Health information systems

~' I r '­ iy Contents Contents 11 Change management Rodney Gapp 154 12 Health economics Ian Edwards 169 Part 4 - Health Information Systems 13 25 186 14 Health information systems Dianne[r]

Existing health information systems have demon- strated that they can improve health and health services, although most are not able to share information. Addi- tional benefits are bound to accrue when, for example, a pediatrician seeing a child for a well-infant visit is alerted by the information system that the child failed a new- born hearing screening test but has not yet been fully evaluated, diagnosed, or treated. Because so few infor- mation systems are currently integrated, it is not yet possible to document these benefits. An effort is under- way (supported by the Robert Wood Johnson Founda- tion and the federal Maternal and Child Health Bureau) to develop the business case for integrated child health information systems. 28 This effort is focusing on vital

We conducted a literature search between March and August 2010 to identify existing literature on the role and use of health information and health information systems in disaster pre- paredness, response and monitoring and evaluation. The search was conducted through electronic databases, the main ones being the PubMed database (1951–March 2010) and Google Scholar. The search terms in PubMed were ‘health information systems disasters’, and 461 articles were identified from the PubMed database. English-language articles identified from this initial search were screened for specific and detailed content on health information in disaster situations, and such articles were selected for more detailed review. This included scrutinizing for content in the areas of ‘frameworks for health information systems in disasters/emergencies’, ‘health information needs and sources of information in disasters’, ‘health information system competencies required in disaster situations’ and ‘how to make health-related information accessible immediately after a disaster’ and with any specific reference to low- and middle-income countries. In addition, we undertook a focused review of both the reference lists of articles reviewed through the formal literature review process and a targeted search of disaster-related websites such as the Emergency Events Database (EM-DAT) and the United Nation’s Office for the Coordination of Humanitarian Affairs (OCHA) and specific journals such as ‘Disasters’ and ‘Pre-hospital and Disaster Medicine’. In this paper, the PRISM framework is used to guide the analysis and discussion, and the HMN framework is referenced as required (e.g. data sources).

WHO identified six key pillars of an effective health system namely: leadership and governance; service delivery; health workforce; health information systems; medical products, vaccines and technologies and healthcare financing. This study focused on Community-based Health Management Information System (CbHMIS) of health information pillar. A Community-based Health Management Information System (CbHMIS) is a type of health information system based in the rural community and informal settlements of urban areas. CbHMIS’s main objective among others is to produce relevant and quality information to support decision making on public health issues at the community level. The importance of effective information use is still a key impediment to achievement of goals at level one of health care delivery. According to a situation analysis on the state of Community Health Services in year 2014, the functionality of CbHMIS was said to be at 64% which came down considerably to 55% in year 2015 documented by USAID, and that access to quality data was not guaranteed through the current CbHMIS.Lack of technical capacities among the CHVs is a serious gap in achievement of information use in Kenya.This study aimed at establishing the factors influencing technical capacities of community health volunteers on use of CbHMIS in Kenya.Other objectives of this study were: To establish the influence of System Availability on CbHMIS use; to find out effects of availability of skills to CHVs on CbHMIS use, To assess the influence of personnel knowledge on CbHMIS use, To identify competencies of CHVs that influence CbHMIS use. The selected counties were Kiambu, Kajiado and Nairobi which gave a rural, urban and peri-urban representation respectively of the country. This was a cross- sectional analytical study design, with both quantitative and qualitative data collection methods. The target population was 156 active Community Units (CUs) from the 3 counties where a total sample of 122CUs (50 in Kiambu; 26 from Kajiado and 46 from Nairobi CUs) was derived using Mugenda and Mugenda formula of populations less than 10,000. Multistage sampling was used to identify the CUs; Systematic random sampling was used to identify total of 366 respondents 3Community Health Volunteers (CHVs) were purposively sampled form each CU to make a total of 366 (150 in Kiambu; 78 from Kajiado and 138 from Nairobi. A total of 6 KIIs (two from each county) and 3 FGDs (one from each county) were conducted for qualitative data. Interviewer administered questionnaires were used to collect quantitative data, observation checklist was also used. Quantitative data

Health Information Systems in India: Challenges and way forward Tripathi, Shruti and Sharma, Rachna and Nagarajan, Shyama.[r]

With the incidence of disasters increasing both internationally and nationally, the development of appropriate measures for the management of patient information during a time of surges in demand has become a priority for hospitals and their health information services worldwide. A comprehensive search of the existing interna- tional literature addressing specialised health information systems and medical records for disasters identified a number of studies that investigated some aspect of identifying and triaging patients during disaster situations (DeMars, Buss & Cleland 1980; Milholland, Cowley & Panos 1981; Barton & Bodiwala 1991; Noordegraaf et al. 1996; Nocera & Garner 1999; Otomo et al., cited in Shinchin 2003; Garner 2003). These studies focused predominantly on the identification and management of patients in the pre-hospital phase of disaster care.

