Health Management Information System

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Health Management Information System :

Health Management Information System State Institute of Health and Family Welfare, Jaipur

Basic Definitions:

Basic Definitions Data “Messages not evaluated for their worth in specific situations” Primary Secondary Information “Evaluated data” “A resource with cost & benefit “Potential knowledge” “An essential input for decision making SIHFW : an ISO 9001:2008 certified institution 2

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Record “A document of transaction between a client and service provider containing details of who did what to whom, when and where”, e.g. A bill A prescription A discharge ticket A laboratory report A register SIHFW : an ISO 9001:2008 certified institution 3

Information System:

Information System “Comprehensive, coherent arrangement organized on an organizational or major program basis to collect, process and provide coordinated information to serve multiple needs of management system” SIHFW : an ISO 9001:2008 certified institution 4

Data Triangulation:

Data Triangulation The synthesis and integration of data from multiple sources through collection, examination, comparison and interpretation SIHFW : an ISO 9001:2008 certified institution 5

12 step approach to triangulation:

12 step approach to triangulation Planning for triangulation Brainstorm questions Identify questions that are important, actionable, answerable and appropriate for triangulation Identify data sources and gather background information Refine the investigation question(s) Conducting triangulation Gather data/reports Make observations from each dataset SIHFW : an ISO 9001:2008 certified institution 6

12 step approach to triangulation:

12 step approach to triangulation Note trends across datasets and hypothesize Check (corroborate, refute, modify) hypotheses Identify additional data source(s) and return to step 5 Summarize findings and draw conclusions Communicating the results of triangulation Communicate the results and recommendations Outline next steps based on findings SIHFW : an ISO 9001:2008 certified institution 7

Characteristics of Data Sources for Triangulation:

Characteristics of Data Sources for Triangulation Programmatic data Biological data (surveys) Behavioural data SIHFW : an ISO 9001:2008 certified institution 8

Health Information System:

Health Information System “an integrated effort to collect, process, report and use health information & knowledge for influencing policy-making, program action, and research. SIHFW : an ISO 9001:2008 certified institution 9

M.I.S. ? :

M.I.S. ? A two directional characteristic of information flow, with systematically designed arrangement to - Generate Collect Analyze Store Present Make available required information to different managerial levels for improved and timely decisions and actions SIHFW : an ISO 9001:2008 certified institution 10

Definition::

Definition: MIS is a system having a combination of persons, a set of manuals, and certain equipments to select, store, process and retrieve data to - reduce the uncertainty in decision making by yielding information to managers at the time they can most efficiently use it. SIHFW : an ISO 9001:2008 certified institution 11

Essential Features of Information System:

Essential Features of Information System Reliable Not too much paper work Data transmission - accurate and timely Availability in disaggregated form Shortest time lag between collection and transmission Data must be available to assess both quantity and quality of health care Simple- recording reporting and analysis SIHFW : an ISO 9001:2008 certified institution 12

Service statistics v/s MIS:

Service statistics v/s MIS Service statistics- generate data MIS -utilization of data in the planning and control activities, in an organization SIHFW : an ISO 9001:2008 certified institution 13

Information in Health Care Delivery: why:

Information in Health Care Delivery: why Evidence based policy and strategic decision-making Program management Monitoring the process and outcomes Evaluation of achievements SIHFW : an ISO 9001:2008 certified institution 14

HMIS- Need:

HMIS- Need Increasing utilization Increasing client satisfaction Increasing health status Induction of manpower Problem solving Resource allocation Rewards / Promotions ( at times for Fault finding) SIHFW : an ISO 9001:2008 certified institution 15

HMIS: Objectives:

HMIS: Objectives Strategic planning Disease surveillance systems Use of ICD-10 National health database Technical support to strengthen data analysis Research Use of scientific evidence based on research SIHFW : an ISO 9001:2008 certified institution 16

Other objectives:

Other objectives Medical care- Quality assurance & Assessment of outcome Cost control & productivity enhancement Utilization analysis and demand estimation Program planning & evaluation Simplification of Records Education Clinical research SIHFW : an ISO 9001:2008 certified institution 17

Sources of Data:

Sources of Data Diaries Family registers Hospital registers / Records Periodic reports Rapid surveys Exit interviews National sample survey Census Special studies SIHFW : an ISO 9001:2008 certified institution 18

Data :attributes :

Data :attributes Accurate Valid Reliable Timely Complete Retrievable SIHFW : an ISO 9001:2008 certified institution 19

Collection of Data::

Collection of Data : Data Collection Tools Reporting Formats Online reporting Eligible Couple Survey Concurrent Evaluation/ Studies Survey by different Agencies Monitoring and Validation Exercise SIHFW : an ISO 9001:2008 certified institution 20

Data Requirements at Different Levels of Decision Making:

