GHANA HEALTH SERVICE HEALTH INFORMATION EXCHANGE
IMPLEMENTED BY THE CENTRE FOR HEALTH INFORMATION MANAGEMENTPOLICY PLANING MONITORING AND EVALUATION DIVISION
DOMINIC K ATWEAM
HEALTH INFORMATION SYSTEMS ANALYST
GHANA HEALTH SERVICE
POLICY PLANING MONITORING AND EVALUATION DIVISION
• Overview of the Ghana Health Service Health Information Exchange
• The nationwide District Health Information Management Systems –
DHIMS2 (DEMO)
• EPI data sets and reports
• EPI group sets of indicators in DHIMS2
• DVD-MT like dasboard on DHIMS2 based on agreed minimum outputs
• EPI agreed minimum outputs agreed on with WHO-Afro,WHO HQ ,
GHS, MOH , WHO -GH
• New EPI Vaccine districts regional and national ONLY Store report (
not facilities)
• Revised monthly EPI faclity report
• DVD-MT and RIM like excel template from DHIMS2 to allow data
exchange from DHIMS2 to DVD MT and RIM
• Performance Feedback to Regions and Districts
• Capacity Building
• Kintampo Case Study
• Over view of the GHS eTRACKER for matarnal and child health
services (DEMO)
GHANA HEALTH SERVICE HEALTH
INFORMATION EXCHANGE –GHS/HIE
Overview GHS HIE
 The Ghana HIE is composed of existing functional
components
 The HIE reflects current concrete reality (from the
ground up) of data flows and systems delivering
current use value
 It is also forward looking
 There is scope for it to be further elaborated
INDIVIDUAL CLIENT
RECORDS
IDENTITY
MONITORING
MANAGEMENT
HEALTH SECTOR
REPORTING PORTAL
DISTRICT HEALTH
INFORMATION SYSTEM.
DATA WAREHOUSE
DHIMS2
MCH, TB, HIV/AIDS
TRAINING
INSTANCE OF
DHIMS2 DATA
WAREHOUSE
BACKUP OF
DHIMS2
AND INDIVIDUAL
DATA WAREHOUSE
FACILITY REGISTRY/
DATA DICTIONARY
INTEROPERABILITY LAYER
• Orchestrate Data flows
• Alerting
• Gateway security
• Co-ordinate backups
LOGISTICS
MANAGEMENT
(open LMIS)
HEALTH WORKER
REGISTRY
(iHRIS)
PATIENT LEVEL
SYSTEMS
(Hams, iHost,
OpenMRS etc.)
LAB SYSTEM
(BLIS)
MOBILE
GATEWAY
(USSID, SMS,
short codes
• The Ghana HIE is composed of existing
functional components.
• The HIE reflects current concrete reality
(from the ground up) of data flows and
systems delivering current use value.
• It is also forward looking. There is
scope for it to be further elaborated.
Individual Data Warehouse
E-Tracker and Line Listing data
Identity Management
Single sign-on/user management on across applications
Monitoring
System and application level monitoring
DHIMS
The national aggregate routine reporting system
Training
Temporary system for user training
Back Up
Archiving for disaster recovery
Facility Registry
Public facing master facility service
Data Dictionary
Structural metadata and vocabulary service
Data in Individual data
warehouse is aggregated
and posted as routine
report into DHIMS.
DHIMS database is
replicated to Training
Database.
Backups are scheduled,
moved off-site and tested.
• Hospital data (HAMS) is
aggregated
and posted to DHIMS. Potentially
other EMR systems eg. OpenMRS,
iHOST)
• Routine data posted from Lab
System (BLIS)
• Health worker system (iHRIS)
Aggregate reports of HR data
CSD integration with infoman?
• OpenLMIS
• Mobile gateways
DHIMS is then moved to
backup in data
warehouse.
Live
Planned
Live
Live
Live
Live
Pending
Routing and TLS encryption
(nginx reverse proxy)
Orchestration of data flows
Implemented through a set
of PHP scripts controlled by
a
central configuration file
• DHIMS to facility registry.
DHIMS is facility data source.
Facility registry is driven by changes in
DHIMSAlerting intercept to
monitor/log
changes being made at district level.
• DHIMS to data dictionary.
Data element, disaggregation and
dataset definitions Published annually.
Individual data
compiled and
transported to backup.
