1. Health Management Information Systems

2. Why health information system?
Good management is a prerequisite for increasing the efficiency of health services.
Improved health information system is clearly linked to good management.
Information is crucial at all management levels of the health services from periphery to the centre. It is required by policymakers, managers, health care providers, community health workers.
“Changing the way information is gathered, processed, and used for decision-making implies changing the way an organization operates.”

3. Definitions
System - Any collection of components that work together to achieve a common objective.
Health System - All the activities whose primary purpose is to promote, restore or maintain health.
Information - Meaningful collection of facts or data.
Information System - Systems that provide specific information support to the decision-making process at each level of an organization.
Health Information System - A set of components and procedures organized with the objective of generating information which will improve health care management decisions at all levels of the health system.
The ultimate objective of health information system is not “to gain information” but “to improve action”

4. What is wrong with current health MIS?
Irrelevance of the information gathered
Poor quality of data
Duplication and waste among parallel health information system
Lack of timely reporting and feedback
Poor use of information
The difference in culture between data people and decision makers: Planning and management staff rely primarily on “gut feeling” to formulate ad hoc decisions rather seek pertinent data.

5. Relations between functions and objectives of a health system
Stewardship
Responsiveness
to people’s non-medical
expectation
Creating resources
investment and training
Delivering services
(provision)
Health
Fair (financial)
contribution
Financing
(collecting, pooling
& purchasing)

6. Service delivery functions in health units
First level (dispensaries)
To provide curative care for the most common health problems
To provide prenatal care services
To organize under-5 clinics (including immunization)
To provide family planning services
To provide IEC services in the catchment area
Secondary level (First referral level)
To organize out-patient referral clinics
To provide in-patient services
To manage medical, surgical & gynecological emergencies
To provide X-ray and laboratory facilities
Tertiary level
To provide all types of surgical interventions
To provide specialized care

7. Management functions in a health service system
The central level (Ministry of Health) is responsible for:
Health policy formulation, including policy on intersectoral activities
Production of national health plans and guidelines for local planning
Advisory role on allocation of resources, particularly capital funds
Source of high level technical advice for specific programmes
Training and regulation of health personal development
Regulation of private profit and nonprofit health organization
Control of national health organizations and research institutes
Liaison with international health organizations and aid agencies
State level is responsible for:
State health planning and programme monitoring
Co-ordination of all regional health activities
Employment and control of the health personnel
Budgeting and Auditing the health expenditure
Managerial and technical supervision of district health teams
Provision of supplies and other logistical support

8. Management functions in a health service system (contd.)
The Districts have the following main functions:
Organizing and running the district hospital
Managing all other government health facilities
Implementing all community-based health programmes
Managing and controlling local health budgets
Co-ordination and supervision of all government, non-government and private health services within the district
Promoting active links with local government departments
Promoting community participation in local health service planning
Preparing an annual health plan
Raising additional local funds
In-service training of health workers
Supervising and controlling all community health workers in the district
Collecting and compiling routine health information and forwarding it to regions and ministries of health

9. Steps involved in restructuring of Health MIS
Step 1: Identifying information needs and feasible indicators
Step 2: Defining data sources and developing data collection instruments for each of the indicators selected
Step 3: Developing a data transmission and processing system
Step 4: Ensuring use of the information generated
Step 5: Planning for health MIS resources
Step 6: Developing a set of organizational rules for health information system management

10. Step 1: Identifying information needs and feasible indicators
Identifying information needs for follow-up of a pregnant woman in a primary level
Identifying indicators to ensure efficient drug management in a referral hospital
Identifying indicators to ensure efficient Information, Education and Communication in the community
Identifying indicators to monitor the quality of supervision by the district management team

11. Step 2: Defining data sources and developing data collection instruments for each of the indicators selected
Develop an appropriate record form for follow-up of haemo-dialysis in a tertiary care hospital
Develop a monthly reporting form for activities performed in a primary level clinic
Define data sources for a situational analysis at the district level
Develop data sources for monitoring the quality of teaching in a medical college

12. Step 3: Developing a data transmission and processing system
Structure the information flow on pregnant women between the traditional birth attendant and midwife in the health centre
Ensure that monthly report forms from health centres are entered in the district computer in a timely and accurate manner
Develop a mechanism for reporting of Research done in a research centre

13. Step 4: Ensuring use of the information generated
Develop user-friendly feedback formats for regional mangers on the utilization of inpatient services in the region
Train health auxiliaries in follow-up procedures for hypertension patients using a standard record form
Develop a curriculum for the undergraduate and post-graduate students depending upon the need in the country
Ensure research on the priority health issues for the country

