BME 307 Health Management Information System PDF

BME 307: Health Management Information System Data Management Systems Felix Sukums (PhD) Directorate of ICT MUHAS BME 307: HMIS – Course Aim This course aims to equip students with knowledge and skills of Information Technology...

BME 307: Health Management Information System Data Management Systems Felix Sukums (PhD) Directorate of ICT MUHAS BME 307: HMIS – Course Aim This course aims to equip students with knowledge and skills of Information Technology and its applications in health management systems. Expected Course Outcome(s)  At the end of the course students will be able to: Distinguish various types of healthcare information systems. Identify major health informatics applications Distinguish between administrative and clinical decision support systems Identify basic healthcare information technology products Develop basic health information system. Course Content  Introduction to Health Informatics  Electronic Health Records and Electronic Prescribing  Integrated Practice Management System  Health Information Technology Interoperability  Computer Networks and Mobile Technology  Telehealth including Telemedicine  Patient Safety and Technology  Public Health Informatics  Disease Management and Disease Registries Teaching and Learning Activities  This Course will be conducted through Lectures, Tutorials, Group works, Site visits, simulations/demonstrations, practicals and Assignments Assessment Methods Coursework will consist of  tests  assignments  examination Reading references  Shortliffe, Edward H.; Cimino, James J. (2014) Biomedical Informatics: Computer Applications in Health Care and Biomedicine, 4th ed.  Coiera, Enrico, (2015), Guide to health informatics, 3rd. ed  Baltzan, P., Detlor, B., & Walsh, C. (2015). Business Driven Information Systems. 4th Canadian Edition. McGraw-Hill Ryerson Press,  Rainer, R.K. Jr& Turban, E. (2009) Introduction to Information Systems: Supporting and Transforming Business – 2nd Edition. John Wiley & Sons  Tanzania Digital Health Strategy 2019-2024 and Investment Roadmap 2019-2024  WHO Global Strategy on Digital Health 2020-2025  Digital implementation investment guide: integrating digital interventions into health programmes. Geneva: World Health Organization; 2020. Licence: CC BY- NC-SA 3.0 IGO. References  Monitoring and evaluating digital health interventions: a practical guide to conducting research and assessment. Geneva: World Health Organization; 2016. apps.who.int/iris/bitstream/10665/252183/1/9789241511766-eng.pdf  World Health Organization. (2018). Classification of digital health interventions v1.0: a shared language to describe the uses of digital technology for health. World Health Organization. http://www.who.int/iris/handle/10665/260480.  ROUTINE HEALTH INFORMATION SYSTEMS: A Curriculum on Basic Concepts and Practice. https://www.measureevaluation.org/our-work/routine-health-information-systems  Indicators. Presentation at the Regional Workshop on the Monitoring and Evaluation of HIV/AIDS Programs February 14 – 24, 2011 New Delhi, India by MEASURE Evaluation  https://www.healthdatacollaborative.org/fileadmin/uploads/hdc/Documents/Working_Groups/RHIS_ curriculum_facilitators__guide.pdf  World Health Organization. (2015). Global reference list of 100 core health indicators. Retrieved from http://www.who.int/healthinfo/indicators/2015/en/  Aqil A, Lippeveld T, Hozumi D. PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health information systems. Health policy and planning. 2009 Mar 20;24(3):217-28. WHO 2007: Everybody's’ Business. Strengthening health systems to improve health outcomes Definitions  Management information system is system designed to produce information to be presented to the management to assist in decision-making and to enable management to ascertain the progress made by the organization in the achievement of its major objectives.  An HIS is a system that provides specific information support to the decision-making process at each level of the health system.  MIS/HIS can be paper or electronic based system Definitions …  HMIS is the system designed to collect facility based health and health related data, compile, store and retrieve for data analysis produce report which in turn inform service providers, health managers, decision markers/policy makers and the public make informed decision on health planning, monitoring and evaluation.  HMIS in Tanzania in Kiswahili is called MTUHA.  MTUHA is the acronym for ‘Mfumo wa Taarifa za Uendeshaji wa Huduma za Afya’. Components of Computer based Information Systems  Hardware is a set of devices such as  Network is a connecting system that processor, monitor, keyboard, and permits the sharing of printer. resources/information between computers.  Software is a set of programs that enable the hardware to process data.  Procedures are the set of instructions about how to combine the above components.  