Module 1 - Introduction To Health Systems In The Philippines PDF

Module 1 - INTRODUCTION TO HEALTH SYSTEMS IN THE PHILIPPINES ***Educational Institution*** - is based on an age grade system from preschool, primary, intermediate, and secondary level (junior and senior high school), to tertiary level (colleges and universities). Types of Educational In...

Module 1 - INTRODUCTION TO HEALTH SYSTEMS IN THE PHILIPPINES ***Educational Institution*** - is based on an age grade system from preschool, primary, intermediate, and secondary level (junior and senior high school), to tertiary level (colleges and universities). Types of Educational Institutions: ***Formal Education*** - Deals with the conventional classroom setup where structured methods of learning are administered in educational institutions. Government recognition in terms of curricular offering that predetermines the books and materials to be used for instructions is necessary to establish the standards in the academic community. ***Informal Education*** - is anything learned independently outside the conventional classroom setup. involves the students\' behavior skills through interaction and exploration on a daily basis as well as the teachers\' traits that vary based on their expertise, skills, and experience. A **vision statement** is the end desire aspiration of an academic institution. It is usually a one-sentence statement describing the distinct and motivating long-term desired transformation resulting from institutional program. Vision should be *clear, memorable and concise* with an average length of 14 words. a **mission statement** is a one-sentence relating the intention of your institution existence. This answer the question "What you do or Who you do this for". Mission must be clear by using simple language, Concise, no fluff aims for 5 to 14 words with a maximum of 20 max and Valuable, that is inform, focus and guided. **Comparison Table Vision versus Mission Statement** +-----------------------+-----------------------+-----------------------+ | **Vision Statement** | **Mission Statement** | | +-----------------------+-----------------------+-----------------------+ | **Function** | Its inspires to give | Define the key | | | the best and shapes | measure of the | | | your understanding of | institution success. | | | why you are in the | | | | institution | | +-----------------------+-----------------------+-----------------------+ | **Developing | When do we want to | What do we do today? | | Statement** | reach success? | | | | | For whom do we do it? | | | Where do want to go | | | | forward? | Why we do what we do? | | | | | | | How do we want to do | | | | it? | | +-----------------------+-----------------------+-----------------------+ | **Time** | Talks about future | Talk about present | | | | leading to the future | +-----------------------+-----------------------+-----------------------+ | **Question** | Where do we aim to | What makes us | | | be? | different? | +-----------------------+-----------------------+-----------------------+ | **About** | Where you want to be? | How you will get | | | | where you want to be? | +-----------------------+-----------------------+-----------------------+ A **values statement** is a list of fundamental doctrines that guide and direct the educational institution and its belief. This creates the moral direction of the institution and its academic community that guides decision-making and create a yardstick against any action. The core value are the standard structure that is shared and acted upon the academic community. Values statements consider the following questions: What values are distinctive to our educational institution? What value should be the direction of the management of the institution? An ***Educational objectives***, or goals, are short statements that learners should achieve within or at the end of the course or lesson. When setting the objectives, curriculum developers must think of the SMART criteria; that is, objectives must be Specific, Measurable, Attainable, Realistic, and Time-Bound. **Mission, Vision, and Educational Philosophy** **NEU\'s mission** is to provide quality education anchored on Christian values with the prime purpose of bringing honor and glory to God. This mission statement emphasizes the university\'s commitment to integrating Christian principles into its educational programs and fostering a culture of faith and service. **The vision** of NEU is to become a world-class institution of learning with a unique Christian culture of excellence, discipline, and service to humanity. This vision statement highlights the university\'s aspiration to achieve academic excellence while maintaining its Christian identity and promoting values like discipline and service. **NEU\'s educational philosophy** is grounded in the belief that \"godliness is the foundation of knowledge.\"This philosophy underscores the importance of integrating faith and knowledge, emphasizing the role of spiritual values in shaping a holistic education. **Educational Objectives** NEU has outlined several specific goals and objectives to achieve its mission and vision. These objectives include: Imparting value-laden education to the total development of man. This objective emphasizes the university\'s commitment to providing a holistic education that addresses the intellectual, social, emotional, and spiritual needs of its students. Offering curricula responsive to the needs of the time. NEU aims to provide relevant and up-to-date educational programs that equip students with the skills and knowledge necessary to succeed in a rapidly changing world. Optimizing learning through the adoption and utilization of appropriate instructional methods and resources. The university seeks to enhance the learning experience by employing effective teaching methods and utilizing modern educational resources. Propelling institutional development through the conduct of useful and significant researches. NEU promotes research and scholarship to contribute to knowledge creation and address societal challenges. Extending outreach services which promote self-help in the community. The university is committed to serving the community through various outreach programs that empower individuals and promote social development. Promoting access to non-conventional higher education and basic education programs. NEU aims to make quality education accessible to a wider range of individuals by offering alternative educational pathways and programs. Developing servant leaders among staff, faculty members, and administrators. The university seeks to cultivate leadership qualities that emphasize service, integrity, and ethical conduct. Producing God-fearing, competent, and disciplined graduates. This objective reflects the university\'s ultimate goal of graduating well-rounded individuals who are equipped to make a positive contribution to society. General Principles of Educational Institutions Educational Institution: A place where learners of different ages gain education. Vision Statement: Conveys the desired end of an academic institution; clear, memorable, and concise. Mission Statement: The intention of an institution\'s existence. Core Values: Fundamental doctrines that guide and direct the educational institution. Educational Objectives: Short statements that learners should achieve within or at the end of a course or lesson. Specific to Health Information Systems (HIS) in Medical Laboratory Science HIS: A system designed to manage and process health information. Importance of HIS: Reduces costs, increases quality of healthcare, and improves service provision. HIS in Medical Laboratories: Focuses on managing laboratory data, workflows, and reporting. To find the specific vision, mission, goals, and