UNIT1: HEALTH SYSTEM (TOPIC 1)
A. HEALTH SYSTEM

Health System are agencies that plan, fund and regulate health care. The money that finances health
care, those who provide preventive health services, clinical services, provide specialized inputs into health
care, such as the education of healthcare professionals and the production of drugs and medical devices
– WHO
.
Health

It is the combination of resources, organization, financing, and management that culminate in the delivery
of health services to the population (Roemer, 1991). This system consists of many parts such as the
community, department or ministries of health, health care providers, health service organizations,
pharmaceutical companies, health financing bodies, and other organizations related to the health sector.
Each plays a role in the system such as governance, health service provisions, and financing.
a. 1. Public health systems are commonly defined as “all public, private, and voluntary entities that contribute to
the delivery of essential public health services within a jurisdiction.” This concept ensures that all entities’
contributions to the health and well-being of the community or state are recognized in assessing the provision of
public health services.
The public health system includes:






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Public health agencies at state and local levels
Healthcare providers
Public safety agencies
Human service and charity organizations
Education and youth development organizations
Recreation and arts-related organizations
Economic and philanthropic organizations
Environmental agencies and organizations
Figure 1.1. The Public Health System
Figure 1.2. The 10 Essential Public Health Services
The 10 Essential Public Health Services describe the public health activities that all communities should
undertake:
1. Monitor health status to identify and solve community health problems
2. Diagnose and investigate health problems and health hazards in the community
3. Inform, educate, and empower people about health issues
4. Mobilize community partnerships and action to identify and solve health problems
5. Develop policies and plans that support individual and community health efforts
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6. Enforce laws and regulations that protect health and ensure safety
7. Link people to needed personal health services and assure the provision of health care when otherwise
unavailable
8. Assure competent public and personal health care workforce
9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services
10. Research for new insights and innovative solutions to health problems
The Core Public Health Functions Steering Committee developed the framework for the Essential Services in
1994. The committee included representatives from US Public Health Service agencies and other major public
health organizations
UNIT 1 – TOPIC 2: GOALS AND FUNCTIONS OF HEALTH SYSTEM
A. HEALTH SYSTEM GOALS
Figure 2.1. The schematic diagram of health system goals and functions.
 The World Health Organization (WHO) institutionalize the three main goals for health system: 1. Health, 2.
Responsiveness and 3. Fairness in financing. It is considered as the intrinsic goal that every country
should be routinely monitored as basis for the assessment of health system performance facilitated by
WHO. Therefore, the work on operationalizing the measurement of goal attainment is focused on
measuring these three goals as well as relating goal attainment to resource use in order to evaluate
performance and efficiency.
 There are also cross-system goals for the health system: how much does the health system help or hinder
education, democratic participation, economic production etc. These cross-system goals are potentially
very important and should be the subject of ad hoc analysis and evaluation. One of the more important
cross-system goals that should be emphasized is the contribution of the health system to economic
production. Health and health systems may increase or decrease economic production.
1. Health.
The defining goal for the health system is to improve the health of the population. Health of the population should
reflect the health of individuals throughout the life course and include both premature mortality and non-fatal
health outcomes as key components.
2. Responsiveness. The second intrinsic goal is to enhance the responsiveness of the health system to the
legitimate expectations of the population. Responsiveness expressly excludes the health improvement
expectations of the public, as these are fully reflected in the first goal above. The term ‘‘legitimate’’ is used to
make it clear that although some may have frivolous expectations for the health system these should play no part
in articulating responsiveness.
Two major components
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1. The first can be called ‘‘respect for persons’’, and it captures aspects of the interaction of
individuals with the health system that often have an important ethical dimension.
a. Respect for dignity. Health systems might be able to achieve higher levels of health by
incarcerating individuals with a communicable disease or sterilizing individuals with a genetic
disorder, but this would be a violation of basic human rights. Respect for dignity also includes
interactions with providers, such as courtesy and sensitivity to potentially embarrassing moments
of clinical interrogation or physical exploration.
b. Respect for individual autonomy. The individual should be able to act autonomously when
making choices about his/her own health. Individuals, when competent, or their agents, should
have the right to choose what interventions they do and do not receive.
c. Respect confidentiality. When interacting with the health system, individuals should have the
right to preserve the confidentiality of their personal health information. Respect for confidentiality
serves an instrumental goal of improving the quality of health care; when individuals have
confidence that the confidentiality of their personal health information will be respected, they are
more likely to give important medical history information to health care providers. In addition,
respect for confidentiality is intrinsically valuable because it upholds a core notion of privacy and
individual control over personal information.
2. The second can be called “Client orientation” and it includes several dimensions of consumer
satisfaction that are not a function of health improvement.
Prompt attention to health needs. Surveys of population satisfaction with health services routinely
demonstrate that prompt attention is a key dimension. Individuals value prompt attention because
it may lead to better health outcomes; this instrumental value is captured in the defining goal of
health. Individuals may also value prompt attention because it can allay fears and concerns that
come with waiting for diagnosis or treatment. Both the intrinsic and instrumental value of prompt
attention are critically affected by factors such as physical, social and financial access.
Basic amenities. The basic amenities of health services, such as clean waiting rooms or adequate
beds and food in hospitals, are aspects of care that are often highly valued by the population.
Access to social support networks for individuals receiving care. Even when care is promptly
available, if it is provided far from the individual’s family and community, access to social support
networks during care and recovery may be hampered. An expectation of access to social support
is not only an instrumental goal, because it may enhance health outcomes, but it is also an
intrinsically valued attribute.
Choice of institution and individual providing care. Patients may want to select who provides them
with health care. This concern is most often for the individual provider and only secondarily for the
institution providing care. Choice is a legitimate component of responsiveness and takes on an
increasing importance as other items in this list have been satisfied.
