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HEALTH MANAGEMENT INFORMATION SYSTEMS IN DEVELOPING COUNTRIES
An Essential Component of Health Systems Strengthening
Presented on: May 23, 2011Akiko Maeda
Health, Nutrition & Population NetworkThe World Bank
Health care is the world’s most information-intense industry due to the complexity and uncertainties inherent in the sector.
Health Information Management is the glue which links health information to the health care delivery system.
Information Technology is a critically necessary tool, but not sufficient for ensuring effective management support to the health system
A Quick Overview of the Complexity of the Information Structure of the Health System
Multiple Applications of HMIS
HMIS Modules
1. Patient Management
2. Population Management
3. Disease State Management
4. Resource Management
5. Utilization Management
6. Financial & Fiduciary Management
7. Quality Management
• National Policy & Planning, Resource Allocation Decisions
• Clinical Services Management
• Health Insurance/ Payer Contract Management
• Public Health Surveillance &Program Management
• Evidence-Based Medicine (R&D)
Courtesy, Dennis Streveler, University of Hawaii
Uses of HMIS: Examples
1. Patient Management
2. Population Management
3. Disease State Management
4. Resource Management
5. Utilization Management
6. Financial Management
7. Quality Management
Clinic Information Systems
Hospital Information Systems
Laboratory, Radiology and Pharmacy Information Systems
The Discharge Summary
The Encounter Form The Electronic Medical
Record
Uses of HMIS: Examples
1. Patient Management
2. Population Management
3. Disease State Management
4. Resource Management
5. Utilization Management
6. Financial Management
7. Quality Management
Public Health Statistics (air, water, food…) quality
Retrospective Reporting including the Annual Report
Biostatistical analyses
Epidemiological studies
Health Education
Uses of HMIS: Examples
1. Patient Management
2. Population Management
3. Disease State Management
4. Resource Management
5. Utilization Management
6. Financial Management
7. Quality Management
Communicable Disease Surveillance
Cancer Registry Diabetes Registry Hypertension
Registry Coronary Arterial
Disease Registry HIV Registry Other chronic case
management
Uses of HMIS: Examples
1. Patient Management
2. Population Management
3. Disease State Management
4. Resource Management
5. Utilization Management
6. Financial Management
7. Quality Management
Facility Management Biomedical
Engineering Human Resource
Management Pharmaceutical
Inventory Supplies Inventory Management of
scarce resources
Uses of HMIS: Examples
1. Patient Management
2. Population Management
3. Disease State Management
4. Resource Management
5. Utilization Management
6. Financial Management
7. Quality Management
Utilization of inpatient services
Utilization of outpatient services
Utilization of diagnostic services
Utilization of operating room theaters
Utilization of pharmaceutical therapies
Uses of HMIS: Examples
1. Patient Management
2. Population Management
3. Disease State Management
4. Resource Management
5. Utilization Management
6. Financial Management
7. Quality Management
Accounting Billing Budgeting Interface with
insurance eligibility, insurance claims submission, insurance payments
Use of HMIS: Examples
1. Patient Management
2. Population Management
3. Disease State Management
4. Resource Management
5. Utilization Management
6. Financial Management
7. Quality Management
LAST BUT NOT LEAST:
Implementing clinical protocols and guidelines
Quality Improvement and Safety Measures
Outcomes Analysis
Building the Health Management Information System
8. Advanced Technologies
7. Electronic Record Keeping
6. Health Insurance Systems
5. Clinical Venue Systems
4. Management & Planning Tools
3. Resource Management
2. Accounting & Inventory
1. Health Statistics
0. Standard Setting and Master Planning 1 2 3 4 5 6 7 8 9 10
Hie
rarc
hy o
f In
ter-
depe
nden
cy
Increasing Level of Development
Examples of World Bank HMIS ProjectsFrom Slovenia, West Bank/Gaza, and Egypt
Slovenia – Evolution of the National Health Information StrategyInitiated as a Health Information
Clearinghouse concept based on the banking ATM system…
… with secure smart card accessed only by using Professional Card (PC) used by Medical Professionals (Doctors and Nurses) according to their Data Access Rights
Self-Service Terminals located at most Health Care Service Providers, Health Insurance Information locations and major Voluntary Health Insurance Companies
Slovenia Health Information Project Health Information Systems
Standardization
Healthcare Management - business process review and upgrading
Health Information Center and its Governance who “owns” HMIS, who has access (security,
confidentiality), and who governs information standards and ensures interoperability?
HMIS in West Bank/Gaza – an integral part of Health Systems Development Government Computer Center and
Clinical Information System In 2000, a low-cost,
secure platform was made available through the Government Computer Center. Health sector was one of the first to make use of this internet highway...
… to create common service framework across a non-contiguous territory & building a “virtual HMIS” team from “islands” of expertise
HMIS in West Bank/Gaza – an integral part of Health Systems Development
Foundational HMIS Components
Proposed Next Steps
Health Insurance: beneficiary registration & eligibility checking
Link to clinic info system for utilization reviews
Clinic Info System: patient encounter forms, appointments (diabetes)
Patient referrals, drug /laboratory modules, cost accounting
Contract tracking and monitoring system
Provider performance reviews, medical audits
Creating a “Health Information Center” as the focus of information technology expertise in the public sector (supported by the Government Computer Center)
Sponsoring Palestinian Data Dictionary and Data Modeling activity across systems, venues and sectors
Promoting the use of email as a way to link geographically separated workgroups
Project progress stopped due to the political situation on the ground
HMIS in West Bank/Gaza – an integral part of Health Systems Development
Project Objective: To improve the
financial sustainability and efficiency of social health insurance operations through the adoption of a proven business model for health insurance operations.
>> HMIS is the backbone of the project.
Egypt – Health Insurance Systems Development Project ($75 million)
Egypt – Health Insurance Systems Development ProjectNew operational procedures for:• Contribution management• Claims management,• Utilization management, including fraud control approved by the health insurance Board
INDICATORS % of health insurance claims
captured and processed through the new business management systems
% of electronically processed claims rejected or escalated for medical appropriateness vs. rates detected by manual audit
Egypt Health Insurance Systems Development Project Design
Health Insurance Management Information Systems are complex to design and implement.
To maximize chances of success, the project was designed around three core contracts that will allow continuous feedback and adjustment process.
HMIS Verification
and Validation
Firm
IT System
HMIS Development
and Implementati
on
