Unit Five

Health Management Information System (HMIS)

Learning objectives

At the end of this unit, the learner will be able to;

1.Define HMIS

2.Describe deficits of HMIS in Ethiopia

3.List elements of HMIS

4.Explain indicators of HMIS

5.Discus the steps of developing HMIS

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Basic concepts

System: A 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: A system that provides information support to the decision-making process at each level of an organization

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Basic concepts…

Health Information System: A system that integrates data collection, processing, reporting, and use of the information necessary for improving health service effectiveness and efficiency through better management at all levels of health services

Management information system: A formal method of making available accurate and timely information to management that is necessary to facilitate the decision- making process and enable the organizations planning, control and operational functions to be carried out effectively.

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Basic concepts…

Health Management Information System: It is an application of the principles of management information system in health care systems. Or an information system specially designed to assist in the management and planning of health programmes, as opposed to delivery of care

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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 center.

• The system provides information on past, present and projected future & relevant events inside and outside the organization.

Why health information system?...

• 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.

Why health information system?...

• With the widespread computerization of health records and other information sources, including hospital administration functions and health human resources information, health informatics and health information technology are being increasingly utilized in information management practices in the health care sector.

Health information management professionals

• Plan information systems, develop health policy, and identify current and future information needs.

• Apply the science of informatics to the collection, storage, use, and transmission of information to meet the legal, professional, ethical and administrative records-keeping requirements of health care delivery.

• Work with clinical, epidemiological, demographic, financial, reference, and coded healthcare data.

Evolution

In the past, mostly informal. Present, electronic data processing (EDP) –

use of computers in information management (computer based information system).

Now called MIS.

HMIS in developing countries

Information system procedures were not intentionally planned to provide management support in an integrated way

Too much emphasis was given (placed) on the measurement of impacts which called for costly assessment

Many decisions on policy, planning and resource allocation are made without analysis of the information that is readily available

The data received are often incomplete, inaccurate, untimely, obsolete, and unrelated to priority tasks and functions of the local health personnel

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HMIS in Ethiopia

The RHBs are primary institutions responsible for the health service delivery.

Capacity for effective health management at all levels remains to be low.

There is major concern regarding the HMIS. Timeliness and completeness of the system

reporting are among the major weaknesses of the system.

Progresses are also observed in some regions.

HMIS in Ethiopia…

The RHB of SNNP has developed reporting formats and a reference guideline for health workers in the region with collaboration between the RHB, Regional government, and the ESHE/JST project funded by USAID.

This guideline consists of standard data collection formats, standard information presentation instruments; such as charts and tables to be followed by the health workers and other pertinent information on the subject.

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HMIS in Ethiopia…

The Tigray RHB has also conducted similar efforts.

Initiatives are also under process to prepare National Management Health Information System Strategy by the Planning and Programming Department (PPD) of the FMOH (PPD, 2003).

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Deficiencies of HMIS in Ethiopia

Considering the problems experienced by many developing countries, the HMIS in Ethiopia seems not to be different from other developing countries.

Preliminary assessment of NHMIS and experiences of some regions (SNNR); the current HMIS showed that it has the following major deficiencies.

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Deficiencies of HMIS in Ethiopia…

In general, the current HMIS is inadequate in providing the required information for management support.

Hence, data coming from the system is not a resourceful input for decision making.

There is considerable underutilization of the information generated by the system for decision making at all levels specially in the front line where the data is collected and information is generated.

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Factors attributed to deficient HMIS in Ethiopia

The data quality is considered to be very poor Outputs of HMIS are not related to the priority

tasks and functions of the local health personnel Lack of technical knowledge and skill of data

collectors at the lower level Lack of uniformity and consistency in definitions. Outdated ICD Considerable limitation of financial and material

resources

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What is wrong with current HMIS?

• 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.

(WHO 2000, Regional Office for Africa, 2004).

Constraints with current HMIS

• Limited funding• Deficiency in information infrastructure• The network is still vulnerable to external shock

caused by virus, repair and /or replacement delays, difficult system codes etc.

• Significant underutilization of data / information for decision making

• Lack of interest or / and experience of use of information by managers

• Inadequate human resource, lack of expertise

What’s the HMIS objective?

Ensuring the quality of all health data. Strengthening the ability to analyze and use

the data. Making informed and cohesive decisions can

and will positively affect the health and lives of the people.

