Health Management Information Systems and Integrated
Health Information Architecture
Learning Objectives
• Students should build an understanding of
– Different types of health information systems
(HIS)
– Integrated Health Information Architecture (IHIA)
– Why is it important to have an IHIA perspective
– Tools for enabling an IHIA
– A social systems perspective towards IHIAs
Key concepts
•
•
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•
•
•
•
•
•
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System
Health Information Systems
Health Management Information System
Electronic Medical Records
Human Resource Information System
Logistics Managament Information System
IHIAs
Data warehouse
Data, Information, and Knowledge
Social systems perspective
4
A System
•
A system can be conceptualized as interconnected components with
processes around:
– Input
– Throughput
– Output
– Feedback.
•
Example: An Educational system
– Input: resources, students, teachers, schools etc
– Throughput: teaching, group work, exams etc
– Output: students with degrees, skills, experiences etc
– Feedback: quality of teaching, employment of students
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Health Information Systems (HIS)
• A health information system denotes processes of
input, throughput, output, and feedback around
health related information
• The goal of an HIS is to is to produce relevant
information that health system stakeholders can use
for making transparent and evidence-based
decisions for health system interventions (HMN
2005)
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Information part of the larger Health
System
7
HIS has multiple meanings
• For the health managers, it means aggregate data;
Health Management Information System (HMIS)
• For the nurses and doctors, it means data related to
patients; (electronic) medical records (EMR)
• For the lab technicians, it means data related to
blood samples and test results; laboratory
information system
• Similarly, for human resources, logistics, finance, etc
• Thus, HIS is a much broader term which
encompasses these various information systems
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Health Management Information
System (HMIS)
• Focus on the needs for health management
– Processes of PODC - (Planning, Organizing,
Directing & Controlling).
• The collection and use of information in order
to make decisions regarding the effective and
efficient allocation of resources.
• Emphasis is on routine (service) aggregate
data and its analysis over time and across
geographical space
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Management Process
Ungathered
Information
Gathering
Information
Gathered
Information
Decision making
(about effective &
efficient
allocation of
resources)
Decision
Unallocated
Resources
Decision
implementing
/resource
allocation
Achievement
Effectively & efficiently of desired
aim
allocated resources
Electronic Medical Records (EMR)
• Are related to patient care, and focus on
patient data (name, age, symptoms, medical
history, test results etc), and is collected
longitudinally over time
• Functionality is around patient care,
registration symptoms, test results, medicine
prescription, referrals, billing, etc.
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EMR: Supports patient workflow
Hisp India
Human Resource Information System
(HRIS)
• For the management of human resources,
with data related to staff (name, profession,
diplomas, salary, etc)
• Functionality of the system is geared towards
managing hiring, distribution, payment,
education, training, and certification of staff,
over time
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Source: Good Health at Low Cost 25 Years on
What make a successful health system?
Countries with a Critical Shortage of Health Care Providers
N. Engl. J.Med 2007, 2564-67
Logistics Management Information
Systems (LMIS)
• Related to the logistical tasks around
distributing health related commodities,
such as vaccines, medicines, instruments,
etc
• Functionality for inventory management,
ordering and procurement, tracking
commodities, certifying suppliers, forecasting
etc
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Integrated Health Information
Architectures (IHIAs)
• An overall framework for how these various information
systems work together and speak to each other (HMIS, EMR,
HRIS, etc)
• Integrated:
– Working together, sharing definitions and data
– Integrated has different meanings to different people: here it
means they can speak to each other and share data across
the subsystems
• Architecture
– Collection of sub-systems; organized to form a whole, but
have different roles
– An architecture describes their roles and relationships
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IHIA is a system of systems, and their
roles and relationships
IHIA
HMIS
LMIS
HRIS
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Labor
atory
IS
EMR
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Why is it important with IHIAs?
• To share data
– Build powerful analysis by combining data
sources and study cross-cutting indicators
– Improve quality by reducing duplication and
manual transmission of data
• Resource optimization
– Reduce duplication of data collection
– Reduce development and maintenance of
overlapping systems
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Example: Connecting HR and clinical data
•
Service delivery data comes from many sources
HMIS
Patient records
•
Health worker deployment also data comes from many
sources
Payroll at Ministry of Finance,
HR System at Ministry of Health
Licensure and Registration from councils
Training information systems
•
Connecting these two data sets among multiple systems
allows new questions to be asked and answered
What facility is most in need of nurse midwives?
Which districts should we target training for chronic diseases?
Where should we prioritize financial incentives to retain health workers?
DRAFT
Example: Calculating deliveries per midwife
Number of deliveries
aggregated and
shared
Data
warehouse
Statistical
data
Number of midwives
aggregated and
shared
Medical records
Human resource
system
Data and functionaity
for each delivery
Data and functionality
on each staff
Tools for enabling an IHIA
• Data warehouse
• Standards and interoperability
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Data warehouse
• A database compiled from differerent
sources, designed to process and present
data for a multiplicity of users, based on their
needs
• For an IHIA, a data warehouse should
contain data from all the subsystems related
to health, including service data, census,
surveys, environmental data etc.