Attention to the role of HIT in child health care has existed for some time but long was limited to a narrow group of technical experts. Beginning in 2001, when the Agency for Healthcare Research and Quality convened an expert meeting on HIT in children’s health, a series of activities have occurred and have resulted in position statements and conferences summarizing the progress we are making in the development of child health information systems. The latest of these efforts, and the focus of this supplement, was a conference held in March 2006 in Orlando, Florida. The conference was cosponsored by the Agency for Healthcare Research and Quality, the National Initiative for Children’s Healthcare Quality, the Public Health Informatics Institute, and the All Children’s Hospital Foundation. A number of articles were commissioned as part of that work and they are included here, with other invited articles. The articles were presented in draft form at the conference, engendered a rich discussion, and were revised for this supplement.

Many Chief Medical Information Officers are starting to see the benefits of a hybrid approach. Hybrid PHR systems help increase workflow efficiency while at the same time increasing patient satisfaction. The current problem in implementing these systems is lack of standardization and security. Linda Reed, Chief Information Officer of Atlantic Health said, “Everyone wants secure records, but we found that putting robust security in place frustrates account owners and seems to discourage usage.” I believe that this frustration can be eliminated or reduced if an efficient authorization access model was present in health information systems, which would still secure patient information but would make the system more dynamic and user friendly. [7]

The Internet of things has particularly novel implications in the area of public health. This is due to (1) The rapid and widespread adoption of powerful contemporary Smartphone’s; (2) The increasing availability and use of health and fitness sensors, wearable sensor patches, smart watches, wireless-enabled digital tattoos and ambient sensors; and (3) The nature of public health to implicitly involve connectivity with and the acquisition of data in relation to large num- bers of individuals up to population scale. Of particular relevance in relation to the Internet of Things (IoT) and public health is the need for privacy and anonymity of users. It should be noted that IoT capabilities are not inconsistent with maintaining privacy, due to the focus of public health on aggregate data not individual data and broad public health in- terventions. In addition, public health information systems utilizing IoT capabilities can be constructed to specifically ensure privacy, security and anonymity, as has been developed and evaluated in this work. In this paper we describe the particular characteristics of the IoT that can play a role in enabling emerging public health capabilities; we describe a privacy-preserving IoT-based public health information system architecture; and provide a privacy evaluation.

Normally, several agencies and donors provide technical cooperation to various aspects of health information systems and data management in a country at one point of time. Several of them will likely have national experts and resident advisors, and consultants who could be interested and available to support this process, particularly WHO, UNICEF and UNDP, plus other major donors and bilateral projects. In addition, while the HMN is often in a position to provide qualified facilitators who are familiar with these procedures, they are not always able to do so. The source of qualified external facilitation needs to be confirmed well in advance, if the national authorities feel it is needed. Additionally, it is appropriate for experienced HMN facilitators

Computer Science is a rich field with many growing application areas, such as Health Information Systems. What we suggest here is that multi-disciplinary threads can be introduced to supple- ment, enhance, and strengthen the primary area of study in a course. We call these supplementa- ry materials threads, because they are executed alongside the material presented in the course, reinforcing and augmenting it but not replacing it. Many studies have been performed on how making a topic more meaningful and relevant to students can improve their outcomes. Integrating Health Information Systems into the Computer Science curriculum can achieve this. In this paper, we present a case study in which the development of a health system is integrated into a Database course. The results indicate that students enjoyed the course more, were more motivated to com- plete the course project, and were able to learn and apply the core course materials more readily. Keywords: multi-disciplinary, health information systems, threads, database, curriculum

In the third step, based on results of the previous stage, health information management and computer experts’ opin- ions, and observations of the five selected hospitals, a com- prehensive form was designed to assess the status of ISRM for computerized health information systems, including four dis- tinct parts encompassing general information about hospitals, specifications of computerized health information systems, information security incidences, and self-assessment checklist of ISRM. Its content validity was confirmed by 12 experts of health information management, medical informatics, information technology (IT), and computer engineering (three professionals per area of study).These scholars were selected on the basis of their previous work experience in the hospital’s IT departments or their familiarity with the structure of the IT department in the hospitals of Iran. For data collection, this questionnaire and its guideline were sent to all 908 active hospitals in Iran by the Ministry of Health of Iran. To remove any possible ambiguity, an instruction sheet was attached to this questionnaire, explaining all sections. The hospitals were selected with regard to their CHIS application, such as hospi- tal information system, Electronic Medical Record, Patient’s Admission and Discharge Systems, and so on. Hospitals that did not use CHIS at the time of this research were excluded. To facilitate and expedite the collection of data, this form was placed electronically in the official Web site (portal) of the Ministry of Health of Iran and hospitals were asked to register the relevant information in the aforementioned Web site.

Participatory health information systems (PHIS) are emerging platforms to capture, manage and understand this body of information. They aim to empower a network of support, consisting of healthcare institutes, practitioners, caregivers, family members and patients, to communicate, collaborate and contribute towards health and wellbeing objectives. Besides healthy outcomes and resource usage optimisation, PHIS facilitate the accumulation of multi- dimensional information on a broad spectrum of healthcare topics ranging from disease variations to patient lifestyle choices and behaviours. This information provides an entire body of knowledge that has an immediate impact on the advancement of medical and clinical research. Hence, it is in the strategic interest of policymakers, healthcare industry, as well as patients to endorse research, development and evaluation of participatory health information systems that enable patient-centred care.