objectives of the institution in Health Information Systems for Medical Laboratory Science by Nuevo, J., et. al., 2018, you would need to: Locate the original source: Search for the publication \"Health Information Systems for Medical Laboratory Science\" by Nuevo, J., et. al., 2018. This could be a journal article, a book chapter, or a conference paper. Review the publication: Once you find the source, carefully read the text to identify the institution\'s vision, mission, goals, and objectives related to health information systems in medical laboratory science. **Week 2 - Health System** In World Health Organization Report in 2000, **health system** was defined as "all the organizations, institutions and resources that are devoted to producing health actions." On the other hand, health action is defined as "any effort, whether in personal health care, public health services or through intersectoral initiatives, whose primary purpose is to improve health." WHO has identified 3 main goals for health systems: 1\. **Improving the health of populations** Improving population health is the overarching goal. Health status should be measured over the entire population and across different socioeconomic groups. 2\. **Improving the responsiveness of the health system to the population it serves** Responsiveness represent the concept that the health system provides services in the manner that people want or desire and engages people as active partners. 3\. **Fairness in financial contribution** An ideal health system will provide social and financial risk protection in health and be fairly financed. Paying for health care should not impoverish individuals or families. Four Vital Health System Functions: 1\. ***Health Service Provision*** - the most visible product of the health system is public and private health service provision. A health service is any service, not limited to clinical services, aimed at improving the health of populations. 2\. ***Health Service Inputs*** - it also known as managing resources, means generating the essential physical resources for the delivery of health services which include medications, human resources, and medical equipment. Resources such as trained doctors and medical staff and supply of medications often take time to be produced. 3\. ***Stewardship*** - or the overall insight, it the main responsibility of the government. This function sets the direction, context, and policy framework for the overall health system. The core of the stewardship function includes: a\. Identifying health priorities for allocation of public resources; b\. Identifying an institutional framework; c\. Coordinating activities with other systems related to external health care; d\. Analyzing health priorities and resource generation trends and their implications; and e\. Generating appropriate data for effective decision-making and policymaking on health matters. 1\. ***Health Financing***. It includes raising and pooling resources to pay for health services.\ a. ***[Revenue Collection]*** - Revenue is earned from payments for health care services. The mechanisms for revenue collection include general taxation, direct household out-of-pocket expenditures, mandatory payroll contributions, mandatory or voluntary risk-rated contributions, donor financing, and other forms of personal savings. b\. ***[Risk pooling.]*** It is a form of risk management which aims to spread financial risk from an individual to all pool members. It is considered a core function of health insurance companies. This mechanism prevents outright payment for health services which discourages patients belonging to the poor sector from seeking health care system. ***Bismark model*** - uses an insurance system where the sickness fund finances both the employers and the employees through payroll reduction. ***Beveridge model*** - health care is provided and funded by the government through tax payments. Due to the fact, that majority of hospitals and clinics were owned by the government. c\. ***[Strategic purchasing]***. Risk-pooling organizations use collected funds and pooled financial resources to finance health care services for the members. The purchasers define the substantial part of the health provider\'s external incentives to develop the provider-user interaction and the health service delivery models. **WHO Health System Framework** The functions identified in the *World health report 2000* have been broken down into a set of six essential groups. These are needed to improve targeted health outcomes or overall goals. 1\. **Service delivery** those which deliver effective, safe, quality personal and non-personal health interventions to those who need them, when and where needed, with minimum waste of resources. 2\. **Health Workforce** one which works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances. For example, there are sufficient numbers and mix of staff, fairly distributed; they are competent, responsive and productive. 3\. **Information** one that ensures the production, analysis, dissemination and use if reliable and timely information on health determinants, health systems performance and health status. 4\. **Medical Products, Vaccines and Technologies** ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use. 5\. **Financing** raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them. 6\. **Leadership and Governance** involves ensuring strategic policy frameworks exist and are combined with effective stewardship, coalition-building, the provision of appropriate regulations and incentives, attention to system-design, and accountability. **Philippine Health System** The major areas of the following health reform initiatives are the health service delivery, health regulation and health financing. These health reforms targeted to address issues such as poor accessibility, inequity and inefficiency. **1979: Adoption of Primary Health Care** - Promoted participatory management of the local health care system. **1982: Reorganization of DOH** - Integrated public health and hospital services. **1988: The Generics Act** - Prescriptions are written using the generic name of the drug. **1991: RA 7160 \"Local Government Code\"** - Transfer of responsibility of health service provisions to the local government units. **1995: National Health Act** - Aims to provide all citizens a mechanism for financial protection with priority given to the poor. **1996: Health Sector Reform Agenda** - Major organizational restructuring of the DOH to improve the way health care is delivered, regulated and financed. **2005: FOURmula One (F1) for Health**- Adoption of operational framework to undertake reforms with speed, precision, and effective coordination. **2008: RA 9502 \"Access to Cheaper and Quality Medicines Act\"** - Promote and ensure access to affordable quality drugs and medicines for all. **2010: AO 2010-0036 \"Kalusugang Pangkalahatan\"** - Universal health coverage and access to quality health care for all Filipinos.  