As with health, we are concerned not only with the average level of responsiveness, but also with
inequalities in its distribution. A concern for the distribution of responsiveness across individuals
means that we are implicitly interested in differences related to social, economic, demographic and
other factors
3. Fair financing. To be fair, financing of the health system should
challenges.
address
two
key
First, households should not become impoverished, or pay an excessive share of their income in
obtaining needed health care. In other words, fairness in financial contribution requires an important
degree of financial risk pooling.
Second, poor households should pay less towards the health system than rich households. Not only
do poor households have lower incomes but a larger share of their income goes to basic needs such
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as food or shelter. Contribution to the health system should reflect this difference in disposable income
between rich and poor. These considerations translate into the normative proposition that every
household should pay a fair share towards the costs of the health system. (In the case of very poor
households, ‘‘fair share’’ might mean no payment at all.) Payment should be based on income and for
the most part should not reflect use of services or risk. Acceptable notions of a fair share for the poor
depend on the role assigned to the health system in general income redistribution.
- In some political settings, it may be easier to redistribute income by providing free health services to
the poor than through direct redistributive mechanisms. From the perspective of the health system,
however, it should perhaps be assumed that society is redistributing general income through other
mechanisms, such as direct transfers, when evaluating fairness in financial contribution. The broad
social acceptance
According to Valletta and Gruber, some methods of organizing health financing, such as some forms
of employment-based insurance, may hinder labour mobility and macro-economic performance. At the
same time, there is increasing evidence that improvements in health can enhance economic growth.
B. HEALTH SYSTEM FUNCTIONS:
Figure 1.3. The World Health Organization designed four (4) vital health functions as illustrated below:
Health
Service
Provision
Health
Service
Inputs
Stewardship
Health
Financing
1. Health service provision is the most visible product of health system both in private and public. It is any
service, not limited to clinical services, aimed at improving the health of populations. Preventive measures as
well as promotion of a healthy way of living in order to avoid illnesses in the community.
2. Health service inputs means generating the essential physical resources for the delivery of health services
which include medications, human resources and medical equipment. Resources such as trained doctors
and medical staff and supply of medications often take time to be produced; hence, the health system
policymakers have to respond and use the available resources to address short-term population needs.
“Delivering health services is thus an essential part of what the system does--but it is not what the system is”
3. Stewardship, or the overall system eyesight, is the main responsibility of the government. This function sets
the direction, context, and policy framework for the overall health systems.
 Core of the Stewardship Function:
 Identify health priorities for allocation of public resources
 Identify the institutional framework
 Coordinating activities with other systems related to external health care
 Analyzing health priorities and resource generation trends and their implications
 Identify information needed to ensure effective decision-making on health matters
 Generating appropriate data for effective decision-making and policy making on health matters
4. Health financing includes collecting revenues, pooling financial risk, and allocating revenue.
a. Revenue collection.
Revenue collection is earned from payments for health care services. The mechanism for revenue include
general taxation, direct household out-of-pocket expenditures, mandatory payroll contributions, mandatory or
voluntary risk-rated contributions, donor financing, and other forms of personal things.
Each source of health financing is associated with a specific manner of organizing and pooling of funds and
purchasing services. Public health systems rely on general taxation for its financing, while social security
organizations are funded through the mandatory payroll contributions from workers and employees.
b. Risk pooling.
collection and management of financial resources in a way that spreads financial risks from an individual to
all pool members
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Bismark Model (Bismark’s Law on Health Insurance of 1883). This model uses an insurance system where
the sickness fund finances both the employees and employers through payroll deductions.
Beveridge Model (Beveridge Report or the Social Insurance and Allied Services). Health care is provided and
funded by the government. The government owns many, but not all, hospitals and clinics in the country.
Doctors may be government or private employees who collect their professional fees from the government.
c. Strategic purchasing.
Use collected and pooled financial resources to finance or buy health care services for their members. The
purchaser defines the substantial part of the health provider’s external incentives to develop the provider-user
intersection and the health service delivery modes.
UNIT 1 – TOPIC 3: WHO HEALTH SYSTEM FRAMEWORK
In its World Health Report 2000, WHO released a single framework (figure 4) with six clearly defined building
blocks and priorities which are necessary in strengthening health systems and improving overall health outcomes.
Figure 1.4. The WHO Health System Framework
o
o
o
o
o
o
o
Good service deliveries are those which deliver effective, safe, quality personal and non-personal health
interventions to those that need them, when and where needed, with minimum waste of resources.
A well-performing health workforce is one that works in responsive ways, fair and efficient to achieve the best
health outcomes possible, given available resources and circumstances.
A well-functioning health information system is one that ensures the production, analysis, dissemination and
use of reliable and timely information on health determinants, health system performance and health status.
A well-functioning health system ensures equitable access to essential medical products, vaccines and
technologies of assured quality, safety, efficacy and cost-effectiveness, with scientifically sound and costeffective use.
A good health financing system raises adequate funds for health, in ways that ensure people can use needed
services and are protected from financial catastrophe or impoverishment associated with having to pay for
them.
Leadership and governance involve ensuring the existence of policy frameworks combined with effective
oversight, coalition building, regulation, attention to system design and accountability. Strengthening health
system means improving these six health system building blocks and managing their interactions in ways that
achieve more equitable and sustained improvements across health services and health outcomes which
require technical and political knowledge and action.
The WHO has supported its health system framework with a monitoring and evaluation framework to monitor
program management of health system investments, assess health system performance and evaluate the
results of health reform investments.
UNIT 1 – TOPIC 4: THE PHILIPPINE HEALTH SYSTEM
The vision of the country is to become the healthiest people in Southeast Asia by 2022, and Asia by 2040. Its
mission is to lead the country in the Development of a productive, resilient, equitable and people-centered health
system.
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The Historical Background.