❖ Provincial departments of health should adopt minimum PHC data sets where they have not already done so, and then move on fairly quickly to identifying additional elements of essential information. District management teams should also be encouraged to identify their own district- specific data items and indicators that should be collected in addition to the provincial MDS. In addition to a focus on the content of data collected, attention to the format and presentation of data is critical if data is to be useful for district level decision making. The importance of these issues will become more apparent as districts gain experience working through a budget cycle. ❖ District management teams should step back and review their practices for analysis and feedback

In terms of patient/episode-level indicators, a plethora of instru- ments were described for assessing disability, however, they do not always have sufficient focus on functioning to adequately inform re- habilitation planning. As a Laotian disability advisor stated, ‘The key question is not how many people with disability are there and what are their types of disability but what are their needs to make them functional’. A MoH informant from the Cook Islands said, ‘We need to capture the difference between physical disability and the functional quality of life’. In this respect, the use of indicators which measure functional assessment was highly supported by re- spondents, even in settings where the capacity of the HIS was lim- ited. For example, a respondent from Lao PDR said that often in rural or remote settings, people with disabilities may not have a for- mal diagnosis due to shortages of trained health professionals. They can, however, be offered rehabilitation following a functional as- sessment, which is relatively simple to perform and can be under- taken by a range of health-workers and auxiliary staff (Durham et al. 2015). In Thailand, indicators of functioning based on the ICF have been used in a pilot project to create functional profiles of peo- ple with disabilities (Tongsiri and Hawsutisima 2013). These pro- files were then used to inform and evaluate the effectiveness of home modifications in increasing functionality and independence. In Australia, a push towards patient-centred treatment goals, such as improvement in function rather than by diagnosis and procedure, led to the design of the Australian National Subacute and Non- Acute Patient (ANSNAP) case mix classification (Green and Gordon

Stefanie Weber presented the German model in the context of the e-Health as an example. The epSOS project (http://www.epsos.eu/), which ended in June this year, aimed to design, build and evaluate a service infrastructure to demonstrate cross-border interoperability between electronic health record systems in Europe for emergency patients. The epSOS team defined a master file used to describe the data to be transmitted with emergency patients in order for physicians from one country to access patient data in a centralised database. The epSOS file is now an open source, freely available tool for all users. The master file cannot, however, be used in Germany due to licensing issues. From this experience, if a project is to work across Europe, it should be made as simple as possible. The responsibility for file contents should be given to each country to make sure they cover their local needs, since international standards may not be applicable in all countries.

The purpose of this study was the problem of the formation of various regis- ters on the basis of information accumulated during the life of an individual in the HIS. For this, it is proposed to use the modular principle of electronic medi- cal records with the assignment of a permanent personal identifier at birth. At the same time, it is supposed to exchange with the personal medical records of people, the data in which come directly from patients or parents. This approach significantly reduces the time for register formation and provides more complete and high quality data in the registers. An important aspect can be considered the creation of national registries of rare diseases and their integration into higher level registers (European, American, Asian, international), which is especially important for the prevalence and diagnosis at a very low frequency of individual diseases and for the identification of new clinical forms of diseases. The novelty of the presented research lies in the automatic generation of various registers based on modules from Electronic Healthcare Record (EHR) data, which will speed up the quality of data exchange with HIS. In this case, specialized registers will be presented as virtual systems for solving problems in certain areas of medicine. If necessary, additional information, which is not available in standard EHRs, satellites medical or medical-social maps, including necessary informa- tion (for example, pedigrees and results of genetic studies, treatment methods in intensive care units, information on occupational hazards, etc.).

Until the submission of this article, two different strategies for defining model transformation rules that combine clinical data models and architectural information were evaluated:.. 1[r]

when using the classical system development life cycle (SDLC)—pre-implementation (development), during imple- mentation, post-implementation or routine operation [23]. In the health informatics domain, four evaluation phases have been identified, which are also based on the SDLC: prelim- inary, validity, functionality and impact [24–26]. Each phase addresses specific evaluation aspects. Depending when in the system development life cycle it is done, evaluation can be for- mative or summative. The aim of formative evaluation is to improve the system under development or during implemen- tation; thus, problems can be identified as they emerge and the system can be improved as it is being developed. Evaluation should start with the system conception while its integration into system development should ensure a more comprehen- sive evaluation, alert possible causes for failure, and thereby avoid wasted time and effort [24].

Kwale District is Kenya's first computerised district level HMIS. It is a joint effort between the Kenya MoH and the Community Health Department of the Aga Khan Health Services. The programme developed simple user-friendly software to collect and analyse data from local health facilities to provide more timely information for planning and decision-making, to give feedback to the clinics, and to encourage clinics to meet their targets and improve their performance. [7]