Health informatics system chapter five ppt

Health informatics system

1. Wachemo University College of Medicine and Health Science school of Public Health Department of health Informatics Fundamental of health informatics By Fitsum M . D ec. 2023 1

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3. Session Objectives At the end of the session the students will be able to: Define RHIS and HMIS Discuss on the HMIS reform guiding principles and reporting hierarchy identify the HMIS implementation challenges Describe the information cycle Mention the characteristics of good data quality 3

4. RHIS A routine health information system produces information through routine data collection (periods of less than a year) methods. Ongoing data collection of health status , health interventions , and health resources Data are collected by care providers in communities, in primary care facilities, in hospitals, and by routine health-facility assessment ( through supervision of surveys ). Routine Health Information Sources: Individual records Service records Resource records Health facility surveys 4

5. Cont.…. It is any system of data collection, distribution & use that provides information at regular intervals and that is produced through  routine   mechanisms to address predictable health information needs. An effective RHIS has two main objectives : to produce high quality routine health information & the effective use of the routine health information for decision-making.

6. Cont.…. It is any system of data collection, aggregation, analysis, interpretation, communication and use that provides information at regular intervals and that is produced through routine mechanisms to address predictable health information needs. It comprises data collected at regular intervals at public, private and community level heath facilities and institutions. The data give picture of health status, health service and health resources. It includes HMIS, CHIS, LMIS, HRIS and LIS.

7. Cont.…. The Universe of RHIS Individual record systems Paper-based records Electronic medical records (EMR) Service record systems Health management information systems (HMIS) Laboratory information system (LIS) imaging information systems (IIS) 7

8. Resource record systems Financial management information systems (FMIS) Human resource information systems (HRIS) Logistics management information systems (LMIS) Infrastructure and equipment management information systems (IEMIS) Health facility surveys Service availability and readiness Quality of care Supervisory records 8 Cont.….

9. Cont.…. RHIS in Ethiopia FMOH adopted the three ones of harmonization principles; i.e. one plan , one report and one budget principles across the health system The Ethiopian HMIS is designed in a way that can capture data from the different level health institutions (health facilities and administrative health units) in the country, including public health institutions, private for not profit facilities, , private for profit, and other governmental organizations.

10. Cont.…. The HMIS report includes data elements regarding the services they provide, the disease cases they treat, mortality data and on administrative data such as human resources, finance and logistics. Data from facilities will be aggregated and reviewed on a monthly and/quarterly basis and are transmitted through an integrated channel to assure standardization. 10

11. Cont.…. Health Management Information System (HMIS) Is a system for collection, compilation and analysis of routine health service data. It is the processing of data from various health components into information that enables health workers & managers, planners, policy makers and other stakeholders to make informed decisions.

12. Cont.…. Purposes of HMIS The purpose of HMIS is to routinely generate quality health information and use that information at each level of the health system for management decisions to improve the performance of health services delivery.

13. Cont.…. HMIS includes: Routine collection and aggregation of quality health information Availing accurate, timely and complete data Provide specific information support to health decision making process Strengthening the use of locally generated data for evidence based decision making 13

14. Cont.…. HMIS reform guiding principles 1. Standardization Common definitions throughout the health sector Define standardized recording and reporting instruments & procedures 2. Integration One report and one reporting channel 3. Simplicity Reduce number of data items, limited to those required by indicators selected Develop user friendly forms and procedures

15. HMIS reporting hierarchy/channel

16. HMIS information flow

17. Cont.…. HMIS reporting formats By Type: Service delivery report forms Disease (Morbidity & Mortality) report form By Health institution: Health post, Health center ,Hospital, clinics and WorHO /ZHD/RHB By reporting Period: Immediate/ Weekly report Monthly /Quarterly/annual administrative report

18. Cont.…. HMIS implementation challenges The reason for non-use and under-use of information includes:- Leadership Working environment Accountability Resource constraint Lack of management training, skills and personality Inadequate dissemination

19. Cont.…. Factors determine HMIS In general; the following three factors determine the HMIS in producing quality information in a sustainable manner as stipulated in the figure below

20. Information cycle information cycle is a diagrammatic way of looking at data and information. It enables one to see the links between the different stages of information. The phases of information handling include: Data Collection Data Processing Information Presentation Information Use 20

21. Cont.…. Information Cycle is a diagrammatic way of looking at information and enables you to see the links between the different phases: collecting, processing, analyzing, presenting, interpreting and using information. 21

22. Collect & collation processing presentation Information use Feed back Data quality - manual Data quality - computer Data analysis Format reports: tables, graphs, maps Formalize data flow Review feedback mechanisms Review data – trends Decision making Change action M & E Cont.…. 22

23. Cont.…. Data converted to information What do we do with it? How do we present it? How do we use it? data sources & tools Process & Analysis Reports & graphs Interpretation of information Good quality data What do we collect? Decision-making for effective management feedback Stages Tools Outputs Quality at every stage 23

24. Cont.…. Data Collection Data collection is the process of data capturing or gathering through observation of real events. Data collection normally begins at the community/facility level. Data are collected reasonably accurately. 24

25. Cont.…. Data collection tools Individual patient medical record Registers Tally sheets Reports Observation and interviews

26. Cont.…. guiding principles WHO health care workers at all levels WHAT Essential Data Set WHEN daily – collated weekly & processed monthly WHERE work sites, facilities, districts HOW data sources (tally sheets, registers etc…) WHY To monitor progress towards goals & targets To Plan new policies and changes To evaluate current services To assist health management processes 26