The health reform initiative carried over the years in the Philippines were primarily focused on these areas of
concern: health delivery system, regulation, and health financing. These health reforms aimed addressing issues
such as poor accessibility, inequality, and inefficient of the Philippine health system.
The Philippine Health System Historical Background
1979: Adoption of Primary Health Care Strategy (LOI 949)
promoted participatory management of the local health care system
1982: Reorganization of DOH (EO 851)
integrated the components of health care delivery into its field operation
1988: The Generics Act (RA 6675)
ushered the writing of prescriptions using the generic name of the drug
1991: Local Government Code (RA 7160)
transferred the responsibility of providing health to the LGU
1995: National Health Insurance Act (RA 7875)
instituted a national health mechanism for financial protection with priority given to the poor
1999: Health Sector Reform Agenda
ordered the major organizational restructuring of the DOH to improve the way health care is delivered,
regulated, and financed
2005: FOURmula One (F1) for Health
adopted an operational framework to undertake reforms with speed, precision, and effective
coordination and to improve the Philippine health system
2008: Universally Accessible Cheaper and Quality Medicine Act (RA 9502)
promoted and ensured access to affordable quality drugs and medicines
2010: Kalusugang Pangkalahatan or Universal Health Care (AO 2010-0036)
provide universal health coverage and access to quality health care for all Filipinos

DOH Vision and Mission
VISION
Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040
MISSION
To lead the country in the development of a productive, resilient, equitable and people-centered health
system

DOH Leadership and Governance
DOH FUNCTION
1. Development of plans, guidelines, and standards for the health sector
2. Technical assistance
3. Capacity building
4. Advisory services for disease prevention
5. Control of medical supplies and vaccines
DOH is duty-bound to:
1.
2.
3.
4.
5.
Develop policies and programs for the health sector
Provide technical assistance to its partners
Encourage performance of the partners in the priority health programs
Develop and enforce policies standards
Design programs for large segments of the population
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6. Provide specialized and tertiary level care
Figure 1.5. DOH Structure
Under the decentralization or devolved structure, the state is represented by national offices and LGUs, with
provincial, city, municipality, and barangay or village offices. DOH, LGUs and private sector participate,
cooperate, and collaborate inte h care of the population. Before devolution, the national health systems consisted
of a three-tiered system under the direct control of the DOH (1) Tertiary hospitals at the national and regional
levels; (2) the provincial and district hospitals and city and municipal health centers, and (3) the barangay (village)
health centers.
Directions of the Philippine Health Sector
1. The Philippine Health Agenda 2016-2022 (DOH AO 2016-0038)
Health system guarantees:
a. Population and individual level interventions for all stages that promote health and wellness, prevent
and treat the triple burden of disease, delay complications, rehabilitation and provide palliation for both
the well and the sick
b. Access to health interventions through functional service delivery networks (SDNs)
c. Financial freedom when accessing these interventions through Universal Health Insurance
2. The Philippine Development Plan 2017-2022
This is the first of the four medium-term plans to translate the vision of a “matatag, maginhawa, at panatag
na buhay” for the Filipinos and the country.
3. NEDA AmBisyon Natin 2040
A product of the Philippine Development Plan 2017-2022, this collective long-term plan envisions better
life for the Filipinos and the country in the next 25 years by formulating policies and implementing
programs and projects to attain this Ambisyon. This plan focuses on four areas: building a prosperous,
predominantly middle-class society where no one is poor; promoting a long and healthy life; becoming
smarter and more innovative, and building a high-trust society.
4. Sustainable Development Goals 2030
Also known as the 2030 Agenda, this compilation of 17 global development goals targets to end poverty,
fight inequality and injustice, and confront issues involving climate change.
UNIT 2 – TOPIC 1: HEALTH INFORMATICS
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Public health informatics is the application of computer science and information technology to public health. The
patient health information system is an example on how data are being collected, stored and retrieved in an
instant manner. This may give a chance to every patient enjoy the quick services in the hospitals.
Topic 1 will guide the learners to define health informatics and its role in health the care environment.
A. HEALTH INFORMATICS.
Health Informatics applies the principles of information science to solve problems using data. It involves the
practice of information processing and the engineering of information systems. The field considers the interaction
between humans and information alongside the construction of interfaces, organizations, technologies and
systems. As such, informatics encompasses many academic disciplines, including computer science, information
systems, information technology and statistics. Since the advent of computers, individuals and organizations
increasingly process information digitally. This has led to the study of informatics with computational,
mathematical, biological, cognitive and social aspects, including study of the social impact of information
technologies.

Figure 2.1 below defines the health informatics as an application technology tools and information
systems in a healthcare setting or context.
Public health informatics describes the application of informatics techniques in managing the proper care to every
patient. Its main focus is on the health of the population including the social problems associated with burden of
chronic illnesses. The term e-health is often used to denote consumer and patient perspective, whether it refers
to the personal health record or to access to the medical record created by the health team during the course of
care. Once almost impossible to obtain without a lengthy wait and without paying for copying charges, one’s own
medical record in electronic form is potentially only a few clicks away. Timothy Schultz presents examples of the
application of big data technology across the pharmaceutical life cycle – from genomics and drug development
through clinical monitoring, and finally pharmacovigilance, the detection, assessment and prevention of the
adverse effect of drugs.
Health Informatics in the Cloud
The role of cloud technology is undeniably significant in our everyday lives. Currently, 83 percent of the health
care organizations are making use of clinical-based applications, and it is changing the landscape of the health
care system and health informatics. However, both benefits and threats exist (University of Illinois, 2014)
Advantages of Cloud Technology
1. Integrated and Efficient Patient Care. Cloud technology offers a single access point for patient
information which allows multiple doctors to review laboratory results or notes on patients. Physicians
can spend more time deciding and performing patient treatment instead of waiting for information from
different departments.
