HIBBs is a program of the Global Health Informatics Partnership

DESALEGN TEGABU ZEGEYE (MD,MPH)DEPARTMENT OF HEALTH INFORMATICS

UNIVERSITY OF GONDARFEBRUARY 2011

Introduction to Routine Health Information Systems

Objectives

Explain the roles of routine health information systems (RHIS) in health service management

Examine strategies used to improve routine health information systems

Acquaint with skills to carry out the process of improving RHIS performance

Discuss three categories of determinants that influence RHIS

Outline

Definitions

RHIS concepts

Strategies used to improve routine health information systems

Analytical Framework for Understanding RHIS Performance –The Prism Concept

DefinitionsHealth System - is defined as the system of all

actors, institutions, and resources that undertake “health actions” – i.e. actions whose primary purpose is to promote, restore, or maintain health (WHO 2000).

Information System - System that provide specific information support to the decision-making process at each level of an organization

Health Information System - “A system that provides specific information support to the decision-making process at each level of an organization.” (Hurtubise, 1984)

Why Health Information System?Good management is a prerequisite for increasing

the efficiency of health services

Improved health information system is clearly linked to good management

Information is crucial at all management levels of the health services from periphery to the centre. It is required by policymakers, managers, health care providers, community health workers

Routine Health Information System (RHIS)

Definition:

Ongoing data collection of health status, health interventions, and health resources

Examples: facility-based service statistics, health administration statistics and community-based information systems

RHIS includes…

Health service statistics for routine service and special program reporting

Administrative data (revenue and costs, drugs, personnel, training, research and documentation)

Epidemiological and surveillance data

Data on community-based health actions

Issues with Routine Data Collection Instruments

Content (comprehensive) Record filing (patient-retained vs. health unit-

retained) Layout (self-explanatory) Production form Electronic patient record

Guiding Principles of RHISData for decision making

Collection of only essential health data used for decision making

Data collection for local analysis and use by the health worker

Data collected by all health workers as they perform their day to day duties

Data processing and analysis are done starting from the point of collection

Integration of all routine information systems

Simple to operate and maintain

What is Wrong with Current RHIS? Irrelevance of the information gathered

Poor quality of data

Duplication and waste among parallel health information system

Lack of timely reporting and feedback

Poor use of information

The difference in culture between data people and decision makers: Planning and management staff rely primarily on “gut feeling” to formulate ad hoc decisions rather seek pertinent data

STEP 1: Assessment of theExisting System

Rapid Assessment of the current use and performance of the existing system.

Find out how and how well the current system works, to describe the various components of the system and the organizational environment

STEP 2: Develop Essential Indicators

Select essential indicators for management functions at each level of the health system:

Health status (and disease surveillance) indicators

Health services (and national program) indicators

Resource indicators (human, physical, financial)

What Data Elements Should be Collected?

Can provide useful information (affecting the management decisions)

Cannot be obtained elsewhere

Are easy to collect

Do not require much work or time

Can be collected relatively accurately

ESSENTIAL DATA SET based on indicators reflecting the health status of the community

Essential Data Set (From Shaw,2005)

MUST KNOW

Essential Dataset (continued)

WHAT?WHAT?

The minimum amount of data that needs to be collected

WHY?WHY?

For the effective management of services which allows them to make the greatest impact on the health needs of the community which they serve (improving coverage & quality)

HOW?HOW?

Through routine data collection

EDS - Choosing a TypeEDS - Choosing a TypeData - led

Focuses on the need to collect data which is required, is of interest, or may be useful

Is usually vague on what information output can be obtained from data

Action - led

Focuses on the need to collect data that reflect identified priority health needs & are required by pre-determined indicators

Indicator driven – national & local

Usually directly linked to specific objectives and targets

Action-led systems are the most practical way to go

Community Information Systems

District Information Systems

Zonal Information Systems

National Inf. Systems

International IS

Indicators,Procedures, datasets & use of info for ACTION:

Community

District

Province

National

International

• Standardised

• Usefulness

• Address the needs of all stakeholders

• User-friendly

• Dynamic

EDS at Each Level:EDS at Each Level:The Information Filter The Information Filter (From Shaw 2005)(From Shaw 2005)

Step 3: Data Sources and Data Collection Tools

Defining data sources and developing data collection instruments for each of the indicators selected.

