HEALTH MANAGEMENT HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS)INFORMATION SYSTEM (HMIS)

““A mechanism for the collection, A mechanism for the collection, processing, analysis and transmission processing, analysis and transmission of information required for organizing of information required for organizing and operating health services, and and operating health services, and also for research and training”. also for research and training”.

THE OBJECTIVES OF HMISTHE OBJECTIVES OF HMIS

To provide reliable information To provide reliable information Relevant & up-to-date informationRelevant & up-to-date information Adequate & timely informationAdequate & timely information Complete information for health managers Complete information for health managers

at all levels.at all levels. Sharing of technical and scientific Sharing of technical and scientific

informationinformation FORFOR

Planning purposesPlanning purposes Evaluate H services & programmesEvaluate H services & programmes Trends in demands and work load.Trends in demands and work load.

REQUIREMENTS OF HEALTH INFROMATION REQUIREMENTS OF HEALTH INFROMATION SYSTEMS:SYSTEMS:

The system should be population based The system should be population based The system should avoid the The system should avoid the

unnecessary agglomeration of dataunnecessary agglomeration of data The system should be problem-orientedThe system should be problem-oriented The system should employ functional The system should employ functional

and operational terms and operational terms The system should express information The system should express information

briefly and imaginatively (e.g., tables, briefly and imaginatively (e.g., tables, charts, percentages)charts, percentages)

The system should make provision for The system should make provision for the feed-back of data.the feed-back of data.

USES OF HMISUSES OF HMIS To measure the health status of the people and To measure the health status of the people and

to quantify their health problems and medical to quantify their health problems and medical and health care needs.and health care needs.

For local, national and international comparisons For local, national and international comparisons of health status. of health status.

Data need to be standardizedData need to be standardized Quality control.Quality control.

For planning, administration and effective For planning, administration and effective management of health services and programmesmanagement of health services and programmes

For assessing whether health services are For assessing whether health services are accomplishing their objectives in terms of their accomplishing their objectives in terms of their effectiveness and efficiencyeffectiveness and efficiency

For assessing the attitudes and degree of For assessing the attitudes and degree of satisfaction of the beneficiaries with the health satisfaction of the beneficiaries with the health system, and system, and

For research into particular problems of health For research into particular problems of health and disease.and disease.

COMPONENTS OF HMISCOMPONENTS OF HMIS

Demography and vital eventsDemography and vital eventsEnvironmental health statisticsEnvironmental health statisticsHealth statusHealth statusHealth resources, facilities, Health resources, facilities,

manpowermanpowerUtilization of health servicesUtilization of health servicesFinancial statisticsFinancial statisticsOutcome of medical careOutcome of medical care

SOURCES OF HEALHT INFORMATIONSOURCES OF HEALHT INFORMATION CensusCensus Registration of vital eventsRegistration of vital events Sample Registration System (SRS)Sample Registration System (SRS) Notification of DiseasesNotification of Diseases Hospital recordsHospital records Disease RegistersDisease Registers Record LinkageRecord Linkage Epidemiological surveillanceEpidemiological surveillance Health service recordsHealth service records Environmental health dataEnvironmental health data Health manpowerHealth manpower Population surveysPopulation surveys Other routine statistics related to healthOther routine statistics related to health

1.CENSUS1.CENSUS

The total process of collecting, compiling The total process of collecting, compiling and publishing demographic, economic and publishing demographic, economic and social data pertaining at a specified and social data pertaining at a specified time to all persons in a country.time to all persons in a country. Contact every member of population in a given Contact every member of population in a given

timetime Variety of information is collectedVariety of information is collected

NeedsNeeds An big organizationAn big organization Considerable time for full resultsConsiderable time for full results

CENSUSCENSUS

FIRST CENSUS IN THE WORLD-1749FIRST CENSUS IN THE WORLD-1749FIRST CENSUS IN INDO-PAKISTANFIRST CENSUS IN INDO-PAKISTAN

1867-721867-72REPEATED IN-1881REPEATED IN-1881

FIRST CENSUS IN PAKISTAN-1951FIRST CENSUS IN PAKISTAN-1951CARRIED OUT EVERY 10 YEARS, 1961,CARRIED OUT EVERY 10 YEARS, 1961,1972, 1981, 1998.1972, 1981, 1998.

censuscensus

EnumerationEnumeration Questionnaire methodQuestionnaire method Both combinedBoth combined EnumerationEnumeration

Visit of every homeVisit of every home Collection of desired information like age, sex, Collection of desired information like age, sex,

marital status, caste, educational marital status, caste, educational characteristics, monthly income, occupation, characteristics, monthly income, occupation, rural and urban, condition of living etcrural and urban, condition of living etc

Base line information for medicine, Base line information for medicine, ecology, social sciences & entire govt. ecology, social sciences & entire govt. system.system.