2. Better Management of Data. The accumulations of electronic health records will allow more
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meaningful data mining that can better assess the health of the general public. More data can mean
more opportunities to identify trends in diseases and crisis.
Disadvantages of Cloud Technology
1. Potential Risks to Personal Information. The strength of cloud technology is also the very
characteristics that makes it vulnerable to data breaches. The information contained within medical
records may be subjected to theft, or other violations of privacy and confidentiality.
2. Cloud Setup Seems Cumbersome. The transition of a traditional to an automated system might be
difficult for some members of the health care organization that may not be familiar with cloud
technology.
Health Informatics in the Philippines.
The Philippines used the Community Health Information Tracking System (CHIT), an electronic medical record
developed through the collaboration of Information and Communication Technology (ICT) community and health
workers, primarily designed for use in the Philippines health centers in disadvantaged areas.
Despite the development of health informatics in the Philippines, still suffers from issues that humper progress,
one this is the lack of interest in the field, decision makers do not use the benefits of information technology in the
health sector. The large initial expenditure for a health information system remains another barrier to the
integration of IT in the Philippines health care system
UNIT 2 – TOPIC 2: HEALTH INFORMATION TECHNOLOGY
Health Information Technology (HIT) is an area in information technology involving various tasks in order to
improve the medical care in the country.
B. HEALTH INFORMATION TECHNOLOGY (HIT)
Rouse (2016) defines Health Information Technology (HIT) as the area of Information Technology (IT) involving
the designs, development, creation, use, and maintenance of information systems for the health care industry.
Automated and interoperable health care information systems are expected to improve the medical care, lower
costs, increase efficiency, reduce error, and improve patient satisfaction while also optimizing reimbursement for
ambulatory and in-patient health care providers.
Health information technology vows to provide innovative to health care delivery and connection among users
and stakeholders in the e-health market. Systems such as electronic health records, decision support systems,
and personal health records are promising and are becoming widely deployed worldwide (Kushniruk & Borycki,
2017).
Rouse (2016) enumerates the following types of health information technology:
a. EHR - Electronic Health Record, also called Electronic Medical Record (EMR). One of the
fundamental components of health information technology infrastructure.
b. PHR – Personal Health Record. A personal self-maintained health record;
c. HIE – Health Information Exchange. Is the health data clearing house which is comprised of health
care organizations with interoperability pact to share data among their health information technology
systems.
d. PACS – Picture Archiving and Communication Systems.
e. VNA – Vendor Neutral Archives.
f. PACS and VNAs integrate radiology into the main hospital workflow. Radiology used the primary
repository for medical images. Other specialties such as cardiology and neurology are also among the
large scale producers of images.
TOPIC 3. HEALTH INFORMATION MANAGEMENT
Health Information Management (HIM) is specially designed to assist in the management and planning of health
programmes as opposed to delivery of care. (WHO)
HEALTH INFORMATION MANAGEMENT (HIMS)
Health Information Management System - Also known as HIMS, is “specially designed to assist in the
management and planning of health programmes, as opposed to the delivery of care-WHO 2004”. The health
components of HIMS refers to clinical studies to understand medical terminologies, clinical procedures, and
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database processes; management refers to the principles that help administer the health care enterprise, and
information system refers to the ability to analyze and implement applications for efficient and effective transfer of
patient information. An HMIS is one of the six building blocks essential for health system strengthening. It is a
data collection system specifically designed to support planning, management, and decision making in health
facilities and organizations.
HIMS is a set of integrated components and procedures organized with the objective of generating information
that will improve health care management decisions at all levels of the health system. It is a routine monitoring
system that evaluates the process with the intention of providing warning signals through the use of indicators.
As the health unit level, HMIS is used by the health unit in-charge and health unit management committee to plan
and coordinate health care services in their catchment area.
 HMIS was developed with the framework of the following concepts (Republic of Uganda Ministry of Health
Resource Center, 2010).
 The information collected is relevant to the policies and goals of the health care institution, and to the
responsibilities of the health professionals at the level of collection.
 The information collected is functional as it is to be used immediately for management and should not wait
for feedback from higher levels.
 Information collection is integrated for these is one set of form and no duplication of reporting.
 The information is collected on a routine basis from every health unit.
Roles of HMIS
The major role of HMIS is to provide quality information to support decision making at all levels of the health care
system in any medical institution. In addition to encouraging the use of health information in hospitals. It also
iams to aid in the setting of performance at all levels of health service delivery and to assist in assessing
performance at all levels of the health sector. (Republic of Ugaddan Ministry of Health Resource Center 2010).
AN HMIS needs to be complete, consistent, clear, simple, cost-effective, accessible, and confidential (Janneth,
2002). It should be complete with all information but avoiding duplication and consistent in assigning definitions
to similar information from various sources. It should also be simply to use and clear as to what is measured by
the elements. The elible users must have access and should be able to use the system with ease. The
confidentiality of patient information and data privacy should always be a top priority. While providing all these
benefits, the system must prove its cost-effectiveness through its operation.
Functions of HMIS
The information form an HMIS should be used in planning, epidemic prediction and decision, designing
interventions, monitoring, and resource allocation (Republic of Ugaddan Ministry of Health Resource Center
2010).
Historically, the aforementioned systems, including HMIS, are build ipon the conceptualization of three
fundamental information- processing phases: data input, data management and data output. Each phase comes
with elements (Tan, 2010).
1. Data input includes data acquisition and data verification.
a. Data acquisition refers to the generation and collection of data through input of standard coded
formats (e.g., bar codes) to assist in the faster mechanical reading and capturing of data
b. Data verification involves data authentication and validation. The authority, validity, and reliability of
the data sources help ensure quality of gathered data.
