Authors

Dr. Lo Veasnakiry, DPHI Director

Dr. Khol Khemrary, DPHI

Mr. Buth Saben, DPHI

Dr. York Dararith, DPHI

Dr. Meas Vanthan, DPHI

Mr. Sek Sokna, DPHI

Dr. Mean Reatanak Sambath, URC

Mr. Hong Roith, URC

Ms. Oeng Sothary, URC

Health Management Informa! on System (HMIS) Launching

HMIS launching on October 6, 2011.

Photographer: Mr. Pen Darith

On 6 October 2011, Cambodian Ministry of Health

(MoH) with supports of USAID (US Agency for

Interna! onal Development) through URC- Be" er

Health Services Project (BHS) launched the

MOH Health Management Informa! on System.

The launch was organized and prepared by the

technical team of the Department of Planning and

Health Informa! on (DPHI) and URC Cambodia. It

was presided by HE Prof Eng Huot, Secretary of

State, Ministry of Health, and representa! ve of

USAID Cambodia. HE Prof Eng Huot appreciates

the support of USAID and URC on HMIS work

in Cambodia. A total of 134 par! cipants (30

females) a" ended the launch. The par! cipa! ons

are representa! ves of the MoH departments,

na! onal programs, na! onal hospitals, provincial

health departments, opera! onal district, private

www.hiscambodia.org

Eff ec" ve health informa" on system management is a contribu" ng factor in be# er

decisions and quality health service provision.

Kingdom of Cambodia

Na! on - Religion - KingPlanning And Health Informa! on Department

Health Informa! on Bureau

Ministry of Health

Issue No. 3 | May 2012Quarterly Bulle" n

providers and health development partners. URC

staff presented the general concepts of the HMIS

database integra! on. Ten HMIS users (3 MoH

department, 1 URC, 2 PHD, 1 MCH-PHD, 1 OD,

Contents

Health Management Informa! on System

(HMIS) Launching 1

The Pa! ent Electronic Medical Record System 2

Cambodian Health Management

Informa! on System 3

Background 3

Outcomes 3

HMIS Users 4

HMIS Daily Users 6

Hospital Coverage 6

MCH Health Sta! s! cs 7

2 • Cambodian Health Management Informa� on System

Pa ent Electronic Medical Record System

URC Cambodia has an area where the MoH has

specifically nominated the BHS Project to take

lead in developing Pa" ent Electronic Medical

Record System. The ini" al project is star" ng

from pa" ent registra" on, payment record and

pa" ent informa" on record. URC team have

been working at field level with the Siem Reap

provincial hospital in which is level 3 (called

CPA3- Complementary Package of Ac" vi" es)

in Cambodia. URC developed hospital based

pa" ent registra" on database along with other

work of the technical team who is consulted

and discussed about medical requirement

and pre condi" on for hospital based database

implementa" on. Finally the hospital pa" ent

database was launched on 16-11-2011. Hospital

enrolled 197 pa" ents at first day and 196 pa" ents

at second day, 213 pa" ents at third day.

The five database worksta" ons are now located

in registra" on room and cashier room. The

registra" on services are worked 24 hours including

weekend days. This is an integra" on pa" ent

database that will track mul" ple pa" ent related

data such as pa" ent demographic, payment,

diagnosis and other supported services. This is a

first MoH public hospital at the field level who

implement one way pa" ent entry and centralize

pa" ent registra" on database. Hospital director and

hospital staff are very happy and demonstrated

strong collabora" on with URC and ownership to

manage hospital pa" ent database. URC team also

reported this process to DPHI/MoH and keeps

them informed about the success.

URC staff explained data clerk for gathering and entering

pa� ent informa� on through computerized system at first day

of launches in Siem Reap provincial hospital in Cambodia on

16-11-2011. Photographer: Ms. Oeng Sothary

2 private providers) presented their experience

and prac" ce of the HMIS web based database.

All presenters accounted that HMIS web based

database is a useful and appropriate solu" on

for managing the health informa" on system in

Cambodia. The director of Kien Svay OD presented

a data quality check prac" ce and how they use

HMIS web based database system.

As of September 2011, the HMIS covers 5 different

data sources: public health facility health sta" s" cs;

private and NGO health sta" s" cs, the PMTCT and

Linked Response programs, the Maternal Death

Surveillance System; and results from the health

facility assessments conducted by the QAO Office.

The launch was close with frui% ul results and Dr.

Lo Veasnakiry, DPHI director, made a remark in the

closing sec" on.

