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Integrated Health Information Architecture (IHIA). Learning Objectives. Health System is more than point of care Different types of health information systems Integrated Health Information Architecture (IHIA) Global movement towards IHIAs Enablers of an IHIA data warehouse - PowerPoint PPT Presentation
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Integrated Health Information Architecture (IHIA)
Learning Objectives
– Health System is more than point of care– Different types of health information systems– Integrated Health Information Architecture
(IHIA) – Global movement towards IHIAs– Enablers of an IHIA
• data warehouse • Standards and interoperability
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What is health?
4
What is health service quality?
Political commitment to health as a social goal Societal values of equity, political participation
and community involvement in health Investments in Primary Health Care Widespread education (women)
Societal factors contributing to health
6
1) to understand and influence how the health care service delivery operates: access, coverage, continuity of care, risk assessment
2) efficient and effective service delivery
Health care resource allocation indicators (per capita): distribution of qualified health personnel
distribution and type of health services distribution of health expenditure on personnel, supplies, facilities
Health care utilization indicators: immunization coverage antenatal care coverage proportion of births attended by a skilled attendant
Health status indicators: Infant mortality rate maternal mortality life expectancy at birth prevalence/incidence of infectious diseases
Benchmarks for National Health Systems
Source: Good Health at Low Cost 25 Years onWhat make a successful health system?
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WHO Health System building blocks
Human resources
Source: Good Health at Low Cost 25 Years onWhat make a successful health system?
Countries with a Critical Shortage of Health Care Providers
N. Engl. J.Med 2007, 2564-67
Human Resource Information System (HRIS)
For the management of human resources, with data related to staff (name, profession, diplomas, salary, etc)
Functionality of the system is geared towards managing hiring, distribution, payment, education, and certification of staff, over time
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Electronic Medical Records (EMR)
- Are related to patient care, and focus on patient data (name, age, symptoms, medical history, test results etc)
- Functionality around patient care, registration symptoms, test results, medicine prescription, referrals, billing, etc.
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EMR: Support Patient workflow
Logistics Management Information Systems (LMIS)- Related to the logistical tasks around
distributing health related commodities, such as vaccines, medicines, instruments, etc
- Functionality for inventory management, ordering and procurement, tracking commodities, certifying suppliers, forecasting etc
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Health information subsystems
A National health information system consist of several subsystems
Routine data collection based on patient and service records and regular reporting from community health workers & health facilities
Disease surveillance and outbreak notification Programme-specific monitoring and evaluation
(ex: EPI, Malaria, TB, HIV/AIDS) Administration and resource management
(budget, personnel, supplies) Data generated through household surveys Registration of vital events and censuses
(births, deaths and causes of death)
Individual /program tracking
Individual /program tracking
Aggregate dataAggregate data
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Some benefits of good HIS
- providing (continuity of) care to patients (medical staff)- assist decision makers in detecting and controlling
emerging and endemic health problems- monitor progress towards health goals/targets (MDGs)- promote equity (many not counted!)- strengthening the evidence base for effective health
policies- permitting evaluation of health system interventions
over time- ensuring accountability in the way resources are used
HIS around the world
Huge differences between national health information systems (HIS), however generally a move from paper to digital and hence potential integration of systems
Common national challenges:– Little use of health information (locally)– Too much data collected – Low quality of information– Fragmentation of information streams– HIS Staffing not prioritized
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Typical national HIS setup
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Integrated Health Information Architectures (IHIAs)An overall framework for how these various information systems
work together (HMIS, EMR, HRIS, LMIS, etc)
Integrated (appearing as one)– Working together, sharing definitions and data across
information systems
Architecture– Collection of sub-systems; organized to form a whole, but
have different roles– An architecture describes roles and relationships between
systems
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IHIA as a system of systems, their roles, and relationships
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HMIS
EMRHRIS
Lab. IS
LMIS
IHIA
Why is it important with IHIAs?
To share data– powerful analysis by combining data sources– improve quality by reducing duplication and
manual transmission of data
Resource optimization– reduce duplication of data collection– reduce development and maintenance of
overlapping systems
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Example: Combining HR and clinical data
• Service delivery data comes from many sources HMIS such as DHIS2 Electronic Health Records
• Health worker deployment data comes from many sources Payroll at Ministry of Finance, HR System at Ministry of Health Licensure and Registration from councils
• Combining these two data sets across multiple systems allows new questions to be asked and answered What facility is most in need of nurse midwives? Which districts should we target training for chronic diseases? Where should we prioritize financial incentives to retain health workers?
Example: Calculating deliveries per midwife
Global Movement towards IHIA
Health Metrics Network (since 2005)– Build consensus around integrated data warehouses – provide a framework for building IHIAs– many countries have developed strategic plans to work
towards an IHIA
Donors changing approach: Paris declaration (2005) – build on local systems; local government decisions, but still
donor specific reporting requirements – collaboration between donors (harmonization), but hard to
accomplish in practice– shift funding towards evidence-based interventions, but
dependent on reliable information
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Data warehouse
- A database compiled from differerent sources, designed to process and present data for a multiplicity of users, based on their needs
- For an IHIA, a data warehouse should contain data from all the subsystems related to health, including service data, census, surveys, environmental data etc.
- Also called an integrated data repository26
The HMN model of a data warehouse - integrated data repository
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Example: combining various dataCHIEFDOM LEAGUE TABLE
2ND QUARTER APRIL – JUNE 2009
20.893.632.4114.34391.4Total
14143.228.3100.038.273.82954.9Bumpeh
12123.738.677.8101.268.02961.1Upper Banta
12123.760.5100.057.453.72671.8Ribbi
884.364.086.689.492.64049.8Kori
884.336.5100.077.693.24580.4Kargboro
884.386.5100.0140.769.73555.6Kamaje
884.332.193.092.4110.33761.4Bagruwa
664.735.6100.0120.8201.64888.3Lower Banta
664.778.2100.046.796.552118.4Kowa
334.833.091.791.7106.846140.3Timidale
334.871.375.093.4162.75590.3Kaiyamba
334.845.9100.086.390.557134.9Dasse
225.048.1100.086.2154.362124.3Fakunya
115.393.386.696.6170.94598.2Kongbora
RankingRankingAverage Score
% Exclusive Breastfeeding
at Penta3
% MMRC Submitted
% 2nd Dose of IPT
% 3rd ANC Visit
% PHU Delivery2nd
Quarter
% FullImmunized 2nd Quarter
Chiefdoms
Immunization &
population
Deliveries and
population
Antenatal & population
MalariaData Quality
Nutrition and
population
Standards and Interoperability
- Standards allows the various subsystems of an IHIA to share data– Standard data definition– Data exchange standards
- When the sub-systems can share data and work together as an IHIA, they are interoperable
More about these two concepts later in the course
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