2. Data Management. Also called processing phase. Indicates data storage, data classification, data update,
and data computation
3. Data output includes data retrieval and data presentation
List of Functions of HMIS
1. Client data releases to all the information of the client which is related to his or her transactions, reports,
and other information such as client billing data, clinical data, and other client data.
2. Scheduling is observed to distribute resources to areas that need them. An example is the linking of
schedule to the billing of the entity.
3. Authorized tracking focuses on monitoring of the authorized personnel and their used of the authorized
units.
4. Billing refers to the notification of the charges for the patient and other related documents such as the
compliant electronic claim.
5. Accounts receivables (A/R) management ensures that customers are properly notified above their bill and
will settle it accordingly. Data for A/R management include tracking aging of unpaid services, tracking
reasons for denials, and aged receivable report by prayer source.
6. Reporting refers to the reports issued by the entity which could be basic reports or report writer.
7. Medical record, also called an electronic health records (EHR), is a collection of digital information about a
patient. Aside from patient registration, the data could include assessment and treatment plan, and
progress/encounter notes.
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8. Compliance refers to procedure that should be followed for the improvement of the condition of the patient
or service provided such as treatment plan and progress notes.
9. Financial data refers to information relating to the performance of the entity collected for administering
purposes. These include financial reports, general ledger, payroll, and accounts payable.
Determinants of HMIS Performance Area
The determinants affecting the performance of HMIS may be behavioral, organizational and technical.
Behavioral determinants. The data collection and users of the HMIS need to have confidence, motivation, and
competence to perform HMIS tasks in order to improve the routine health information system (RHIS), process.
The chance of the task being performed is affected by the individual perceptions on the outcome and the
complexity of the task (Aqil, Lippeveld, & Hozumi, 2009). Lack of motivation and enough knowledge on the use of
data has been found to be a major drawback in the data quality and information use. Changing people’s attitude
towards data collection and analysis is necessary in order to maximize the performance of the RHIS process
(Routine Health Information Network, 2003).
Organization determinants. The important factors that affect the development of the RHIS process are the
structure of the health institution, resources, procedures, support services, and the culture within the
segmentation Aqil, Lippeveld, & Hozumi, 2009). However, other factors which include lack of funds, human
resources and management support contribute to the determinant of RHIS process.
Having system is place which supports data collection and analysis and transforms it into useful information will
help in promoting evidence based decision-making. Thus, all components within the system are ideal in making
the RHIS perform better. As improved RHIS performance means an effective organization culture that promotes
information use by collecting, analyzing and using information to accomplish the organization’s goals and mission
(Sanga, 2015).
Technical determinants. Technical factors involve the overall design used int eh collection of information. It
comprises the complexity of the reporting forms, the procedure set forward in the collection of data and the overall
design of the computer software used int eh collection of information (Sanga, 2015).
PRISM Framework
The performance of Performance of Routine Information System Management (PRISM) is a conceptual
framework that broadens the analysis of HMIS or RHIS by including the three determinants of HMIS performance,
namely:
Behavioral determinants – knowledge, skills, attitudes, values, and motivation of the people who collect and use
the data.
Organizational/environment determinants – information culture, structure, resources, rules, and responsibilities
of the health system and key contribution at each level, and Technical determinants - data collection process,
systems, forms, and methods.
This framework identifies the strengths and weaknesses in certain areas, as well as the correlation among these
areas. This assessment aids in designing and prioritizing interventions to improve RHIS performance, which in
turn improves the performance of the health system.
The PRISM framework, founded on performance improvement principles, defines the various components of the
routine health information system and their linkages to produce better quality data and continuous use of
information, leading to better health system performance and, consequently, better health outcomes (Aqil,
Lippeveld, & Hrozumi, 2009).
Summary:
 A health management information system (HMIS) is “specially designed to assist in the management and
planning of health programmes, as opposed to the delivery of care-WHO 2004”.
 The major role of HMIS is to provide quality information to support decision making at all levels of health
care system in any medical institutions.
 HMIS are built upon the conceptualization of three fundamental information processing hases: data input,
data management, and data output. Each phase comes with elements that perform specific functions.
The eight elements are: data acquisition, verification, classification, computation, update, retrieve and
presentation.
 The determinants affecting HMIS performance are behavioral, organizational and technical.
 The PRISM framework defines various components of the RHIS and their linkages to produce better
quality data and continuous use of information, leading to better health system performance and,
consequently, better health outcomes.
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UNIT 3: HEALTH INFORMATION SYSTEM FOR MEDICAL LABORATORY SCIENCE
 Health information system cover different systems that capture, store, manage, and transmit health-related
information that can be sourced from individuals or activities of a health institution.
Ex. PAS – Patient Administration System
HRMIS – Human Resource Management Information System
LIS – Laboratory Information System
 HIS should be sustainable, user friendly and economical– health care personnel should be educated on
the use of the routine data collected from the system and significance of good quality data in improving health
(Pacific Health Information Network 2016)
 Role and Function of Health Information System – Sheahan (2017) defines HIS as a mechanism which
keeps track of all data related to the patient:
a) Patient’s medical history
b) Contact information
c) Medication log
d) Appointment schedule
e) Insurance information
f) Financial account (billing and payment
 Role and Function of a well-implemented Health Information System–
1. Easier access to files
2. Better control
3. Easier update
4. Improved communications
o A good HIS delivers accurate information in a timely manner, enabling decision makers to make
informed choices about the different aspects of health institution, from patient care to annual
budgets. It also upholds transparency and accountability due to easier access to information
 COMPONENTS OF HEALTH INFORMATION SYSTEM
The Health Metrics Network (HMN), in its framework and standards for country health information systems as
consisting of six different components.
1. Health information system resources
2. Indicators
3. Data sources
4. Data management
5. Information products
6. Dissemination and use
 DIFFERENT DATA SOURCES FOR HEALTH INFORMATION SYSTEM
1. Demographic Data– Patient age, birthdate, gender, marital status, address of residence, race, and
ethnic origin, educational attainment and information of immediate member of the family in case of
emergency.