14. Step 5: Planning for health MIS resources
Create positions of computer operators in cases where district level data processing is computerized
Submit revised recurrent cost budgets based on proposed new data collection procedures
Step 6: Developing a set of organizational rules for health information system management
Develop standard case definitions
Change the job description of doctors in cases where health information system restructuring involves their active participation in data collection
Develop an instruction manual for computer operators

15. planning and management
Information process
Data collection
Resources
Data transmission
Management
Data processing
Organizational rules
Data analysis
Information for use in
planning and management

16. Knowledge states Processing activities
Valuation
Weighing option
Interpretation
Analysis
Sorting selection
Collection
Decision
Judgement
Understanding
Knowledge
Information
Data

17. Advice from peers Donors
Budget constraints
Advice from peers Donors
Political parties Unions
Community Past experience
Religious groups Special interests Media
Information
Process of decision-
making
Decision

18. Ways to enhance the use of information in decision-making
Characteristics of the data
Characteristics of the problems and the decisions they require
Organizational or structural characteristics
Cultural differences between ‘data people’ and ‘action people’
The communication between the two

19. Characteristics of the data
Ownership and relevance
Validity and reliability
Aggregation of data
Customizing information to the users’ needs
Timeliness of feedback

20. Different characteristics of the users (action people) and the providers of data (data people)

21. Sybsystems of Health Information System
WHO proposes to categorize the health information system under five interrelated “subsystems”:
Epidemiological Surveillance (notifiable infectious diseases, environmental conditions, and risk factors)
Routine service reporting
Special programmes reporting systems (tuberculosis and leprosy control, MCH, school health)
Administrative systems (health care financing systems, health personnel systems, logistic systems)
Vital registration systems (births, deaths, and migratory movements)

22. Communication Communication process within a health team
Feedback process
Communication products
Time comparison
Geographical comparison
Comparison of actual performance vs. mean performance
Comparison of actual vs. planned performance

23. A framework for defining information needs and indicators
Perform a functional analysis at each management level of the health service system
Identify information needs and select feasible indicators
Patient / Client management
Health Unit management
Health System management

24. Indicators
Indicators are variables that help to measure changes, directly or indirectly. - WHO
Indicators are variables that indicate or show a given situation, and thus can be used to measure change Green
Input indicator
Process indicator
Output indicator
Outcome indicator
Determinant indicator
Count indicator
Proportion indicator
Rate indicator
Ratio indicator
Index

25. Helpful questions in selecting good indicators
What is the indicator supposed to measure (validity)?
What will be the cost of measuring the data to arrive at the numerator and denominator of the indicator?
What is the relative importance of the subject matter to be addressed and the decision to be made based on the indicator (relevance)?
Does the indicator actually capture the changes that occur in the situation under study (specificity)?
Is the change shown by the indicator a true change in the situation under study

26. Helpful questions for operationalizing the indicator
What are the sources of the data (numerator & denominator)?
At what frequency should the numerator and denominator be collected?
At what frequency should the indicator be processed and analyzed?
Who will actually make use of the indicator?
What is the target of the indicator that needs to be collected?
What is the threshold for the minimum and maximum value of the indicator that should trigger an action?
What will be the nature of the action (decision) once the indicator reaches the threshold?

27. Types of routine data collection methods
Health unit data collection
Community data collection
to monitor activities performed in the community by health unit staff or by community health workers
to obtain more representative data on the health status and living environment of the communities served, including data on births and deaths in the community, agricultural and meteorological data, data on education etc.
to assist in planning for health services that are more accessible to community
Civil registration systems

28. Data collection instruments
Data collection instruments for patient/ client management
Preventive
Growth cards
MCH cards
School health card
Family registration records
Curative
Medical records
Laboratory forms
Referral forms
Other issues
Content (comprehensive)
Record filing (patient-retained vs.. health unit-retained)
Layout (self-explanatory)
Production form
Electronic patient record

29. Data collection instruments for health unit management
Service delivery records
Registers
Tally sheets (Abstract register
Population charts
Resource Management records

30. Data collection instruments for system management
Health unit report forms
Supervisory checklists
ISSUES
Layout
Computerization

31. Design & Implementation of routine data collection systems
How many and what type of data collection instruments will be needed to respond adequately to the defined information needs?
Are existing instruments adequate, or do they need to be modified?
If new instruments are needed, how will they be developed?
How will the new data collection instruments be introduced to the care providers in charge of data collection?
Other issues
Relevance
Feasibility
Burden
Layout & Clarity

32. Nonroutine methods & types of data generated

33. Health System Model management D E M Burden of A disease N Service
delivery
organization
infrastructure S A T I F Y
financing
Other
factors

