HEALTH MANAGEMENT INFORMATION SYSTEM

Presenter: Akash RanjanModerator: Dr. D.G.Dhambhare

Frame work: HMIS

1 Health Informatics2. HMIS – Concept, 3.Framework for designing HMIS4.Identifying information needs and indicators5. Data collection methods6. Data transmission, data processing (Use of information)7.Management of HIS8. Approaches to strengthening HIS9. HMIS in NRHM 10. HMIS in Wardha11. Benefits and Challenges12. References

1. Health Informatics

Discipline at the intersection of information science, computer science and health care.

Deals with  the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health

Tools include computer, clinical guidelines, information and communication system.

HIS is a component of Health informatics, enables the health system in better decision making and ultimately for the betterment of quality of health care.

Introduction

“Health Information systems”- “A system that provides specific information support to the decision-making process at each level of an organization”

It integrate 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.

Information is crucial at all management levels of the health services, from the periphery to the centre

The challenge for the health system is to optimize the management of service delivery in a way that minimize losses in effectiveness

Fig1: Information support to each step in the management cycle

Information

Situation analysis

Evaluation

Implementation &

Monitoring

Programming

Option appraisal

Priority setting

2 Framework for designing HMSComponents of Health Information

System

A Health Information System can broken down in two components:Resources:Persons (e.g. planners, managers, statisticians, epidemiologists, data

collectors)Hardware (e.g. registers, telephones, computers); Software (e.g. carbon paper, report forms, data-processing programs) Financial resources. A set of organizational rules. the use of diagnostic and treatment standardsdefinition of staff responsibilities, supply management procedurescomputer maintenance procedures

Organization model of Health Services

3 Identifying information needs and indicators

Indicator- “A data element placed in a given context so that it becomes information that can be acted upon and can be used for programme monitoring and management.

Proxy of a situation

Type of indicators1. Count Indicators: Measure the number of events without a denominator eg. Number of newly detected cases of Tuberculosis2. Proportion Indicators: Expressed as percentage, numerator is contained in denominator Proportion Indicators = Number of PHC’s without delivery table Total number of PHC

• 3 Rate Indicators: Measures the frequency of an event during the specified time, usually expressed per 1,000 or 100,000 population

Eg. Rate Indicator= No of cases of malaria in children of age <5 yr X k

Mid year population of children of age <5yr Basic measure of disease occurrence4. Ratio Indicator: Numerator is not included in denominator eg Ratio indicator= No of Male deaths due to HIV No of female deaths due to HIV

Classification of indicators: 3 types1. Based on logical framework of system2. Programme Indicators: Family planning, reproductive health & nutrition3. Monitoring & Evaluation indicators:

Classification based on logical framework Input indicators-indicate resources invested in the system, e.g., number

of doctors per 100,000 people.Process indicators-indicate activities of the health system, e.g.,

percentage of doctors trained in safe delivery skillsOutput indicators-indicate achievements made in specific health

strategies e.g. percentage of women who received 3 ANCsOutcome indicators-indicate achievements of a health programme or

health system. e.g institutional delivery rate, breastfeeding in one hour rate etc

Impact indicators-indicate achievements in health status of particular group of people e.g. Maternal Mortality Ratio, Infant Mortality Rate, Total Fertility Rate etc.

Data Quality:• Data quality refers to the extent to which data measures what they intend toParameters of data quality are:• Completeness • Timeliness• Accuracy• Data entry errors• Systemic errors

What to do if the error has been found in report?Go back to the registers and check the value, correct itStaff understands meaning of this data element In the forthcoming month, check the value

5 Data transmission, data processing

Data Transmission: Transfer of raw data from lowest level to higher levels of health system for the purpose of data processingwell designed information system will ensure relevant not only for the

decisions that must be made by higher levels, but also for day to day m/m at the health centre level

Vertical data Transmission-transfer of information between levels of health care system

Horizontal data transmission-Transfer of data among actors and consumers at the same level of health care system.

Purpose:1. Provide data that is directly relevant to decision making at lowest level of

HCS.2. data that are useful to inform decision making but that require further

processing in order to do so.3. community actors and consumers have access to compiled information from

the health system

Data processing:Goal: To present information, that aids decision making at all levels of health

care systemProduces information that is useful for decision making, that is presented in a

summary form that is most comprehensible to a wide range of players in the health care system.