2. Administrative Data – tests, procedures, physicians specialty, nature of institution, charges and
payments.
3. Health Risk Information – lifestyle and behavior, use of tobacco products, engage in strenuous
activities, facts about her medical history and other genetic factors.
4. Health Status- quality of life a patient leads which is crucial to her health.
5. Patient Medical History – past medical encounters like hospital admissions, pregnancies and live
birth,surgical or family history
6. Current Medical Management- Patient’s health screening session, diagnosis, allergies (especially
on medications), current health problems, medications, diagnostic, therapeutic procedures,
laboratory tests, and counseling health problems
7. Outcome data – presents the measures of aftereffects of healthcare and of various health
problems. (readmission to hospital, unexpected complications or side effects), measure of
satisfaction with care.
UNIT 5: MATERIAL MANAGEMENT SYSTEM
Materials Management plays a vital role in the smooth, economical, efficient, and effective acquisition, storage,
irretrievability, distribution, use and disposal of supplies and equipment. It includes planning, directing, controlling
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and coordinating activities which are concerned with materials and inventory requirements such as procurement
of machines and equipment, stock control, inspection of the material received and material handling operation.
Material management influences the clinical and financial outcomes of a health care system. It provides adequate
and uninterrupted supply of materials to ensure continuity of service and minimizing waste leading to higher
productivity. Thus, it is important for an institution to have a system that automates the control and regulation of
the flow of material in relation to changes in variables like demand, prices, availability, quality, and delivery
schedules.
This unit introduces the basic concepts, explain the scope and explicate the key objectives of material
management system. It also describes the functional modules of material management system including
purchasing, inventory control, receiving, tracking, distribution, and storage of items.
TOPIC 1
RIGHT MATERIAL in RIGHT QUANTITIES at RIGHT TIME at RIGHT PRICE from RIGHT SOURCE at a
LEAST COST.”
As production is steadily increasing, the demand for tangible components is also increasing as well. This
expanding demand for supplies establishes a need for material management. In most hospitals, the materials
management function is responsible for the complete supply process--from purchasing to distribution. The
management of supplies, purchase orders, and equipment is of critical importance to the operation of a health
care organization.
Material management is a method for the planning, coordination and control of all those activities which are
primarily concerned with the flow of materials into an organization. It is an optimal way of coordinating, planning,
supplying, purchasing and storing construction materials, as well as providing quality control. This ensures that
the right quantity of right materials are supplied exactly when they are needed at the right time, at the right place,
with the right quality, and at the right price. Materials management performance centers around four basic goals:
have material on hand when needed, pay the lowest possible prices, consistent with quality and value
requirements for purchased materials, minimize inventory investment and operate efficiently.
Material management handles purchasing, inventory control, shipment and receiving functions, as well as
production control, purchasing, master scheduling (demand planning) and warehousing. Purchasing activity
involves mainly the identification of materials needed, market research and maintaining materials records.
Whereas, procurement activity involves the determination material specifications, materials studies and receiving
of materials. On the other hand, inventory control includes material handling, storage and monitoring. Lastly,
supply management is responsible for controlling the handling of in-plant supplies and for strategic inventory
preparation. Careful monitoring of materials consumption leads to efficient supply chain management and lowers
costs by ensuring that enough materials are on hand and used until their expiry date.
Materials Management System automates these continuous cycles of supplies
procurement and usage throughout the care delivery organization (CDO). It ensures that
services are rendered successfully from one source to an end-user and covers several areas of
hospital and could drastically affect the expenses of the medical institution. This system is used
to manage functions like purchasing, accounting, inventory management, and patient supply
charges. Incorporating this system in a clinical setting helps in organizing all of its supply,
vendor, location, purchase order, and equipment data. Thus, allowing a health care
organization to respond more rapidly and accurately to inquiries, provide flexibility and permit it
to define the inventory as best fits a particular situation.
Materials management system functional modules include requisitioning (online
requisition generation and approval), ordering (purchase order generation and electronic data
interchange or web-based transmission to vendor), receiving (receipt generation and tracking),
distribution (tracking where and when supplies are dispersed throughout the organization),
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usage (usage tracking and charging of supplies to patient accounts), invoice and payment
processing (invoice tracking, EDI or Web transmission of payments, and forwarding of financial
data to the general ledger system), inventory control (support for just-in-time or par-level
inventory and automatic requisitioning when supplies drop to user-defined levels) vendor
database (bidding, contract management, and online vendor supply catalogs) and management
reporting. Electronic Data Interchange (EDI) mentioned above is responsible for the exchange
of electronic documents between suppliers/manufacturers and users. This is consist of
standardized electronic message formats, called transaction sets, for common business
documents, such as Request for Quotation, Purchase Order, Purchase Order Change, Bill of
Lading, Receiving Advice, and Invoice.
Effective hospital MMIS automates the materials distribution and control process. Fully
integrated HMMIS includes a computerized inventory control system, computerized patient
supply charge system and EDI links with many of the hospital's suppliers.
TOPIC 2: MATERIAL MANAGEMENT SYSTEM FUNCTIONAL MODULES
Materials Management System has a fully integrated, comprehensive capability for requisitioning, procurement,
warehousing as well as inventory. Effective materials management involves a complex set of interactions
between processes, suppliers, inventory, and the data that links them all together. This section will describe the
functional modules integral to a material management system.
