DEVELOPMENT OF A NATIONAL HEALTH
DATA DICTIONARY:
A PALESTINIAN EXAMPLE
Mazen Skeik, BSc. MPH
Oct. 5th 2011
Palestinian Territories:
(West Bank, Gaza Strip and East Jerusalem)
Population:
o
o3.8
million
42.6% Refugees:
o
o28.5%
in West Bank
o71.5% In Gaza)
o
1.3 M
Health Care Providers :
1.
2.
3.
4.
5.
Gov. (MOH)
UNRWA
NGO’s
Private
Military and Police
The Health Data Dictionary (HDD) in Palestine:

Health System Development Project (*HSDP)
1.
Creating a HDD
2.
Designing and implementing a Clinical Information
System (CIS)
o
3.
To test the HDD
Implementing a Health Insurance Information System
* Financed by the International Development Association (IDA)
MIS Component (Design and Proposed by Dennis Streveler (World Bank Consultant))
1. Creating an HDD – Preparations:

Preparation of data items and definitions
(proposed time frame 8-10 months)

Participation in several consultative meetings with representatives
from:








Policy Makers (MOH)
Government Computer Centre
Ministry of Interior (MOI)
Computer Centre
International projects
United Nations (UN) agencies
NGOs.
Initiation of a National Workshop was supported and attended by the
Palestinian Minister of Health
1. Creating an HDD – Groups Involved in design,
implementation, and maintenance:
National Health Data
Dictionary Committee
Coordinator
(Technical Adviser)
Key persons
Representatives from Different
departments in the MoH
-
-
Statistics & Information Dept.
Computer Dept.
Health Insurance
Special Treatment Dept.
Hospitals
Primary Health Care (PHC)
Laboratories
Pharmacist Dept.
Financial Dept.
Personnel Dept.
Procurement and Purchasing Dept.
Data Dictionary
Specialist I
Expert Working Group
Representatives from MoH &
Different Ministries
 Ministry of Health:
Medical specialists, nurses, health care
quality experts, management information
system experts, allied health professionals,
pharmacists, Computer programmers,
statisticians and administrators.
 Ministry of Interior
 Government Computer Center (GCC).
 Palestinian Central Bureau of Statistics
(PCBS).
1. Creating an HDD – Formatting data elements:

Successful HDDs in other countries were investigated,
and a template was created:









Data Element Name
Reference ID
Data Element Type
Definition
Data Type
Field Size
Usage and Content
Codes and Values
Technical Comments
1. Creating an HDD – Involvement of Specialized groups:


Collaboration between groups working on related fields:

Senior Medical specialists

Senior Nurses

Health care quality experts

Management information system experts

Allied health professionals

Pharmacists

Computer experts

Statisticians and administrators
Agreements reached between each group involving
definition and value of the data
1. Creating an HDD – Drafts and finalized HDD:

First draft was introduced in a final national conference


Final draft was reviewed by the national HDD committee


Endorsed by the Ministry of Health
Version 1 of HDD was published and produced


Through video conferencing between WB and Gaza
Distribution of hard copy of HDD in national workshop
Version 2 of HDD was published in 2005

As an online PDF on the Ministry of Health website
(www.moh.ps)
1. Creating an HDD – Important outcomes to the MOH:

The Standardized Pharmacy:

The (550) drugs in Gaza and the (700) in West Bank were merged
into one list. The formulary is structured on 30 therapeutic groups.

Codes and Values: (Concatenation of)
A
Type of healthcare product
NN Name of category
N
Name of sub category
N
Name of sub-sub category
NN Dosage form
NN Product number












For Example: (E EDL)
06
ANTI INFECTIVE DRUGS
2
ANTI BACTERIALS
1
B-LACTAM DRUGS
11
VIAL
E06211107 BENZYLPENICILLIN 10
MILL IU
When a dictionary can “enforce” accurate drug codes and positively
identify the drug(s) being ordered, human errors and mistakes can be
reduced.
1. Creating an HDD – Difficulties:

Patient Identification Number (ID Number)


A patient's unique number that is given at birth to facilitate
retrieval of individual clinical records.
Medical Record Number

The number used by the Medical Records Department to
identify the patient's permanent medical/health record file.
1. Creating an HDD – Difficulties: (Decision Made by Policy Maker)
Decision made by H.E. Minister of Health:
In MOH patient ID number and patient medical record
number must be the same.
1. Creating an HDD – International Standard vs. Local
Standard :
Local Standard
PHC Diagnosis Code

The diagnosis established
after study to be chiefly
responsible for occasioning
the patient’s episode of care
in attendance at the primary
health care facility.
International standard
(Principal Diagnosis in
Hospital (ICD10)

The diagnosis established
after study to be chiefly
responsible for occasioning
the patient’s episode of care
in hospital (or attendance at
the health care facility).
2. Testing the HDD – Implementing the CIS:

The Clinical Information System (CIS)



i.
ii.
Registration
Pharmacy
Chronic Patient File
To demonstrate conformance to standards as defined in the
data dictionary
Provide ongoing education and training for all staff in the clinic
as appropriate to their use of data elements and their
definitions
2. Testing the HDD – Pre/post measurement Indicators:

Pre Measurement:



Too many patients at one time (Registration takes too much time)
Shortage of drugs for chronic patients (Unavailable accurate
number of patients and schedules to get their treatment)
Post Measurement:


Patient registered one time, therefore resulted in fast retrieve of
patient records and insurance checks
Drug supplies now available for chronic patient
2. Testing the HDD – Implementation of CIS
Patient Registration at the time of arrival
2. Testing the HDD – Changing to Computerized System:
2. Testing the HDD – European Gaza Hospital (EGH):

Adoption of the HDD by another health organization




EGH was running under European project
Budget available allowed for the Implementation and Integration
of HMIS in the Hospital
HDD was used
Training Conducted
NOTE: Key representative from EGH were involved in creating the
HDD
Factors of Success:
Political
i.

Support from High Level Policy Makers
Organizational
ii.

Teamwork and close co-operation amongst the key
stakeholders and senior specialists.
Technical
iii.

Easy data module identified priorities to be included in the 1st
HDD.
Financial
iv.

All stakeholders were working volunteers
Challenges:

Political Situation


Implementation




Curfew (between and within WB and Gaza)
Some un-interest and resistance from health staff to use HDD
and change to a computerized system (more work!)
Continuous education of new staff
No commitment from other Health institutions to use the
dictionary
Sustainability


Running cost for maintenance and updating the HDD
Redesigning new forms
Future Directions: Developing Countries





Establish priorities and timing
Sustainability (Short and Long Term Financial)
Assign work to appropriate working groups
Electronic Documentation and Publications
Increase adoption of international standard
Palestinian Health Information Centre
Meeting With Health Information Centre Staff
Meeting With Director of Computer Centre in the
Ministry of Interior (MOI)
Computer Department – European Gaza Hospital