27. Cont.…. 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 27

28. Cont.…. Dangerous to know Nice to know MUST KNOW Useful to know 28

29. The figure shows that there is a lot of information that one can collect, but only small amount of this information can be said to be core information ( must know information ). The next band in the diagram, valuable information ( Should know )- is not absolutely necessary but can give valuable information. Cont.…. 29

30. Nice to know information- this information is not particularly useful. But it may satisfy some ones curiosity. Dangerous to know information- this information will not in any way influence decision! Cont.…. 30

31. Cont.…. Information focus at hierarchical levles Input : Raw data, raw facts, etc (community) Staff attendence, vaccines, to whom, when, where Process : Converting raw data to usable form (district) Vaccination of children Output : Processed results, (regional) Coverage of child immunization Outcome: Immediate out puts (national) Immunization rates going up Impact: Long term outcome, (international) Healthier children, less disease. Synergies 31

32. Cont.…. Essential data sets 32

33. Cont.…. Data Analysis ( Turning data into information ) Turns good quality data into information Facilitates Comparisons Assessment of progress toward targets Supports decision-making HOW? Uses basic epidemiological concepts Indicators 33

34. Cont.…. Indicator :An indicator is a variable that evaluates status and permits measurement of changes over time. Types of Indicator: Based on Calculation 1 . Count – no denominator Count indicator: measures the number of event without a denominator. Count Indicator = Number of malaria cases reported E.g. Number of malaria cases = 45 34

35. Cont.…. 2 . proportion – numerator is part of denominator Proportion indicator: Resultant value are typically expressed as a percentage where the numerator is also contained within the denominator. E.g. Health centers with out X-ray machine equals to number of health centers without x-ray machine divided by total health centers 3 . Ratio – numerator is not part of denominator comparing 2 different numerators Eg . Male to Female ratio(M/F) I.e1:2 35

36. Cont… 4 . Rate - Measures the frequency of an event during a specified time, usually expressed per 1000 or per 100,000 population. E .g. Rate of malaria infection in < 5 children equals to number of cases of malaria in children < 5 years old times a constant k divided by midyear population of children under 5. 36

37. Cont.…. Data presentation Did you observe how much data in manual system is tiresome? 37

38. Cont.…. 3 C’s of Good Data Quality Correct no mathematical errors (validation rules) Complete submission by all (most) reporting facilities all data items reported on (value filled in) Consistent data within normal ranges

39. Cont.…. Good Data Quality AVAILABLE ON TIME: fix dates for reporting AVAILABLE AT ALL LEVELS: who reports to whom - feedback mechanisms RELIABLE & ACCURATE: check that all data is correct, complete, consistent COMPREHENSIVE: collected from all possible data sources USABLE: if no action, throw data out COMPARABLE: same numerator & denominator definition used by all

40. Cont.…. Why is Information presented? To facilitate monitoring of progress made toward achieving stated objectives against set targets Share knowledge – provide feedback on performance To promote understanding – make sense of information How should data be Presented?  Report format – tables, graphs, reports Report time frames 

41. Cont.…. Construction of tables General principles should be addressed in constructing tables. Tables should be as simple as possible. 2. Tables should be self-explanatory for that purpose of: Title should be clear and to the point( a good title answers: what? when? where? how classified ?) and it be placed above the table. Each row and column should be labeled.

42. Cont.…. Numerical entities of zero should be explicitly written rather than indicated by a dash. Dashed are reserved for missing or unobserved data. Totals should be shown either in the top row and the first column or in the last row and last column. 3. If data are not original, their source should be given in a footnote. 42

43. Cont.…. Uses : Trends over time Comparisons Pick up outliers 43

44. Cont.…. Constructing graph The choice of the particular form among the different possibilities will depend on personal choices and/or the type of the data. • Bar charts and pie chart are commonly used for qualitative or quantitative discrete data. • Histograms, frequency polygons are used for quantitative continuous data.

45. Cont.…. 1 . Every graph should be self-explanatory and as simple as possible. 2. Titles are usually placed below the graph and it should again question what ? Where? When? How classified? 3. Legends or keys should be used to differentiate variables if more than one is shown. 4. The axes label should be placed to read from the left side and from the bottom. 5. The units in to which the scale is divided should be clearly indicated. 6. The numerical scale representing frequency must start at zero.

46. Graph elements

47. Cont.…. A bar chart is a diagram consisting of columns (bars), the heights of which indicate frequencies. Distance b/n each bar is equal & equal width of bars. A histogram is similar to a bar chart, but without gaps between columns. However, bar charts can be used with qualitative and discrete data e.g.. Gender, on the x axis, but histograms can use continuous data, e.g . height, weight, etc.

48. Cont.…. Uses: Bar Graphs displays data over time or can compare 2 or more different facilities / districts / regions / years. The stacked bar graph is useful if you want to compare two or more data elements, but also want to display the total of the compared elements. 48

49. Cont.…. 49

50. Cont.…. A pie chart is particularly suitable for displaying how a population is divided up into different parts and what proportion of the whole each portion represents. The bigger the proportion, the bigger the slice of pie!!

51. Cont.…. Line graphs are used to show a trend over time or how a participant’s experiences change. The x-axis on a line graph must always use continuous units of measurement, for example time. A Histogram can also be used to display continuous data, when the bars are joined with a line, this is known as a frequency polygon.

52. Cont.…. 52

53. Thank you!!! 53