Purchase Request, Orders and Approval
Purchasing function assumes importance for every health care organization as it fulfills, to a large degree, the
organization's input needs. Purchasing describes the “process of buying”. This element of material
management has a wider function of procurement and includes activities such as identification and selection of
vendor/supplier, ordering, expediting, receipt and payment. The purchasing cycle consists of the following steps:
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Receiving and analyzing purchase requisitions
Selecting suppliers
Determining the right price
Issuing purchase orders
Following up to ensure delivery dates are met
Receiving and accepting goods
Approving supplier’s invoice for payment
Purchasing process starts with a Purchase Request (PR). A purchase request contains the quantity and
timeframe of the items requested and the authorization information needed. It is a document that notifies the
purchasing department that certain items or services need to be replenished.
Requested items are confirmed using the purchased order and supplier is nominated and this document serves
also as basis of accepting the delivered items. When the vendor receives a purchase order it is a legally binding
document which shows that the seller has already accepted the order issued by the buyer. A purchase order
specifies information about the buyer and seller (name, address, contact details); order number and date; item
description (quantity, unit, and total price); shipping information (shipping dates and address); the price agreed
upon; billing address; delivery requirements; terms of payment and authorized signature.
The Originator is the person who creates the document (purchase order or request). Originator is notified that the
document needs approval if the document fails to meet the approval requisites. Once the document has been
approved an internal notice is sent to the originator and the approver can access the document in the
Messages/Alerts Overview Window.
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The final stage is receiving delivery, where the products are inspected for indents and damage during
receipt of delivery. Items that are damaged or have indents while being transported from the source to the
warehouse may be returned when the supplier allows it (Retail and Distribution Industries) with a guarantee
of replacement without additional payments. The damaged items are moved to another warehouse for them
to be monitored.
Inventory Control
An inventory is a list of materials and supplies that an institution carries either for sale or to provide inputs
or supplies to the production process. It is considered as one of the biggest expenses for most medical
institution. Inventory control. Inventory control describes the control and management of quantities of items.
The system has an automatic inventory monitoring, so that orders are placed as soon as the re-order level
is reached. Material manage system provides an overview of the entire institution’s purchasing and
inventory control processes so they have more reliable information regarding the drugs and consumables
which is critical to decision making.
Below is a summary of strategies to improve inventory control in a healthcare organization.
Strategies in improving inventory control in the health care facility
The Item Master Maintenance Screen (BizBox) of this system has different sections. Upper portion contains
the master information while the Item Tab is used for the maintenance of the attributes of the item (e.g.
product type, item class, item type). Users may set the product type to group similar items for sales analysis
and inventory reporting. Item Availability Form specifies inventory levels across all warehouses.
Reorder Level and Minimum and Maximum Inventory Ordering
Reorder level of stock also known as reorder point or order point in an organization
is a fixed level of stock or inventory at which the company places a new order with its
suppliers to procure inventory of raw materials or finished products. It is the minimum
quantity of an item that a company has in stock, and the item must be reordered when
the stock reaches the minimum quantity specified (purchased order / order for
production).
Min / Max Inventory Ordering Method, seen in the figure below, is a basic
reordering method used in many Enterprise Resource Planning (ERPs) and other
software for inventory management. This is an unpolished inventory ordering method but
settings can be adjusted to deliver better performance in the inventory. The Min Value
represents the stock level that prompts the reorder while the Max Value sets the new
targeted level that follows the reorder. The Economic Order Quantity (EOQ) is often
interpreted as the main difference between the Min and Max value. This is used to identify
the greatest number of product units to order to minimize buying.
Enquiries and Quotations for Drugs, Consumables, Assets, and General Items
Consumables are items which are used in a short period of time, and need to be replaced frequently. These
include all the medications, drugs, vitamin, supplements and infusion fluids (for intravenous use) as well as
disposable items of equipment (single-use) and other supplies. These items are frequently used in your
healthcare work and therefore need to be restocked regularly. Ordering supplies for a health care
organization must be done efficiently to ensure that it will not run out of essential items and avoid wastage
due to ordering too much. The following are the documents required in this process:
Purchase quotation, as mentioned above, is a document requesting prices and delivery information from a
vendor before the purchase order. The system receives replies from the vendors detailing the conditions of
their offers. The vendors' details will be recorded in the purchase quotations in the application. Quotation
comparison displays the price and quantity quoted by the vendor. Using this quotation, the right supplier
can be chosen. This system minimizes costs, improve product or service quality and increase on-time
delivery. It also allows the comparison of deals to choose the best vendor for the purchasing scenario.
A vendor or supplier is a party in the supply chain that makes goods and services available to companies.
Vendor-selection process has a significant impact on the productivity, quality and competitiveness of an
organization. Companies usually keeps a list of preferred vendors from whom they purchase their supplies.
There are numbers of criteria that can be used to select vendors, these include on-time performance, offers
reasonable costs, provides high quality products and services, fully licensed, bonded, and insured product
and services, and has good business practices. It is important to remember that these criteria may be
different for each item you are sourcing and possibly different between regions or countries.
Receiving and Tracking Items
Material management systems allows an organization to define workflow and processes by tracking the
receipt, transfer, and delivery of items. Here is an outline of the policies for the proper receipt and
inspection of items.
a. Signing for Deliveries
The person who receives the delivery should inspect the delivered items for damage before signing the
receiving documents and the packing list. The document should be submitted to the appropriate
department for reconciliation. Verify the number of items indicated on the packing list. The person who
receives the delivery should inspect for damage to the shipped items before signing the receiving
documents and the packing list. The document should be forwarded to the appropriate department for
reconciliation. Verify the number of items indicated on the packing list.
a. Refusing Delivery
Receiving department should refuse to accept any shipment if packaging appears to be damage or if there
is any item that does not have corresponding purchase order.
b. Record Retention
The packing list should be provided for proper documentation and all files should be kept accordingly to the
guidelines of the entity for tracking partial and staggered deliveries.
