Reminders
- Deadline of quiz: 4:30 pm
- Deadline of lab assignment: 7:50 pm
- MIDTERMS: more on definitions
7th WEEK: HMIS MONITORING & EVALUATION
Monitoring and Evaluation
Define, Explain and Discuss Monitoring &
Evaluation Purpose, Plan and Frameworks
Þ Monitoring
- observation of HMIS
- systematic collection, analysis and use of
information from programs for three basic
purposes:
M&E with HMIS Indicators
Þ Indicator
- A variable whose value changes.
- Measures the values of the change in meaningful
units that can be compared to past and future units.
Relationship Between M & E with HMIS Indicators
Categories of HMIS + data quality
1. Learning from the experience acquired (learning
function)
2. Accounting internally and externally for the
resources used
3. Results obtained (monitoring function) and
taking decisions (steering function)
Þ Evaluation
- evaluation or what to be improved in HMIS
- assessing an ongoing/completed program/policy
as systematically and as objectively as possible.
The objective is to be able to make statements about
their relevance, effectiveness, efficiency, impact and
sustainability.
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Learning Function – lessons learned need to be
incorporated into future proposals or policy.
Monitoring Function – partners and members
review the implementation of policy based on
objectives and resources mobilized.
Monitoring and evaluation are complementary.
Purpose
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The primary aim is to have a strong M&E and
review system in place for the national health
strategic plan that comprises all major disease
programs and health systems.
A robust monitoring and evaluation (M&E) system is
required to assess the effect of integrated service
delivery.
Existing country health-sector review processes are
key events to assess progress and performance.
Progress of any medical institution are monitored and
evaluated through various activities such as
monitoring reports, HMIS, surveys and evaluation
studies.
Framework (diagram, page 117)
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Monitoring and evaluation (M&E) is a core
component of current efforts to scale up for better
health.
The core is the strengthening of a common country
platform for M&E of HSS, which should result in
better alignment of country and global M&E systems
and can be used both for monitoring the health
systems funding platform, as well as for tracking
the performance of specific programs.
Key Indicators – indicates the effectiveness of a certain
program of performance; compares past to the future.
DPT: diphtheria, pertussis, and tetanus
(Indicators for monitoring FP/Immunization integration
page, 119)
Relationship of HMIS Indicators with Health
Program
Maternal Survival Strategy (framework, page 124)
Þ Maternal Survival Strategies lays down a
framework for achieving the fifth Millennium
Development Goal of reducing maternal mortality.
HMIS indicators related to pregnancy care interventions
are:
1. 1st antenatal care attendances
2. 4th antenatal care attendances
3. Cases of abnormal pregnancies attended at out-patient
departments (OPD) of health facilities
4. Institutional cases of maternal morbidity and
mortality due to Antepartum hemorrhage (APH),
hypertension and edema reported by In-patient
departments (IPD) of health facilities
5. Cases of abortion attended at health facilities
6. Cases of medical (safe) abortions conducted at health
facilities
HMIS indicators related to:
Inter-partum (during pregnancy)
• Family planning method acceptors (New and Repeat)
• Family planning methods issued by type of method
Intrapartum care (during delivery):
• Deliveries by skilled attendance (at health facilities)
• Deliveries by Health Extension Workers (HEW) (at
home of Health Posts)
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Institutional cases of maternal morbidity and
mortality due to obstructed labor
Post-partum care (after birth):
• 1st postnatal care attendance
• Institutional cases of maternal morbidity and
mortality due to Postpartum hemorrhage (PPH) and
Puerperal sepsis
Child Mortality & Child Survival Interventions
Þ Ethiopia – countries who have made great strides
toward reducing the under-5 mortalities based on
Ethiopia Maternal and Child Health Data (2012).
Ethiopia is implementing interventions targeting under
5 yr old children through:
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Universal Immunization Coverage,
Nutrition program,
Integrated Management of Childhood Illnesses
and the Community Case Management of
Childhood Illnesses
Through Health Development Army to – improve
water, sanitation and hygiene– Malaria
prevention
through
Integrated
Household Spraying and distribution of
Insecticide Treated Nets (ITN) (USAID, 2013).