GHS HIE STANDARD
Facility Registry Expansion Development (FRED)
The GHS HIE aligns to established standards such as DICOM and HL7 which support our specific
system needs
API specifications v1.0 for the FRED facility registry service.
This provides information for analysts, architects and systems integrators to understand the
behavioral and structural characteristics of compliant FRED facilities registries and
consumers. It describes the FRED interfaces at a wire level, covering both the host and client
services. This is based on the March 22, 2013 version of the API developed
collaboratively by the facility registry community.

Facility registry public API . IHE.net Care Service Discovery (CSD) http://www.ihe.net
 OpenHIE FRED api https://ohie.hingx.org
 Data Dictionary public API - DHIS2 native api to data dictionary components
• Overview of the Ghana Health Service Health Information
Exchange
• The Nationwide District Health Information Management
Systems –DHIMS2 (DEMO)
• EPI data sets and reports
• EPI group sets of indicators in DHIMS2
• DVD-MT like dasboard on DHIMS2 based on agreed minimum outputs
• New EPI Vaccine districts regional and national ONLY Store
report ( not facilities)
• Revised monthly EPI faclity report
• EPI agreed minimum out puts agreed on with WHO-Afro,WHO
HQ , GHS, MOH , WHO -GH
• DVD-MT and RIM like excel template from DHIMS2 to allow
data exchange from DHIMS2 to DVD MT and RIM
• Capacity Building
• Kintampo Case Study
• Performance Feedback to Regions and Districts
• Over view of the GHS eTRACKER for matarnal and child health
services (DEMO)
AGREED EPI MINIMUM OUTPUTS
Ministry of Health / Ghana Health Service
Integration and optimization of tools for the management of immunization data in Ghana 16 TH
-20TH NOVEMBER 2015
Public Health Division (EPI) & Policy, Planning, Monitoring and Evaluation Division (PPMED)
WHO AFRO, WHO HQ , GAVI
Agreed Minimum Output for EPI Reporting
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Timeliness and Completeness by District and health facility -Already in the DHIMS so track
completeness and timeliness of district stock level by district and region( Table with
percentages)
Table RED (Penta1 &3) by sub district and district (Table: Performance & Dropout colour
coded by standard cut off points ,monthly cumulative)
CAT table should be in sub district, district and Region (Table: colour coded, Penta1 &
dropout(penta1 _penta3) rate)
Vaccination Sheet : should be both monthly and cumulative for the selected antigen by all
levels, (Table: Absolute numbers of monthly and cumulative vaccination )
Coverage Sheet: should be both monthly and cumulative for selected antigen by all levels
(Table: percentage of monthly and cumulative coverages)
Synth_Vacc sheet should be done for all levels and for selected months for all antigens
(Table: All antigens- monthly and cumulative in absolute numbers)
Synth_Cov sheet should be done for all levels selected months and for all antigens (Table: All
antigens- monthly and cumulative by coverage)
Stock Vaccine table for selected vaccines should be filtered for all levels (Table: Absolute
numbers, monthly and cumulative, )
Bundling shd be kept as it is in the DVDMT (Table: ratio of vaccine vrs syringes by months by
district and region of YTD)
Supply table: stock level shd be by facility, daily and should cover at least the last 12 months
regardless of the year(Table: Proportion of device availability, including closed vial wastage
& forecasted demand ratio)
Report Table: shd be maintained with option to be selected by region and national
(summary of indicator table for selected level and period)
Graph tables should be by coverage, performance and by supply as it is already in the
DVDMT. Drop down menu shd be created for region or national level (Charts: coverage,
categories, district performances on Penta3 for YTD)
Number of days of stock-out by facility, sub district and District (Table: Absolute numbers of
reported by month (including number of existing health facilities), average number of days
of stock out by facility for YTD)
Full stock availability at service level (Graph of proportion of health facilities with zero days
of stockout for all vaccines for selected period by level)
Map of Coverage rate by district: for selected vaccines (annualised coverage) for YTD for
selected period (Map)
Table on AEFI by seriousness by levels for selected periods (Table)
Proportion of conducted IEC sessions by levels for selected period (Table)
Proportion of immunizations conducted by type and level for selected period (Table)
Trends in absolute number of children vaccinated and target population by month and by
level for selected antigens (Graph: Isolated maps, by year or the last XX months).