Database is a collection of related files, tables, relations, and so on, that stores  People are those individuals who work data. with the system or use its output. 12  Information system … Source: https://vistamis1.fandom.com/wiki/Five-Component_Framework FRAMEWORKS FOR UNDERSTANDING A WELL-FUNCTIONING HMIS The purpose of an HMIS  The purpose of an HMIS is to routinely generate high-quality health information that provides specific information support for decision making to monitor and improve performance of the health sector.  Hence, HMIS is more than a system for data collection and generating quality information, and encompasses the continued use of the information for decision making. “Reliable and timely health information can make a difference”. Health information system (HIS) ….. Nonroutine data Routine data Administrative Census records systems Vital Services records registration systems Individual Population- records based systems surveys Population-based Health institution data sources (including community-based data sources) www.measureevaluation.org Health information system (HIS) ….. Source: doi: 10.1093/heapol/czp010 Well-functioning HMIS A well-functioning HMIS is one that ensures the – production, – analysis, – dissemination and – use of reliable and timely information on health determinants, health systems performance and health status Well-functioning HMIS …  A well-functioning HMIS is an integrated effort to collect, process, report, and use health information and knowledge to influence policy and decision making, program action, individual and public health outcomes, and research (WHO, 2010).  A well-functioning HMIS is necessary for the collection, aggregation, analysis, and use of health data.  The performance of an HMIS is defined both in terms of the ability of the system to produce high-quality information as well as the use of information for decision making. Well-functioning HMIS … Responsive & efficient health system Good decisions Use Good data Data quality assurance Data management Well-functioning HMIS www.measureevaluation.org What is a Conceptual Framework?  Conceptual frameworks are best understood as useful tools for understanding and analysing a concept, a problem or even a program.  They are used to make conceptual distinctions and organize ideas.  Strong conceptual frameworks capture something real and do this in a way that is easy to remember and apply.  There are a number of Frameworks for assessing HMIS Performance. For instance The Performance of Routine Information System Management (PRISM) The 12 Components Framework, designed by the Joint United Nations Programme on HIV/AIDS (UNAIDS) PRISM Framework  The Performance of Routine Information System Management (PRISM) framework is an innovative approach to design, strengthen and evaluate RHIS  Optimal performance of the HMIS depends on improvements and successes in three interrelated areas Technical determinants Organizational determinants Behavioural/Individual determinants  PRISM framework promotes building and sustaining information systems, for the promotion of an information culture, and for encouraging accountability in health systems. rhinonet.org PRISM framework … PRISM framework …  Technical determinants include: Data collection processes in place Well-designed data collection forms that streamline the amount of data collected A standard set of clearly defined indicators Having enough staff who can complete data collection and reporting forms Appropriate technology for data analysis, transfer, and presentation Processes in place for using the data PRISM framework …  Organizational determinants include : Organizational structure, Functions, Management, Roles and responsibilities, Information culture  Behavioural determinants include: Knowledge, skills, competence, attitude, motivation Technical determinants  Technical determinants: are the technical aspects of the routine health information system and relate to data collection tools, data management procedures, IT support for data processing, etc. Complexity of the HMIS design, unresponsiveness of the HMIS to meet the information needs of the program managers, Complexity of the HMIS software etc can influence the production of quality data and use of HMIS information. Organizational determinants  Organizational determinants: related to How an organization values the information system and Promotes the culture of information use. Allocating resources for HMIS, Building capacity to do HMIS/RHIS tasks, Nurturing a culture of data demand and Use for decision making at every level of health system management influence the HMIS performance directly or indirectly through behavioral determinants. Behavioral determinants  Behavioral determinants: relate to the demand for HMIS data, and confidence, motivation and competence to perform RHIS/HMIS tasks. If the staff or the managers are not aware of or do not appreciate the usefulness of HMIS data then it will negatively affect the data quality and its use. Similarly, lack of skills to ensure data quality and use HMIS information will have adverse effects on HMIS. Organisational issues about HMIS The 12 Components Framework (UNAIDS) The 12 Components Framework  The 12 components are organized in three rings  Outer ring - partnerships, people, and planning It includes individuals, organisations, functions/actions, and the organizational culture that are fundamental to improving and sustaining M&E system performance.  