Health Information System

Presented by:

Ashish Bhatia (roll no.-511) Chander Pal (513) Chandra Prakash Yadav (514) Deepika Chopra (515) Dinesh Kumar (517) Divya Gupta (518)

Under the guidance of DR.ANITA THAKUR

Overview

Definition Purpose & choice of information Types of sources Categories of information Reporting system Sources of information Conclusion

Definition

Mechanism for the collection, processing, analysis & transmission of information required for organizing & operating health services & also for research & training.

Combination of vital & health statistical data collected from multiple sources

Purpose of Information

To facilitate health planning, implementation & evaluation

Supports managerial & technical functions Makes available information which is

necessary for:-1. Measurement of community health2. Community diagnosis3. Finding solution to health problems4. Prioritization5. Planning of interventions

6. Directing & controlling health programmes7. Development of procedures, definitions,

classification & methods of collection, analysis, storage & retrieval of data

8. Establishing administrative standards9. Carrying on of performance appraisal10. Determination of met & unmet health needs11. Monitoring & evaluation of health programmes12. Carry out Information-Education-Communication

activities for community & decision makers13. Demand social support for health activites14. Support health legislation

Contd…

Choice of Information

Information must be:-1. Relevant : related to the particular programme

2. Sensitive : should change with situation

3. Valid : enable the measurement to be carried out of what it purports to measure

4. Specific : should reflect changes only in the variable concerned

5. Sufficiently accurate6. Capable of proper analysis & interpretation :

difficulties arise in qualitative information

7. Timely

Types of sources

1. Systems organized on a national scale : Population & housing census Civil registration system Information on certain specific notifiable diseases at different

levels on a national scale Periodic reports by Ministry of Health Policy documents of central govt., approach papers, 5-yr

development plans, political statements, health legislation, budget proposals, proceedings of review meetings, statements in parliament etc. provide essential information

2. Activities of Health services at local level : Routine service records & registers routinely

maintained by health personnel at different levels

Contd…

Periodic reports Records of dispensaries, health centres, hospitals, maternal &

child health centres, labs etc.

3. Findings of special epidemiological & other surveys :

Objectives- case detection for TB, leprosy, blindness & malaria Ongoing surveillance for communicable diseases, cancer registry

or registers for other specific conditions Process of planning & implementing mass campaigns

4. Information from other sectors : Information on social, demographic& economic status Developmental activities

Categories of Information

1. Pertaining to health including nutritional status of individuals & communities

Information on infant, childhood, maternal & general mortality rates & their causes

Morbidity patterns Incidence & prevalence of various major endemic diseases Disease-specific morbidity & mortality rates etc.

2. Pertaining to determinants of health & disease including physical & social envt., demographic profile, cultural factors, economic aspects, planned development programmes, food supply position, income distribution etc.

Contd…

3. Pertaining to health policies, priorities, plans, programmes & strategies, health care patterns, health manpower & material resources & facilities, financial, administrative & organizational aspects

Reporting systems

Information at 1 level is processed, grouped, condensed, classified or partly interpreted & sent to next level

Feed back is essential At each level, types of records & registers to be maintained should

be carefully designed 2 types :

1. Baseline record basic information about population covered Data like geographical location of villages, sex & broad age

distribution etc. Need periodic updating Yearly survey + other action-oriented programmes give reasonably

accurate information

2. Other records Need continuous updating

Contd…

Example- information on pregnant women, ante-natal care given to them & the results of follow-up

In a well managed system- the frequency of submission of reports is stipulated initially itself, the submissions being made in a prescribed format. This ensures quick initiation of feedback & corrective action

Management of information

Standardization of formats, frequencies & procedures helps in eliminating chaos & monitoring information

Data handling facilities like adequate physical space & equipment essential

Information which cant be traced & retrieved at the time it is needed lost information

Misplaced record lost record Retrieval system must allow the stored information to

be available quickly & with minimum effort

Requirements to be satisfied by Health Information Systems :

WHO expert committee identified the following :-1. Population based2. Avoid unnecessary agglomeration of data3. Problem-oriented4. Should employ functional & operational terms (for

ex- episodes of illness, lab tests etc.)5. Express information briefly & imaginatively (using

tables, charts etc.)6. Provisions for feedback

Sources of Information

Population Census Civil Registration system (CRS) Sample Registration System (SRS) National Sample Survey (NSS) National Family Health Survey (NFHS) Model Registration Scheme (MRS) Surveys Lay reporting Medical certification of cause of death Surveillance Notification

Population Census

The census is a total enumeration of the population of a particular area.

Earliest reference of census in India- “Arthshastra”

The 1865 & 1872 census were non synchronous.

From 1881 onwards- uninterruptedly once every 10 year.

Contd…

Carried out in 1st quarter of 1st year of each decade.

Constitution of India (article 256) makes this exercise mandatory for union government.

Legal basis- Census act 1948 Headed by Registrar General & Census

Commissioner. Deputy commissioner- dist. Level SDMO- Sub division

Census Operations

Biphasic

1st phase- house numbering & house listing (April-September 2000)

2nd phase- Population enumeration (9th – 28th Feb 2001)

Houseless population enumerated on 28th night.

