1. Integrated Health Information Architecture (IHIA)

2. Learning Objectives –Health System is more than point of care –Different types of health information systems –Integrated Health Information Architecture (IHIA) –Global movement towards IHIAs –Enablers of an IHIA data warehouse Standards and interoperability

3. 4 What is health?

4. 5 What is health service quality?

5.  Political commitment to health as a social goal  Societal values of equity, political participation and community involvement in health  Investments in Primary Health Care  Widespread education (women) Societal factors contributing to health

6. 7 1)to understand and influence how the health care service delivery operates: access, coverage, continuity of care, risk assessment 2)efficient and effective service delivery Health care resource allocation indicators (per capita):  distribution of qualified health personnel  distribution and type of health services  distribution of health expenditure on personnel, supplies, facilities Health care utilization indicators:  immunization coverage  antenatal care coverage  proportion of births attended by a skilled attendant Health status indicators:  Infant mortality rate  maternal mortality  life expectancy at birth  prevalence/incidence of infectious diseases Benchmarks for National Health Systems

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

8. 9 WHO Health System building blocks

9. Human resources

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

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

12. 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, and certification of staff, over time 13

13. Electronic Medical Records (EMR) -Are related to patient care, and focus on patient data (name, age, symptoms, medical history, test results etc) -Functionality around patient care, registration symptoms, test results, medicine prescription, referrals, billing, etc. 14

14. EMR: Support Patient workflow

15. 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 16

16. 17 Health information subsystems A National health information system consist of several subsystems  Routine data collection based on patient and service records and regular reporting from community health workers & health facilities  Disease surveillance and outbreak notification  Programme-specific monitoring and evaluation (ex: EPI, Malaria, TB, HIV/AIDS)  Administration and resource management (budget, personnel, supplies)  Data generated through household surveys  Registration of vital events and censuses (births, deaths and causes of death) Individual /program tracking Aggregate data

17. 18 Some benefits of good HIS -providing (continuity of) care to patients (medical staff) -assist decision makers in detecting and controlling emerging and endemic health problems -monitor progress towards health goals/targets (MDGs) -promote equity (many not counted!) -strengthening the evidence base for effective health policies -permitting evaluation of health system interventions over time -ensuring accountability in the way resources are used

18. HIS around the world Huge differences between national health information systems (HIS), however generally a move from paper to digital and hence potential integration of systems Common national challenges: –Little use of health information (locally) –Too much data collected –Low quality of information –Fragmentation of information streams –HIS Staffing not prioritized 19

19. 20 Typical national HIS setup 20

20. Integrated Health Information Architectures (IHIAs) An overall framework for how these various information systems work together (HMIS, EMR, HRIS, LMIS, etc) Integrated (appearing as one) –Working together, sharing definitions and data across information systems Architecture –Collection of sub-systems; organized to form a whole, but have different roles –An architecture describes roles and relationships between systems 21

21. IHIA as a system of systems, their roles, and relationships 22 HMIS EMR HRIS Lab. IS LMIS IHIA

22. Why is it important with IHIAs? To share data –powerful analysis by combining data sources –improve quality by reducing duplication and manual transmission of data Resource optimization –reduce duplication of data collection –reduce development and maintenance of overlapping systems 23

23. Example: Combining HR and clinical data Service delivery data comes from many sources HMIS such as DHIS2 Electronic Health Records Health worker deployment data comes from many sources Payroll at Ministry of Finance, HR System at Ministry of Health Licensure and Registration from councils Combining these two data sets across 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?

24. Example: Calculating deliveries per midwife

25. Global Movement towards IHIA Health Metrics Network (since 2005) –Build consensus around integrated data warehouses –provide a framework for building IHIAs –many countries have developed strategic plans to work towards an IHIA Donors changing approach: Paris declaration (2005) –build on local systems; local government decisions, but still donor specific reporting requirements –collaboration between donors (harmonization), but hard to accomplish in practice –shift funding towards evidence-based interventions, but dependent on reliable information 26

26. 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 27

27. The HMN model of a data warehouse - integrated data repository 28

28. Example: combining various data Immunization & population Deliveries and population Antenatal & population Malaria Data Quality Nutrition and population

29. Standards and Interoperability -Standards allows the various subsystems of an IHIA to share data –Standard data definition –Data exchange standards - When the sub-systems can share data and work together as an IHIA, they are interoperable More about these two concepts later in the course 30