Data Requirements at Different Levels of Decision Making Quantity Quality ……Top level…. ….Middle level…. ….Lower level…. SIHFW : an ISO 9001:2008 certified institution 21

Health information Tools for Different Levels of the Health System :

Health information Tools for Different Levels of the Health System SIHFW : an ISO 9001:2008 certified institution 22 Global Regions Countries Provinces Districts Communities Facilities Modeling & estimates HMIS Surveys SRS Vital Registration Censuses Outbreak Surveillance

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SIHFW : an ISO 9001:2008 certified institution 23 Health systems inputs Policy Financing Human resources Organization Health systems outputs Information Service availability & quality Health systems outcomes Service utilization Health status Mortality Morbidity/ disability Well-being Health determinants Risk factors Behaviors Genetics Environment Socio-economic & demographic

Attributes of HMIS:

Attributes of HMIS Timeliness Accuracy Relevance Up-to-datedness Adequacy No Overloading Format Clarity No duplication Explicitness SIHFW : an ISO 9001:2008 certified institution 24

Strengths of HMIS :

Strengths of HMIS In streamlining and standardizing of data records. In creation of an integrated warehouse In collecting data from different sources Conducting cross analysis. Rationalizing of reporting flows Supporting customized reporting. Indicator based analysis. Integration of various software applications such as GIS and Excel. Conducting data quality validation. SIHFW : an ISO 9001:2008 certified institution 25

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HMIS does not offer “Ready - made” solution Each HMIS is “Tailor made” specific to an organization and levels within it SIHFW : an ISO 9001:2008 certified institution 26

HMIS- Issue:

HMIS- Issue Is there a policy existing for Health Information system? Does an organizational structure exist at the National level for HMIS? Functional linkages between sub-systems Capacity building-potential, activities and resources SIHFW : an ISO 9001:2008 certified institution 27

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Is there a Fixed- frequency review of reports and records? How are reports made and who makes them? Is there a built in system for checking reliability of data generated at the lowest level ? SIHFW : an ISO 9001:2008 certified institution 28

HMIS- Purpose :

HMIS- Purpose Planning Implementation Monitoring Evaluation Monitoring Control - Cost -Time -Resources Information Needed for Purpose SIHFW : an ISO 9001:2008 certified institution 29

HMIS-Application should Provide Support to-:

HMIS-Application should Provide Support to- Health Workers: Understand health needs Prioritizing clients Estimate requirement Program Mangers: Assess quality & Coverage Allocate resources Reduce wastage and duplication SIHFW : an ISO 9001:2008 certified institution 30

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Policy Makers: Assess cost-effectiveness Decide content & mode of service delivery Develop norms Financial Infrastructure Staffing Logistics SIHFW : an ISO 9001:2008 certified institution 31

Prerequisites of HMIS:

Prerequisites of HMIS Existing formats, transmission system & channels, capacity of data handlers and analyzers and the resources (hard and soft) available. Exploring possibilities of additions and deletion of parameters Complimentary or contradictory nature of sub-systems of the System SIHFW : an ISO 9001:2008 certified institution 32

Components -Basic Management process:

Components -Basic Management process 5 components of the basic mgt. process in healthcare- Establishing goals & Objective Estimate demand for services Allocate resources including manpower to meet demands Control quality Evaluate performance SIHFW : an ISO 9001:2008 certified institution 33

Establishing goals & Objective :

Establishing goals & Objective Problem indicators Mortality morbidity Social indicators Economic data Health seeking behavior Data on services delivered by other community organizations Resources available SIHFW : an ISO 9001:2008 certified institution 34

Estimate demand for services :

Estimate demand for services Data on utilization Demographic data Community projections SIHFW : an ISO 9001:2008 certified institution 35

Allocate resources :

Allocate resources Data on work force Financial information Capital requirements Short term demand forecasts SIHFW : an ISO 9001:2008 certified institution 36

Control quality :

Control quality Output measure Quality control data Work sampling & measurement Medical audit SIHFW : an ISO 9001:2008 certified institution 37

Evaluate performance :

Evaluate performance Changes in problem indicators Cost benefit analysis Changes in community’s capability to provide services SIHFW : an ISO 9001:2008 certified institution 38

HMIS- Components:

HMIS- Components Identification Collection Classification Processing Communication Interpretation Storage Retrieval SIHFW : an ISO 9001:2008 certified institution 39

Factors Required to Develop and Implement HMIS: :

Factors Required to Develop and Implement HMIS: Strong political backing A culture that values and uses information Involving all levels in changes to HMIS Starting with improving the paper based system Ensuring the feedback loop is continuous and reliable SIHFW : an ISO 9001:2008 certified institution 40

Levels at Which We Need Information :

Levels at Which We Need Information Point of entry of client into the System Point of Service Point of decision-making SIHFW : an ISO 9001:2008 certified institution 41