Contd…

Census enumerators – School teachers/ patwari.

Supervisor – Graduate/Inspector.

Includes data of 593 districts, 5564 tehsils/ talukas, 5161 towns, around 6.4 lacs villages.

Census in Himachal

The scanning of data is now done in Chandigarh.

Earlier the scanning was done in Shimla manually.

Findings of Census 2001

India is the 2nd largest populated country.

16.87% of worlds population.

Growth rate (1.9%) much higher than China(1%)

Information provided & uses

Data for calculation of many rates used as demographic and socio-economic indicators

Size, age & sex structure of population Distribution & density of population Religion, educational level for male &

female population

Civil Registration System (CRS)

Concerned with vital statistical data Mode of information collection-

functionary entrusted For collection, registration,

transmission, analysis and publication of information, more than 1 department are involved.

Registration of Birth & Death

Under birth and death act 1969 Aim is to collect and compile vital

statistics. Chief registrar- Director of health

services. Registrar – rural area drawn from

panchayat, police, health department. Urban area – health officers or

municipalities.

Contd…

Every registrar has to register births and death occurring within his/her administrative area.

Both events to be registered within 21 days. In case of delay upto 30 days fine is charged. If delay is more than 30 days but within a year

an affidavit from a notary public or an officer is required for registration besides late fees.

For delay beyond 1 year, an order from class 1 officer/ magistrate is neccesary.

Limitations of CRS

Unsatisfactory Incomplete coverage Mistakes of omission as well as

commission Variable degree of under-registration Time lag between collection &

compilation of data

Sample Registration System (SRS)

Biggest sample survey system run on a continuing basis in the field of demography

Collection of data- from randomly selected urban blocks and villages

Local volunteer- Enumerator maintains the list

…..list is periodically updated……

Contd…

Every six months- SUPERVISOR visits

Checks population, vital events & sends a report

These reports are collected at district centers & data is compiled

Advantages of SRS

Better coverage, content & timeliness

Urgent necessity of having reliable estimates achieved

Data collected is separate for rural & urban areas

National Sample Survey (NSS)

Agency engaged in collection of factual information regarding :-

i. Socialii. Economiciii. Demographiciv. Industrialv. Agricultural conditions through sample surveys on the countrywide basis

is the National Sample Survey Organisation

Contd…

Permanent survey organization Undertakes research for improving quality of

survey data Surveys conducted are integrated surveys, each

covering several topics with emphasis on 1 or 2 Each 1 is taken up in the form of “Rounds”

stretched over a specific period Information is collected on health topics. For ex-

fertility, morbidity, maternity & child care etc.

National Family Health Survey (NFHS)

Household survey

NFHS-1(1992-93),NFHS-2(1998-99),NFHS-3(2005-06)

Ministry of health & family welfare

Contd…

Nodal agency-international institute for population sciences, Mumbai

Interviews with more than 2,30,000 women(15-49) & men(15-54)

Tested –women & men for HIV &adults & young children for anemia

Survey Process

Designing the sample, questionnaire (household,woman’s &man’s), survey procedures

Selecting & training survey organizations

Translating data into electronic data file

Preparation of reports

Objective

Provide state & national estimates of fertility

Practice of family planning

Infant& child mortality

Maternal and child health

Utilization of health services provided to mothers & children

Information on -

Quality of health & family welfare services

Indicators of the status of women

Women’s reproductive health

Domestic violence

In Addition -

Height & Weight measurements

Blood test

Testing cooking salt

Blood for HIV testing

NFHS-3 also provides information on-

Perinatal mortality,male involvement in family welfare,adolescent reproductive health,high risk sexual behavior,family life education,safe injection,TB & malaria

Family welfare & health conditions among slum & non slum dwellers.

Model Registration Scheme (MRS)

(Survey of causes of death)Questionnaire + postmortem study

Causes of death (major causes and subcauses)

Trained paramedical staff

PHCs

Major Causes

Accidents & injuries Childbirth & pregnancy complications Fever Cough Digestive disorders Disorders of CNS Disorders of circulatory system Causes peculiar to infancy Senility

Recording of data by Health Guide

Record births & deaths

Birth weights

Lay Reporting of cause of deathCollection of information, its

use &Transmission to other levels ofHealth system by non-professionalHealth workers(probable cause of death by broad categories)

Medical Certification of cause of death

Legal Record

Geographical Distribution

Vulnerability of different age & sex groups

Cause of death does not mean themode of dying e.g. HF

It means the disease,injury or complications which caused death

RESPONSIBILITY OF CERTIFYING MP

Antecedent conditions

Direct cause

Epidemiological tool for study of disease as a dynamic process involving the ecology, the organisms, the host, reservoir, vector & environment, as well as the complex mechanism concerned with the spread of infection & the extent to which spread occurs.

