RATIONALISING HEALTH INFORMATION SYSTEMS TO IMPROVE HEALTH OUTCOMES Public Health Services Queensland Health Australia

Dr Magnolia Cardona Coordinating Epidemiologist MB.BS, MPH, Grad DAE, CHEcon

Objectives of this lecture §Provide an overview of information system types and potential uses §Increase awareness on need to balance amount of data with cost and confidentiality concerns §Present case scenarios to set up and enhance information systems

Characteristics of Good Health Surveillance Systems §Clear objectives administration routine documentation monitoring research/evaluation §Simple (MDS) §Standard item format §Justification and validation of items

Characteristics of Good Health Surveillance Systems (cont) Relevant to users Minimum burden to providers Amenable to modification Provision for security/confidentiality Associated reporting system Feedback to collectors Linked to action

Options Paper-based centralised Sentinel/selected surveillance Computerised stand alone Single site Multicentre

Options Computerised networked Encrypted data transfer Combination Paper-based notifications electronic entry at central location

Setting up a Health Information System Which option is best?

SCENARIO: Cholera epidemic in Africa §No routine surveillance §Poorly kept clinical records §Understaffed facilities §Unreliable communications §No ongoing funding §No computers

Cholera epidemic in Africa Example of a paper-based system that worked in an endemic area for at least 2 years

Occupational exposure to bloodborne illnesses among health staff §Hundreds of health facilities §Infrequent incidents §Non-compulsory recording §No ongoing funding §Confidentiality issues §Compensation issues

Nutritional Status Monitoring in a remote indigenous community §Routine surveillance of some conditions §Somehow comprehensive clinical records §Services staffed by community §Unreliable communications §Some funding available §Some computers usable

How the data will be collected How the data will be used Who will have access to the data Confidentiality issues Perceived discrimination Financial implications Major stakeholder’s concerns

Indigenous Community Health §Computerised system §Easy front-end §Complete patient information (alias/residence) §Promotes opportunistic P.H. action §Capability for health worker plans §Population based reporting system §Generates customised prevalence/incidence

Burden of depression at Medical Practitioners rooms §Non-standard recording practices §? Availability of clinical records §Busy medical practices §Variable communication systems §Low computer coverage §Ethical issues §Incentives required for doctors

Doctors-based Sentinel Surveillance Enables documentation of non-hospital data Burden of disease measurement Paper-based with weekly notifications Limited patient information & # conditions Selected Locations (self-selected doctors) Inability to calculate prevalence/incidence

Example of project to maximise efficiency of existing health information systems Real case scenario

Improve health outcomes through enhancement of Public Health information systems Aim

Objectives l High quality /timely data l Minimise duplication/cost l Standard coding practices l Common table structures l Common operating environment l Shared hardware l Data Linkage

Inventory of Databases §Purpose/Scope /Contents §Size/Accessibility §Operating system/server/interface §Data tables §Remote access/re-development §Special requirements §Staff involved

Integration Protocols §Hardware /software §Data definitions {NHDD} §Reference tables §Data Entry & Transfer §Security /Confidentiality

Working Group l Discuss IT requirements l Re/development experience l Security Principles l Sharing of reference tables l Integration protocols l Recommendations

Network (WAN, LAN) Platforms (hardware) Database ( execute instructions ) Data use (structure) User interface Business Levels Integration

Business Interface Data use Database Platforms Network *BSRPSRLead*NOCsVIVAS *MODDs                      

How does this improve Health Outcomes? §Outbreak response/timing §Immunisation rates §Prescription control §Standard Indigenous identifiers §Early cancer detection\QA

Summary §Relevance & cost-effectiveness §Consultation with users and data holders §Financial considerations §Ethical implications §Ultimate goal to improve health