In the context of the above these child survival
interventions, the related HMIS indicators are:
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Number of treatments for children under five
provided by health facility by disease: Diarrhea,
dysentery, pneumonia, measles, malaria, neonatal
tetanus
Number of infants immunized for measles
Latrine coverage
Safe water coverage
Household with ITN
Stop TB Program (framework, page 128)
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With the vision to have a TB FREE WORLD, the
goal of the STOP TB Program (STP) is to
dramatically reduce the global burden of TB by 2015,
in line with the Millennium Development Goals and
the Stop TB Partnership targets of the World Health
Organization (2006).
One of the main objectives of the program is to
achieve universal access to high-quality care (i.e.
universal access to high quality diagnosis and patient
centered treatment) for all people with TB (including
those co-infected with HIV and those with drugresistant TB).
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Number of new extra pulmonary TB cases detected
HIV – TB – Co-infection
Proportion of newly diagnosed TB cases tested to
HIV
HIV+ new TB patients enrolled in DOTS
TB Treatment outcome
Treatment completed PTB+
Cured PTB+, Defaulted PTB+, Deaths PTB+
TB Positive: Acid Fuss bacilli positive (blue to red)
8th WEEK: HMIS DATA QUALITY
Data Quality
Þ Data Quality
is the overall utility of a dataset(s) as a function of
its ability to be processed easily and analyzed for
a database, data warehouse, or data analytics
system.
- Means the data is good and complete
Aspects of data quality:
1. Accuracy
2. Completeness
3. Update status
4. Relevance
5. Consistency
6. Reliability
7. Appropriate presentation
8. Accessibility
HMIS, more specific (in lab): LIS (lab info system)
Low Data Quality
High Data Quality
Generates costs
Useful and consistent
Affects the customer
Data cleansing can be
satisfaction, company’s
done to raise the quality
reputation and even the
of available data
strategic decisions of the
(importance: accurate
management
census)
e.g. cheaper product v branded/pricy product
A. Lot Quality Assessment Sampling (LQAS)
Lot Quality Assessment (LQAS) is a tool that allows the
use of small random samples to distinguish bt different
groups of data elements (or lots) w/ high and low data
quality.
HMIS Indicators to Monitor STOP TB Program
B. Routine Data Quality Assessment (RDQA)
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The Routine Data Quality Assessment tool (RDQA) is
a simplified version of the Data Quality Audit (DQA)
which allows programs and projects to verify and assess
the quality of their reported data. It also aims to strengthen
their data management and reporting systems.
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TB patients on DOTS
Number of new smear pulmonary TB cases enrolled
in the cohort
TB Case Detection
Number of New smear positive pulmonary TB cases
detected
Number of new smear negative pulmonary TB cases
detected
The Failure Mode and Effects Analysis (FMEA) is a
technique which is aimed to find various modes for failure
within a system. FMEA requires several steps for
execution:
C. Development Implementation Plan
Implementation Plan
o Project management tool that shows how a project
will evolve at a high level
o helps ensure that a development team is working to
deliver and complete tasks on time
o ensure that the communication between those who are
involved in the project will not encounter any issues
Key Components
1. Define goals/objectives
2. Schedule milestones
3. Allocate resources
4. Designate team member responsibilities
5. Define metrics for success
1. All failure modes (the way in which an observed
failure occurs) must be determined.
2. How many times does a cause of failure occur?
3. What actions are implemented to prevent this
cause from occurring again?
4. Are the actions effective and efficient?
FMEA is often performed and updated any time a new
product or process is generated, when changes are made
to current conditions, or to the design, when new
regulations occur, or when there is a problem determined
through customer feedback.
3. Pareto Analysis
The Pareto Analysis operates using Pareto principle
(20% of the work creates 80% of the results)
runs any time when there are multiple potential causes to
a problem.
Data Quality Tools
Þ Data Quality Tools
- analyzes information and identifies incomplete or
incorrect data.
- used
to
address
the
data
quality
problem:
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Cleansing – such data follows after the
completion of the profiling of data concerns,
which could range anywhere from removing
abnormalities to merging repeated information.
o Bad data: duplicated data, missing data,
inaccurate data, & incorrect data
Application of Data Quality tools
Þ Data Quality Management (DQM) – generally
integrate profiling, parsing, standardization,
cleansing, and matching processes (Goasdue, Nugier,
Duqeunnoy, & Laboisse, 2007).