Monthly trend of Number and Proportion of functional vaccine refrigerators by levels for
selected period (Table of existing, functional and proportional refrigerators-filtered by level
by month )
Temperature alarms (Graph & table of temperature alarms per facility for selected period by
level)
NEW EPI VACCINE DISTRICTS REGIONAL AND NATIONAL ONLY STORE REPORT ( NOT FACILITIES)
MINISTRY OF HEALTH/GHANA HEALTH SERVICE
EXPANDED PROGRAMME ON IMMUNIZATION
VACCINE STORE REPORT
(To be completed by national, regional and district stores ONLY)
Region: _____________________
District:____________________
Month: ______________________
Year:_______________
Status & utilisation of vaccine stocks and other commodities
Beginning
Received
Issued
Quantity (doses)
VVM Status change
Expired
(3 or 4)
Other losses
Stock at end
BCG
Hep B
OPV
IPV
Rotavirus
Penta
PCV
Measles-Rubella
Measles
YF
Men A
Td
HPV
RTS,S
LLIN
Vitamin A (100,000 IU) - Blue
Vitamin A (200,000 IU) - Red
ADS_0.05ml
ADS_0.5ml
Sdilution_2ml
Sdilution_5ml
Safety boxes
Child Health Records
Cold chain temperatures at Vaccine stores
Maximum temperature recorded
Minimum temperature recorded
Number of days with high temperature alarms
Number of days with low temperature alarms
Number of refrigerators available
Number of functional refrigerators
COMPILED BY:
Name: _____________________
APPROVED BY:
Name: _____________________
Designation: _____________________
Designation: _____________________
Date: _____________________
Date: _____________________
Contact Number: _____________________
Contact Number: _____________________
No. of days of
stockouts
REVISED MONTHLY VACCINATION REPORT
MINISTRY(OF(HEALTH/GHANA(HEALTH(SERVICE
EXPANDED(PROGRAMME(ON(IMMUNIZATION
MONTHLY VACCINATION REPORT
Region: _____________________
District:____________________
Name of Reporting Facility:________________________
Month: ______________________
Sub-District:________________
Year:_______________
1. Demographic data
Total Population
Infants 0-11 months
Children 12 - 23 months
Expected Pregnancy
Annual
2. Vaccination sessions
Monthly
Planned
Conducted
No. of fixed vaccination sessions
No. of outreach vaccination sessions
No. of school vaccination sessions
BCG
3. Vaccination coverage rates
Penta1
Penta3
PCV3
IPV
MR1
MR2
Monthly coverage (%)
Cumulative coverage (%)
Dropout rate (%)
Cum (Penta1 - Penta3) *100
Penta1
Cum (BCG - MR1) * 100
BCG
4. Monthly vaccinations given by Age
Vaccine/Commodities
0 - 11 months
5. HPV Vaccination at 9 years
Number Given (By age group)
12 - 23
>= 24 months
Total Administered
months
BCG
Dose
In-school
Out-of-school
Total
HPV 1
HPV 2
Hep B
OPV0
6. Vitamin A Supplementation
OPV-1
6-11 mths
OPV-2
OPV-3
12-59 mths
Post-partum
Vitamin A
IPV
Rotavirus - 1
Rotavirus - 2
7. A.E.F.I.
Penta-1
No. of cases reported
Non-serious
Serious
Penta-2
Penta-3
8. Waste management
PCV-1
No. of safety boxes used during the month
PCV-2
No. of safety boxes disposed during the month
PCV-3
MR1
MR2
9. Cold chain temperatures at Health Facilities
YF
Maximum temperature recorded
Men A
Minimum temperature recorded
Fully Immunized
Number of days with high temperature alarms
LLIN - Children
Number of days with low temperature alarms
Pregnant Women
Td-1
Non-Pregnant
Others
Number of refrigerators available
Number of functional refrigerators
Td-2
Td-3
Td-4
10. IE & C
Td-5
No. of IEC sessions
Td-5+ (Not vaccinated)
No. of participants
LLIN - Pregnant Women
No. of home visit sessions
Planned
Conducted
STATUS & UTILISATION OF VACCINE STOCKS AND OTHER COMMODITIES –FACILITY
LEVEL
PERFORMANCE FEEDBACK TO THE REGIONAL HEALTH
DIRECTORATES & GHS DIVISIONS
OCTOBER 2015
HIGHLIGHTS
EDITORIAL TEAM
Dr. Anthony Ofosu
No suspected cholera cases in Central, Northern, Volta and Western Regions.
