Unit 9: Health Information
Systems
Outline
• Typology of Health Information Systems
• Agents, Units, and Institutions in health
information
• What goes wrong? What goes right?
Part 1: Health Information Typology
Information for Decisions
• Types of information follow types of
decisions
– Primary health delivery
– Health workforce
– Quality and governance
– Financing
– Supply chain
Decisions for primary health delivery
• Primary health worker
decisions
– Strategies for diagnosing
and treating
• What is the local
epidemiology?
• What are local treatment
options?
• What are my patients’
priorities?
– Quality feedback
• How am I performing?
• Are my patients
responding to treatment?
• Health district supervisor
decisions
– Reach
•
•
•
•
Local epidemiology
Facility location
Facility staffing
Facility utilization
– Impact
• Provider quality
• Supply adequacy
Information Sources in Primary Care
• Passive Data from
Facilities
– Patient registers
– Stock registers
– Staff attendance logs
• Active Data Collection
from Facilities
–
–
–
–
Exit interviews
Site inspections
Mystery Shoppers
Quality testing of drugs
• Household surveys
– Vital events registration
– Demographic and Health
Surveys
– Morbidity surveys with or
without biomarkers
Decisions for Workforce
• Decisions at Schools
– Are we teaching
workers what they
need to know?
– What new programs
will we need?
– What old programs
need to close
– How to finance training
• Decisions at Ministry
– What types of workers
will we need?
– What types of workers
do we have
– How many?
Information Sources for Workforce
•
•
•
•
Census of licensed professionals
Census of schools and class size
Household surveys: “Who did you see?”
Active market surveys
– Prices of services
– Prices of medical resources
– Numbers of private sellers
National Data :Ecology of Medical Care
Decisions on Quality
• How? Who? Where? to intervene on
quality levels
• Assess performance of norms and
institutions
– What information could improve ability of
principals and agents to execute contracts?
– What governance procedures are working
best—what would help them work better?
– What laws and regulations are needed?
Information on Quality
• Grievances
– Complaints by peers,
patients, inspectors
• Statistical outliers
– Poorest performers in
a facility survey
• Epidemiology
– Epidemics of
preventable diseases
– Vaccine coverage
Palace of the ruler of Venice:
Box for citizens to denounce corrupt
officials.
(Photo by D Bishai 2008)
Information on Institutions
• Practice surveys
– Adherence to guidelines
– Provider knowledge quizzes
– Incentives to adhere
• Population surveys
– How much do they know about their provider?
– What information can they use?
Decisions in Financing
• Who is paying out of pocket and do they need
financial protection?
– Frequency and depth of catastrophic medical
spending?
• What are costs of care? Where are costs falling?
– To design actuarially fair premium
– How fairly are costs of care being borne?
• Where is new revenue for health going to come
from?
– Chart of sources of health system finance over time
Information in Health Financing
• National Health Accounts
– Public
“Health Spending”
• Look at ministry of health accounts
• Look at NGO spending
– Private “Health Spending”
• Household surveys of out of pocket medical spending
• “Public Health”
Spending
– Public Health is financed by several agencies at many
different levels of government
• Education, Transport, Defense, Environment
Decisions on Supply
•
•
•
•
•
Where is my stuff?
When will it get here?
Where are the bottlenecks?
Where is the wastage?
How much should I order?
Supply Informatics
• Shipment tracking systems
• Accessible inventory data
• Forecasts
– Based on last year’s performance
– Based on last year plus trend
– Based on population information
Part 2: Agents, Units, Institutions
Information and Development
• Less developed countries
– Information is power
– Exploited, never shared
• More developed countries
– Information sharing institutions get support
– Information is a public good
• Public funding devoted to health information units
• Health information collected and made public
National Health Information Unit
• Nationally representative databases
– Household surveys (DHS)
– Facility surveys
– Price surveys
• Epidemiological reports all public
– Reportable infectious diseases
– Chronic diseases
– Injuries
– Deaths, Births
Health Services Data
• Facility quality report cards public
– Facility staffing public
– Supply availability public
• Utilization data for Hospitals, Clinics,
Offices public
• Provider performance public
– National provider complaint databases
• Price data on medical prices public
Privatizing Information?
• Some health information starts out private
– Drug sales at retail pharmacy chains
– Insurance claims by private insurers
• Can be resold and remain private
– Valued by pharmaceutical companies
– Valued by other insurers
Part 3: Pitfalls
Humans: The Weakest Link
• Health information systems built on 3 legs
– Hardware
– Software
– People
• Upgrades to hardware and software are
objective and easy to finance
• Upgrading producers and users of health
information is difficult
Leading and Trailing Edge
• Health information systems are a blend of
software and hardware and people from
the last 10-20 years
• Coexistence
– Leading edge institutions have the latest of
everything
– Trailing edge has components from the past
• Rapidly developing countries have to work
harder to make these compatible
Diagnosis 1: Information hoarding
• Human holdovers from trailing edge see
information as power and do not share
– Political incentives remain
– Information threatens some groups and they will push
to keep information hidden
• Institutions that should be working to fix this:
– Media
– Universities
– Public health champions
• Simple rule: if information is paid for by public
and does not violate privacy it must be made
public
Diagnosis 2:Information wastage
• Ready sources of health utilization
information are never collated
• Public finance for information units is
usually the culprit
– Diagnosis of information hoarding should be
suspected
• Institutions that reward managers who
make evidence based decisions would
lead them to not waste data
Diagnosis 3: Misreports
• Often an unintended
consequence of hefty
incentives in a
contract
• Data process checks
only partly helpful
• Gold standard checks
are also necessary
In 2004 after Gavi began to pay $30 per
Covered child, Niger’s reported coverage
Deviated markedly from mother’s reports
(Lim et al. Lancet December 2008)
Diagnosis 4: Information neglect
• Most common syndrome
• Information that could have informed a
decision is not accessed or disregarded
– Information in inaccessible format
– Human decision makers don’t know how to
use data
– Information threatens political balance
• Solutions are both technical and human
Best Practices in Information
• Have wise leaders who understand the
value of investing in freely flowing health
information
• Invest in people as well as machines
• Integrate the data generating and data
using systems
Summary
• Health information needs exist wherever
there are decisions in health systems
• Health information collection and
distribution is a public good and subject to
undersupply and underutilization
• Developed societies led by wise leaders
open the doors and let information flow