Health Care &Hospital Administration Dept. COB-Rabigh Health Management Information Systems All Chapters …

Health Management Information Systems

Why health information system? Good management is a prerequisite for increasing the efficiency of health services. Improved health information system is clearly linked to good management. Information is crucial at all management levels of the health services from periphery to the centre. It is required by policymakers, managers, health care providers, community health workers. “Changing the way information is gathered, processed, and used for decision-making implies changing the way an organization operates.”

Definitions System - Any collection of components that work together to achieve a common objective. Health System - All the activities whose primary purpose is to promote, restore or maintain health. Information - Meaningful collection of facts or data. Information System - Systems that provide specific information support to the decision-making process at each level of an organization. Health Information System - A set of components and procedures organized with the objective of generating information which will improve health care management decisions at all levels of the health system. The ultimate objective of health information system is not “to gain information” but “to improve action”

What is wrong with current health MIS? Irrelevance of the information gathered Poor quality of data Duplication and waste among parallel health information system Lack of timely reporting and feedback Poor use of information The difference in culture between data people and decision makers: Planning and management staff rely primarily on “gut feeling” to formulate ad hoc decisions rather seek pertinent data.

Steps involved in restructuring of Health MIS Step 1: Identifying information needs and feasible indicators Step 2: Defining data sources and developing data collection instruments for each of the indicators selected Step 3: Developing a data transmission and processing system Step 4: Ensuring use of the information generated Step 5: Planning for health MIS resources Step 6: Developing a set of organizational rules for health information system management

Step 1: Identifying information needs and feasible indicators Identifying information needs for follow-up of a pregnant woman in a primary level Identifying indicators to ensure efficient drug management in a referral hospital Identifying indicators to ensure efficient Information, Education and Communication in the community Identifying indicators to monitor the quality of supervision by the district management team

Step 2: Defining data sources and developing data collection instruments for each of the indicators selected Develop an appropriate record form for follow-up of haemo-dialysis in a tertiary care hospital Develop a monthly reporting form for activities performed in a primary level clinic Define data sources for a situational analysis at the district level Develop data sources for monitoring the quality of teaching in a medical college

Step 3: Developing a data transmission and processing system Structure the information flow on pregnant women between the traditional birth attendant and midwife in the health centre Ensure that monthly report forms from health centres are entered in the district computer in a timely and accurate manner Develop a mechanism for reporting of Research done in a research centre

Step 4: Ensuring use of the information generated Develop user-friendly feedback formats for regional mangers on the utilization of inpatient services in the region Train health auxiliaries in follow-up procedures for hypertension patients using a standard record form Develop a curriculum for the undergraduate and post-graduate students depending upon the need in the country Ensure research on the priority health issues for the country

Step 5: Planning for health MIS resources Create positions of computer operators in cases where district level data processing is computerized Submit revised recurrent cost budgets based on proposed new data collection procedures Step 6: Developing a set of organizational rules for health information system management Develop standard case definitions Change the job description of doctors in cases where health information system restructuring involves their active participation in data collection Develop an instruction manual for computer operators

Information process Data collection Resources Data transmission Management Data processing Organizational rules Data analysis Information for use in planning and management

Ways to enhance the use of information in decision-making Characteristics of the data Characteristics of the data Characteristics of the data Characteristics of the data Characteristics of the problems and the decisions they require Organizational or structural characteristics Cultural differences between ‘data people’ and ‘action people’ The communication between the two The communication between the two The communication between the two The communication between the two

Characteristics of the data Ownership and relevance Validity and reliability Aggregation of data Customizing information to the users’ needs Timeliness of feedback

Sybsystems of Health Information System WHO proposes to categorize the health information system under five interrelated “subsystems”: Epidemiological Surveillance (notifiable infectious diseases, environmental conditions, and risk factors) Routine service reporting Special programmes reporting systems (tuberculosis and leprosy control, MCH, school health) Administrative systems (health care financing systems, health personnel systems, logistic systems) Vital registration systems (births, deaths, and migratory movements)

Communication Communication process within a health team Feedback process Communication products – Time comparison – Geographical comparison – Comparison of actual performance vs. mean performance – Comparison of actual vs. planned performance

A framework for defining information needs and indicators Perform a functional analysis at each management level of the health service system Identify information needs and select feasible indicators Patient / Client management Health Unit management Health System management

Types of routine data collection methods Health unit data collection Community data collection – to monitor activities performed in the community by health unit staff or by community health workers – to obtain more representative data on the health status and living environment of the communities served, including data on births and deaths in the community, agricultural and meteorological data, data on education etc. – to assist in planning for health services that are more accessible to community Civil registration systems

Data collection instruments Data collection instruments for patient/ client management Preventive Growth cards MCH cards School health card Family registration records Curative Medical records Laboratory forms Referral forms