Dr. Boateng Boakye
Northern still achieves Penta 3 Coverage over 10-percentage above 100%.
Measles 2 Coverage has seen improvement over time, but all coverages are below the National
Target.
Six (6) Regions achieve National Target for under 5 Malaria CFR.
All Regions achieve TB CNR of less than 5%, with Brong Ahafo, Northern & Upper West having CNR
of %!
All HIV+ pregnant women received ART for PMTCT in Upper East.
IDSR weekly Completeness & Timeliness – All regions performed below 80% & 75% respectively.
Data Percentage Completeness & Timeliness - All regions performed below 85% & 80% respectively.
Only Upper East Region achieved National Target for Percentage Data Timeliness!
Data Entry Authorisation Timeliness - All regions performed below 70%.
INTRODUCTION
This October 2015 feedback highlights best and least performing regions with respect
to key service outcome indicators from the dhims2 platform. A “League of Regional
Performance” from the best to least performing, inclusive of the national performance
1
is illustrated for each indicator. Then evidence-based “core interventions” that can lead
to at least 80% of the desired outcome for a specific indicator is listed per the “80/20
2
Parieto Principle”. A spreadsheet of National Targets of the selected indicators is
embedded as a footnote below, to facilitate focus on Ghana Health Service (GHS) desired
outcomes, thereby assisting Managerial Leaders at all levels to track performance. The
feedback thus helps the assessment of progress towards measurable objectives of the
chosen intervention strategies, permitting necessary adjustments in choice of strategies
and knowing whether their associated intervention activities have been effectively
implemented. Finally emanating regional best practices are to be leveraged across
regions/districts in real time, on social media platforms and during peer reviews.
1Notably
in these regional performance feedback “bars/columns” of best& least performing regions per an
indicator is coloured green & red respectively and the national performance is coloured blue.
22015
GHS TARGETS (Selected Indicators) Double Click on Icon
H Y-G H S 2015
Perfo rman ce Targ et Matrix.xls
ANALYSIS OF REGIONAL PERFORMANCE - 2015 SEPTEMBER
1.0
NEONATAL CARE
Institutional Neonatal Mortality Rate (iNMR):
National Target: 4/1000 LBs
National attained 4.2/1000 LBs
The lowest iNMR was 2.2/1000 LBs in Eastern Region.
The highest iNMR was 7.7/1000 LBs in Brong Ahafo Region.
League of Regional Performance
Regional Neonatal Deaths per 1000 Live Births - October 2015
10
9
8
7
6
5
4
3
2
1
0
7
2.2
Eastern
2.8
2.9
Upper
East
AshanI
3.6
3.9
Central
Volta
4.2
4.4
7.7
5.1
Greater Northern Western
Accra
4.2
Upper
West
Brong
Ahafo
Ghana
CORE INTERVENTIONS
Kangaroo Mother Care (KMC), Essential Nutrition Action (ENA), provision of incubators,
early post-natal care, training and a Champion Pediatrician mentor.
2.0
INFANT & CHILD CARE
Institutional Infant Mortality Rate (iIMR):
National Target: <6/1000 LBs
National attained 4.2/1,000 LBS
The lowest iIMR was 2.0/1000 LBS in Upper West Region.
The highest was 6.4/1,000 LBS in Volta Region.
