Integrated Health Information Architecture (IHIA)
Learning Objectives
– Health System is more than point of care
– Different types of health information systems
– Integrated Health Information Architecture
(IHIA)
– Global movement towards IHIAs
– Enablers of an IHIA
• data warehouse
• Standards and interoperability
What is health?
4
What is health
service quality?
5
Societal factors contributing to health
 Political commitment to health as a social goal
 Societal values of equity, political participation
and community involvement in health
 Investments in Primary Health Care
 Widespread education (women)
Benchmarks for National Health Systems
1) to understand and influence how the health care service delivery
operates: access, coverage, continuity of care, risk assessment
2) efficient and effective service delivery
Health care resource allocation indicators (per capita):
 distribution of qualified health personnel
 distribution and type of health services
 distribution of health expenditure on personnel, supplies, facilities
Health care utilization indicators:
 immunization coverage
 antenatal care coverage
 proportion of births attended by a skilled attendant
Health status indicators:
 Infant mortality rate
 maternal mortality
 life expectancy at birth
 prevalence/incidence of infectious diseases
7
Source: Good Health at Low Cost 25 Years on
What make a successful health system?
WHO Health System building blocks
9
Human resources
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
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, and certification of staff, over time
13
Electronic Medical Records (EMR)
- Are related to patient care, and focus on
patient data (name, age, symptoms, medical
history, test results etc)
- Functionality around patient care,
registration symptoms, test results, medicine
prescription, referrals, billing, etc.
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EMR: Support Patient workflow
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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Health information subsystems
A National health information system consist of several subsystems
 Routine data collection based on patient and service records and
regular reporting from community health workers & health facilities
 Disease surveillance and outbreak notification
 Programme-specific monitoring and evaluation
(ex: EPI, Malaria, TB, HIV/AIDS)
 Administration and resource management
(budget, personnel, supplies)
 Data generated through household surveys
 Registration of vital events and censuses
(births, deaths and causes of death)
Aggregate data
Individual /program
tracking
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Some benefits of good HIS
- providing (continuity of) care to patients (medical staff)
- assist decision makers in detecting and controlling
emerging and endemic health problems
- monitor progress towards health goals/targets (MDGs)
- promote equity (many not counted!)
- strengthening the evidence base for effective health
policies
- permitting evaluation of health system interventions
over time
- ensuring accountability in the way resources are used
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HIS around the world
Huge differences between national health information
systems (HIS), however generally a move from paper
to digital and hence potential integration of systems
Common national challenges:
–
–
–
–
–
Little use of health information (locally)
Too much data collected
Low quality of information
Fragmentation of information streams
HIS Staffing not prioritized
19
Typical national HIS setup
20
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Integrated Health Information
Architectures (IHIAs)
An overall framework for how these various information systems
work together (HMIS, EMR, HRIS, LMIS, etc)
Integrated (appearing as one)
– Working together, sharing definitions and data across
information systems
Architecture
– Collection of sub-systems; organized to form a whole, but
have different roles
– An architecture describes roles and relationships between
systems
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IHIA as a system of systems, their
roles, and relationships
IHIA
HMIS
LMIS
HRIS
Lab.
IS
EMR
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Why is it important with IHIAs?
To share data
– powerful analysis by combining data sources
– 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: Combining HR and clinical data
•
Service delivery data comes from many sources
HMIS such as DHIS2
Electronic Health Records
•
Health worker deployment data comes from many
sources
Payroll at Ministry of Finance,
HR System at Ministry of Health
Licensure and Registration from councils
•
Combining these two data sets across 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?
Example: Calculating deliveries per midwife
Global Movement towards IHIA
Health Metrics Network (since 2005)
– Build consensus around integrated data warehouses
– provide a framework for building IHIAs
– many countries have developed strategic plans to work
towards an IHIA
Donors changing approach: Paris declaration (2005)
– build on local systems; local government decisions, but still
donor specific reporting requirements
– collaboration between donors (harmonization), but hard to
accomplish in practice
– shift funding towards evidence-based interventions, but
dependent on reliable information
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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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Example: combining various data
CHIEFDOM LEAGUE 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
Standards and Interoperability
- Standards allows the various subsystems of an IHIA
to share data
– Standard data definition
– Data exchange standards
- When the sub-systems can share data and work
together as an IHIA, they are interoperable
More about these two concepts later in the course
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