The DOH as mandated has the duty to: Developing health policies and programs; Enhancing partners' capacity through technical assistance; Leveraging performance for priority health programs among these partners; Developing and enforcing regulatory policies and standards; Providing specific programs that affect large segments of the population; Providing specialized and tertiary level care. **Directions of the Philippine Health Sector** \(1) The Philippine Health Agenda (DOH Administrative Order 2016-0038) \(2) The Philippine Developmental Plan 2017-2022 \(3) NEDA AmBisyon Natin 2040 \(4) Sustainable Developmental Goals 2030 **Week 3 - Primary Health Care and the Philippine Health Care Delivery System** The Declaration of Alma-Ata states that ***primary health care*** is essential health care based on scientifically sound and socially acceptable methods, universally accessible to individuals and families with their full participation at a cost that the community and country can afford in a spirit of self-reliance and self-determination. (WHO-WPRO, 2018) ***Primary health care* (PHC)** is essential [[health]](http://nursingexercise.com/community-health-education-method/) care made universally accessible to individuals and acceptable to them, through full participation and at a cost the [[community]](http://nursingexercise.com/hospital-nurse-community-nurse/) and country can afford. It is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy. ***Primary health-care* (PHC)** has basic essential elements and objectives that help to attain better health services for all. ***Health Care System*** refers to an organized plan of health services (Miller-Keane, 1987). ***Health Care Delivery*** is the rendering of health care services to the people (Williams-Tungpalan, 1981). ***Health Care Delivery System*** (Williams-Tungpalan, 1981) refers to the network of health facilities and personnel which carries out the task of rendering health care to the people. ***Philippine Health care system*** is a complex set of organizations interacting to provide an array of health services (Dizon, 1977). The ultimate goal of primary health care is better health for all. WHO has identified five key elements to achieving that goal: 1\. universal coverage to reduce exclusion and social disparities in health; 2\. service delivery organized around people\'s needs and expectations; 3\. public policy that integrates health into all sectors; 4\. leadership that enhances collaborative models of policy dialogue; and 5\. Increased stakeholder participation. **Essential Elements of Primary Health Care (PHC)**: 1\. Education concerning prevailing health problems and the methods of identifying, preventing and controlling them. 2\. Locally endemic disease prevention and control. 3\. Expanded program of immunization against major infectious diseases. 4\. Maternal and child health care including family planning. 5\. Essential drugs arrangement. 6\. Nutritional food supplement, an adequate supply of safe and basic nutrition. 7\. Treatment of communicable and non-communicable disease and promotion of mental health. 8\. Safe water and sanitation. Other elements of Primary Health Care 1\. Expended options of immunizations. 2\. Reproductive health needs. 3\. Provision of essential technologies for health. 4\. Health promotion. 5\. Prevention and control of non-communicable diseases. 6\. Food safety and provision of selected food supplements A health system based on primary health care will: 1\. build on the Alma-Ata principles of equity, universal access, community participation, and intersectoral approaches; 2\. take account of broader population health issues, reflecting and reinforcing public health functions; 3\. create the conditions for effective provision of services to poor and excluded groups; 4\. organize integrated and seamless care, linking prevention, acute care and chronic care across all components of the health system; 5\. continuously evaluate and strive to improve performance Management Principles in relation to Organizing **Authority, responsibility, and accountability** a\. **Authority** is a manager\'s formal and legitimate right to make decisions, issue orders, and allocate resources to achieve organizationally desired outcomes. b\. **Responsibility** means an employee\'s duty to perform assigned task or activities. **Types of authority (and responsibility)** **Line authority** managers have the formal power to direct and control immediate subordinates. The superior issues orders and is responsible for the result---the subordinate obeys and is responsible only for executing the order according to instructions. **Functional authority** is where managers have formal power over a specific subset of activities. **Staff authority** is granted to staff specialists in their areas of expertise. It is not a real authority in the sense that a staff manager does not order or instruct but simply advises, recommends, and counsels in the staff specialists\' area of expertise. c\. **Accountability** means that those with authority and responsibility must report and justify task outcomes to those above them in the chain of command. **Centralization, decentralization, and formalization** a\. **Centralization** - The location of decision making authority near top organizational levels. b\. **Decentralization** - The location of decision making authority near lower organizational levels. c\. **Formalization** - The written documentation used to direct and control employees. **Staffing** Assignment of individuals to responsible positions identified in a management plan Determine the competencies required for a position through: ü Identify key result areas (KRA's) per major activities in the plan ü Determine qualifications and competencies required to perform the activities and achieve the KRA's Assign or recruit staff that qualifies for the responsibilities For existing programs and services ü Review and adjust the competency requirements for each major activity with corresponding KRA's ü Match competency requirements vis a vis the responsible person already assigned to the activity **The Philippine Health Care System** **The Department of Health Mandate:** The Department of Health shall be responsible for the following: formulation and development of national health policies, guidelines, standards and manual of operations for health services and programs; issuance of rules and regulations, licenses and accreditation; promulgation of national health standards, goals, priorities and indicators; development of special health programs and projects and advocacy for legislation on health policies and programs. The primary function of the Department of Health is the promotion, protection, preservation or restoration of the health of the people through the provision and delivery of health services and through the regulation and encouragement of providers of health goods and services (E.O. No. 119, Sec. 3). **Vision:** Health as a right. Health for All Filipinos by the year 2000 and Health in the Hands of the People by the year 2020. **Mission:** The mission of the DOH, in partnership with the people to ensure equity, quality and access to health care: by making services available by arousing community awareness by mobilizing resources by promoting the means to better health **LEVELS OF HEALTH CARE FACILITIES** **1. PRIMARY LEVEL OF HEALTH CARE FACILITIES** This includes rural health units, their sub-centers, chest clinics, malaria eradication units, and schistosomiasis control units operated by the DOH; puericulture centers operated by League of Puericulture Centers; tuberculosis clinics and hospitals of the Philippine Tuberculosis Society; private clinics, clinics operated by the Philippine Medical Association; clinics operated by large industrial firms for their employees; community hospitals and health centers operated by the Philippine Medicare Care Commission and other health facilities operated by voluntary religious and civic groups (Williams-Tungpalan, 1981). **2. SECONDARY LEVEL OF HEALTH CARE FACILITIES** These are the smaller, non-departmentalized hospitals including emergency and regional hospitals in which services to patients with symptomatic stages of disease, which require moderately specialized knowledge and technical resources for adequate treatment are offered. **3. TERTIARY LEVEL OF HEALTH CARE FACILITIES** These are the highly technological and sophisticated services offered by medical centers and large hospitals. These are the specialized national hospitals. The services rendered at this level are for clients afflicted with