Types of censusTypes of census

De facto: De facto: A person is counted where he or A person is counted where he or

she is found at the time of countingshe is found at the time of counting

Dejure:Dejure:A person is counted at the place of A person is counted at the place of

his or her usual or normal his or her usual or normal residenceresidence

ESTIMATION OF POPULATIONESTIMATION OF POPULATION

Natural increase methodNatural increase method

Arithmetic progression method (APM)Arithmetic progression method (APM)

Geometric progression method Geometric progression method

APMAPM

Estimate mid year population for 1990?Estimate mid year population for 1990? First of April 1971 = 500,000First of April 1971 = 500,000 First of April 1981 = 700,000First of April 1981 = 700,000

increase in 10 years=700,000-500,000increase in 10 years=700,000-500,000 =200,000=200,000

Increase in 1 year=200,000/10=20,000Increase in 1 year=200,000/10=20,000 increase in 9 years & 3 months=20000increase in 9 years & 3 months=20000×28/3×28/3

186,667186,667

Population in Mid year Population in Mid year 1990=700,000+186,6671990=700,000+186,667

=886,667.=886,667.

POPULATION OF PAKISTANPOPULATION OF PAKISTAN

POPULATION OF PAKISTAN

16.6 19.4 21.1 23.6 28.3 33.7 42.964.9

83.8

112122 130.58

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2.Registration of vital events2.Registration of vital events

Registration, statistical recording and reporting of Registration, statistical recording and reporting of occurrence of, and the collection, compilation, occurrence of, and the collection, compilation, presentation, analysis and distribution of presentation, analysis and distribution of statistics pertaining to vital events, i.e., live statistics pertaining to vital events, i.e., live births, deaths, foetal deaths, marriages, divorces, births, deaths, foetal deaths, marriages, divorces, adoptions & legal separations.adoptions & legal separations.

Census is an intermittent of population,Census is an intermittent of population, Registration of vital events keeps a continuous Registration of vital events keeps a continuous

check on demographic changes. check on demographic changes. It can serve as a reliable source of health It can serve as a reliable source of health

information.information. Rural areasRural areas Urban areasUrban areas

3.Notification of Diseases3.Notification of Diseases

The primary purpose of notification is to effect The primary purpose of notification is to effect prevention and/or control of the disease. prevention and/or control of the disease.

Notification is also a valuable source of morbidity Notification is also a valuable source of morbidity data i.e., serious menaces to public health. data i.e., serious menaces to public health.

Incidence of diseases in a community/ country.Incidence of diseases in a community/ country. Fluctuations among dis. Frequency/communitiesFluctuations among dis. Frequency/communities International –cholera, plague, yellow feverInternational –cholera, plague, yellow fever

It covers small part of sickness in the communityIt covers small part of sickness in the community System suffers under reportingSystem suffers under reporting Escape of clinical / sub clinical casesEscape of clinical / sub clinical cases

4.Hospital records4.Hospital records

Basic and primary source of Basic and primary source of information about diseases prevalent information about diseases prevalent in the community. in the community.

No definite population served by a No definite population served by a hospitalhospital

Health care activities and utilization Health care activities and utilization can be derived from hospital records. can be derived from hospital records.

Hospital recordsHospital records A study of hospital data provides informationA study of hospital data provides information

geographic sources of patientsgeographic sources of patients age and sex distribution of diff. diseasesage and sex distribution of diff. diseases distribution of health problems & their magnitudedistribution of health problems & their magnitude association between different diseasesassociation between different diseases the period between disease and hospital the period between disease and hospital

admissionadmission the distribution of patients a/c areas, social the distribution of patients a/c areas, social

&culture&culture Period between disease & hospital admissionPeriod between disease & hospital admission the cost of hospital care.the cost of hospital care. Bed occupancy ratesBed occupancy rates Duration of stay in the hospitalDuration of stay in the hospital

For planning & monitoring of H. servicesFor planning & monitoring of H. services

5.Disease registers5.Disease registers

Valuable source of information about Valuable source of information about morbidity, stay in hospital,morbidity, stay in hospital,