Surveillance

Functions of Surveillance

Helps to assess the incidence & prevalence of diseases

Helps to establish priorities & plan preventive programmes

Essential for identifying high risk groups Helps in understanding of local

epidemiological trends & patterns Useful in monitoring & impact evaluation

of control programmes against specific diseases

Surveillance activities may include collection of data by active surveillance, passive surveillance, routine service activities, establishment of sentinel surveillance centres, special epidemiological investigations & undertaking sample surveys.

Routine Service Statistics

Routine reporting of cases of selected communicable diseases can be done by all Medical institutions, treatment centres etc.

A list of some 20 diseases for submission of monthly reports has been laid down by National Institute of Communicable Diseases, Delhi (N.I.C.D.) under the Integrated Disease Surveillance Project (I.D.S.P)

Sentinel Surveillance

A reporting system based on selected institutions or individuals that provide regular, complete reports (or from whom data is regularly collected) on one or more E.P.I. target diseases occuring, ideally, in a defined catchment area

Routine Health Service Record

Useful data are recorded as a routine requirement for providing health care & may be made use of after making allowance for the possible limitations

Information on provision & availability of essential drugs, as well as the operation of referral system, provision of the backup service, etc. can also be obtained in this way

Most of records/registers in use were probably devised for obtaining data for administrative use of permitting checks & controls rather than building up of indicators to monitor progress or measure effectivity

Modification/addition may be required in the system to make it suitable for monitoring purposes

Notification of Diseases

Notification denotes a mere reporting of the occurrence of an event

It is required to be done under appropriate public health legislation

This is essential to ensure prompt notification so that speedy action to prevent the spread of communicable diseases & occupational diseases

Notification of diseases is not an end in itself but the beginning of various action aimed at prevention & control

The existence of a legal necessity making it obligatory for hospitals, private medical practitioners or other professional groups, parents does not automatically ensure completeness

The information obtained from notified cases, keeping limitations of inaccuracy & incompleteness in mind, provide data of epidemiological interest such as distribution of diseases & time trends

Disease Registers

For gathering information of the incidence, prevalence & outcome of certain diseases & other epidemiological features of interest, disease registers may be maintained in the case of diseases which are public health problems

Population bases registries with proper planning, they can form a representative sample enabling estimates to be made with reasonable accuracy for larger area

Registers for diseases like cancers, tuberculosis etc. provide useful information in this way

Morbidity Statistics

Provides information on occurrence of different diseases with reference to age, sex, social class, locality & other such factors studied in epidemiology

Useful in evaluation & research & indicate the failure or success of various interventions for prevention of ill health

Problems peculiar to Morbidity Statistics :-

Death is a unique event, occurring only once in a person, while illness may occur repeatedly in the same person due to same or different causes

Death occur at only one point of time whereas illness extends over a period of time

Death is simply defined & understood by all whereas illness presents many problems in comparison

Problems of diagnosis also arise commonly

Sources of Morbidity Statistics

1. Special morbidity survey- general /specific

2. Notification of diseases3. Hospital statistics – govt./private4. Health/MCH centre statistics5. Records of health workers6. Medical practitioners records7. Sickness absence records8. Disease registries9. Industrial sickness benefit

records10. Mass diagnostic camps

Collection of information by Surveys

Common purpose is to obtain information on health conditions of the population

Surveys are necessary for planning, prioritizing, monitoring or evaluating health programmes

May be carried out to gather accurate & complete information on disease condition e.g disease detection surveys

May be carried out for all population or only a fraction of the population as in a sample survey

Types of Surveys

Descriptive survey Analytical survey Observational survey Cross-sectional survey (instantaneous,

static, prevalence, naturalistic) Longitudinal survey ( follow-up,

dynamic) To test a hypothesis

Information by Surveys

Birth rate, age-specific fertility rates, family size

Death rate, infant & childhood mortality rates, maternal mortality rate, still-birth rate

Probable cause of death by lay reporting, classification of death by broad categories.

Nutritional status

Occurence, degree & endemicity of diseases.

Contd…

General morbidity rate & disease specific morbidity rate

Availability of health care

Economic status, employment position & income levels

Environmental conditions

Determinant of disease & death in physical or social environment

Geographical Information System (GIS)

A set of elements that allow the computerized handling of geographically defined data, their entry, storage, analysis & presentation

Data of 2 varieties :-

1. Geographical data- defined by the geographical location

2. Attribute data- provide the characteristics of each data point

Application of GIS within HIS

Health status (outcome)

Programme planning

Planning health infrastructure & maintenance

Displaying performance indicators

Displaying health care coverage

To Conclude…

Primary objective of a HIS is to provide reliable, relevant, up to date, adequate, timely & reasonably complete information for health managers at all levels, & at the sharing of technical & scientific information

Also to provide at periodic intervals, data that shows the general performance of the health services

Unfortunately, it is still very difficult to get the information where it matters the most i.e at the community level

Contd…

No country at present has such a thoughtfully constructed HIS in operation, though the concept is receiving attention now

The system should be such that Data collected should be transformed into information, which should further be transformed into intelligence

Thank You