Middle ring - collect, capture, and verify mechanisms through which data are collected, verified, and analysed.  Inner ring - data for decisions the primary purpose of the M&E system: using data for decision making. Data analysis, interpretation, use, communication and dissemination PRISM framework  Technical determinants: the tools and functional aspects associated with data processing and management.  Organizational determinants: the system or organizational context that supports data collection, availability, and use  Behavioural determinants: the behaviour of individuals who produce and use data and other information Note: Each of the determinants and their components need to be in place and functioning for an improved HMIS performance. Summary: HMIS  Health management information systems serve multiple users and a wide array of purposes generate information to enable decision-makers at all levels of the health system to identify problems and needs, make evidence-based decisions on health policy, plans and allocate scarce resources optimally  A well-functioning HMIS produces quality information which can be used to address health system challenges WHO classification of health system challenges (WHO, 2020) WHO 2007: Everybody's’ Business. Strengthening health systems to improve health outcomes Health Facility Business Process Framework Source: MOHCDGEC, 2016 Health Facility Business Process Framework Health Management Information Systems in Tanzania  Health Facility Business Process Framework Health information systems support the six health system building blocks Major HIS Data Management Systems Source: DUP Assessment findings, 2016 Major HIS Data Management Systems  DHIS 2 - (District Health Information Software version 2)  Hospital Information Management Systems e.g. GoTHoMIS  eLMIS – Electronic Logistics Management System  Integrated financial information management system  VIMS – Vaccine Information Management System  TiMR -Tanzania Immunization Registry  HRHIS – Human Resources for Health Information System  TIIS – Health Training Institution Information System  HFR – Health Facility Registry or Master Facility List HIS Data Management Systems …  Health services  Health facility management information systems with electronic medical/health records enhances diagnosis and treatment by providing accurate and timely patient information. with resources/inventory and financial management modules/sub systems improves the operations and financial efficiency of health care systems. e.g. Jeeva, MediPro, GoT-HoMIS, eHMS, AfyaPro, Care2x, Wellsoft EDIS, CTC2 at HIV care and treatment centres, Case based Electronic TB & Leprosy Register (ETL) software)  Diagnostics information systems e.g. LabNet, Daisa, Skylims, PACS HIS Data Management Systems …  Health promotion: use of mHealth apps and social media. Systems for health information, education and communication e.g. mHealth platform eIDSR Kifua Kikuu, TB Self-Check app Wazazi Nipendeni Maoni Huduma ya Afya Elimu ya Afya NHIF SMS notification app HIS Data Management Systems …  Health workforce systems Improved human resource planning, management and development through accuracy and timely provision of quality human resource information for decision making Human Capital Management Information System (HCMIS/LAWSON) for all public employees including health professionals Human resource for health information system (HRHIS) for public and private human resource for health Training institutions information system (TIIS) for public and private health training institutions Professional councils/bodies’ registration systems e.g. MCTIS, Pharmacy Council (PCIS) HIS Data Management Systems …  Health commodities Implemented EPICOR 9 (E9) at MSD Electronic logistics management information system (eLMIS) Vaccine Information Management System (VIMS) Stock control/ inventory management system at health facilities/institutions  Health financing PlanRep, FFARS, Revenue collection Point of Sales (POS) e.g. NMB, CRDB Fahari Huduma services NHIF esolutions (e.g. e-membership, e-verification, eClaim), Insurance Management Information System for CHF Mobile payment, GePG HIS Data Systems …  DHIS2 This web-based system for the management of routinely collected health data is the main health data management software program in the country. DHIS2 is interoperable with other systems for seamless and secure data