Techniques in Root Cause Analysis
Þ Root Cause Analysis
- is a class of problem-solving methods aimed at
identifying the root causes of the problems or
events instead of simply addressing the obvious
symptoms.
- among the core building blocks in the
continuous improvement efforts of the
organization
- root cause analysis alone will not produce any
results
1. Ask Why 5 Times
By identifying the problem, and then asking "WHY" five
times - getting progressively deeper into the problem, the
root cause can be strategically identified and tackled.
2. Failure Mode and Effects Analysis (FMEA)
4. Fault Tree Analysis
Fault Tree Analysis uses boolean logic to determine the
root causes of an undesirable event. This technique is
usually used in risk and safety analysis.
At the top of the fault tree, the undesirable result is listed.
From this event, all potential causes tree down from it.
Each potential cause is listed on the diagram in the shape
of an upside down tree.
5. Current Reality Tree (CRT)
Current Reality Tree analyzes a system at once. It would
be used when many problems exist and you want to get to
the root causes of all the problems.
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The first step in creating a current reality tree is
listing all of the undesirables or, problems.
Then begin a chart starting with each of those
problems using causal language (if...and...then).
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The tree will depict each potential cause for a
problem.
Eventually, the tree will show one cause that is
linked to all four problems.
6. Fishbone or Ishikawa / Cause and Effect
Diagram
No matter what term you use for the fishbone diagram,
the truth is, that it is a useful technique that will help you
in your root cause analysis. A fishbone diagram will group
causes into categories including:
1. People
2. Measurements
3. Methods
4. Materials
5. Environment
6. Machines
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hospital information systems include the
integration of all scientific, financial and
administrative programs.
Many hospitals have as many as 200 disparate
systems integrated into their HIS.
Benefits:
• The system should be user friendly and should
include training by the vendors.
• An excellent HIS gives several advantages to a
hospital such as but not limited to the delivery of
high-quality patient care and better financial
management.
• The HIS must also be patient centric, medical
personnel centric, affordable and scalable.
• An effective HIS additionally provides benefits
including:
o enhanced facts integrity
o reduced transcription errors
o reduced duplication of facts entries
o optimized report turnaround times (TAT)
HIS for Different Department:
Nursing Information Systems (NIS)
- computer based information systems are designed
to assist nurses and offer enhanced patient care.
7. Kepner-Tregoe Technique / Rational Process
Kepner-Tregoe Technique is intended to break a
problem down to its root cause.
1. Appraisal of the situation - what are the priorities and
orders for concerns for specific issues?
2. Problem analysis is undertaken to get to the cause of
undesired events.
3. Decision analysis is tackled, outlining various
decisions that must be made.
Potential problem analysis is made to ensure that the
actions decided upon in step three are sustainable.
INCIDENT REPORT
8. RPR Problem Diagnosis (who utilizes this
technique? Professionals)
Rapid Problem Resolution deals with diagnosing the
causes of recurrent problems.
Benefits:
o improving personnel schedules, accurate patient
charting and better clinical data integration.
o better-managed work force thru agenda packages,
enabling managers to handle absences and overtime.
o reveal staffing levels and obtain more cost-effective
staffing.
o patients critical signs.
o admission information, care plan and all applicable
nursing notes.
o nurses to collect, retrieve and examine the medical
records after which integrate it to design a patients
care plan
Physician Information Systems (PIS)
- PIS systems aim to enhance the practice of
physicians and also are encouraged by the
government for deployment.
- PIS are added thru computers, servers, networks,
and use extensively deployed and popular
programs such as, Electronic Medical Records
(EMRs), Electronic Health Records (EHRs), and
others. (exam)
This process has three phases:
1. Discover - team members gather data and
analyze their findings
2. Investigate - a diagnostic plan is created and the
root cause is identified through careful analysis of
the diagnostic data
3. Fix - the problem is fixed and monitored to ensure
that the proper root cause was identified.
Radiology Information System (RIS)
9th WEEK: HOSPITAL INFORMATION SYSTEM
Pharmacy Information Systems (PIS)
Þ Hospital Information System (HIS)
- a computer system that could manage all the
information to permit health care providers to do
their jobs efficiently.
Benefits:
o provide radiology billing services, appointment
scheduling as well as reporting and patient
database storage.
o to control the commercial enterprise side of their
practices.