c. Inspecting a Shipment
The personnel receiving the item should inspect the goods to ensure the following conditions are met:
1. Received items match the requirements stated in the purchase order (e.g. type, description,
color)
2. Quantity is correct
3. Item has no damage, discoloration, and issues
4. Quantity per unit measurement is accurate
5. Packing list, certifications, and other delivery documentation are completely provided
6. Perishable items be in good condition and have not reached the expiration dates
7. The items are functioning properly
Inspect the contents as soon as possible (ideally, within 24 hours) for concealed damage, unidentifiable
items, items not conforming to specifications or other discrepancies.
d. Partial Deliveries
Advise the purchasing department for approval and further instruction when items are delivered partially
without notification from supplier. This should also be noted in the packing list or the receiving document
e. Tracking Goods
Items are easily tracked/traced when managed by serial numbers. Aging of products can also be monitored
based on how long they have been in the warehouse. Create a label in the tracking system and label the
items so that it can be tracked throughout the rest of the receiving and delivery process.
Purchase Returns along with Returnable/ Non-Returnable Gate Pass
Sometimes a shipment arrives with a problem, which may include damage,
missing items, overages, or shortages. All problems with shipments must be reported to
the vendor or carrier, depending on the nature of the problem. Purchase/sales returns
may be due to defective or substandard quality goods, incorrect order delivery and
deteriorated purchased and sold items. When purchased goods are returned, the
materials management system updates inventory levels to reflect the decrease in
quantity. For temporary movement, a returnable gate pass is issued, whereas for
permanent movement, a non-returnable gate pass is given. Non-returnable gate pass
helps monitor outgoing deliveries, repair and fitting parts to identify what is issued and
delivered and what is the accurate stock available in the warehouse. The gate pass is
generated by the system and it should be attached to the delivery. The system can also
monitor due dates for returnable items and provide detail reports of the status of different
items.
Consignment Stock Receipt, Consumption, and Regularization
Consignment means that the items procured are still in vendors ownership, but
the company is keeping the material on stock. The items become the property of the
company only in the case of consuming. In the process of consignment, the vendor or
consignor issues materials to the receiver or consignee, and these materials are stored
in the consignee’s premises. Vendor maintains legal ownership until such materials are
removed from consignment stores. Invoice is due at predetermined interval. The
customer can also arrange to take ownership of the remaining consignment material after
a certain period. The customer can access product at any time from their warehouse and
company will issue invoices for only accessed product. If customer return product due to
damage, poor quality, expiry, then this process is called consignment return.
Expired Stock and Quarantine
a. Expired Stock/Inventory
Expiration dates and decrease in values of items must be reflected in the financial
records so discrepancies in financial statements will be prevented. Amount that
reduces inventory in the records is recognized as a loss which equates to a reduction
in profit.
b. Quarantine Stock/Inventory
When undecided about how to handle defective goods, whether to be sold as
scrap, reworked, returned, or used as it is, a quarantine location or warehouse can
be used to temporarily house them until a final decision is reached. Inventory is put
into quarantine if it is initially rejected during:
1. Production, upon completion of an operation, when specified as “Move
Rejected End Item to Quarantine”
2. Inbound inspection upon receipt of:
 Manufactured end items
 Purchased items
 Sold items on sales return orders
 Enterprise planning distribution orders
 Outbound inspection upon issue of materials to production
Issue Methods
In order to avoid accumulation of expired and obsolete stock, items should be
stored and issued on a First In, First Out (FIFO), Last In, First Out (LIFO) or First
Expired, First Out (FEFO) basis described below.
The stock control system must record the expiry date and the date of receipt. Stock
must be stored so that the earliest expiring or first delivered batches can be picked or
issued first. When small quantities are involved, this goal can be achieved by placing the
newly received stock at the back of the shelf behind the existing stock. When large
quantities are involved, the newly received items can be placed on the upper levels of
the pallet racking.
Generic Tax Formula Configurations
Material Management System usually allow tax rates to be defined internally via
tax codes, or imported from an external source. Master data such as customer, vendor,
and material, as well as transactional data like POs and Sales Orders are key to
determining the correct tax. Tax configuration is done by country. Automatic calculation
of tax dues during the purchasing process makes the process less susceptible to clerical
errors. The following taxes that can usually be processed while posting documents: Tax
on sales and purchase, Additional tax like VAT, Sales and use tax (USA) and Withholding
tax (income tax in India).
Periodic Physical Stock Taking and Adjustments with Tracking
Inventory Count is the process where an organization/business physically counts
its entire inventory. The actual counts are then compared to the quantities reported on
the detailed inventory records. This may be mandated by financial accounting rules or
tax regulations to place an accurate value on the inventory. If a difference exists, the
quantity shown on the inventory record should be changed to the physical count. The
following tactics can be used to minimize disruption during the physical inventory:
Inventory Services (provide labor and automation to quickly count inventory and minimize
shutdown time); Inventory Control System Software (speed up the physical inventory
process); Perpetual Inventory System (tracks the receipt and use of inventory, and
calculate the quantity on hand); and Cycle Counting (alternative to physical inventory and
less disruptive). In addition to the Barcode and Radio Frequency Identification (RFID)
functionality, the material management system provides all of these, ensuring reliable
and less burdensome counts.
SUMMARY
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Materials Management System automates the continuous cycle of supplies
throughout the health care organization from purchasing, accounting, inventory
control, receiving and tracking items and patient supply charges and as well as
dealing with expired stock and quarantine.
Purchasing involves mainly identification of materials needs, market research and
maintaining materials records while inventory management involves planning and
controlling of materials handling, storing materials and managing material
supplies.
Policies for proper receiving and inspection include signing of deliveries, refusing
delivery, record retention, inspecting a shipment, partial deliveries, tracking goods.
Damage items may be returned when the supplier allows it or moved to a
warehouse for monitoring.
A quarantine location or warehouse can be used to temporarily house expired
stock or defective items