diseases which seriously threaten their health and which require highly technical and specialized knowledge, facilities and personnel to treat effectively (Williams-Tungpalan, 1981). **FACTORS ON THE VARIOUS CATEGORIES OF HEALTH WORKERS AMONG COUNTRIES AND COMMUNITIES** 1\. Available health manpower resources 2\. Local health needs and problems 3\. Political and financial feasibility **THREE LEVELS OF PRIMARY HEALTH CARE WORKERS** ***A. Village or Grassroots Health Worker*** First contacts of the community and initial links of health care. Provide simple curative and preventive health care measures promoting healthy environment. Participate in activities geared towards the improvement of the socio-economic level of the community like food production program. Community health worker, volunteers or traditional birth attendants. ***B. Intermediate Level Health Worker*** Represent the first source of professional health care Attends to health problems beyond the competence of village workers Provide support to front-line health workers in terms of supervision, training, supplies, and services. Medical practitioners, nurses and midwives. ***C. First Line Hospital Personnel*** Provide backup health services for cases that require hospitalization Establish close contact with intermediate level health workers or village health workers. Physicians with specialty, nurses, dentist, pharmacists, other health professionals. **Week 4: Overview of Health Informatics** **Health Informatics** **Health informatics**, also known as medical informatics, deals with the methods or devices that are used to acquire, store, retrieve, and use information in the health care industry. It includes computers, clinical guidelines, terminology, and information/communication systems. Technology is a critical part of the health informatics field. It enables a health care provider to keep electronic medical records for billing, scheduling, and research... rather than the hard copy record-keeping systems.  Health informatics is a 'means' to exchange information. An electronic entry made by one faction of the healthcare community can quickly and accurately exchange information with other departments, agencies, or even the patient. Part of the health informatics overall picture is a system of medical vocabulary that is universally recognized by human beings and electronic devices. Medical vocabularies include names, terms, codes, abbreviations, and other identifiers. The use of hand-held or portable devices to assist the healthcare provider with data entry or medical decision--making is sometimes called 'mHealth', and is a developing technology in the health informatics field. Area of IT involving the design, development, creation, use and maintenance of information systems of the health care industry. Automated and interoperable healthcare information system are expected to improve medical care, lower costs, increase efficiency, reduce error, and improve patient satisfaction while also optimizing reimbursement for ambulatory and in-patient health care providers. It vows to provide innovation to health care delivery and connection among users and stakeholders in the e-health market. Systems such as electronic health records, decision support systems and personal health records are promising and becoming widely deployed worldwide (Kushniruk & Borycki, 2017).  ***Rouse (2016)*** enumerates the following types of health information technology: ***Electronic Health Record (EHR)/Electronic Medical Record (EMR)*** -- central component of the health IT Infrastructure. It is the patient's official health record in digital form and this information is shared across multiple health care providers and agencies. **Person health record (PHR) -** it is a person's self-maintained health record **Health Information Exchange (HIE)** -- health data clearing house which is comprised of health care organizations with interoperability pact to share data among their health information systems There are two widely used types of health information technology, **Picture Archiving and Communication Systems (PACS**) and **Vendor Neutral Archives (VNA).** PACS and VNA integrate radiology into the main hospital workflow. Radiology used to be the primary repository of medical images. Presently, other specialties such as cardiology and neurology are also among the large-scale producers of clinical images. VNAs can also be installed for the purpose of merging stored imaging data from various departments into a multi-facility health care system. **Different Types of Health Informatics** 1\. **Clinical Informatics** - It focuses on computer applications for all types of medical data and knowledge that may be collected, organized, analyzed, stored , and used in a medical clinic. 2\. **Imaging Informatics** - It is the study of how information about and contained within medical images is retrieved, analyzed, enhanced, and exchanged within the radiology department and other departments within the healthcare system. Digitalized images are widely used in the practices of cardiology, dermatology, surgery, gastroenterology, obstetrics, oncology, gynecology, and pathology. 3\. **Consumers Health Informatics** - is a branch of health informatics that has emerged as a method that helps patients and healthy consumers use their computers and telecommunications to better manage their own health decisions. 4\. **Public Health Informatics** - emphasizes data about populations rather than individuals. The CDC and WHO provides national leadership and coordination with state or county departments of health in collecting, storing, and analyzing data such as: vital statistics (birth and death records); incidents of communicable diseases, child immunization and lead screening information; evidence of biological threats; and hospital capacity information to allow for planning of responses in case of emergencies. 5\. **Dental Informatics** - it is the understanding, skills and tools that enable the sharing and use of information to promote oral health and improve dental practice, research, education, and management. It encompasses electronic health records, CAD/CAM technology, diagnostic digital imaging and administrative information for all dentistry disciplines. **6. Translational Research Informatics -** It analyzes data and applies discoveries generated during research in the laboratory and in pre-clinical studies, to the development of clinical trials and studies on human beings, their tissues, specimens, cognitive abilities, or behaviors. 7\. **Clinical Laboratory Informatics** - It analyzes data, test results, quality control, patient preparation, test turnaround time, purpose and significance of the laboratory examinations. Interpretation of results and its disease associated. 8\. **Clinical Research Informatics** - is the key instrument used to manage a clinical trial. It includes the theory and methods used to design, conduct and improve clinical research and disseminate the information generated. 9\. **Veterinary Informatics** - Application of Information Technology in treatment and management among animals. 