Nov-11

Nu

mb

er

Dec-11 Jan-12 Feb-12 Mar-12

OPD IPD Total

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

Figure 1: Number of Siem Reap Provincial hospital

pa"ents

Issue No. 3 | May 2012 • 3

Background

Department of Planning and Health Informa� on

of the Ministry of Health with technical support

of the URC Be� er Health Services Project in

Cambodia upgraded HIS Access database to

the HMIS (Health Management Informa� on

System) web based database since mid-2010.

BHS harnessed new technologies, such as open-

source so� ware and dynamic scrip� ng languages

(namely, MySQL and PHP) to build a new, user-

friendly web interface.

The result was a full-featured, web-based

applica� on for entering, reviewing, and edi� ng

health informa� on at all system levels. The

new HMIS also has advanced func� onality

for repor� ng to reflect the key indicators in

Cambodia’s second Na� onal Strategic Plan

(HSP2). Cambodia Health Management

Informa� on System Web based Databases were

developed to organize large web sites and

allow data capture via browser-based forms. By

enabling users outside a closed network, access

to a central or standalone database, they permit

greater flexibility than through using tradi� onal

‘client-server’ systems.

Accordingly, web-enabled databases have

introduced a new tool for health managers,

health staff and officers, permi! ng direct data

capture at source and thus avoiding many of the

delays and errors arising from paper forms, data

transmission and mul� ple data entry. In addi� on,

real-� me data collec� on permits sophis� cated

decision support and repor� ng, and thus

improved project co-ordina� on, planning and

par� cipa� on.

Outcomes

A� er one year of implementa� on, HMIS

shows great results as shown by the following

outcome indicators:

Cambodian Health Management Informa! on System

Pe

rce

nta

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of

Mo

Hh

ea

lth

fa

cili

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sre

po

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g H

MIS

da

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ith

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ely

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HM

IS

Pe

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nta

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100%100%

87%

0%

20%

40%

60%

80%

100%

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er

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aci

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an

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O h

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ata

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rep

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ng

PM

TC

T/LR

da

ta t

hro

ug

h H

MIS

0

200

400

600

800

1000

12001097

1090

162

Figure 2: Data quality as percentage

Figure 3: Number of health facility reported

through HMIS

4 • Cambodian Health Management Informa� on System

HMIS User

The figure 4 shows about the top- ten PHD used HMIS for the last 9 months that started from April,

2011 to December, 2011. The top three provinces are Prey Veng, Kampong Cham and Kampong

Chhnang.

The figure 5 displays the top-ten of Opera" onal Districts used HMIS among the 77 ODs in the whole

country. For number one goes to Memut , number two goes to Pearaing and for number three goes

to Ba# ambang.

4768

3757

3030

2777

2133

2011

1951

1871

1786

1785Banteay Meanchey

Pailin

Siemreap

Takeo

Preah Vihear

Fre

qu

en

cy

Ratanakiri

Kampong Thom

Kampong Chhnang

Kampong Cham

Prey Veng12

34

56

78

91

0

10518

8964

8336

7911

7101

6915

6874

6774

6706

6495

12

34

56

78

91

0 Kampong Thom

Tbong Khmum - Kroch Chhmar

Svay Antor

Boribo

Choeung Prey - Batheay

Sampov Meas

Kean Svay

Fre

qu

en

cy

Ba!ambang

Pearaing

Memut

Figure 4: Top Ten PHD Used HMIS , April -Dec 2011

Figure 5: Top Ten OD Used HMIS , April -Dec 2011

Issue No. 3 | May 2012 • 5

The figure 6 shows about the top ten hospital used HMIS for the last nine months. For number one

run to Prey Veng Provincial Hospital, number two run to Cheychumnash Hospital and the number

three run to Pailin Provincial Hospital.

The figure 7 displays the top-ten HC used HMIS started from May, 2011 to December, 2011. Ta Sanh

HC in ba� ambang OD, Banteay Neang HC and Russei Kraok II HC in Mongkol OD are remarkably

achieved of highly using HMIS in HC level.

2025

1540

1488

1353

1324

1309

1298

1033

1019

1003

12

34

56

78

91

0 Kra e Prov. Hosp.

Stung Treng Prov. Hosp.

Svay Rieng Prov Hosp.

Kampong Trabek Hosp.

Kampot Prov. Hosp.

Preah Sihanouk Prov. Hosp

Na onal Pediatric Hosp.

Fre

qu

en

cy

Pailin Prov. Hosp.

Cheychumnash Hosp.