Planning, organizing, leading, controlling and decision-making.

Elements of HMIS

Training standards Software design Procurement/

Distribution Quality assurance Private sector

Organization rules Data collection

standards Case definitions Data transmission Confidentiality

Factors to evaluate information received

1. Information quality – accuracy and reliability.

2. Information timeliness – before deviations occur.

3. Information quantity – Just sufficient.

4. Information relevance – related tasks and responsibilities.

Design of HMIS

• Desired characteristics of information in health services

RelevanceAccuracyCompletenessTimelinessConciseness

Sources of Information System

o Health institutions (inpatient/outpatient and other activities)

• Vital registration systems (births, deaths, and migratory movements)

o Laboratories and pharmaceuticalso Community

Sources of Information System…

o Censuso Special programmes reporting systems

(tuberculosis and leprosy control, MCH, school health)

o Administrative systems (health care financing systems, health personnel systems, logistic systems)

Sources of Information System…

o Investigation of outbreaks– Surveys and surveillances– Diseases notifications– Routine reports

Which of the above sources are computerized?

Each source has its own advantages and limitations.

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

Indicators are variables that help to measure changes, directly or indirectly (WHO).

A framework for defining information needs and indicators…

Indicators are important to: To analyze present situation To make comparisons To measure trends

Most health indicators are quantitative (numbers)

Helpful questions in selecting good indicators

• What is the indicator supposed to measure (validity)?

• What will be the cost of measuring the data to arrive at the numerator and denominator of the indicator?

• Is the change shown by the indicator a true change in the situation under study.

Helpful questions in selecting good indicators…

What is the relative importance of the subject matter to be addressed and the decision to be made based on the indicator (relevance)?

Does the indicator actually capture the changes that occur in the situation under study (specificity)?

Types of Indicators

Health policy Social and Economic Development Indicators Population changes Provision of health care Health Status (nutritional, morbidity, mortality)

Information is collected, analyzed, presented and communicated.

Steps in Developing a HMIS

(1) Review the existing system(2) Define the data needs of relevant units

within the health system(3) Determine the most appropriate and

effective data flow(4) Design the data collection and reporting

tools(5) Develop the procedures and mechanisms

for data processing

Steps in Developing a HMIS…

(6) Develop and implement a training programme for data providers and data users

(7) Pre-test, and if necessary, redesign the system for data collection, data flow, data processing and data utilization

(8) Monitor and evaluate the system(9) Develop effective data dissemination and

feedback mechanisms(10) Enhance the HMIS

Steps involved in restructuring of HMIS

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

Steps involved in restructuring of HMIS…

Step 4: Ensuring use of the information generated

Step 5: Planning for HMIS resources

Step 6: Developing a set of organizational rules for health information system management

(WHO, 2000)

Key issues of HMIS

Movement of data through out the system Accessibility and analyzability of data Transmission of finding to potential users

Tasks of HMIS

Filing and storing Compiling Analyzing

Types of reports

Operational: detailed Technical: mentoring and evaluation Strategic: to justify priorities and decisions

Managing the flow of data

Impose strict timetable at each level. Ensure two-way flow. Establish regular cycle of analysis and

feedback.

Data collection instruments

1. Data collection instruments for patient/ client management

A. Curative• Medical records• Laboratory forms• Referral forms

Data collection instruments…

B. Preventive• Growth cards• MCH cards• School health card• Family registration records

Data collection instruments…

2. Data collection instruments for health unit management

A. Service delivery records.– Registers– Tally sheets (Abstract register– Population charts

B. Resource Management records

Strategies for MIS Development

Plan carefully for modification of existing system establishing new.

Change attitudes to information gathering processing and utilization.

Participate staff in HMIS. Provide training for utilizing HIS

Computer applications in health service delivery

1. Clinical information systems

2. Administrative information systems

Computer applications in health service delivery…

How to decide on need for a computer?

o Technical feasibility

o Operational feasibility

o Economic feasibility

Computer applications in health service delivery…

How to introduce micro computerso Choose softwareo Choose computero Assess the physical environmento Assess the organizational environment

Computer applications in health service delivery…

o Train personnel to use computerso Social behavioro Training for managerso Training for problem solvingo Define role of computer in work

environment