10\. **Pharmacy Informatics** - It is the application of computers to the storage, retrieval and analysis of drug and prescription information. Pharmacy informaticists work with pharmacy information management systems that help the pharmacist make excellent decisions about patient drug therapies with respect to, medical insurance records, drug interactions, as well as prescription and patient information. **Health Information Ecosystem** It is a composition of individuals, systems and processes that share, exchange, and access all forms of health information, including discrete, narrative and multimedia \[Healthcare Information and Management Systems Society, 2017\]. Individuals, patients, providers, hospital/health systems, researchers, payors, suppliers, and systems are potential stakeholders within such ecosystems. Each is involved in the creation, exchange, and use of health information and/or data. An efficient health interoperability ecosystem provides an information infrastructures that uses technical standards, policies and protocols to enable seamless and secure capture, discovery, exchange and utilization of health information. **Health Informatics in the Cloud** **Advantages of Cloud Technology** **1. Integrated and Efficient Patient Care** **Cloud technology** offers a single access point for patient information which allows multiple doctors to review laboratory results or notes on patients. Physicians can spend more time deciding and performing patient treatment instead of waiting for information from different departments. **2. Better Management of Data** The accumulations of electronic health records will allow more meaningful data mining that can better assess the health got the general public. More data can mean more opportunities to identifies in diseases and crises. **Disadvantages of Cloud Technology** **1. Potential Risks to Personal Information** The strength of cloud technology is also the very same characteristic makes its vulnerable to data breaches. The information contained within medical records may be subjected to theft or other violation of privacy and confidentiality. Fortunately safeguards may be put in place to minimize such threats such as encryption, proper data disposal and other security features. **2. Cloud Setup Seems Cumbersome** The transition from a traditional to an automated system might be difficult for some members of health care organizations that may not be familiar with cloud technology. This technology, however, will be adopted by more institutions in the future. With proper education and illustration of its function, hesitant practitioners may be able to see its advantages. **Health Informatics in the Philippines** **Health Informatics** is the application of both technology and systems in health care setting. It has been loosely practiced in the Philippines since the 1980s. ***Community Health Information Tracking System (CHITS)* --** a electronic medical record (EMR) developed through the collaboration of the Information and Communication Technology community and health workers, primarily designed for use in the Philippines health centers in disadvantaged areas. **Week 5: Health Information Systems and Literacy** In Health Informatics or Health Information System, it is very important to the health care professionals that they were literate not only in the language of computer but also to the information and the system he/she handles and manages. ***Literacy*** is *the ability, confidence and willingness to engage with language to acquire, construct and communicate meaning in all aspects of daily living, there are three types of literacy*, [Computer Literacy], [Information Literacy] and [Information System Literacy]. When we talk about ***Computer Literacy*** it is knowledge in computer hardware and software applications, ***Information Literacy*** is the ability to recognize the information needed to be stored and discarded; and ***Information System Literacy*** is the ability to know how the information systems work. Health information can help the clinicians to make good strong decisions to provide proper patient management. What Information to use? Let us now discuss the Elements of Information. **Elements of Information Literacy** 1\. ***Recognize*** - Describe the question you're trying to answer. The information needed by the clinicians. 2\. ***Access*** -- it comes in variety of ways: Population Based (Census, Registration, Surveys) and Institutional Based (Individual Records, Service Records) ***3. Evaluate*** *Accuracy* -- is it the information you need? *Authority* -- is it credible? *Objectivity* -- supporting information *Currency* -- does the information updated? *Coverage* -- Is it complete? Is it available? 4\. ***Organize*** - Organize the information gathered in a way that provides clarity to the question/cases. 5\. ***Use*** - Last element of information literacy. Date and information can be utilized to answer and make better decisions. In Information System Literacy, the health care workers should know the hierarchy of data/information and its differences. 1\. **Data** -- a thing, no meaningful relationship to anything else. Factual 2\. **Information** -- formatted, filtered, organised, structure interpreted and summarized data. 3\. **Knowledge** -- application of information to make a decision or take an action. 4\. **Wisdom** -- if the expertise is added in the knowledge.  Information System covers all three levels: Database -- data level; Information storage and retrieval system -- information level; Knowledge system -- knowledge level. Information system makes a slow progress in terms of health services. Where it is located? ***In-house*** -- developed and managed in the health care organization ***Shared*** -- developed and managed at the vendor site ***Turnkey system*** -- developed by vendor, installed and managed by health care organization ***Stand-alone*** -- lack of information sharing. Legacy system. Health Informatics is the application of both technology and systems in a health care setting. While health information technology focuses in tools, health information systems cover the records, coding, documentation, and administration of patient and ancillary services. Health Information (HIS) cover different systems that capture, store, manage, and transmit health-related information that can be sourced from individuals or activities of a health institution. These includes disease surveillance systems, district level routine information systems, hospital patient administration systems (PAS), human resources management information systems (HRMIS) and Laboratory Information System (LIS). The information collected from a well-functioning HIS is very useful in policymaking ad decision making of health institutions and becomes the basis in creating program action. This translates to efficient resource allocation at the policy level, and improvement of the quality and effectiveness of health at the delivery level. HIS should be sustainable, user-friendly, and economical. Health care personnel should be educated on the use of the routine data collected from the system and the significance of good quality data in improving health (Pacific Health Information Network, 2016). **Types of Health Information System:** 1\. Operational and tactical systems (Work Instructions, Procedural Manual, Lab Guidelines) 2\. Clinical and administrative systems 3\. Subject and task based systems (Electronic Medical/Health Records) 4\. Financial systems (Billing, revenues) **Roles and Functions of Health Information System** Sheahan (2017) defines health information systems (HIS) as a mechanism which keeps track of all data related to the patient such as patient's medical history, contact information, medication logs, appointment schedule, insurance information, and financial account including billing and payment. The roles that a well-implemented HIS can perform in improving health services are as follows: **Easier access to files.