Prey Veng Prov. Hosp.

970

784

747

732

715

676

617

604

556

517

12

34

56

78

91

0 Ponley

Chamkar Samrong

Ro!anak

Ou Russei

Poipet I

Preas ponlea

Malai

Russei Kraok II

Fre

qu

en

cy

Banteay Neang

Ta Sanh

Figure 6: Top Ten Hospital Used, April -Dec 2011

Figure 7: Top Ten HC used HMIS, May-Dec 2011

6 • Cambodian Health Management Informa� on System

HMIS Daily Users

The HMIS daily users have been significantly increased since it had been officially introduced for

na# onal usage.

Hospital Coverages

The fi gure 9 iden# fies the

categories of hospitals which

provide complementary care

in 2011 in Cambodia. The base

graph demonstrates that 45%

of hospitals has implemented

CPA1, 32.5% used CPA2, and

22.5% used CPA3. It means

that around half of all hospitals

in Cambodia has provided

CPA1 services, especially at

the countryside.

0

1000

2000

3000

4000

5000

6000

7000

8000

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26

18

0 10 20 30 40 50 60 70 80 90

Total

CPA

Nu

mb

er

1

CPA 2

CPA 3

Figure 8: Daily Rate of HMIS Page Visits. April 2011-Jan 2012

Figure 9 : Hospitals by Categories in Cambodia 2011

Issue No. 3 | May 2012 • 7

MCH Sta! s! cs

• Antenatal care visits

• Antenatal care visit in 2011

The fi gure 10 represents the percentage

of progress of ANC2/ANC4 from 2006

and 2011. The line graph shows that

pregnancy women who visited hospital

for 2nd antenatal care gradually increased

from 64%-89% in 2006 to 2009, but it

slowly decreased at the beginning of

2010 (80%) then went up to 86% in 2011.

The figure 11 shows the number and

percentages of the cascade of ANC in

2011. This graph clearly indicates, the

101% (371,445) of pregnancy women

a! end their first antenatal services, 86%

(315,717) for ANC2, 64% ( 235,187) for

ANC3 and 53% (191,298) for ANC4 during

the specific pregnancy.

For the 4th antenatal care visited was

progressively gone up from 25% to 52% in

2006 -2011. It could be the effec# ve of the

health awareness educa# on through or more

understanding of the advantage of pregnancy

preven# on.

This indicates that maternal women in Cambodia

regards antenatal care as a one-# me service,

while in fact they should make several visits

before their delivery.

64%69%

75%

89%

80%

86%

25% 26%30%

45% 46%

52%

0%

10%

20%

30%

40%

50%

60

Pe

rce

nta

ge

%

70%

80%

90%

100%

2006 2007 2008 2009 2010 2011

ANC 2 ANC 4

Figure 10 : Trend of Antenatal Care Visits from 2006 to 2011

8 • Cambodian Health Management Informa� on System

• Births

The fi gure 12 represents the percentage

of deliveries by trained health personnel

and health facili" es in2006 to 2011. The

line graph displays that the percentages

of delivered by trained health personnel

gradually increased from 40%-72% in

2006-2011. The percentage of deliveries by health

facili" es increased parallelism from 19%- 61% by

2006-2011 with the trained health personnel. It

means that more than 60% of delivered respond

by trained or skill health personnel.

Delivered by trained health personel Delivered at health facility

40%

46%

53%

64%70% 72%

19%24%

35%

50%

59%61%

0 %

10 %

20 %

30 %

40

Pe

rce

nta

ge

%

50 %

60 %

70 %

80 %

2006 2007 2008 2009 2010 2011

Number Percentage

371445N

um

be

r

315717

235187

191298101 %

86 %

64 %52%

ANC 1 ANC 2 ANC 3 ANC 4

Figure 11 Antenatal Care Visits Cascade in 2011

Figure 12: Percentage of Deliveries

Issue No. 3 | May 2012 • 9

• Post partum care cascade

• Post partum care cascade in 2011

To be strengthening the health

care of women post partum, MOH has

encouraged all women should be

received at least 2 � mes of post partum

care a� er their delivery. The chart shows

the 2nd post partum care follow up from

It is quite good that our women have

con� nued their post partum care

services. The figure 14 shows the

result of Post partum care in Cambodia

in 2011. The base-chart displays that

the percentages of post partum care

visit is 60% (221,427) in the PNC1,

37% (135,784) in PNC2, 16% ( 60,074)

in PNC3 and 6% (22,843) in PNC4

a� er delivery. It would be be" er if all

maternal women could complete their

four post partum visits to ensure their

medical well-being.