6 Management of HIS

Elements of Health Information system(HIS) Management

The basis for HIS management is a solid management structure, including affordable HIS resources and a well established set of organizational rules

7. Approaches to strengthening health information systems

Plethora of irrelevant or low-quality data. Make decisions based on “gut feeling”Characteristics of health information system development approaches

that are likely to failThe folly of pursuing the grand design HIS restructuring for central-level data accumulation(Page 145) Collection of non useful data. Information needs based on detailed decisions (lengthy data)Mistaking computerization for HIS restructuringDonor-driven health information system

Characteristics of HIS development approaches that are likely to succeed

Start every HIS development effort with the definition of indicatorsApply an evolutionary, problem-directed approach for improving the HIS Include policy analysis as a full part of HIS assessmentEnable broad participation in the health information system design process,

but ensure technical soundness throughout by the use of a HIS design team Introduce information technology in an effective, efficient, and sustainable

manner

8. HMIS in NRHM

One of the major contributions of NRHM has been to put in place a nationwide HMIS

Quality of data reported increasing but the challenge now is to make the information available to Programme Managers, and help them to use it for improving service delivery and health outcomes

HMIS Portal • To enable capturing of public health data from both public and private

institutions• Initially rolled out up to the District Level and now being expanded to the Sub

District/Block level facility wise data entry

Objectives• To enable user to preview, compare, modify and forward data to the next

level.• The data stored by using the Data Entry Application would be transformed

and will be used for Statistics, Analytical & Ad-hoc reporting. • To consolidate the data entered at facility, sub-district level/block, district level,

at the state level and further at national level and store it into the central database

• HMIs portal is a reservoir of health related information of MOHFW.

• It is divided into two domains, Public and Secured.

• The information available in the public domain is accessible to all and anyone can view and download the reports in this section.

• The information in the secured domain is accessible to a selected set of users

of HMIS Portal. This is secured by a user ID and password provided by GoI. • The secured domain is for the Block/District/State and National Level users,

to enter and view the data. 

Flow of Data: Bottom up

DH

SDH

CHC CHC

SDH

CHC

PHCPHCPHC

SC SC

Data aggregation unit

Place where the data is collected and consolidated District HQ, Block HQ, Sub-Divisional Hospital, District Hospital, CHC or a even a PHC

Analytical reports • Analytical report is for Monitoring and Evaluation of performance indicators

of RCH and other programs. There are few build in report which can be generated from the portal.

• 1. Performance of RCH • 2. HMIS indicators • 3. District wise contribution/RCH  Feedback and Queries • For feedback, queries, suggestions, error reporting or any help/support hmis-nrhm@nic.in .The emails are answers within 48 working hours.

9. HMIS in Wardha District

• HMIS is working in the form of DHISII since 2010-11. It is basically online reporting system, the flow of data is bottom up.

• Flow of data

PHCDistrict

State

First 5 days in month

First 10 days in month

Till First 15 days in everymonth

Benefits• Transparent, once data entered no chance of manipulation• Faster, data can be entered online or offline.• Critical analysis of data can done at every step from PHC, district,

and state, in comparison to previous system where it was done at the or beyond the district level.

• Information of previous month is available at state level with in the first 15 days of every month.

• Most of them appreciated the improvement of system in last 2 years.

 

Challenges:• Not skilled man power, especially at peripheral level. Even at district level

data entry operators, and monitoring & evaluation officer (Mulya Mapan Adhikari) post is on adhoc basis.

• Once the data is entered in forward mode, can’t be change (Even the typographical mistakes)

• A total of 631 entries at SC level, and 1908 entries have to fill at PHC level.• Peripheral workers don’t get feedback, that doesn’t help in motivating them

for quality work and participation in the process. 

References:

1. Design and implementation of health information system. Geneva: World health Organization, 2000.2. Guidelines for the development of Health Management Information System. Manila: Regional Office for the western pecific, 1993. Report No.: 92 9061 106 53. HEALTH PROGRAMME MANAGERS’ MANUAL: Understanding Health Management Information System: MoHFW, editor. New Delhi 2011. 

 

Thank You

The real problem is not unavailability of information but “plethora of irrelevant”.The real challenge is use valid & appropriate information rather than “gut feeling” in decision making