34. Rapid assessment procedures
Key elements
Short interval for data presentation
A methodological pluralism
Orientation towards action
Methods used
Participant observation
Individual interviews
Focus group
Review of reports and other documents
Checklists for facilities, equipment etc.
(Clinic exit surveys & household surveys)

35. Computers in MIS
Optimization of the scarce resources available for health care, specially in developing countries
Information - accurate, comprehensive
Retrieval of information - quick
Decisions - quick
Implementation - rapid
Monitoring - adequate
Large geographical area can be covered

36. If computer network is established to cover all the CHCs
More speedy communication of data
At national, state & district levels, processing can be done for valuable information
Obtaining coverage levels for various activities
Age-specific & area-specific figures
Check suspect data from CHCs
Identification of problems requiring research
Prompt reporting of results
Achieve data standards
Data for comparative purposes

37. Surveillance Active Surveillance Passive Surveillance
Helps to assess the incidence and prevalence of diseases so that the magnitude of the problems and their importance can be known
Helps to establish priorities and plan preventive programmes
Essential to identify high risk groups
Helps understand the local epidemiological trends and patterns
Useful in monitoring and impact evaluation of control programmes against specific diseases
Active Surveillance
Passive Surveillance
Sentinel Surveillance -
A reporting system based on selected institutions or individuals that provide regular, complete reports on one or more EPI target diseases.

38. Vertical Data Transmission Horizontal
Data quality: The degree to which the data or statistics measure what was intended to be measured when the data collection system was designed
Inappropriate data collection
Failure to report data
Unintentional recording and reporting of inaccurate data
Intentional recording and reporting of false data
Errors in processing data - Editing, Coding, Data entry, Tabulating
Vertical
Data Transmission
Horizontal

39. What can be done to improve and ensure data quality
Keep the design of the information system as simple as possible
Involve users in the design of the system
Standardize procedures and definitions
Design of data collection instruments
Develop an appropriate incentive structure
Plan for effective checking procedures
Training

40. Population-based community health information systems
The five E’s
Epidemiology
Empowerment
Efficiency
Equity
Effectiveness

41. Development of community health information systems
Determining community health activities
PHC-MAP programme
Autodiagnosis
Iran’s Vital horoscope
Community-based maternal records
Community-based growth monitoring

42. Open questions
How much equity can be achieved without a population-based community health information system?
How much can we streamline population-based community health information system?
How can we focus, expand, and refine the target group?
What is the relationship between population-based community health information system and research?
How do we invert the data collection/data response ratio?
Can more communities design, implement, and manage their own information systems?

43. Health information activities and level
Community
Promote community demand for health information
Map and house numbering
Enroll each family
Count the population from the enrollment forms, identify age-sex profile
Create children’s and women’s rosters, copying their names from enrollment forms
Create and distribute the home-based instruments
Community health worker
Visits homes regularly to promote health behaviours, update records, report pregnancies, births, deaths, migrations

44. Health information activities and level
Health Supervisors
Supervise CHWs, Monitor systems outputs, Control information quality
Collect vital statistics data
Report results of supervision
Data transmission to higher levels
Coordinator and local management
Computerize data
Summarize monitoring and supervision reports at periodic intervals and report to all levels with appropriate commentary

45. Data collection instruments
Home-based records: Immunization cards, Growth-monitoring card, Maternal health card
Health worker based records: Pregnancy/birth card, death report form, child records, women’s register, workers work form
Supervisor’s based: Supervisor’s roster
District-based records: Family enrollment forms, birth registers, death registers, health worker’s report, supervisor’s report
Home office- and donor-based reports of health project outputs and population health status

46. Elements of Health information system management
Organization rules
Data collection standards
Case definitions
Data transmission
Confidentiality
Training standards
Software design
Procurement/ Distribution
Quality assurance
Private sector
Basic Health Services HIS
Staff
Training
HIS Supplies
Hardware/ Software
Financial Resources
HMIS
Management
Hospital HMIS

47. Geographical Information System
Definition: GIS can be defined as a set of elements that allow the computerized handling of geographically defined data, their entry, storage, analysis, and presentation
Process: Linking an already existing, computerized health information system database to a digitized map
Core elements: Geographical data & Attribute data
Sources of geographical data: Digitizing maps, Surveys using global positioning systems
Sources of attribute data: Routine health information system data, Census data, Survey data, Data from other sectors
Advantages: Health outcome, Programme planning, Displaying performance indicators, Analytical possibilities, Displaying health care coverage, Intersectoral use of geographical information system

48. HMIS in context of Health Sector Reforms
The more radical and innovative the proposed change is in regard to the information system, the greater the implications for change in the organization
Reforms: systemic, programmatic, organizational, & instrumental
The objective of producing and utilizing information more effectively will affect the behavior and motivation of all personnel