2006-2011. This line graph indicates that the

percentages of post partum care progressively

increased from 22% to 37% in 2006-2011. The

result shows the posi� ve outcome, but it is not

reach the MOH target.

PNC 2

22%24% 25%

29%

34%

37%

0%

5%

10%

15%

20

Pe

rce

nta

ge

%

25%

30%

35%

40%

2006 2007 2008 2009 2010 2011

Number

Nu

mb

er

Percentage

PNC 1 PNC 2 PNC 3 PNC 4

221427

135784

60074

22843

60%

37%

16%6%0

50000

100000

150000

200000

250000

Figure 13: Percentage of Post Partum Care from 2006 to 2011

Figure 14: Post Partum Care Cascade in 2011

10 • Cambodian Health Management Informa� on System

• Family planning

• Bed occupancy rate in 2011

Hospital management is very important;

Data analysis is more value to evaluate

the progress of quality of bed occupa! on

in hospital. The fi gure 16 indicates the

over all of percentage of bed occupa! on

rate is over the 50%, the majority of

its is 92.7% in Pediatric ward, then 87.2%

The figure 15 represents the sta! s! cal

of birth spacing current user in 2011

(N=5810910). Pill is the main most

popular method that is being used by

in surgery, 86.1% in maternity, 83.9 in Medicine,

57% in Gynecology and other wards is 67.5%. It

mean that the most of services are occupied at

least 57% in hospital in 2011. Other meaning is

in this year, the most common of pa! ents who

infected is children.

women (51 %). The second choice method is

injec! on (36 %) but for Tubal Liga! on method

is rarely used by women 0.12% according to the

chart above.

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

51%

36%

4%8%

1% 0.12%

Pills

Pe

rce

tag

e

Injec!ons Condoms IUD Norplant Tubal Liga!on

83.9%87.2%

92.7%86.1%

57.0%

67.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Medicine

Ra

te

Surgery Pediatric Maternity Gynecology other

Figure 15 : Percentage of Birth Spacing Current Users in 2011 (N=581901)

Figure 16: Bed Occupancy Rate in 2011

Issue No. 3 | May 2012 • 11

• Average Length of Stay (ALS)

In order to evaluate the quality of health

care services or measure the outcome of

treatment, it would be monitor the length

of pa� ent staying in hospital. The base-

chart below shows that among 6 main

wards, the surgery ward is taken longer

than other wards, it took 7days in average

compared to medicine is 5.4 days, gynecology is

5days, pediatric is 4.9 days, maternity is 3.7 days

and other wards is 4.3 days in 2011. In generally,

all kind of diseases that admi� ed in hospital

were taken 4-7 days in average. It means that all

cases are the acute diseases.

5.4

7.0

4.9

3.7

5.0

4.3

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

Medicine

Ave

rag

e

len

gth

of

sta

y

Surgery Pediatric Maternity Gynecology other

6.2

6

5.8

5.6

5.4

5.2

5

4.8

4.6

2006

Ave

rag

e l

en

gth

of

sta

y

2007 2008 2009 2010 2011

6.13

5.645.52

5.53

5.255.24

Figure 17 : Average length of stay in Hospital in 2011

Figure 18 : Average length of stay in Hospital from 2006 to 2011

12 • Cambodian Health Management Informa� on System

Events:

= January 17, 2012 : Workshop on Reviewing

HMIS Implementa! on in Siem Reap Province

= March 14-15, 2012 : HMIS training Course

for Private and NGO provider in Ba" ambang

Province

= March and April 2012: Mee! ng on reviewing

and revising HMIS registers (Maternal and

Newborn Health) in Phnom Penh

= April 20, 2012: HMIS Management Training

Course at URC Phnom Penh Offi ce

= March 21-22, 2012 : HMIS Training Course

for PMTCT/LR at Kampong Cham Province.

Siem Reap Provincial Hospital staff discussed on Pa� ent

Electronic Medical Record on Dec 2011.

Photographer : Ms. Oeng Sothary

Siem Reap Provincial Hospital staff discussed on Pa� ent

Electronic Medical Record on Dec 2011.

Photographer : Ms. Oeng Sothary

Photographer : Ms. Oeng Sothary

This bulle� n was made possible by the support of the American people through the United States Agency for Interna� onal Development

(USAID). The contents of this bulle� n are the sole responsibility of the Ministry of Health, and do not necessarily reflect the views of

USAID or the United States Government.

Supported by