Permanent record be establishedPermanent record be establishedCases can be followed upCases can be followed up Morbidity registers exist only for Morbidity registers exist only for

certain diseases, acute & chronic like certain diseases, acute & chronic like myocardial infarction, cancer, case myocardial infarction, cancer, case fatality and survivalfatality and survival

Mortality data, causes of deathsMortality data, causes of deaths

HEALTH SYSTEM REPORTINGHEALTH SYSTEM REPORTING

instruments for collection of data instruments for collection of data from FLCFfrom FLCFPopulation data collectionPopulation data collectionPatient / client recordPatient / client recordFacility record keepingFacility record keepingFacility reportsFacility reports

Immediate report for epidemic diseasesImmediate report for epidemic diseasesMonthly reportsMonthly reportsAnnual reportsAnnual reports

PRIORITY HEALTH PROBLEMSPRIORITY HEALTH PROBLEMSHMIS CODEHMIS CODE HEALTH PROBLEMHEALTH PROBLEM

101101 Diarrhoea < 5 yearsDiarrhoea < 5 years

101.0101.0 Without dehydrationWithout dehydration

101.1101.1 With some With some dehydrationdehydration

101.2101.2 With severe With severe dehydrationdehydration

101.9101.9 Dehydration status Dehydration status not specifiednot specified

102102 DysenteryDysentery

103103 Acute respi infectionAcute respi infection

104104 Fever ( clinical Fever ( clinical malaria)malaria)

105105 Cough > 2 weeksCough > 2 weeks

106106 SUSPECTED CholeraSUSPECTED Cholera

107107SUSPECTED meningococcal SUSPECTED meningococcal

MeningitisMeningitis

108108 PROBABLE poliomyelitisPROBABLE poliomyelitis

109109 Probable MeaslesProbable Measles

110110Probable/Confirmed Neonatal Probable/Confirmed Neonatal

TetanusTetanus

111111 Probable DiphtheriaProbable Diphtheria

112112 Probable Whooping CoughProbable Whooping Cough

113113 GoiterGoiter

114114 Suspected Viral HepatitisSuspected Viral Hepatitis

115115 Suspected AIDSSuspected AIDS

116116 Snake bite (s/s) of poisoningSnake bite (s/s) of poisoning

117117 Dog biteDog bite

118118 ScabiesScabies

6.Record Linkage6.Record Linkage

The process of bringing together records The process of bringing together records relating to one individual originating in relating to one individual originating in different times or placesdifferent times or places

Medical record linkage: Medical record linkage: the assembly the assembly and maintenance of a file for each and maintenance of a file for each individual in a population, individual in a population, records relating to his healthi.e. Birth, records relating to his healthi.e. Birth,

marriage,, hospital admission and discharge & marriage,, hospital admission and discharge & death, Sickness absence from work, death, Sickness absence from work, prophylactic procedures,prophylactic procedures,

A method for studying associations between A method for studying associations between diseases; diseases;

7.Epidemiological surveillance

8.Health service records8.Health service records

From hospital OPDFrom hospital OPDPHCs & BHUsPHCs & BHUsPolyclinicsPolyclinicsPrivate hospitalsPrivate hospitalsMCH centersMCH centersSpecialized hospitalsSpecialized hospitals

9.ENVIRONMENTAL HEALTH DATA9.ENVIRONMENTAL HEALTH DATA

AIR QUALTY & POLLUTIONAIR QUALTY & POLLUTIONWATER QUALITY & POLLUTIONWATER QUALITY & POLLUTIONHARMFUL FOOD ADDITIVESHARMFUL FOOD ADDITIVES INDUSTRIAL TOXICANTSINDUSTRIAL TOXICANTS INADEQUATE WASTE INADEQUATE WASTE DISPOSALPOPULATION EXPLOSIONDISPOSALPOPULATION EXPLOSION IDENTIFICATION OF CAUSES OF IDENTIFICATION OF CAUSES OF

SISEASESSISEASES

10.10. HEALTH MANPOWER HEALTH MANPOWER STATISTICSSTATISTICS

No. of physicians / dentistsNo. of physicians / dentistsAge, sexAge, sexSpecialtySpecialtyPlace of workPlace of work

Hospital nurses, pharmacistsHospital nurses, pharmacistsHealth techniciansHealth techniciansPMDCPMDC

No. admitted / yearNo. admitted / yearNo. qualified / yearNo. qualified / yearNo. of specialists etcNo. of specialists etc