** The systems have revolutionized the collection and management of patient information. The need of hardcopy of the patient's medical records becomes optional as the systems are electronic. **Better control**. Only authorized personnel can have access information on the patient's health. Doctors may be given permission to update patient information while a receptionist may only have the authority to update patient appointments. **Easier update**. After creation of the record, patient information can be accessed and reviewed any time and copies can be printed and released to the patient upon request. **Improved communications**. HIS assists communication among doctor and hospitals. However, medical professionals must adhere to regulations on patient privacy and security to ensure that information is kept confidential and safe from the unauthorized access. **Components of Health Information Systems** The Health Metrics Network (HMN), in its Framework and Standards for Country Health Information Systems (2008), defines health information systems as consisting of six components. **Health Information Systems Resources** - these include the framework on legislation, regulation, planning, and the resources required for the system to be fully functional. (e.g. personnel, logistics support, financing, ICT, and the component's coordinating mechanism). **Indicators** - the basis of the HIS plan and strategy includes indicators and related targets such as the determinants of health; health system inputs, outputs and outcomes; and the health status. **Data Sources**- It is divided into two main categories: Population based and Institution based. **Data management -** it refers to handling of data, starting from collection and storage to data flow and quality assurance, processing, compilation and data analysis. **Information products.** -- Data is transformed into useful information that serves as an evidence and provides insight crucial to shaping health in action. **Dissemination and use --** HIS enhances the value of health information by making it readily available to policymakers and data users **INPUTS --** refer to the health information system resources. **PROCESS --** it is a core indictors are needed as bases for program planning, monitoring and evaluation. **OUTPUTS --** refers to the transformation of data into information that can be used for decision-making and to the dissemination and use of such information. **DIFFERENT DATA SOURCES for HEALTH INFORMATION SYSTEMS** **Demographic data** -- refers to the facts about the patient which include age and birthdate, gender, marital status, address of residence, race and ethnic origin. Information on educational background and employment is also recorded along with information on immediate family members to be contacted during emergency. **Administrative data** -- includes information on services such as diagnostic tests or out-patient procedures, kind of practitioner, physician's specialty, nature of institution, and charges and payments. **Health risk information** -- records the lifestyle and behavior of a patient and fact about his or her family's history and other genetic factors. **Health status** -- refers to the quality of life that a patient leads which is crucial to his or her health. This shows the domains of health which include physical functioning, mental and emotional well-being, cognitive functioning, and social functioning. **Patient medical history** -- gives information on past medical encounters like hospital admissions, pregnancies and live births, surgical procedures, and the like. It also includes previous illnesses and family history. **Current medical arrangement** -- reflects the patient's health screening sessions, diagnoses, allergies(especially on medications), current health problems, medications, diagnostics or therapeutic procedures, laboratory test, and counselling on health problems. **Outcomes data** -- present the measures of after effects of healthcare and of various health problems. These data usually show the health care events (e.g. readmission to hospital, unexpected complications or side effects) and measures of satisfactions with care. Outcomes directly reported by the patient after treatment will be most useful. **Advantages of Health Information Systems:** **Data Centralization**. Health Information System help to keep all data centralized bridging geographical barriers as any patients files can be accessed from any hospital or clinic provided they are connected to the central database. **Increase Efficiency**. It is a result of easy accessibility of the patient's information such as patient histories as there is no need to wait for the physical file to be brought. It is also eliminates some clerical processes such appointment reminders and laboratory result notifications. **Security and Confidentiality**. Health Information Systems help improve the security of patient health information as they usually require authentication to be accessed. **Storage and access capabilities**: With electronic files there is potential for increased storage capabilities and the files can be accessed by multiple sites at the same time. **Increased Accuracy.** Health Information System can be built with the ability to detect and flag results that seem out of range or even life threatening drug combinations. The detecting of abnormal results can help with accuracy but does not completely do away with human error during data entry. **Disadvantage of Health Information Systems** **Cost.** The biggest problem associated with HIS is costly for many reasons there is actual system, which in most cases needs to be custom developed and this will expensive, then there is hardware that will be used to house the system that will also run up the costs. Training costs. **Learning Curve.** Some people are resistant to change and even after the training they might be hesitant to use the new system as it might have a lot to learn **Lesson 6 -- Health Management Information System** ***Health Management Information System (HMIS) -*** is an information system specially designed to assist in the management and planning of health programs, as opposed to delivery of care. ***Roles of the HMIS*** **Complete** - all information but avoiding duplication **Consistent** -- assigning different definitions to similar informations from various sources. **Clear** -- as to what measured elements **Simple to use** **Cost Effective** -- providing all the benefits **Accessible** -- should be able to use the system at ease **Confidential** -- patient information is the top priority. **Basic Functions of Health Management Information System** **1. Data input** -- includes data acquisition and data verification. a\. **Data acquisition** -- refers to the generation and collection of data through the input of standard coded formats (e.g. bar codes) to assist in he faster mechanical reading and capturing the data. b\. **Data Verification** -- involves the data authentication and validation. The authority, validity and reliability of the data sources help ensure quality of the gathered data. **2. Data management** -- also called processing phase, includes data storage, data classification, data update, and data computation. a\. **Data storage** -- includes preservation and archiving the data. It is advisable that data which are no longer actively used should be archived. At times, it is mandatory and part of legislation. b\. **Data classification** -- also called as data organization which sets the efficiency of the system. Key parameters should be used for data classification scheme for easier data search. c\. **Data computation** - requires various forms of data manipulation and data transformation (ex. Math models, linear and non linear transformations, statistical and probabilistic approaches and other data analytic processes). This function allows data analysis, synthesis, and evaluation so that the data can be used not only for decision-making but also for other tactical and operational use. d\. **Data update --** facilitates new and changing information and requires constant monitoring. For HMIS, the mechanism for data maintenance must be in place for updating changes for manual or automated transactions. **3. Data output** -- includes data