• Also called an integrated data repository
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The HMN model of a data
warehouse/integrated data repository
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The benefits of a data warehouse
• Availability of different data sources in one
place: for creation of indicators for analysis
– Can combine different data sources
•
•
•
•
Enables business analysis intelligence
Enables data mining
Customized outputs for different users
Enables the possibility of new systems and
data sources being plugged in (and out)
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Example: availability of various data
in one place
– fromLEAGUE
Sierra Leone
CHIEFDOM
TABLE
2ND QUARTER APRIL – JUNE 2009
Chiefdoms
% Full
Immunized
2nd
Quarter
% PHU
Delivery
2nd
Quarter
% 3rd
ANC
Visit
% 2nd
Dose
of
IPT
%
MMRC
Submitted
% Exclusive
Breastfeeding
at
Penta3
Average
Score
Ranking
Kongbora
98.2
45
170.9
96.6
86.6
93.3
5.3
1
Fakunya
124.3
62
154.3
86.2
100.0
48.1
5.0
2
Dasse
134.9
57
90.5
86.3
100.0
45.9
4.8
3
Kaiyamba
90.3
55
162.7
93.4
75.0
71.3
4.8
3
Timidale
140.3
46
106.8
91.7
91.7
33.0
4.8
3
Kowa
118.4
52
96.5
46.7
100.0
78.2
4.7
6
Lower Banta
88.3
48
201.6
120.8
100.0
35.6
4.7
6
Bagruwa
61.4
37
110.3
92.4
93.0
32.1
4.3
8
Kamaje
55.6
35
69.7
140.7
100.0
86.5
4.3
8
Kargboro
80.4
45
93.2
77.6
100.0
36.5
4.3
8
Kori
49.8
40
92.6
89.4
86.6
64.0
4.3
8
Ribbi
71.8
26
53.7
57.4
100.0
60.5
3.7
12
Upper Banta
61.1
29
68.0
101.2
77.8
38.6
3.7
12
Bumpeh
54.9
29
73.8
38.2
100.0
28.3
3.2
14
Total
91.4
43
114.3
32.4
93.6
20.8
Example: Dissemination and
presentation: Customized dashboards
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Example: Dissemination and presentation
Standards and Interoperability
• Standards allows the various subsystems of
an IHIA to share data
– Standard data definitions
– Data exchange standards
• When subssystems can share data and work
together as an IHIA, they are interoperable
• Contentious area: a «standard» is not just
created and accepted by all
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Data, Information, Knowledge:
founding blocks of an (H)IS
Data
Information
Increasing
usefulness
Knowledge
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From Data to Knowledge
• Data- is raw material in form of numbers,
characters, images. This is the basis of
creating information after analysis
• Information: is a meaningful collection of
data organized with reference to a context
(time, other facilities, denominators)
• Knowledge: when information is analyzed,
communicated and acted upon, it becomes
knowledge
Data
Information
Knowledge
Example of value chain from Data to
Knowledge
• Data: 23 children with Malaria in a district
• Context makes Information: There are 1425
children in this district. This gives a incidence rate of
1.6%
• Analysis and action creates Knowledge: This is not
so high, but higher than last month and the
neighbouring district. Why is this? We must check if
they have enough bednets to distribute at the
facilities
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A social systems perspective:
”Airplanes don’t fly, airlines do”
• An IHIA does not exist in a vacuum:
– It is not only about technology and software
• An IHIA is not built from scratch
– There are existing structures in all countries, the
IHIA grows out of this
• A social systems perspective helps us to
understand the complexity of the IHIA
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A social systems perspective
• People, routines, organizations, institutions, tools
(such as a data warehouse, and paper forms),
legislature, instructions etc
• These exist in a context, shaped by history, social,
institutional and political conditions
• It can be seen as a social web of ministry officials,
vendors, other government entities, international
organizations, NGOs, involvement of evolving
technology and infrastructure
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A social system is a complex system
• The HIS consists of thousands of staff, who
collect, process, analyse and use health data
in a variety of ways, with the help of various
tools, enforced by legislation and shaped by
the larger social system they are part of.
• HIS are thus complex systems
• It is not the technology that is the HIS, but
the social system as a whole. Socio-technical
systems
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HIS development from a social system
perspective
• An HIS is never built from scratch, but exists
as a social system. There is always a history
associated, which has to be engaged with
• The introduction of new routines, new
technology etc. thus takes place in a highly
complex and embedded setting, and will thus
not be simply overruled
• Unintended consequences are the order of
the day – things dont happen to as we plan
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HMN study of over 60 countries
assessment
• Mostly countries from low and middle-income
countries
• Main findings
– Data management and resources are the areas in
which most countries struggle
70.0
Overall score, 54 countries
Percentage of maximum score
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Resources
Indicators
Data Sources
Data
Management
Information
Products
Dissemination
and use
80.0
Across income levels...
Percentage of maximum score
70.0
60.0
50.0
Low Income
Lower Middle Income
Upper Middle Income
40.0
30.0
20.0
10.0
0.0
Resources
Indicators Data Sources
Data
InformationDissemination
Management Products
and use
Common problems I
• Policies for HIS
–
–
–
–
Access
Routines
Ownership
Standards
• Human resources
– With right skills?
– HIS Staffing not prioritized
Common problems II
• Data management
– Fragmented, no central HIS unit
– Appropriate technology
• Information use
– Too much collected, too little used
– Little incentive to use information locally
Recap
• IHIAs consist of many systems which speak
to each other
• A data warehouse is a key tool in the
development of IHIAs
• IHIA is much more than technology, and
requires a social systems perspective to it’s
understanding
• Data is not knowledge; it requires to be
sensitively cultivated
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