exchange DHIS 2 has improved data quality, including completeness and timeliness of reporting. Data are entered directly into the web-based platform, and everyone with access privileges will be able to access data instantly. DHIS2 is the national health data warehouse, https://hmisportal.moh.go.tz/hmisportal/, https://dhis.moh.go.tz/ HIS Data Systems …  HRHIS facilitates the following: A picture of the actual HRH situation in Tanzania at any given time Forecast of trends in aspects of HRH, such as attrition, migration, retention, absorption, and production Information to support HRH planning, projection, capacity building, and management at all levels  HRHIS has been rolled out successfully and is in use  To access HRHIS, please go to: http://hrhis.moh.go.tz. HIS Data Systems …  eIDSR The use of mobile communications technology, such as mobile phones, to assist in disease surveillance and prevention, and response to disease outbreaks and public health events of international concern. Health facilities use mobile phones to report data to DHIS2, where data processing and analysis are done. Health facilities receive data submission reminders and confirmations. Users at other levels can receive notifications of disease outbreaks so they can take action quickly. Developed and maintained as per the national IDSR guidelines (e.g. immediate and weekly reporting) Challenges facing HIS At different levels of the health system  Fragmented and uncoordinated business processes  Fragmented ICT pilots and numerous HIS silos  Inadequate sharing/exchange of health information across the sector  Inadequate coordination and governance on common investment framework  Need of Holistic Approach in planning, implementing and usage the systems as per the national health enterprise architecture  RITA - CRVS NHIF & CHF y ILS Gat MSD - EpiCor ewa eLMIS/VIMS DHIS2 Major digital HIS in Tanzania IDSR HFR HRHIS RBF SAVVY PlanRep CTC 2 (HIV) EpiCor iHMS BID Tanzania HIE Conceptual Model MOHCDGEC, 2018 HMIS Data Flow and Staff Responsibilities The health care pyramid in Tanzania MOHCDGEC, 2019 HMIS Data Flow - Current Health District Regional National facility Level HMIS Data Flow Data entry & access Data access National level Other Regions systems DHIS2 Health Health Facility (Hospital, Health Centre, Dispensary) Districts Facilities Register Books →Tally Sheets → Summary Forms HMIS Data Flow - Future Data entry & access Data access Health Facilities Other Districts systems National Data Warehouse National Regions level HMIS - Staff Responsibilities  Health Facility level Providing healthcare services and recording in the appropriate registers the details of patient demographics (such as age and sex) for each service provided. Summarizing details of the day’s services on service tally sheets before the facility closes each day Compiling monthly summary reports and filling in respective service monthly summary forms Review & sign-off by the in-charge of that facility’s monthly summary form Submission of all monthly summary forms to the district level Entering data to DHIS2* (except facilities which don’t have access to DHIS2) HMIS - Staff Responsibilities …  District Council level: Council health management team (CHMT)  CHMT is supervised by the DMO and members include the vertical program coordinators, the district health secretary, and the district HMIS focal person. CHMT is responsible for Receiving data from health facilities in the district and entering data into DHIS2 (from health facilities which don’t have access to DHIS2) Following up with health facilities that are not reporting data Checking the quality of data submitted by health facilities Conducting data-related supervisory visits to health facilities Conducting district-level data quality assessment and analysis using DHIS2 Providing technical support to health facilities Providing feedback to stakeholders HMIS - Staff Responsibilities …  Regional level: Regional health management team (RHMT)  RHMT is chaired by the RMO and members include the regional HMIS focal person, vertical programme coordinators, and the regional health secretary.  RHMT is responsible for Supervising and following up HMIS data entry issues at the district level Running data quality assessments Conducting data-related supervisory visits to council and health facility levels Conducting regional-level data analysis and providing feedback to stakeholders Providing technical support to CHMTs and HFs HMIS - Staff Responsibilities …  National level (MOHCDGEC, PO-RALG) Running data quality assessments Conducting data-related supervisory visits to regional, district, and health facility levels Conducting national-level data analysis Managing and maintaining the National data warehouse (DHIS2) and related systems Providing technical support Providing feedback to national stakeholders on the country’s health status, as well as following up on any actions required at the national level HIS Interoperability  System integration is the process of aggregating the component sub- systems into one system so that the resulting system is able to deliver the overarching functionality  System interoperability is the ability of different information technology systems to communicate with one another and exchange data.  