Design & Implementation of routine data collection systems How many and what type of data collection instruments will be needed to respond adequately to the defined information needs? Are existing instruments adequate, or do they need to be modified? If new instruments are needed, how will they be developed? How will the new data collection instruments be introduced to the care providers in charge of data collection? Other issues » Relevance » Feasibility » Burden » Layout & Clarity

Computers in MIS Optimization of the scarce resources available for health care, specially in developing countries Information - accurate, comprehensive Retrieval of information - quick Decisions - quick Implementation - rapid Monitoring - adequate Large geographical area can be covered

If computer network is established in health organization More speedy communication of data At national, state & district levels, processing can be done for valuable information Obtaining coverage levels for various activities Age-specific & area-specific figures Check suspect data from CHCs Identification of problems requiring research Prompt reporting of results Achieve data standards Data for comparative purposes

What can be done to improve and ensure data quality Keep the design of the information system as simple as possible Involve users in the design of the system Standardize procedures and definitions Design of data collection instruments Develop an appropriate incentive structure Plan for effective checking procedures Training

Data collection instruments Home-based records: Immunization cards, Growth- monitoring card, Maternal health card Health worker based records: Pregnancy/birth card, death report form, child records, women’s register, workers work form Supervisor’s based: Supervisor’s roster District-based records: Family enrollment forms, birth registers, death registers, health worker’s report, supervisor’s report Home office- and donor-based reports of health project outputs and population health status

Organization rules –Data collection standards –Case definitions –Data transmission –Confidentiality –Training standards –Software design –Procurement/ Distribution –Quality assurance –Private sector Basic Health Services HIS Staff Training HIS Supplies Hardware/ Software Financial Resources Hospital HMIS HMIS Management Elements of Health information system management

HMIS in context of Health Sector Reforms The more radical and innovative the proposed change is in regard to the information system, the greater the implications for change in the organization Reforms: systemic, programmatic, organizational, & instrumental The objective of producing and utilizing information more effectively will affect the behavior and motivation of all personnel

what is HIS?  HIS. Hospital Information System. One that supports all hospital functions and activities such as patient records, scheduling, administration, charge-back and billing, and often links to or includes clinical information systems such as RIS. (Radiology Information System )

Registration Consulting Ward Nursing Pharmacy Stores & Purchase Radiology Laboratory OT Blood Bank Diet & Kitchen And more... Hospital Information System

Patient care Community Outpatient CommunityInpatient Community Administration Community Reception Community Medical Accounting Community Healthcare professional Staff Clinical laboratory technologist Radiological technologist Physician Nurse Hospital administrator Clinical Laboratory Community Radiological Community Pharmaceutical Community Pharmacist Structure of the Hospital Community Medical Service Patient

Management Information System Clinical Information System MIS CIS GMIS Geographical Management Information System Development steps of HIS

The information in hospital

Front office Doctors consultation room Ward Laboratory The service providers like financial and insurance service provider And so on The information of the hospital come from

This information can be categorized as

Patient Administration Clinical Management Resource Management Financial Management Management Information System And more… Information will be used by the areas

The function of HIS

Laboratories Pharmacies Researchers Doctors and consultants Banks and financial institutions Administrators And knowledge managers HIS have the ability to link the following major players

the aim of a HIS is  to adequately enable the execution of information processing functions – for patient care, including administration as well as – for research and education mainly for university hospitals -  considering economic hospital management, as well as  legal and other requirements therefore HIS contributes to a high quality of patient care and medical research

HIS should provide  information, primarily about patients, in a way that it is correct, pertinent and up to date, in time, accessible by the right persons at the right site in a usable format  knowledge, primarily about diseases, but also, for example, about the effects of drug interaction, to support diagnosis and therapy  information about the quality of patient care, hospital performance and costs

in other words: HIS should provide, as far as feasible,  the right information and  the right knowledge  at the right time  in the right place  to the right people  in the right form so that these people can make  the right decisions

1.Admissions, Medical Records & Abstracting (ADM/MRI/ABS) 2.Billing/Account Receivable (BAR) 3.Community Wide Scheduling (CWS) 4.Data Repository (DR) 5.Imaging and Therapeutic Services (ITS) 6.Laboratory, Microbiology, Blood Bank & Anatomical Pathology (LIS) 7.Order Entry & Electronic Medical Record (OE/EMR) 8.Patient Care System (PCS) 9.Pharmacy (PHA) 10.Remote Physician Access ten application areas will be the necessary part of the HIS

importance of HIS

the information system of a hospital is an important quality factor the information system of a hospital is an important cost factor the quality of HIS is becoming increasingly relevant in the competition between hospitals a HIS can provide a holistic view of patients and of a hospital a HIS can be seen as the memory and nervous system of a hospital

Thank you very much. Any questions?