHC PHC SC SC

25. Data aggregation unit • Place where the data is collected and consolidated • District HQ, Block HQ, Sub-Divisional Hospital, District Hospital, CHC • or a even a PHC

26. Analytical reports • Analytical report is for Monitoring and Evaluation of performance indicators of RCH and other programs. There are few build in report which can be generated from the portal. • 1. Performance of RCH • 2. HMIS indicators • 3. District wise contribution/RCH • Feedback and Queries • For feedback, queries, suggestions, error reporting or any help/support hmis-nrhm@nic.in .The emails are answers within 48 working hours.

27. 9. HMIS in Wardha District • HMIS is working in the form of DHISII since 2010-11. It is basically online reporting system, the flow of data is bottom up. • Flow of data

28. Benefits • Transparent, once data entered no chance of manipulation • Faster, data can be entered online or offline. • Critical analysis of data can done at every step from PHC, district, and state, in comparison to previous system where it was done at the or beyond the district level. • Information of previous month is available at state level with in the first 15 days of every month. • Most of them appreciated the improvement of system in last 2 years.

29. Challenges: • Not skilled man power, especially at peripheral level. Even at district level data entry operators, and monitoring & evaluation officer (MulyaMapanAdhikari) post is on adhoc basis. • Once the data is entered in forward mode, can’t be change (Even the typographical mistakes) • A total of 631 entries at SC level, and 1908 entries have to fill at PHC level. • Peripheral workers don’t get feedback, that doesn’t help in motivating them for quality work and participation in the process.

30. References: 1. Design and implementation of health information system. Geneva: World health Organization, 2000. 2. Guidelines for the development of Health Management Information System. Manila: Regional Office for the western pecific, 1993. Report No.: 92 9061 106 5 3. HEALTH PROGRAMME MANAGERS’ MANUAL: Understanding Health Management Information System: MoHFW, editor. New Delhi 2011.

31. The real problem is not unavailability of information but “plethora of irrelevant”. The real challenge is use valid & appropriate information rather than “gut feeling” in decision making Thank You