Benefits:
o enables pharmacists monitor how medicine is
utilized in hospitals.
facilitates users supervise drug allergies and
different medication-related complications.
enables users to identify drug interactions and also
helps administer the appropriate drugs based on the
patients physiologic conditions.
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Selecting an HIS
1.
Total cost of package
It is essential to have a hospital information system
that has a low cost of ownership.
- A few providers reduce prices through having a
design that calls for much less hardware and fewer
servers.
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policies and procedures may be developed by
others without your input.
limitations of referrals and facilities based on the
employing organization.
Billing
- Billing statements itemize all of a purchaser’s
invoices and payments and maintain a rolling
balance of how much they owe.
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2. Web based system
- An excellent HIS system ought to be available on
the internet.
- Availability on the internet means authorized
employees can access the information whenever
they need from anywhere.
- A web based system will become even more vital
if it is used to share data bt / more hospitals.
3. Implementation and Support
- Change is continually resisted by people and
deploying or upgrading a hospital information
system can also invite employee criticism.
- It is always good to invite the vendor for
assistance in an implementation and request for
staff training.
HIS Providers in PH (page 158)
Þ Lab Reporting – a clinical and source documents
that provides interpretation & describes any radiology
procedure conducted by a radiologist.
1. BIZBOX
2. KCCI MEDSYS
3. COMLOGIK
(Pg: 161)
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Help Desk – offer info and guide to the company’s /
institution’s products and services.
Scheduling – access work scheds from everywhere.
Patient Registration / Patient admission form –
facts about the patient.
Admission – routine tests that are carried at the day
of admission.
Discharge – discharge entails the medical
instructions that the patient will need to fully recover.
Transfer – movement of an individual outside a
hospital’s premises at the instruction of any person
employed by the hospital.
Physician practice
Advantage:
o administrative burden of running a practice is
shifted to the employing entity.
o baseline level of compensation.
o support services and opportunities for further
education
and
training.
Disadvantage:
o scheduling and productivity expectations.
Þ Radiology Report
- a clinical and source document that provides
interpretation and describes any radiology
procedure conducted by a radiologist.
- It is an official medical document that provides
description and interpretation for any officially
requested radiological exam.
- The radiology report's main premise is to answer
the clinical question from the radiology request.
Þ Material Management System
- Basically concerned with the planning,
identifying, purchasing, storing, receiving and
distribution of materials.
- The purpose of material management is to
guarantee that the right materials are in the right
location, in the right quantities when needed.
- Generally, they utilize barcodes and RFID tags
with precise identification numbers for each
inventory object to enable accurate tracking and
control.
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The main components are:
1. Patient's demographics. Name, social security
number, etc.
2. Relevant clinical information and ICD-9 code.
3. Body of the report.
4. Impression (conclusion / diagnosis)
Þ Cardiology Reporting - should clearly provide info
about a patient for medical records.
Management Reporting System
- Provides business information.
- Historically, MR structures were simply used
retrieve up data.
Six reasons giving rise to the need for a MRS:
1. Constant need of reports for decision making
and analysis of trends
2. Reports being unavailable with the right
stakeholders at the right time
3. Lack of visibility and a single holistic view of
the enterprise performance
4. Data redundancy, duplication of data leading to
data management and quality issues leading to
error prone reports
5. High value resources
6. Changing a global report to fit local needs
Þ In-built Tally Interface
- TALLY.ERP is a simplified solution that
encompasses accounting, inventory management,
tax management, payroll, and compliance among
many others.
10th WEEK: LABORATORY INFORMATION
MANAGEMENT SYSTEM (LIMS)
Þ Laboratory Information Management System
(LIMS)
- a form of Med Lab Software Program used in
conjunction with Lab Information Systems (LIS).
- software designed to make labs more efficient
and effective.
- especially those that process massive amounts of
samples for research and development (R&D),
manufacturing, and medical research.
Þ Discharge summary
- A discharge summary is a clinical report arranged
by a health practitioner or different health expert
at the conclusion of a hospital stay or series of
treatments.
- It outlines the patient's main complaint, the
diagnostic findings, the treatment administered
and the patient's response to it, and guidelines on
discharge.
Applications:
o Labs dealing with R&D for oil and fuel companies
o Industrial chemical creation and testing
o Water treatment plant testing
o Food safety
o Environmental facilities
Purpose:
o The ultimate motive of a LIMS is to enhance
efficiency in lab operations through reducing
manual responsibilities.