retrieval and data presentation. a. **Data retrieval** pertains to process of data transfer and data distribution. The transfer process considers the duration of transmittal of required data from the source to the appropriate end-users. The economics of producing the needed information is a significant criterion. b. **Data presentation** is the reporting of the interpretation of the information produced by the system. Summary tables and statistical reports are expected but the use of visuals is encouraged especially for high-level managerial decision-making because they provide a better intuitive perspective of the data trend. **List of functions of HMIS**  **Determinants of HMIS Performance Area** **Behavioral determinants**. The data collector and users of the HMIS need to have confidence, motivation and competence to perform HMIS tasks in order to improve the Routine Health Information System (RHIS) process. **Organizational determinants**. Health workers and data collectors work in organizations' environments which have value, norms, culture and practice. The most important organizational factor which affects the RHIS process is related to structure, resource, procedure, support services and the culture. **Technical determinants**. Technical factors involve the overall design used in the collection of the information. It comprises the complexity of the reporting forms, the procedure set forward in the collection of data, the overall design of the computer software used in the collection of information. **PRISM Framework** The Performance of Routine Information Systems Management (PRISM) is a conceptual framework that broadens the analysis of HMIS or RHIS by including the three determinants of HMIS performance. **Technical and Organizational Factors in the PRISM Framework**  **Lesson 7 -- HMIS Monitoring and Evaluation** A health management information system aims primarily at assisting in the planning and management of a national health strategy plans; thus, continuous monitoring and evaluation is necessary for it to be effective. ***Monitoring*** is the systematic collection, analysis and use of information from programs for three basic purposes1) Learning from the experiences acquired (learning function); (2) Accounting internally and externally for the resources used; and (3) the results obtained (monitoring function) and taking decisions (steering function). ***Evaluation*** is assessing an ongoing or completed program or policy as systematically and as objectively as possible. The objective is to gauge the effectiveness of the program so that adjustments can be made in areas that need improvement. **Purpose of M&E** A robust monitoring and evaluation (M&E) system is required to assess the effect of n integrated service delivery. Appropriate indicators, data collection systems, and data analysis to support decision-making help guide the successful implementation o integrated services and measure the effect on both service delivery and use of services (FP/Immunization Integration Working Group, n.d.) **M&E Framework** Monitoring and evaluation (M&E) is a core component of current efforts to scale up for better health. Global partners and countries have developed a general framework for M&E of health system strengthening (HSS). ***M&E Plan*** The national M&E plan and system should address all components of the framework and lay the foundation for regular reviews during the implementation of the national plan. ***WHO Framework for Monitoring and Evaluation of Health Systems Reform/Strengthening***  ***Common framework for monitoring performance and evaluating progress in the scale-up for better health\ ***\ ***USAID -- Key Performance Areas and Indicators*** **Quantitative Indicators for monitoring, family planning/immunization integration**    **Health Management Information System Indicators and Health Programs** The HMIS indicators have been carefully selected to meet the key information needs of monitoring the performance of various health programs and services and provide a snapshot of the available health resources. Maternal Survival Intervention Child Mortality and Child Survival Intervention STOP TB Program **Maternal Survival Interventions** Campbell and Graham (2006) explained, the complexity of the country contexts and maternal health determinants makes it complicated to choose the best strategies in achieving its goal. However, they found that packaging of health facility-oriented interventions is highly effective and has high coverage of the intended target group. HMIS indicators are related to the following: **1. Pregnancy care interventions --** 1st natal care attendees; 4th antenatal care attendees; cases of abnormal pregnancies attended at out-patient departments of health facilities; cases of abortion attended at health facilities. Cases of medical (safe) abortions conducted at the health facilities. **2. Intrapartum care --** deliveries by skilled attendants; deliveries by health extension workers; institutional cases of maternal morbidity and mortality due to obstructed labor. **3. Postpartum care --** 1st postnatal care attendees; instructional cases of maternal morbidity and mortality due to post partum hemorrhage (PPH) and puerperal sepsis. 4\. **Interpartum period --** family planning method acceptors; family planning methods issued by type of method. **CHILD MORTALITY and CHILD SURVIVAL INTERVENTIONS** The Philippine government though the DOH launched various strategies to help ensure good health Filipino Children by 2025. **Child 21** or **The Philippine National Strategic Framework for Plan Development for Children 2000 to 2025** -- serves as framework for policymaking and program planning and as a roadmap for interventions aimed at safeguarding the welfare of Filipino Children. This is the part of the Philippine's commitment to the United Nations Convention on the Rights of the Child (UN CRC) **Children's Health 2025** -- subdocument of Child 21 which focuses on the development of Filipino children and the protection of their rights by utilizing the life cycle approach. **Integrated Management of Childhood Illness (IMCI)** -- IMCI strategy that aims to lower child mortality caused by common illnesses. **Enhanced Child Growth** -- this is an intervention aimed to improve the health and nutrition Filipino children by operatijng community-based health and nutrition posts all throughout the country. Top leading causes of child mortality as reported by the Department of Health (DOH) in 2012. 1\. Pneumonia 2\. Diarrhea and gastroenteritis 3\. Congenital abnormalities 4\. Septicemia 5\. Other diseases of the nervous system 6\. Accidental drowning and submersion 7\. Dengue fever and dengue hemorrhagic fever 8\. Chronic lower respiratory diseases 9\. Meningitis 10\. Leukemia 11\. Pulmonary and Heart Diseases  **Stop TB Programs** Envisioning a tuberculosis-free world, the goal of Stop-TB Program (STP) is to dramatically reduce the global burden of tuberculosis (TB) by 2015. this is inline with WHO's millennium development goals and the Stop TB Partnership which aims to push TB up the world political agenda. Objectives of the program is to achieve universal access to high-quality care for all people with TB (including TB-HIV and MDR-TB). HMIS Indicators to monitor Stop TB Program are: TB patients on DOTS TB case detection HIV-TB co-infection HIV+ new TB patients enrolled in DOTS TB treatment outcome (completed PTB treatment, Cured PTB, Defaulted PTB+, Death PTB) **Lesson 8 - Health Management Information System Data Quality** ***Data** **quality*** is the overall utility of a dataset(s) as a function of its ability to be processed easily and analyzed for a database, data warehouse, or data analytics system. It signifies the data appropriateness to serve its purpose in a given context. Having quality data means that the data is useful and consistent. Data cleansing can be done to raise the quality of available data (Rouse, 2005). **Aspects of Data Quality** ***Lot Quality Assurance Sampling (LQAS)*** is a tool that allows the use of small random samples to distinguish between different group of data elements (or lots) with high and low data quality. For health managers and supervisors, using small samples makes the conduct of surveys more efficient. This tool has been widely applied in the healthcare industry for decades and has been primarily used for quality assurance of products.  