An Essential Component of Health Systems Strengthening Presented on: May 23, 2011 Akiko Maeda Health, Nutrition & Population Network The World Bank

Health care is the worlds most information- intense industry due to the complexity and uncertainties inherent in the sector. Health Information Management is the glue which links health information to the health care delivery system. Information Technology is a critically necessary tool, but not sufficient for ensuring effective management support to the health system

A Quick Overview of the Complexity of the Information Structure of the Health System

Multiple Applications of HMIS HMIS Modules 1. Patient Management 2. Population Management 3. Disease State Management 4. Resource Management 5. Utilization Management 6. Financial & Fiduciary Management 7. Quality Management National Policy & Planning, Resource Allocation Decisions Clinical Services Management Health Insurance/ Payer Contract Management Public Health Surveillance &Program Management Evidence-Based Medicine (R&D) Courtesy, Dennis Streveler, University of Hawaii

Uses of HMIS: Examples 1. Patient Management 2. Population Management 3. Disease State Management 4. Resource Management 5. Utilization Management 6. Financial Management 7. Quality Management Clinic Information Systems Hospital Information Systems Laboratory, Radiology and Pharmacy Information Systems The Discharge Summary The Encounter Form The Electronic Medical Record

Uses of HMIS: Examples 1. Patient Management 2. Population Management 3. Disease State Management 4. Resource Management 5. Utilization Management 6. Financial Management 7. Quality Management Public Health Statistics (air, water, food…) quality Public Health Statistics (air, water, food…) quality Retrospective Reporting including the Annual Report Retrospective Reporting including the Annual Report Biostatistical analyses Biostatistical analyses Epidemiological studies Epidemiological studies Health Education Health Education

Uses of HMIS: Examples 1. Patient Management 2. Population Management 3. Disease State Management 4. Resource Management 5. Utilization Management 6. Financial Management 7. Quality Management Communicable Disease Surveillance Cancer Registry Diabetes Registry Hypertension Registry Coronary Arterial Disease Registry HIV Registry Other chronic case management

Uses of HMIS: Examples 1. Patient Management 2. Population Management 3. Disease State Management 4. Resource Management 5. Utilization Management 6. Financial Management 7. Quality Management Facility Management Biomedical Engineering Human Resource Management Pharmaceutical Inventory Supplies Inventory Management of scarce resources

Uses of HMIS: Examples 1. Patient Management 2. Population Management 3. Disease State Management 4. Resource Management 5. Utilization Management 6. Financial Management 7. Quality Management Utilization of inpatient services Utilization of outpatient services Utilization of diagnostic services Utilization of operating room theaters Utilization of pharmaceutical therapies

Uses of HMIS: Examples 1. Patient Management 2. Population Management 3. Disease State Management 4. Resource Management 5. Utilization Management 6. Financial Management 7. Quality Management Accounting Billing Budgeting Interface with insurance eligibility, insurance claims submission, insurance payments

Use of HMIS: Examples 1. Patient Management 2. Population Management 3. Disease State Management 4. Resource Management 5. Utilization Management 6. Financial Management 7. Quality Management LAST BUT NOT LEAST: Implementing clinical protocols and guidelines Quality Improvement and Safety Measures Outcomes Analysis

Building the Health Management Information System 8. Advanced Technologies 7. Electronic Record Keeping 6. Health Insurance Systems 5. Clinical Venue Systems 4. Management & Planning Tools 3. Resource Management 2. Accounting & Inventory 1. Health Statistics 0. Standard Setting and Master Planning Increasing Level of Development

Examples of World Bank HMIS Projects From Slovenia, West Bank/Gaza, and Egypt

Slovenia – Evolution of the National Health Information Strategy Initiated as a Health Information Clearinghouse concept based on the banking ATM system… … with secure smart card accessed only by using Professional Card (PC) used by Medical Professionals (Doctors and Nurses) according to their Data Access Rights Self-Service Terminals located at most Health Care Service Providers, Health Insurance Information locations and major Voluntary Health Insurance Companies

Slovenia Health Information Project Health Information Systems Standardization Healthcare Management - business process review and upgrading Health Information Center and its Governance who owns HMIS, who has access (security, confidentiality), and who governs information standards and ensures interoperability?

HMIS in West Bank/Gaza – an integral part of Health Systems Development Government Computer Center and Clinical Information System In 2000, a low-cost, secure platform was made available through the Government Computer Center. Health sector was one of the first to make use of this internet highway... … to create common service framework across a non-contiguous territory & building a virtual HMIS team from islands of expertise

HMIS in West Bank/Gaza – an integral part of Health Systems Development

Creating a Health Information Center as the focus of information technology expertise in the public sector (supported by the Government Computer Center) Sponsoring Palestinian Data Dictionary and Data Modeling activity across systems, venues and sectors Promoting the use of as a way to link geographically separated workgroups Project progress stopped due to the political situation on the ground HMIS in West Bank/Gaza – an integral part of Health Systems Development

Project Objective: To improve the financial sustainability and efficiency of social health insurance operations through the adoption of a proven business model for health insurance operations. >> HMIS is the backbone of the project. Egypt – Health Insurance Systems Development Project ($75 million)

Egypt – Health Insurance Systems Development Project New operational procedures for: Contribution management Claims management, Utilization management, including fraud control approved by the health insurance Board INDICATORS % of health insurance claims captured and processed through the new business management systems % of electronically processed claims rejected or escalated for medical appropriateness vs. rates detected by manual audit

Egypt Health Insurance Systems Development Project Design Health Insurance Management Information Systems are complex to design and implement. To maximize chances of success, the project was designed around three core contracts that will allow continuous feedback and adjustment process.