Data collectionData collection

start small - as data quality improves & systems are streamlined - add slowly

collect data – linked to objectives - that can be used to calculate indicators

Data Sources and DataCollection Tools (continued)

Collect only data that is easily available - determine easiest site for recording of data - do not duplicate points of data collection

Use clear & standardised definitions

Train & provide ongoing support to data collectors – improve data quality

Data collection toolsData collection tools

Use a minimum number of tools - user friendly, familiar & acceptable

Step 4:Developing a Data Transmission

and Processing System

Information flows (including referral systems):

Horizontal data transmission

Vertical data transmission

Use appropriate communication technology:

Paper-based

Electronic: Telephones, diskettes

Data Processing and Analysis

Paper-based systems:

Error-prone

Computerized systems:

Off-the-shelve versus customized

Decision support systems

Use of appropriate technology

Capacity-building

Step 5: Ensuring Use of the Information Generated

How can we improve information use?

1.Ownership and relevance of the information must be felt among all potential users of the information, through active participation in the system design

2.Data need to be of appropriate quality, aggregated at the right level, and produced in a timely manner

Ensuring Use of the Information Generated (continued)

3. Performance-based management systems tend to increase use of information for decision making.

4. Cultural differences between data people and action people can be decreased through consensus building, teamwork, and training.

5. Data presentation and communication (feedback) should be customized for users at all levels.

Step 6: Planning for RHIS Resources

Adequate staffing

Adequate logistic system for printed supplies

Computer hardware/software and maintenance

Communications equipment

HIS line-item in MOH recurrent budget

Analytical Framework for Understanding Performance of

Routine Health Information Systems in Developing Countries

The Prism Framework

The Prism, or three-point framework, is predicated on the assumption that improving capacity in RHIS (and subsequently performance) requires interventions that address the environmental behavioral determinants of performance, and the technical determinants

It broadens analysis of routine health information systems to include the behavior of the collectors and users of data and the context in which these professionals work

PRISM framework (From Aqui,2009)

RHIS Performance Diagnostic Tool

1. Data Quality Assessment at District or Higher Level

2. Use of Information Assessment at District or Higher Level

3. Data Quality Assessment at Facility Level

4. Use of Information Assessment at Facility Level

Prism tools (Aqil,2007)

Sources

Aqil A, Hozumi D, Lippeveld T. 2005. PRISM tools. MEASURE Evaluation, JSI. Available online at: http://www.measure.com.

Aqil A, Lippeveld T. 2007. Training manual on continuous improvement of HMIS performance: quality and information use; focus on HIV/AIDS services. MEASURE Evaluation, Guangxi and Yunnan CDC.

Aqil, A, Lippeveld, T & Hozumi, D 2009, PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health information systems. Health Policy and Planning, vol. 24, no. 3, pp. 217-228.

Aqil, A., Lippeveld, T 2010, Improving RHIS Performance For Better Health System Management, Routine Health Information System Course Trainer Guide.

Lippeveld T, Sauerborn R and Bodart C (eds.). Design and Implementation of Health Information Systems. Geneva: World Health Organization, 2000

Helfenbein, S. et al. (1987) Technologies for Management Information Systems in Primary Health Care. Geneva: World Federation of Public Health Associations

Sources (continued)

MEASURE Evaluation http://www.cpc.unc.edu/measure RHINONet:http://rhinonet.org

Shaw, V 2005, Health information system reform in South Africa: developing an essential data set. Bulletin of the World Health Organization, vol. 83, no. 8, pp. 632-636.

Health Metrics Network: http://www.who.int/healthmetrics

WHO,2000. World Health Report 2000: Health Systems: Improving Health Systems Performance; World Health Organization: Geneva.

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