The concept of application of LQAS have been adopted in the context of District Health Information System (DHIS) data quality assurance. The adoption was comprised of designating health facilities, monthly reports, sections of monthly reports, and group of data elements as 'lots' to provide representative samples for data quality assurance of DHIS. **Routine Data Quality Assessment Tool (RDQA)** It is a simplified version of the Data Quality Audit (DQA) which allows programs and projects to verify and assess the quality of their reported data. It aims to strengthen their data management and reporting systems. The objectives are as follows: Rapidly verify the quality of reported data for key indicators at selected sites. Implement corrective measures with action plans for strengthening data management and reporting system and improving data quality. ***Table 8.1 Uses of the RDQA Tool,** Source: RDQA User manual, 2015* Monitor capacity improvements and performance of data management and reporting system to produce quality data **Development Implementation Plan** **Implementation plan** is a project management too that illustrates how a project is expected to progress at a high level. It helps ensure that a development teams is working to deliver and complete tasks on time *(Visual Paradigm, 2009*). It is also important in ensuring the efficient flow of communication between those who are involved in the project so as to minimize issues that would delay delivery of the project. It validates the estimation and schedule of the project plan. An implementation plan is developed through the following key steps *(Smartsheet, 2017)*. **Define goals/objectives.** address the question. *"What do you want to accomplish?"* **Schedule milestone**. Outline the deadline and timelines in implementation phase. **Allocate resources.** Determine whether you have sufficient resources, and decide how you will procure those missing. **Designate team member responsibilities**. Create the general team plan with overall roles that each member will play. **Define metrics for success**. How will you determine if you have achieved your goals? **Data Quality Tools** A ***Data Quality Tool*** analyzes information and identifies incomplete or incorrect data. Recently, these tools started to focus on ***Data Quality Management (DQM),*** which generally integrate profiling, parsing, standardization, cleansing and matching processes (Goasdue, Nugier, Duquennoy, and Laboisse, 2007) A ***Data Cleansing*** follows after the complete profiling of data concerns, which could range anywhere form removing abnormalities to merging repeated information. By maintaining data integrity, the process enhances the reliability of the information being used by an organization. Usually, these data quality software products can share features with master data management, data integration, or big data solutions. Gartner (2017) explains how these data quality tools are used to address problems in data quality: **Application/Scope of Data Quality Tools** The first generation of data quality tools was characterized by dedicated data cleansing tools designed to address normalization and reduplication. However, in the last 10 years, it was observed that there is a generalization of **Extract, Transformation, Load (ETL)** tools which allow the optimization of the alimentation process. **Root Cause Analysis** It is a problem solving method that identifies the root causes of the problems or events instead of simply addressing the obvious symptoms. The aim is to improve the quality of the products by using systematic ways in order to be effective *(Bowen, 2011).* It is the core building blocks in the continuous improvement efforts of an organization in terms of its operation dynamics, especially in the way it handles information. However, root cause analysis alone will not produce any valuable results. Bowen (2011) suggests that "to address the root cause problem, on must identify the problem and ask "why" five times to determine the proper strategies to address its root cause." **1. Failure Mode and Effect Analysis (FMEA)** aims to find various modes of failure within a system and addresses the following questions for execution: a\. What is the mode in which an observed failure occurs? b\. How many times does a cause of failure occur? c\. What actions are implemented to prevent this cause from occurring again? d\. Are these actions effective and efficient?  **2. Pareto Analysis** uses the Pareto Principle which states that 20 percent of the work creates 80 percent of the results. It is used when there are multiple potential cause to a problem. The Pareto chart was created using the Excel software. It lays down the potential causes in a bar graph and tracks the collective percentage in a line graph to the top of table. The reflected causes from the table should account for at least eighty percent of those involved in the analysis. **3. Fault Tree Analysis (FTA)** it is used in risk and safety analysis. It uses Boolean logic to determine the root causes of an undesirable event. The undesirable result is listed at the top of the tree and then all the potential causes are listed down to form the shape of an upside down tree.  4\. **Current Reality Tree (CRT)** is used when the root causes of multiple problems need to be analyzed all at once. The problems are listed down followed by the potential cause for a problem. By doing so, a cause common to all problems will appear. **5. Fishbone Diagram** is also called the Ishikawa or cause-and-effect diagram. The diagram looks alike a fishbone as it shows the categorized cause and sub-causes of a problem. This diagramming technique is useful in grouping causes (e.g. people, measurements, methods, materials, environment, machines) into categories. Categories could be the 4Ms (Manufacturing), the 4Ss (service), or the 8 Ps (also service) depending on the industry.  ***Machine (equipment):* causes are in equipment, such as machinery, computers, tools, instruments, technology\ ** ***Method* (process): causes are in the rules, regulations, laws or standards\ ** ***Material:* causes are in defect or material properties\ ** ***Manpower (people)*: causes are in humans, people\ ** ***Measurement/Medium:* including weather, terrain, obstructions, lighting** **6. Kepner-Tregoe Technique** breaks a problem down to its root cause by assessing a situation using priorities and orders of concern for specific issues. The various decisions that should be made to address the problem are then outlined. Then, a potential problem analysis is made to ensure that the actions recommended are sustainable. **7. Rapid Problem Resolution (RPR Problem Diagnosis)** Another technique for root cause analysis is the rapid problem resolution (RPR Problem diagnosis) which diagnoses the causes of recurrent problems by following the three phases below: **Discover** -- data gathering and analysis of findings. **Investigate** -- creation of a diagnostic plan and identification of the root cause through careful analysis of the diagnostic data. **Fix** -- fixing the problem and monitoring to confirm nd validate tht the correct root cause was identified. **S**