HEALTH MANAGEMENT
INFORMATION SYSTEMS IN
DEVELOPING COUNTRIES
An Essential Component of Health Systems
Strengthening
Presented on: May 23, 2011
Akiko Maeda
Health, Nutrition & Population Network
The World Bank
Health care is the world’s most informationintense industry due to the complexity and
uncertainties inherent in the sector.
Health Information Management is the glue
which links health information to the health
care delivery system.
Information Technology is a critically
necessary tool, but not sufficient for ensuring
effective management support to the health
system
A Quick Overview of the
Complexity of the Information
Structure of the Health System
Multiple Applications of HMIS
1. Patient Management
• National Policy &
Planning, Resource
Allocation Decisions
2. Population
Management
• Clinical Services
Management
3. Disease State
Management
• Health Insurance/ Payer
Contract Management
4. Resource Management
• Public Health
Surveillance &Program
Management
HMIS Modules
5. Utilization Management
6. Financial & Fiduciary
Management
7. Quality Management
• Evidence-Based
Medicine (R&D)
Courtesy, Dennis Streveler, University of Hawaii
Uses of HMIS: Examples
Patient Management
Population
Management
3. Disease State
Management
4. Resource
Management
5. Utilization
Management
6. Financial
Management
7. Quality Management
1.
2.
 Clinic Information





Systems
Hospital Information
Systems
Laboratory, Radiology
and Pharmacy
Information Systems
The Discharge Summary
The Encounter Form
The Electronic Medical
Record
Uses of HMIS: Examples
Patient Management
Population
Management
3. Disease State
Management
4. Resource
Management
5. Utilization
Management
6. Financial
Management
7. Quality Management
1.
2.





Public Health
Statistics (air, water,
food…) quality
Retrospective
Reporting including
the Annual Report
Biostatistical
analyses
Epidemiological
studies
Health Education
Uses of HMIS: Examples
Patient Management
Population
Management
3. Disease State
Management
4. Resource
Management
5. Utilization
Management
6. Financial
Management
7. Quality Management
1.
2.
 Communicable
Disease Surveillance
 Cancer Registry
 Diabetes Registry
 Hypertension
Registry
 Coronary Arterial
Disease Registry
 HIV Registry
 Other chronic case
management
Uses of HMIS: Examples
Patient Management
Population
Management
3. Disease State
Management
4. Resource
Management
5. Utilization
Management
6. Financial
Management
7. Quality Management
1.
2.
 Facility Management
 Biomedical
Engineering
 Human Resource
Management
 Pharmaceutical
Inventory
 Supplies Inventory
 Management of
scarce resources
Uses of HMIS: Examples
Patient Management
Population
Management
3. Disease State
Management
4. Resource
Management
5. Utilization
Management
6. Financial
Management
7. Quality Management
1.
2.
 Utilization of inpatient




services
Utilization of
outpatient services
Utilization of
diagnostic services
Utilization of operating
room theaters
Utilization of
pharmaceutical
therapies
Uses of HMIS: Examples
Patient Management
Population
Management
3. Disease State
Management
4. Resource
Management
5. Utilization
Management
6. Financial
Management
7. Quality Management
1.
2.




Accounting
Billing
Budgeting
Interface with
insurance eligibility,
insurance claims
submission, insurance
payments
Use of HMIS: Examples
Patient Management
Population
Management
3. Disease State
Management
4. Resource
Management
5. Utilization
Management
6. Financial
Management
7. Quality Management
1.
2.
LAST BUT NOT
LEAST:
 Implementing clinical
protocols and
guidelines
 Quality Improvement
and Safety Measures
 Outcomes Analysis
Building the Health Management
Information System
8.
7.
6.
5.
4.
3.
2.
1.
0.
Advanced Technologies
Electronic Record Keeping
Health Insurance Systems
Clinical Venue Systems
Management & Planning Tools
Resource Management
Accounting & Inventory
Health Statistics
Standard Setting and Master Planning
1
2
3
4
5
6
7
Increasing Level of
Development
8
9 10
Examples of World Bank HMIS
Projects
From Slovenia, West Bank/Gaza,
and Egypt
Slovenia – Evolution of the National
Health Information Strategy
Initiated as a Health Information Clearinghouse
concept based on the banking ATM system…
… with secure smart card accessed
only by using Professional Card (PC)
used by Medical Professionals (Doctors
and Nurses) according to their Data
Access Rights
Self-Service Terminals located at most
Health Care Service Providers, Health
Insurance Information locations and major
Voluntary Health Insurance Companies
Slovenia Health Information
Project
 Health Information Systems Standardization
 Healthcare Management - business process
review and upgrading
 Health Information Center and its
Governance
 who “owns” HMIS, who has access (security,
confidentiality), and who governs information
standards and ensures interoperability?
HMIS in West Bank/Gaza – an integral
part of Health Systems Development
 In 2000, a low-cost, secure
platform was made
available through the
Government Computer
Center. Health sector was
one of the first to make
use of this internet
highway...
 … to create common
service framework across
a non-contiguous territory
& building a “virtual
HMIS” team from
“islands” of expertise
Government Computer Center
and Clinical Information System
HMIS in West Bank/Gaza – an
integral part of Health Systems
Development
Foundational HMIS
Components
Proposed Next Steps
Health Insurance: beneficiary
registration & eligibility
checking
Clinic Info System: patient
encounter forms,
appointments (diabetes)
Contract tracking and
monitoring system
Link to clinic info system
for utilization reviews
Patient referrals, drug
/laboratory modules, cost
accounting
Provider performance
reviews, medical audits
HMIS in West Bank/Gaza – an
integral part of Health Systems
Development
 Creating a “Health Information Center” as the focus of
information technology expertise in the public sector
(supported by the Government Computer Center)
 Sponsoring Palestinian Data Dictionary and Data
Modeling activity across systems, venues and sectors
 Promoting the use of email as a way to link
geographically separated workgroups
Project progress stopped due to the political situation on
the ground
Egypt – Health Insurance Systems
Development Project ($75 million)
Project Objective:
 To improve the
financial sustainability
and efficiency of social
health insurance
operations through the
adoption of a proven
business model for
health insurance
operations.
>> HMIS is the backbone of
the project.
Egypt – Health Insurance Systems
Development Project
New operational
procedures for:
• Contribution
management
• Claims
management,
• Utilization
management,
including fraud
control approved
by the health
insurance Board
INDICATORS
 % of health insurance claims
captured and processed
through the new business
management systems
 % of electronically processed
claims rejected or escalated
for medical appropriateness
vs. rates detected by manual
audit
Egypt Health Insurance Systems
Development Project Design
Health Insurance
Management
Information Systems
are complex to design
and implement.
To maximize chances
of success, the
project was designed
around three core
contracts that will
allow continuous
feedback and
adjustment process.
THANK YOU!
amaeda@worldbank.org