The Government of Tanzania is implementing Health Information Exchange (HIE) / Health Information Mediator (HIM) To all HIS as well as other related to system to communicate To simply data dissemination and use among stakeholders – through national data warehouse HIS Data Management Systems  HIS data management systems used in Tanzania  Types of data managed by the systems  How these systems relate to one another interoperability and information sharing  DHIS 2 as a National Data Warehouse the major functional areas of the system Major HIS Data Management Systems  DHIS 2 - (District Health Information Software version 2)  eLMIS – Electronic Logistics Management System ILS – Integrated logistics management system, ILS Gateway EPICOR – integrated financial information management system VIMS – Vaccine Information Management System TiMR -Tanzania Immunization Registry  HRHIS – Human Resources for Health Information System  TIIS – Health Training Institution Information System  HFR – Health Facility Registry or Master Facility List HIS Data Systems …  DHIS 2 National data warehouse, https://hmisportal.moh.go.tz/hmisportal/ HIMIS, https://dhis.moh.go.tz/dhis-web-commons/security/login.action Demo version of DHIS2, https://play.dhis2.org/2.31.0/dhis-web- dataentry/index.action DHIS 2 …  DHIS is an open source software platform (web based system) for reporting, analysis and dissemination of data for all health programs, developed by the Health Information Systems Programme  DHIS 2 is a tool for collection, validation, analysis, and presentation of aggregate and patient-based statistical data, tailored (but not limited) to integrated health information management activities.  Data collection through data entry, import and export of data, aggregation and integration with other systems DHIS 2 Terminology  Data element: A data element is the fundamental building block of DHIS 2 data value that has actually been observed or recorded e.g. # of HIV-positive cases  Data set: This is a collection of data elements organized to facilitate the data collection process  Indicator: The divisor of an indicator  Organisation unit: Represents the geographical context  Period: A period is a specific interval marked by a start date and an end date  Aggregate data: In DHIS 2, this term refers either to data elements or to  indicators that have been derived from other hierarchical data sources. WHO 2007: Everybody's’ Business. Strengthening health systems to improve health outcomes WHO 2007: Everybody's’ Business. Strengthening health systems to improve health outcomes Challenges facing HIS At different levels of the health system  Fragmented and uncoordinated business processes  Fragmented ICT pilots and numerous HIS silos  Inadequate sharing/exchange of health information across the sector  Inexistence of common investment framework  Inadequate governance and coordination  Need of Holistic Approach in planning, implementing the systems Introduced an interoperability Layer (HIM and Muungano Gateway) Developed the Tanzania Health Enterprise Archicture References  Tanzania Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC). (2017). DHIS 2 functions and data use for health information system strengthening: Training manual. Dar es Salaam, Tanzania: MOHCDGEC.  Monitoring and evaluating digital health interventions: a practical guide to conducting research and assessment. Geneva: World Health Organization; 2016. apps.who.int/iris/bitstream/10665/252183/1/9789241511766-eng.pdf  World Health Organization. (2018). Classification of digital health interventions v1.0: a shared language to describe the uses of digital technology for health. World Health Organization. http://www.who.int/iris/handle/10665/260480.  ROUTINE HEALTH INFORMATION SYSTEMS: A Curriculum on Basic Concepts and Practice. https://www.measureevaluation.org/our-work/routine-health-information-systems  https://www.measureevaluation.org/resources/publications/ms-17-123a/at_download/document  Indicators. Presentation at the Regional Workshop on the Monitoring and Evaluation of HIV/AIDS Programs February 14 – 24, 2011 New Delhi, India by MEASURE Evaluation  https://www.healthdatacollaborative.org/fileadmin/uploads/hdc/Documents/Working_Groups/RHIS_curriculum_facilitators__guide. pdf  World Health Organization. (2015). Global reference list of 100 core health indicators. Retrieved from http://www.who.int/healthinfo/indicators/2015/en/  Aqil A, Lippeveld T, Hozumi D. PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health information systems. Health policy and planning. 2009 Mar 20;24(3):217-28. Thank you!