2
CAPACITY BUILDING –KINTAMPO CASE STUDY
INTEGRATING THE GHS/MOH HEALTH MANAGEMENT INFORMATION SYSTEMS STRATEGY
AND POLICIES INTO THE MINISTRY OF HEALTH TRAINING SCHOOLS CURRICULUM – A CASE
STUDY FOR KINTAMPO COLLEGE OF HEALTH AND WELL BEING
Program – Working Sessions With Lecturers and Tutors
DAYS
ACTIVITY
TIME
DAY 1
Introduction by participants
10:00am
Welcome address &
Objectives – Head of School and PPMED lead person
Overview of GHS Standard Operating procedure for HMIS
Introduction to SOP for health information management
·
Purpose
·
Aim
·
Objectives
·
Work guidelines
·
Flow of data
Lunch
Data management responsibilities – what students must know
·
Facility level
·
Sub district/districts level
·
Regional level
·
National level
Identifying key reporting forms and registers for programmes
offered by the school:
10:15am
10:30am -12:30pm
12:30pm – 1:30pm
1:30pm – 3:30pm
3:30pm -4:30pm
(Group work )
·
Nutrition
·
Disease control
·
Laboratory
·
Physician assistants
·
Medical records
·
Oral /dental health
·
Mental health
·
Field technicians
·
Health information
·
Health promotion
·
Others
Day 2
Recap of Day 1
Overview of DHIMS2
Demonstration of the DHIMS2
·
·
·
·
·
10am
10:30am
Dash board and messaging
Data entry
Data set reports
Pivot tables
Dash board
Creating of accounts
·
Ensuring all users can log on to DHIMS2
Practical use of the DHIMS2 – Report generation and analysis
Role of the HIO at various BMCs - SOP
Day 3
Day 4
Day 5
Review the medical record policy and operational guidelines
Group Work
Participants identify key areas linked and to be aligned to their
subject areas
Departure – Back to Accra.
10am – 4:30 pm
10am -4:30 pm
• Overview of the Ghana Health Service Health Information
Exchange
• The nationwide District Health Information Management Systems
–DHIMS2 (DEMO)
• EPI data sets and reports
• EPI group sets of indicators in DHIMS2
• DVD-MT like dasboard on DHIMS2 based on agreed minimum outputs
• New EPI Vaccine districts regional and national ONLY Store report (
not facilities)
• Revised monthly EPI faclity report
• EPI agreed minimum out puts agreed on with WHO-Afro,WHO HQ ,
GHS, MOH , WHO -GH
• DVD-MT and RIM like excel template from DHIMS2 to allow data
exchange from DHIMS2 to DVD MT and RIM
• Capacity Building
• Kintampo Case Study-
• Performance Feedback to Regions and Districts
• Over view of the GHS eTRACKER for matarnal and child health
services (DEMO)
WHAT eTRACKER MEANS FOR DATA
ENTRY IN DHIMS2
eTRACKER WILL POPULATE DHIMS2 DATA SETS WITHOUT
ANY DATA ENTRY BY FACILITIES
FAMILY HEALTH FORMS(RCH )
• Midwives returns (form A)
• Family Planning
• PMTCT
• Child Health Returns(from C)
• Nutrition
• EPI
• TB & HIV/AIDS FORMS
IMPACT ON CHOs WORK AT THE FACILITY
BEFORE eTRACKER
AFTER eTRACKER DEPLOYMENT
Reports
Every month, trained staff in all
health facilities manually tally and
summarize Child and Maternal
Health registries (ANC, Deliveries ,
PNC ,FP & Child Health ) into the
monthly reporting forms
•Form A (midwife returns )
•EPI
•Form C ( child health returns )
•Nutrition
Number of days used to tally
Averagely 3-5 days
Reports
All facility Child and Maternal
Health service reports
automatically populate DHIMS2 in
their respective data sets reports.
Copies can be generated
Number of days used to tally
None
IMPACT ON CHOs WORK AT THE FACILITY
BEFORE eTRACKER
AFTER eTRACKER DEPLOYMENT
Period of reporting
th
5 for entry into dhims2 at facility level or
submit to district for entry to be done for
facility
th
15 For all data to be validated and signed of
by DDHS for the previous month data
Period of reporting
Service data is aggregated by system and
populates respective datasets in eTracker
instance
eTracker datasets is automatically pushed into
th
dhims2 on the 15 of a month for the
previous month .
Services
All clients details need to be recorded in a
register every year.
Client from other facilities have to be
registered again
Hard to trace defaulter and reschedule
Services
Registration is done once .
Clients from other facilities have to be
relocated and services continued
Filter reports by defaulters and can re
schedule etc
TYPICAL TRAINING SESSION
• Mobile Hand Device (MHD) POLICY GUIDE LINES
• DEMONSTRATION OF THE e-TRACKER
• HANDS ON TRAINING
• REGISTERING MOTHERS & CHILDREN AND THEIR SERVICES
WORK PLAN ….
• MCH eTracker System Business Requirement
• MCH work flow
• eTracker agreed requirement for child health records
• National rollout plan
• cPBF work plan
MOST OF THE WORK IS BUILT AROUND WHAT WE AS A COUNTRY HAVE LEARNT FROM THE BID JOINT
LEARNING NETWORK …
• THANK YOU