Use of Information:

Use of Information National & State Ministries for Assessing impact Policy development Financial allocations Health care professionals for Treatment in Hospitals/ CHC/ PHC Choosing alternatives between care lines SIHFW : an ISO 9001:2008 certified institution 42

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Legal bodies As documentary evidence of care Protect interests of Health care professionals and patients Insurance companies for reimbursement of claims SIHFW : an ISO 9001:2008 certified institution 43

Information in Health Planning:

Information in Health Planning Information for assessing need Information for controlling utilization and standards (quality of services) Information for controlling deployment of resources Information for increasing effectiveness of services SIHFW : an ISO 9001:2008 certified institution 44

HMIS- Designing Technical Requirements:

HMIS- Designing Technical Requirements Data collection instrument Simple Minimum Develop a data flow mechanism Who generate Who consolidate Whom to be sent & How (mode) Where & by whom to be analyzed Whom to be reported Frequency of compilation, Analysis & reporting SIHFW : an ISO 9001:2008 certified institution 45

Basic steps in designing HMIS:

Basic steps in designing HMIS Determine organizational need for information Identify sources of information Decide on amount, form and frequency Select means of information communication & processing SIHFW : an ISO 9001:2008 certified institution 46

HMIS- Designing information system: :

HMIS- Designing information system: What data is needed Who generates in what form Quality Processing requirement Types of formats for reporting Frequency of reporting Data storage system Devices for storage What should be the channel for info. flow Determine organizational need for information Identify sources of information Decide on amount, form and frequency Select means of information communication & processing Steps SIHFW : an ISO 9001:2008 certified institution 47

Designing HMIS:

Designing HMIS Design Requirements: Clarity of Objectives Awareness of information need Flexibility to change SIHFW : an ISO 9001:2008 certified institution 48

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2. Considerations in information system design Identifying & listing of objectives and norms Identification of all decision points Determination of relative importance & priority of identified decisions Identifying information need for decision Identification of relationship among decision sets Specification of information system Installation Establishing a review mechanism SIHFW : an ISO 9001:2008 certified institution 49

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3. Information requirements - governed by Decision structure of Program Levels of decision making Questions to be answered Economics of information management, based on these requirements decision shall be taken regarding type of information, which could be- Scientific& Technical (Related to problem & solution Situational (Program environment) Programmatic (Intervention system) SIHFW : an ISO 9001:2008 certified institution 50

HMIS- Process:

HMIS- Process Formulated information (fixed) Constraining Planning Execution Information (Dynamic) Processed information (Dynamic) Monitoring & Control Reports Processing Reports inputs Storage SIHFW : an ISO 9001:2008 certified institution 51

Analyze the Data: :

Analyze the Data: By allotted ELA/Targets By comparison of last year progress By health indicators By annual action plan By Five Year plans SIHFW : an ISO 9001:2008 certified institution 52

HMIS- Problem Areas:

HMIS- Problem Areas Unrealistic expectation of Managers Addressing to –”Report to higher levels” rather than convincing of benefits Too much information asked Poorly trained, Over worked staff, (30-40 % time in reporting) Information-selective & to handle out of pressure ad hoc exigencies Many reporting levels- Data lost SIHFW : an ISO 9001:2008 certified institution 53

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Performance indicators Shifting priorities within program New additions- NO deletions Indicators- simply output oriented Program priorities & timeliness of information flow Retrieval Duplication NO periodic review NO feed back to initiate corrective measures SIHFW : an ISO 9001:2008 certified institution 54

HMIS supports:

HMIS supports Decision makers to: Detect and control emerging and endemic health problems Monitor progress towards health goals, Promote equity Empowering individuals and communities with Timely and understandable health-related information Drive improvements in quality of services SIHFW : an ISO 9001:2008 certified institution 55

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Supports Health Workers, in Understand health needs (based on approaches like CNAA) Prioritizing clients (Estimate requirements (based on Demographic profile, morbidity profile, coverage and /or Expectations) Support Program Mangers , for Assessing quality & Coverage Allocating resources Reducing wastage and duplication SIHFW : an ISO 9001:2008 certified institution 56

Slide 57:

Support Policy makers , to Assess cost-effectiveness Decide content & mode of service delivery Develop norms: Financial Infrastructure Staffing Logistics SIHFW : an ISO 9001:2008 certified institution 57

Slide 58:

Reporting Formats under NRHM Institutions Reporting Format Sub centre Form No. 6 PHC Form No. 7 CHC / FRU / UFWC Form No. 8 Block level Form No. 9 A District level Form No. 9 SIHFW : an ISO 9001:2008 certified institution 58

Thank You :

Thank You For more details log on to www. Sihfwrajasthan.com or contact : Director-SIHFW on sihfwraj@yahoo.co.in

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