Functionality:
1. Sample Management
- Accurate, detailed records are essential to making
sure everything gets done and done right.
- Some use RFID and Barcodes to create and
update audit logs and chain of custody to
automatically track where the sample is in every
2. Workflow Management
- Use an LIMS to automate workflows for the same
reason you should use it to automate
records keeping, but instead of saving work, this
function saves you time.
- LIMS
delegate
decision-making
to
the software.
3. Reporting
- Essential for data analysis auditing and
audit trail
- instrument mostly used: sample backlog,
processing time
Functional Requirements and Features:
1. EMR/HER
- huge asset when managing clinical lab
- functionality built-in, including patient check-in
and billing.
2. Mobile
- mobile-friendly LIMS
3. Enterprise Resource Planning (ERP)
- helps manage inventory
- getting alerts when supplies are running low,
auto-calculation of storage and freezer capacity,
and location management can be extremely
useful in a clinical lab.
Laboratory Standards:
Occupational Safety and Health Administration
(OSHA)
- released an "Occupational Exposure to Hazardous
Chemicals in Laboratories standard (29 CFR
1910.1450)" in 2011 to facilitate laboratory safety
- Lab means a facility where the lab use
of hazardous chemicals occurs. It is a workplace
where relatively small quantities of hazardous
chemicals are used on a non-production basis.
Chemical Hygiene Plan (CHP)
- A CHP is the laboratory's program which
addresses all aspects of the lab standard
- The employer is required to develop and carry out
the provisions of a written CHP.
- A CHP must address virtually every aspect of the
procurement, storage, handling, and disposal of
chemicals in use in a facility.
Other Features:
1. Patient Registration (like EMR)
2. Billing
3. Contract Management
- Customer Customizable invoices: including
balance and charges history analysis, history
balance, detailed services, participation when in
insurance coverage, discounts etc. (if the patient
has philhealth of health card)
4. Accounts Receivable (mga nabayaran ng patients)
5. Worklist & Workflow
- LIMS assist laboratories in setting priorities of
current workloads, based on analyst and
instrument availability.
- batch of samples, or a "lot" of batches
- Queueing: a block of repetitive procedures in a
certain process.
6. Quality Control
- two kinds of results: 1) Patient Result and 2)
Quality Control (QC) result
In QC: testing reagent and machine, Low and
High
Reagent: chem used in lab to test
- result can be Quantitative (in numbers) or
Qualitative (positive or negative) or Semiqualitative (limited to a few different values).
7. Barcode-Generation, Printing & Reading
8. Bi-Directional Interface
- A bi-directional interface involves true two-way
communication
between
the
analyzer
(equipment) and information system interface.
- The LIMS interface downloads specimen ID and
test orders, while the analyzer uploads specimen
ID and test results.
- A Bi-Directional Interface application saves the
technologist the time to program test orders into
the analyzer, and eliminates errors in manual
entry.
- Newer random access testing, bi-directionally
interfaced analyzers also incorporate bar code
specimen label scanning which provides
automatic positive specimen ID capability.
Other info: (LALABAS SA EXAM, not paraphrased;>)
Þ MyPocketDoctor and MyDocNow
- Mobile App-based Telemedicine centers that are
usually in partnership with other international
telemedicine centers.
Þ Medway Healthcare Inc
- Offers the most comprehensive set of
telemedicine services, being the first medical
clinic in the Philippines to mobilize its PreEmployment Medical Examination (PEME) arm
into the path of delivering interactive healthcare.
Þ Proski’s ADKAR® Model
- “Awareness of the business reasons for
change; Desire to engage and participate in
the change; Knowledge about how to change,
Ability to implement change, and Reinforcement
tto ensure change sticks”.
Þ Medgate and Lifeline
- Common features include 24/7 call centers,
diagnosis using images sent via email, medical
certificates, and treatment plan summaries.
Þ Kotter’s 8-Step Model of Change
- Building a strong, collaborative team and a
solid strategy; creating effective communication
channels; supporting staff empowerment; using a
phased and steady approach; and securing the
change within an organization’s culture.
Þ Kurt Lewin’s three-step Model
- The method involves preparing employees for
change, making changes, and finally integrating
and normalizing those changes within the
organization.